Profit or Prophet

Posted on March 2, 2017 by deconstructingdoctor

img_2431There is a financial pressure to see a lot of patients in a day.  Seeing patients equals revenue.  Revenue equals a paycheck for me and everyone else that I employ.  It also feeds the giant corporate machine to which I now belong.  In all honesty, I haven’t felt specific pressure from the corporate machine because for now, I am flying under the radar.  Plus they are nonprofit.  At least on paper.

I know that this reprieve won’t last for long.  We recently changed computer systems, which if I were a few years older, probably would have forced me into retirement.  It was one of the hardest transitions I have ever endured.  Everything feels like a fight.  There is no one accountable when things go south.  You have to talk to a half dozen people just to get to someone who knows WTF you are talking about.

When I print a prescription, it is going to a Pediatricians office in another city.  Why can’t you fix my printer?  Why can’t my computer print to my printer in my office?  That took like 3 weeks.  Not joking.

For now, they are not giving me too much shit, because they know somewhere in their corporate brains that they can’t push us too much.  Not yet.  Not until we get our footing with this system.  With being part of a big machine.  With trying not to lose our humanity.

I had a conversation with another provider recently who said one of their partners saw more than 50 people a day.

This.  Would.  Kill.  Me.

I seriously contemplated the enormity of this.  My first thought was -Jeez, I must suck, I feel overwhelmed when I see 25.  What’s wrong with me?  What am I doing wrong?  Then, I wondered how they weren’t screwing everything up, missing parts in the chart, forgetting to send someone for a mammogram, misdiagnosing a disease because they were in a rush, working on their charts into the wee hours of the night.  If that’s what it takes to stay in this business, to make money, to be a doctor, count me out.  I’ll just be poor.  Debt-ridden.  And happy.

Who once said and I paraphrase, If you do what you love, you’ll never work a day in your life?  This work is a labor of love.  I don’t see dollar signs when I look at these people.  I see mothers, fathers, factory workers, waitresses, broken hearts, fear, perseverance, despair.  I see resilience, faith, trust, joy, prosperity, and forgiveness.  I see healing.

I learn their stories.  I want to learn their stories.  That’s why I feel overwhelmed when 25 people come through my rooms.  I can’t give all of them my attention.  I can’t learn their stories.  Oh, I could see a hundred people in a day.  Line them up like an assembly line.  Dole out the antibiotics.  Gloss over their questions.  Send them for tests. Refer them out to someone else to deal with.  Run ’em through  like cattle.  I can’t be that kind of doctor.  I won’t be that kind of doctor.

If you listen carefully enough, the patient will tell you what’s wrong with them.  The diagnosis will be given to you.  The patient will tell you.  If you just listen.

If you are my patient and I don’t know that your dog died last month, or that your grandson has been deployed, that your daughter is getting married, or that you got that job you wanted, then I am not doing my job right.  If I am not listening to your stories, how will I ever find out what ails you?

 

 

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Resistance

Posted on February 24, 2017 by deconstructingdoctor

_dsc0208I have a list of diseases that I hate the most.  I hate them because I have no way to fight them.  I have no power against them.  I push back and push back, but they don’t budge.  They laugh in my face.  They know my weakness and they gloat.  All the while taking the patient’s life an inch at a time.  Slowly.  While I watch.  Helplessly.  I feel the burning stares of the patient and their families.

Why can’t she help me?  Why can’t she fix this?

I know a thing or two about resistance.  Doctors invented it.  We fight and resist against the inevitable.

Death.

People look to us to do the impossible.  Death is coming for us all, there is no way to fight it, but yet we all still resist.  We all want just one more day.  Just one more chance.  We want to be able to fulfill our purpose, to make the moments count, to have made a difference.  When we die, all our work on this planet is over.  We don’t want to be left out. We don’t want to be forgotten.  How can the earth continue to exist without us?

To be forgotten.  As if all the struggle was for nothing.  All the angst, the sacrifice, the sleepless nights, the turmoil, the work.  All for nothing.

I am not sure I believe that.  Sometimes, I’ll look at my children without them realizing it. I wonder who they will become, what will they do with their lives, who will they fall in love with?  Will they make a difference in the world?  I know that the sum total of all of my experiences and life lessons and those of my husband’s are for them.  Everything that I am  and have done are a gift to them.  I offer them my back, they may step on it, and reach  even higher than me.

I resist death for myself and others.  Just one more day, one more week, one more month, one more year, one more decade and on and on to make a difference in the lives of those we love and those that seek our help.  Continue to fulfill my purpose.  To do good work.  To be a force in the world for good.

Resist.

Even when resistance seems pointless.  Even stupid.  Even when others ask, why bother?  You can’t fix it.  You can’t change it.  Just accept it.

On my deathbed, I’ll accept it, but for now, I will continue to resist.

 

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A New Hope

Posted on February 16, 2017 by deconstructingdoctor

Editor’s note: Shinbone Star staffers have been working so hard that we felt we needed a doctor. So we added one! Not only can she bandage our wounds, but she can write a bit, too! Yes, I stole that title from Star Wars, but that’s what I need right now, a new hope and Star Wars. I don’t have to […]

via A New Hope — THE SHINBONE STAR

Check out my first foray into hard hitting journalism.

Well, they are the journalists, I am the wannabe.

It really is an honor to be a part of the Shinbone Star!  When I read Glenn’s first post about a retired editor and journalists getting back to work, fighting against the attacks on good truthful journalism, I was ecstatic!  What a great idea!  They have nothing to lose!  They can use their collective skills unencumbered by newspaper sales and expectation of unbiased reporting to really dig in and find the truth in a post-truth world.

Consider following the Shinbone Star, you won’t be disappointed!

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Head of the Class

Posted on February 15, 2017 by deconstructingdoctor

david_with_the_head_of_goliathIt was hard to know if I belonged.  I wasn’t like the typical medical student.  I had never set out to become a doctor, it was never expected of me, and believe it or not, I kind of fell into it.  Now I’m not saying it was easy.  No, it was fucking hard.  I had an ulcer during my first year.  Unofficially, of course.  The doc that I saw gave me some Nexium, told me to reduce stress, and come back if I wasn’t better.  I got better and I never went back.

The first 2 years were the hardest.  Two years of sitting in a classroom, listening to endless lectures, dissection and labs, relentless testing and studying.  It was isolating and lonely.  I was so consumed with school, that looking back on pictures of myself, I noticed my hair had grown passed my shoulder blades, something that has never happened before or since.  I hate long hair.

When I met Dr. S during my first clinical rotation as a third year student, I found the equivalent of my spirit animal only in doctor form.  He was quirky.  He was smart.  He engaged with his patients.  He was the kind of doc that pulled up his seat next to the patient and listened!  That was crazy!  They said never sit, it only encourages the patient to talk more…oh what anarchy!  That was who I wanted to be!

Not only did he engage with his patients, but he engaged with me, the lowly med student.  He saw me.  He listened to me and he never berated me even when I didn’t know something.  He made me feel like one of them.  A doctor.  We became a little team.  He would call me up the night before clinic and say, “What color scrubs are you wearing tomorrow?”  He liked to match.  He and I would be like little twins.  I told you, he was quirky.

One of my favorite things about Dr. S?  He loved art.  During the first days of my rotation, he told me I had one homework assignment.  I was to discover and present his favorite piece of art to him by the end of the rotation.  He would give me hints and I would hurriedly scribble them into my pocket notebook between acid/base equations and medications for COPD.  Snippets of art were intermingled with cold hard facts of our trade.

Like a detective, I pieced together his hints.  What I didn’t realize until now is that he was teaching me how to be a detective for the patient.  He was teaching me to take all the hints and string them together to find the diagnosis.  He was teaching me to be a doctor.

By the way, his favorite artist was Caravaggio and his favorite painting was David with the Head of Goliath.  I found this to be quite morbid.  Caravaggio liked to paint decapitated heads.  The head of Goliath in David’s hand was a self portrait of the artist.  Dr. S said no one had ever figured out his favorite painting before.  Hard to believe now, but this was pre-Google days.  I’m pretty sure most of his students didn’t give a shit about art.

When I revealed his favorite artist and painting and gave a brief history, he kind of patted me on the shoulder and said, “You’re going to do alright, kid.”

 

 

 

 

 

 

 

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The Deal of the Art

Posted on February 8, 2017 by deconstructingdoctor

img_1656I had the strange notion to visit an art museum today.  I had the day off, the kids were in school and I had no desire to peruse the aisles of Target again, mindlessly dropping things into my cart that may or may not contribute to the bottom line of some evil CEO and Trump cabinet member.  I hadn’t been to an art museum in years.  I just felt the NEED to go.

I felt the NEED to connect to humans in a way that spans time and space.  I was seeking stillness.  I wanted the art to speak to me, quietly, shyly at first, then explosively like an atomic bomb of understanding.  It can’t lie to me.  It can’t manipulate me.  It can’t mislead me, sell me something, take my money and my dignity.  It can’t take away thought or speech.  It just remains there, suspended for all eternity.  I can take my time with it.  I can look at it or not. I can stand 2 inches from it or 10 feet away.  I can let it wash over me.

And I did.

I intermingled with the retirees and the large groups of school kids.  I eavesdropped on the curators explaining the intricacies of the pieces, their eyes reliving the details as if making the strokes on the canvas themselves.  They must have told the same story a thousand times, but what love in their voices!

How eternal are our human struggles.  Love.  Freedom.  Tyranny.  War.  Family.  Hunger.  Joy.  Oppression.  Humor.  The deep and unrelenting desire to connect the dots.  To make sense of our world.  To make sense of our place.  And our purpose.  It seems that the same human story continues as if on an eternal loop.  We never seem to move much farther ahead.  You win some.  You lose some.  You live to fight another day.  The sum total of all the battles is a life.  One small little human life.

For a brief moment, I found myself outside on a balcony overlooking the city all by myself.  There were large sculptures of a woman and some weird circular thingy with a hole in the center (probably also a woman).  I walked to the edge and stared out over the bustling city.  Noisy and busy.  But also quite beautiful. A man sat on a park bench across the street playing a trumpet.  A homeless man sat against a tree in front of a church.  Business men and women hurriedly walked to and fro, likely heading out for lunch.  The cars and buses, the sirens.  The low drone of voices on cell phones crescendoing at first and then decrescendoing as they walked passed.

The scene was energizing.  I no longer wanted to escape the world.  I wanted to jump back in.  Move forward.  Find my voice and speak my truth.  I walked out of the museum and found my place among the city dwellers, the men and women in their work attire, walking briskly into the future.

 

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Carol

Posted on February 3, 2017 by deconstructingdoctor

421I thought about Carol today.  I was driving to Walmart, listening to the radio, thinking about the long list of errands for the day and I thought about her.  I thought about the last time that I saw her, laying in a hospital bed, only it was in the living room of her home, stretched longways in front of her bay window so that the entire bed was awash in the warmth of natural sunlight.  Every time she stirred, I would sit upright, listen intently for cues to her current need, dutifully adjust the blanket or pillow, bring the straw to her lips if she asked, or just wait for her to settle down again.  Mostly we all just sat around her listening to her breathing.  Sometimes labored with an occasional cough or gasp.

This was hard.  The dying process is almost unbearable for the one who has to bear witness.  My mother’s death only took moments, Carol’s took weeks.

The morning that she passed, her daughter texted me that she was peaceful.  I almost missed it.  I thought, oh, good, she is having a good morning.  It didn’t even dawn on me that she died.  It was a slow realization.  Carol.  Died.

Carol.  One of the best friends I have ever known.  She was almost twice my age.  Her daughters were my age.  Carol.  Always ready for fun.  She never tired.  Girls weekend in Vegas.  Spontaneous Karaoke with a house band in Memphis (or was that Erin?).  Night on the town in Fort Lauderdale.  Beach trips.  Long talks over Starbucks.  Shopping trips where she’d buy another pair of white jeans.  French manicured fingers and toes.

That laugh.  Followed by “Girl, you are crazy!”  Followed by more laughter.

Always searching for true love.  Always waiting on a break.  She worked so hard.  She had so much tragedy in her life, but it never dampened her spirit.  She was so alive.  So grateful.  So thoughtful.  So joyful.  Carol.  I miss you, girl.

When I left her for the last time, I told her I loved her.  I told her that I’d see her again.  I told her that I couldn’t wait to have more adventures with her heaven.  And she smiled at me, tears in her eyes.  She knew.  It wouldn’t be long.

 

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The F Word

Posted on January 31, 2017 by deconstructingdoctor

fullsizeoutput_1fb7In our house, the “F” word is Fart.  That was until Christmas day.

My husband has a few rules about bad words.  He doesn’t like the kids to say Butt, Fart, or Stupid.  I get it.  Hearing a 5 year old say Stupid just seems wrong.  It’s rude.  It’s harsh.  We don’t say that to them or to each other.  We try our gosh darnedest not to say it about others (in the kids’ presence anyway).

He has one rule for me.  He doesn’t like it when I say GD.  You guys know what I’m referring to, right?  I can say Gosh Darn, the more acceptable cousin of GD, but not GD.  Now, he would never tell me I can’t say GD, but the look of absolute betrayal and disappointment on his face when I do say it, has cured me of ever saying it again.  Ever.  Except when I’m so enraged that it just slips out.  Oops.

He never says bad words.  And when he does, it’s equal parts shocking and humorous.  He’s just not the bad word type.  It doesn’t suit him.  He’s that good.  Me, on the other hand, I am the bad word type.  Through and through.  They suit me just fine.  It’s like a natural extension of my inner being.

Which brings me back to Christmas.  I unknowingly unwrapped a coffee cup that my husband bought me that had the real “F” word written all over it.  Like 5 times.  The kids took one look at that cup and were mesmerized.  Being 8 and 5, they can now read so they knew exactly what it said.  It instantly changed their perception of the “F” word.  Fart lost all of its powers of infatuation.  The new “F” word has since taken over.  They want to talk about the cup daddy bought mommy -all the time.  I’ve hidden it deep in the cabinets and told them it will only come out when they are 18.

The oldest informed me that he told his Sunday School teacher about the infamous cup that daddy bought mommy for Christmas.  Then I informed daddy.  And daddy looked like he wanted to puke.

 

 

 

 

 

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Miss Spelled

Posted on January 24, 2017 by deconstructingdoctor
final-5543

Thanks to @tracyswatts on Instagram for the photo opportunity 🙂

My son once asked me what was the most embarrassing thing to ever happen to me in my entire life.  I gave my answer careful consideration and remembered pretty quickly that time I fell out of my chair during a meeting.

More specifically, the chair shot out from behind me out of nowhere.  This all occurred while at a meeting with about a dozen other doctors.  Pretty serious business was going on and in the middle of all that serious talk, I fell out of my chair and onto my ass in front of everyone.  To the credit of my colleagues, no one laughed and they showed genuine concern for my well-being, but honestly, dying right then would have covered up my faux pas and I would have been ok with that.  It would be as if I died, THEN fell out my chair.  Except I lived.  C’est la vie.

Now I have a new most embarrassing moment to share.  I figured I’d give you guys the breaking story.  Sort of a gift, to my beloved bloggers and blog readers, if you will.

My daughter and I decided to participate in the Women’s March in our local big city.  We were both quite excited and busily made protest posters the night before.  My son was scheduled for a basketball game that morning so he couldn’t make it, but he made a poster, too.  His was about trains.  Hers was about cats.

We decorated a wagon that I would use to pull my daughter with posters and flowers.

The next morning, we made it to the march, got great parking, stood in the crowd with our posters and our righteous indignation and began to march with all the other protesters.  People took notice of us, commented on our signs and took our picture along the route.  We met and talked to so many like minded people.  What an incredible experience!

So where’s the embarrassing part you ask?  I’m getting there.

We finished the march, got back in the minivan and prepared to leave.  My protest poster sat in the passenger seat and I looked at it with great pride.  I read the words to myself and a feeling of great dread fell over me.  I am such an idiot!  I misspelled my protest sign!  Who does that?  I instantly went over the days events, all the photos, all the protestors, all the conversations.  And there it was -a missing “H” in the middle of all my good intentions.  That missing “H” that just undermined everything we had done.

“H” is now my least favorite letter of the alphabet.

That “H” has haunted me, but no more.  One little letter, one little mistake does not diminish our intentions.  The missing “H” does not define me or my contributions.  It doesn’t make me a bad doctor.  It does make me a bad speller and someone that has grown too dependent on spellcheck.  It makes me a busy mom, with two kids who wanted to help.  It makes me someone who thought that despite a long day and a long week, I wanted to show  my children what it is like to be an American.  The freedom to march, to speak, to vote, and to misspell your protest poster.

I raise my misspelled protest poster for all the Americans that will likely lose their current insurance coverage without any solution in place.  What will be the replacement?  How will it affect the millions of patients currently covered under the Affordable Care Act (ACA)?  How much worse can it get?  Mammograms, pap smears, colonoscopies, immunizations.  Most preventative measures are covered and having preexisting conditions will not keep you from getting healthcare (I remembered the “H” that time).  What will happen to those aspects of the ACA that benefited Americans?  Healthcare is not a privilege for the wealthy, it is a right for us all.  All Americans should have quality affordable healthcare.  Period.  With or without an “H.”  I would gladly give up that letter (and my pride) if it meant my patients could depend on their coverage when they need it most.

Photo credit to a lovely stranger who took our picture before the march began, you can find her @tracyswatts on Instagram

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Rebellion

Posted on January 22, 2017 by deconstructingdoctor

fullsizeoutput_1ed0If I were to be completely honest, inside I’m a rebel.  Inside I am tattooed, pierced, my hair is purple, and my feet are adorned with combat boots.  My heart is in the shape of a pulsing fist with middle finger promptly displayed.  My blood is 20 degrees hotter and my eyes set dumpster fires with their glare.  I want to take all that is wrong in the world and strangle it, first into submission and then to its glorious demise.  I want to make all that is wrong, right.  Fiercely.  Quickly.  Ruthlessly.  Heroically.

But on the outside, I have succumbed to the constructs of our society.  Hair is a palatable shade of brown with subtle blonde highlights.  The skin is mostly pristine (maybe a tastefully hidden tattoo can be found).  Piercings do not overwhelm or distract the onlooker and are relegated to the appropriate places on the earlobes.  My smile is engaging, my eyes avert at the appropriate times as to not appear threatening.  To strangle anything is unthinkable.  I once almost got in an accident trying to avoid hitting a butterfly with my minivan.

I see the problems in this world.  So so many.  And it is instantly overwhelming.  Where does one begin?  Where does one start to make something good happen in the world?  To make something so very wrong, so very right again?

Sometimes you start by adopting a cat from the pound.  And then you turn around and do it again for a dog.  Maybe you give a homeless man twenty bucks.  You donate your old clothes.  You buy needy kids presents for Christmas.  You donate food to the Boy Scouts.  You recycle.  You buy your car and appliances based on their energy efficiency.  You hold the door for someone.  You let someone with less things skip you in line at War-Mart.

Why do all of those things seem so pointless?  They seem so trivial.  Small.  Minuscule.  Insignificant.  It doesn’t seem much like rebellion.  Rebellion against comfort.  Rebellion against safety.  Rebellion against getting your feelings hurt.  Rebellion against status quo.  The kind of rebellion that puts everything on the line because it’s the right thing to do.

That kind of rebellion is likely in all of us when the right buttons are pushed.  When the right cause is found. When that thing happens that is beyond comprehension.  That thing that goes against all that is good in the world.  That thing that rips down deep into the core and causes us to question everything.  That thing that makes us rage inside, makes us jump up, fist in the air, ready to fight!

Inside we all have purple hair.  Or blue hair.  Or Mohawks.  Inside all of us is a rebel waiting on its cause.  I have burning embers of rebellion deep within.  Smoldering.  Seething.  Churning.  I am a rebel with too many causes to choose from.  So many battles ahead that I thought were behind.  It never really ends, I suppose, battling evil for the greater good.  Godspeed to all that continue the good fight all over the world!

 

 

 

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Corporations are Doctors, Too

Posted on January 19, 2017 by deconstructingdoctor

This blogpost first appeared on new*normal*gal.  This is a great blog about newnormalgal’s journey with breast cancer.  She’s funny and sassy and honest.  While convalescing from surgery, she asked me to fill in for her and this is what I came up with..

i·de·al·ist  noun  a person who is guided more by ideals than by practical considerationsIMG_3342

 I used to be an idealist.  I used to think I could make a difference.  I used to think what I did mattered.  I used to think that if I just persevered, powered through, kept fighting, outlasted the naysayers, I would win in the end.

 I fancy myself an unsung, B-movie, flawed superhero.  You know, one of those fringe superheroes with superpowers that are tempered by some equally devastating affliction.  Like a commanding voice with a speech impediment.  Or the fastest runner with a limp.  Or possessing great physical strength, but blind from birth.

 That’s what being a doctor is like.

 You have all the knowledge and abilities at your fingertips, but something always gets in the way.  There’s always some roadblock.  Someone telling you no.  Maybe it’s good for me in some strange way.  It humbles me.  I can’t have it my way all the time.  Except when I can’t have it my way and someone tells me I have to do it another way, and things go south, I still get blamed for any bad outcomes.  It’s still my fault. It still weighs on my conscious.  Even when it had absolutely nothing to do with me.

My patients get caught in the middle and they are the ones that suffer.

 Who is this super villain that keeps rendering me powerless?  Like any superhero franchise there are many -because you’ve got to make sure there is a sequel.  The insurance companies.  The hospitals.  The government.  The ACO’s.  The drug companies.  Corporate medicine.  All vying for control.  All with their own evil master plan.  All looking to make a profit.  All looking to cut costs.

 Money.  Profit.  Control.  Power.

 Sitting in my rolling chair, facing you while you are on the exam table, my computer perched on my lap. Looking at each other -eye to eye.  Listening to you tell me your fears, your hurts, your sadness.  My mind reeling with the possibilities.  What could be the problem?  What tests should I order?  What’s the worst thing that this could be?  Should I try a medicine first?  Which one?

 I reassure you.  I’ll figure it out.  You breathe a sigh of relief because you know we are going to get to the bottom of it.  And I want so much to fix it.  Heal.  Restore.  Calm.  Just me and you.

 And then the insurance company denies the test.  The labs go to deductible.  The medication I prescribed is not covered.  The medication that is covered didn’t work the first time you took it.  I have to fill out a form asking for them to reconsider.  That takes 3 days for them to deny it again.  By now you’ve gone to the emergency room and had the test I wanted to order in the first place.  You’ve been referred to a specialist that isn’t covered by your insurance company.  And the hospital was out of network.

re·al·ist  noun  a person who tends to view or represent things as they really are

These super villains tend to get in their own way.  I could have saved everyone money, because I know my patient best, but instead the burden of the cost is placed on my patient.  The companies/hospitals/corporations probably made a profit.  But the system is sicker for it.  The patient is sicker for it.

I will not be deterred.  I will continue to fight the small battles for the greater good, for the good of mankind.  And just like any second rate, underrated, B movie superhero, I will take the beatings and live to fight another day.  I’ll do it for my patients.

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