A New Role

I previously believed that I had essentially two roles in my life. The doctor and me. I'm coming to understand that I have the role of wife as well and that this role needs some development. My failure to notice prior to now that the role of "me" and the role of "wife" are not one and the same may well explain a few things and is an area I am trying to work on. I sometimes allow myself to wonder if this is why physician marriages are notoriously bad. I have not pursued that line of thinking much because I suspect the notion is my brain attempting to jam me back into just the doctor and me again. In recent years I have been trying to redevelop my role as adult daughter. For a long time I avoided the daughter part because mom was putting up way to good a fight against my moving into an adult role. Becoming a physician actually made things more complicated because now my family puts me in that role, too. I think they are more comfortable with me as an adult/physician than they are with me as an adult/daughter. I am not sure where the daughter is relative to the "me" I've been working on resuscitating.

Over the weekend I discovered a new role. That of sister. This role needs a lot of work. For one thing I have spent years getting the childish features out of my role as daughter but my sister has the capacity to send me right back to the bazaar and long forgotten places of childhood. I do not think I have felt so completely helpless and despairing since I was a kid as I did when she had her panic attack about flying. I truly felt as if everything around me were dissolving. Each color, each texture, each object and the spaces between each object became something independent and threatening. There was no whole anymore. I felt torn out of space and time like the feelings I was having were a direct channel to the child/me. I had forgotten. I want to forget again but I will not. To forget all that fear and hopelessness would be to cut my sister back out of my life and I will not. This role is an explosive one. A mine field in which I hope my sister will refrain from dancing.

A Spat

For as little time as we've spent together My Sister and I got along pretty well. Saturday night we started to get on each other's nerves. She does things that remind me of mom and I do things that remind her of mom. She and mom both will keep up a continuous narration about the environment if they can get away with it. My Sister effuses loudly over anything "cute" and upbraids me publicly if I fail to notice a booger in her nose. I'm sure she can tell you each and every thing I do that bugs her. Most of the time Ang doesn't mind if I just ignore her. I think I've noticed though that if she is feeling uncomfortable she starts to refuse to be ignored. She asks more questions instead of just keeping up the usual patter. Or, she picks a fight. Part way through Saturday evening I finally went "Could you just shut up!" I hadn't been planning this. As a matter of fact I was quite surprised to hear it come out of my mouth. She replied angrily "I don't have to shut-up." I think I replied "Could you go talk to somebody else then?" Later we apologized to one another and decided to blame it all on mom since she wasn't there to defend herself.

A High

The alarm went off at 6AM. Ang would not get up. I turned on lights. I pulled the covers off of her. When she did get up we found several important sentences to be missing from her presentation. Computer problems kept me from getting my copy out of my email inbox so we went downstairs to "speaker's room" and I retyped the whole thing. I did this with Ang hovering around, firing off questions, and fretting openly. At one point someone associated with the conference came in to open their wireless connection. He seemed annoyed to see us there in his way. Grumpy just had to wait until we got the thing saved, emailed, and printed in a really large font for her to read from. I refer you to my sister's website where I hope you will find out what it was like to get up in front of a room full of people and deliver her talk. All I can say is she was a really big hit. People cried. People came up to her all day and thanked her for her courage. I just gloated. In the afternoon we sneaked away and had naps. We were both exhausted and frazzled. In the evening a sibling squabble broke out. That story next. Check back for the photo I'll be adding as soon as I'm back in the 'Burgh.

A Real Trip

It has been a while since I've done anything as important or as trying or as fun as what I took part in this weekend. This is true on several levels. I'm only going to talk about one of those levels for now if I can even figure out how to say that much. I met my sister here in Salt Lake City on Thursday where I am currently trying to type this damn posting using the TV internet access. This mode has some shortcomings I find. Back to my sister. Ang flew here from Des Moines with the usual difficulties and delays a traveler might expect. For her this was intensely frustrating and demanding. When she finally got to the hotel she had a few other annoyances. Once in the room she went straight to sleep. Meanwhile, as I traveled from Pittsburgh I called the hotel a few times without getting an answer. I preferred to imagine that she had made some new friends and was out having fun but I figured asleep in the dark was a more likely explanation. My sister has told me in the past that she has often had to have help from friends just to make sure she gets out of bed from time to time and eats. This became my job. Thursday wasn't too bad.

Friday was a little more challenging. I don't think I've ever had another adult human being be quite so dependent on me before. At least outside of a hospital. She was scheduled to speak at the conference which was the reason for our visit to Salt Lake City. I was attending as her support person. Friday she drank several cups of coffee and drank 2 or 3 bottles of coke and ate several cookies. Needless to say I was impressed. The last time I got any where near this it made my watch stop for 10 minutes straight. All this combined with the stress of doing something new and emotionally laden resulted in a bad stomach upset and a severe headache. I tried everything I could think of to relieve her discomfort while I watched her struggle to not give in to these symptoms and go up to bed. She did a remarkable job. By evening she'd had it and dinner had to be arranged "in". We looked at her script a little and I made some notes about when to cue which slide. But, after the full and active day she couldn't cope with more so we were left to deal with prepping her in the very early morning. Her talk was scheduled for 8:50. I will leave you to contemplate this state of affairs for the time being. Pardon the type-O's and other unsightlies. This keyboard sucks.

Sparkles

One morning not too long ago I stepped off the elevator in the building where my office is located and was greeted by a patient I'd met for the first time the week prior. He is a very gentle soul whose speach is somewhat distorted by a facial deformity and who is troubled by mental illness. He was clearly waiting for me. He stood in the hall where I was sure to pass having already checked to see if I had arrived. He was holding a small gift-wrapped box which he extended toward me. "It's for you" he said quite simply. I was not completely surprised since I had learned through my staff that he had called after our appointment inquiring about my tastes in jewelry. I was very caught off guard by the presentation however and gravely concerned about the contents of the suspicious little box. Suspicious for bearing all he marks of being from a quite reputable jeweler. "Your really should not give me presents, you know" I said after thanking him. He explained that he took pleasure in offering gifts to people who were important to him and that he really valued my role as his new doctor. The way he put it was more charming. I felt I had to accept it with gratitude and figure out what to do later. "Ok, but no more gifts after this" was my preemptive strike. I walked into my office with the little box and received knowing looks from the staff. In my anxiety to find out the worst I ripped into the box and found its contents to be strikingly similar to a pair of diamond earrings. Doctor-me went "Oh no!" and regular-girl-me went "sparkly!"

While Pittsburgh is not a small town people here are generally separated by significantly less than the usual 6 degrees. Zed was on vacation so the front desk was being commanded by one of my staff I've yet to introduce on the blog and that is Everybody's Mother. Everybody's Mother had mentioned when the gentleman in question first came in that she, and indeed I, knew his sister. She further knew that he frequently did this kind of thing. Pittsburghers also being very neighborhood-y I guessed correctly which mall he would likely have gone to and confirmed with the jeweler that I was indeed in the possession of diamond earrings of significant value. The following morning at 9 on the dot I tracked his sister down at work. She was grateful to come and pick them up and more than happy to return the money to him without disclosing its origins. She and I agreed to keep this a secret in hopes that my earlier admonish against future gifts would hold. Never once did I consider keeping the gift but that primitive part of the human brain that is instinctively drawn to sparkly things produced a few soft focus thought balloons of me happily wearing very sparkly earrings.

Thoughts on Medicare Reimbursement Cuts or: The Slow Starvation of a Family Doctor

I’m one of those “young” physicians. I’m actually not that young having been 28 when I started medical school, but I’ve only been out of residency for 3 years so I’m young in that sense. I chose to become a physician after working out there in the “real world” for a while. I had learned that I needed to do something rewarding and challenging and something that had value for others. I knew I couldn’t stand to work and work if it was just to put money in either my pocket or somebody else’s pocket. So 15 years ago this former French Literature major decided to go to med school. From the beginning I wanted to be a Family Physician. Status and glory have never appealed to me but show me an underdog and I’m there. As a Family Physician I take care of people who are acutely ill of course but I also take care of people who are chronically ill. Chronic illness requires dogged devotion to manage because by definition there is no cure for it. I spend the rest of my time trying to nag, cajole, harangue, charm and otherwise convince people to swap unhealthy behaviors for healthy ones, again, not particularly grand. I nevertheless derive great satisfaction from seeing my patients get a little or a lot healthier and feel a little or a lot better. I believe that the relationship I develop with each individual and each family is the most important therapeutic tool I have and I believe that dignity and respect are essential to life. Not to toot my own horn, but I am exactly what you want in a Family Doctor. How much is it worth to you that every time it snows all winter long I check on my elderly patient who lives on city steps to make sure the way is clear for the Access van driver and the Meals on Wheels volunteer so she doesn’t turn up in the spring having lost 25 pounds. Can you assign a dollar value to this? Is it worth it to society that I exist? How much is it worth? I am $200,000 in debt for my medical education. I am not complaining. I never wanted to get rich doing this. But, I do think I should be able to afford a pleasant and restorative place in which to care for my patients and I should be able to pay my bills. Lacking these two things I will not last long. Is it too much to ask?

Visitors

Cinnamon and Madison
Originally uploaded by still just me.

Sweety's youngest daughter and her friend Cinnamon the hamster came to visit yesterday. Cinnamon has his own little carrying cage thingy and everything. Cinnamon is looking pretty alert and curious in this picture but in my brief experience he seems to like to sleep alot.

Belligerent Ants

This is from "The Once and Future King" published in 1939. Wart has been turned into an ant in a colony which has discovered it has neighbors. Here is what happens:

Later in the afternoon a scouting ant wandered across the rush bridge which Merlyn had commanded him to make. It was an ant of exactly the same species, but it came from the other nest. It was met by one of the scavenging ants and murdered.

The broadcasts (through the antennae) changed after this news had been reported --or rather, they changed as soon as it had been discovered by spies that the other nest had a good store of seeds... the stream of orders were discontinued in favour of lectures about war, patriotism or the economic situation. The fruity voice said that their beloved country was being encircled by a horde of filthy Other-nesters... it also explained that the Ant the Father had ordained in his wisdom that Othernest pismires should always be the slaves of Thisnest ones. Their beloved country had only one feeding tray at present--a disgraceful state of affairs which would have to be remedied if the dear race were not to perish. A third statement was that the national property of Thisnest was being threatened. ...The Wart listened to the broadcasts carefully, so that he would be able to remember them afterwards. One went as follows:

A. We are more numerous than they are, therefore we have a right to their mash.
B. They are more numerous than we are, therefore they are wickedly trying to steal our mash.
C. We are a mighty race and have a natural right to subjugate their puny one.
D. They are a mighty race and are unnaturally trying to subjugate our inoffensive one.
E. We must attack them in self-defense.
F. They are attacking us by defending themselves.
G. If we do not attack them today, they will attack us tomorrow.
H. In any case we are not attacking them at all. We are offering them incalculable benefits.

Long Stories

Like a number of readers out there I sat here two weeks ago waiting for the postman. I had prepared for volume 6 of the Harry Potter series by re-reading the first 5 books in the spring. Imprudently I read all of volume 6 over the weekend. I wish I had the discipline to ration out these stories but I never have and suppose I never will. I was so completely at a loss when I finished it that the next day I started it over again. I managed to drag it out 5 days the second time around. This left me in acute fiction withdrawal with no where promising to turn. I was restless, moody, just generally out of sorts. I contemplated starting the series over again. I raged at J.K. Rawlings for not just spitting out the whole damn story and getting it over with. At the age of 10 I had a similar experienced that must have baffled the hell out of my mother. I had read through the entire Laura Ingalls Wilder Little House on the Prairie Series over the course of about a year. When I finished the last one I realized that Laura had not only gone and grown up without me but that she was dead as a door nail and wouldn't write another word. I was inconsolable. I refused to re-read them or be distracted by any other stories. It was weeks before I read anything at all. Well, my coping skills are slightly more sophisticated now. While I still cannot cope with the possibility of a dismally disappointing read I can at least distract myself with old favorites. I've dredged up a couple of books from the remotest past. Yesterday I began The Once and Future King by T.H.White.

A Dream

Last night I dreamt it was suddenly fall. All the leaves turned brown at once and blew off the trees all brittle and crunchy. No gold, no red, no orange. Just brown. Meanwhile the flowers in the garden were still in bloom just as they are today. The white phlox bobbing gently just above the echinacea. The marigolds still like bright beacons and the celosia like psychedelic brains all over the ground. I was on the verge of understanding what it all meant when the dream ended.