Blogroll, Please! ~ by Jay

Observant readers will notice that I've updated the blogroll after reviewing the blogs I read regularly and the comments we've received. If I've missed you, send up a flag in comments. I haven't included the (few) blogs I read for professional interest, but if you're in the field and curious, I'll tell you. You need but ask.

Things I Could Do Without ~ by Jay

From an online catalog ostensibly aimed at teenage girls but which brags about product placement in a magazine called Kids' Rooms and an endorsement from tween fave Miley Cyrus. Plus they were in The Bratz Movie. There's a selling point. Not.

Public Service Announcement ~ by Jay

Do not contrast a mother's adopted child with her "real" children.

Do not suggest that your friend chose IVF over adoption because "she wanted a child of her own".

Do not assume that "family" is synonymous with "flesh and blood".

Do not refer to my daughter's birthmother as "her mother" or "her real mother".

Do not describe adoption as "buying a baby".

Do not tell an adoptive parent that she is noble for "saving a child".

Do not speak of adoption or infertility as if no adoptive or IVF parent is around to hear you.

Homecoming ~ by Jay

When was it that returning to my mother's house became a visit? When did it stop being home?

My parents bought their house in 1964, and my mother still lives there. Some of the rooms have been redecorated, but the dining room where we had Thanksgiving on Thursday looks almost exactly the same, and the kitchen table where Eve had her morning Froot Loops (special Grandma's-house treat) is the same one I remember.

When I was in college, I left the dorm and went home. In medical school, I actually lived with my parents, so of course it was home. It was after that - after Sam and were married, and I moved to California to be with him. Even though I never said I was "from California" - I always said "I'm from New York but I live in California" - whatever apartment or house Sam and lived in became my home.

I am blessed to have a home that is warm and full of food and light and books and the ones I love, and blessed to know that even if the worst happened to this home, I can return to my mother's. I have always had that safety net. My mother's house is no longer my home, but it remains my shelter. I am luckier than most, and I am grateful.

If my books are there, it must be home. If there are four or five pairs of shoes tumbled on the floor at the foot of an unmade bed, it must be home. If I am grateful to arrive there at the end of a long day, it must be home. And if all of those things are gone, if Sam and Eve are there, it is home.

Engage With Grace ~ by Jay

I've seen this on several blogs over the last few days, and can't remember which ones, so no credit - sorry! I also apologize for the US-centric nature of this post. I don't know what the advance directive policies are in any other country, but I'd be interested to learn from those of you who have time to comment.

Those of us in the US are preparing for Thanksgiving, and for many of us that means we're about to spend one or two or four days with family members we don't see all that often. Millions of conversations will flow over millions of dinner tables. We'll argue about politics, we'll remember embarrassing moments from our past, we'll recreate old patterns in all their glorious function and dysfunction. This year, let's do one more thing: talk about how we want to die.

Spend some time talking about your wishes at the end of life. Give your family the great gift of knowing what choices they should make if you become unable to make your own decisions. Engage With Grace, the One Slide Project, has five questions to get the conversation started. You can download the slide and look at lots of other resources as well. If you ask the question, your family will keep talking. So many of us want to talk about this, but don't know how.

You can take this further with the Five Wishes. The Five Wishes is a clear, concise document that helps you tell your family and your health care providers what kind of medical, emotional and spiritual care you want if you become unable to speak for yourself. It serves as both a living will and a durable power of attorney for health care (or health care proxy) in most states. (Wikipedia offers an adequate summary of the difference; feel free to ask me if you have specific questions). It's a good idea to execute both a proxy and a living will.

If you've ever heard about someone dying on a ventilator and thought "I don't want that to happen to me", you can take action. The death you save may be your own.

Public Service Announcement: Turkey Edition ~ by Jay

'Tis the season for some of us to think about food safety.

I'm pretty laid-back about germs. I wash my hands a whole lot at work; I even carry a hand sanitizer with me for home visits. I use alcohol to clean off my stethoscope and I wear gloves when I'm supposed to. At home I don't use bleach on the counters, stock antibacterial soap or make the kid wash her hands after she plays with the dog.

I am not laid back about food safety. My mother and I have a back-and-forth about allowing meat to come to room temperature before it's cooked (she's for it; I'm against it). I don't leave milk out on the counter. I throw out canned and packaged goods that have passed their expiration date.

And I never, ever cook the turkey with the stuffing in it.

Stuffing that contains any raw turkey, or comes in contact with any part of the raw turkey, must reach a temperature of 165 F to be safe. By the time stuffing in the middle of the bird gets that hot, the breast of the turkey will be over 180 F - can you say "dry"? No, you can't, because your tongue is stuck to the roof of your mouth.

Cook the stuffing in a separate casserole. Use last year's stock (we keep it frozen) or good canned stock or bouillon to flavor it. You can also pull out the turkey innards before you cook the turkey, brown them and use some of that to flavor the stuffing (before you make the gravy). Then you can cook the turkey the easy-peasy way. We heard this on the radio years ago, courtesy of a chef named Narsai David. Use a fresh turkey. Put it in the oven at 350 F. Cook it for 45 minutes plus 7 minutes a pound. Don't turn it. Don't baste it. Don't touch it. Just cook it. It will be perfectly cooked, moist and delicious.

We're headed up to my mother's for Thanksgiving. My brother will cook, and my mother will buy a sensibly small turkey, so at some point in the next few weeks we'll make our own turkey, so we can have sausage-and-apple stuffing and leftover turkey and some rich stock.

If you're traveling, be safe; if you're hosting, relax and let your guests help; if you're not in the US, shake your head and roll your eyes at our lunacy. Whatever you're doing over the next few days, I hope it brings you peace.

Are We Having Fun Yet? ~ by Jay

Could someone please fix the American healthcare system? Please? Now?

I am preparing a summary letter of a patient I have been seeing for five years, trying to explain how we've been managing her terminal illness that is not yet in its final stages. We've stopped doing "routine" screening, we've scaled back the lab work, we're attending to symptoms and keeping her as functional as possible - but she's not, yet, appropriate for hospice. It's a delicate dance and I don't think it's egotistical to say it's a dance that many of my colleagues wouldn't or couldn't do.

Unfortunately, we're about to find out if someone else can pick up the rhythm. My patient never held a "regular" job; she was a housewife and a stay-at-home mother and made extra money off the books as a babysitter and housecleaner. Her husband died years ago and his union pension disappeared before I met her, so she didn't qualify for Medicare and is on a special Medicaid program for seniors. There are six Medicaid managed care programs in our state, and the one she's on is the only one we accept - and as of Monday, they no longer have a program for seniors. She's been moved to an insurance I don't accept.

Even if I agree to see her pro bono, if I'm not her identified PCP I can't order lab work or Xrays or - most important - refer her to hospice when the time comes.

Someone explain to me again why socialized medicine would be a bad thing.

A Step Forward ~ by Jay

Florida's ban on gay adoptions has been declared unconstitutional.

The state will, of course, fight the ruling, but it's a step in the right direction.

Maybe, someday, Florida law will be as smart as a second-grader.

Conversations With My Daughter ~ by Jay

Is there anything you want us to ask your teacher when we have our conference tomorrow?

The moment of silence.

What?

After we say the Pledge, we have a moment of silence. We never did that before. I want to know why.

What does she say about it?

Just "it's time to be quiet for a moment". And mostly we are. I guess it's OK, but I want to know why we're doing it.

How Could I Have Missed That? ~ by Jay

I was 16 when I read it for the first time. Sure, I was young, and I grew up in a family with traditional gender roles, and it was over 30 years ago. But how could I have missed the breathtaking misogyny in Kurt Vonnegut's Player Piano?

I'm sure I recognized that Vonnegut was projecting the family structure of the 1950s corporate world into his dystopian future, along with the punchcards, vacuum tubes and magnetic tape. There were no real career opportunities for women. The (very few) female characters probably had perfectly good reasons for their behavior. Those reasons are never explored; the women are caricatures, not characters, and they are either venal, fat or stupid. It's also clear that fat is just as bad as venal or stupid.

We are not living in Vonnegut's future. We aren't sorted into jobs by giant machines based on our IQ and our family history. Vacuum tubes and punch cards are gone. I wish the idea of women being completely dependent on men had gone with them, but unfortunately that world is all too much with us. Women in Vonnegut's world are either conniving, pushy bitches using sex to keep their husbands in line, overweight empty-headed sentimentalists, or prostitutes (because "what else could a woman sell when her husband loses his job?"). The men's choices are limited or extinguished by a repressive corporatized industrial government, but the women's choices are limited by their very status as women.

I wonder what I thought about those women when I was 16. I don't remember feeling outraged at their creator, as I do today. My English teacher pointed out that "Anita" sounds a lot like "maneater"; what did we say about that? Did we recognize that only two of the women even have names? Did anybody make a connection between Vonnegut's misogynist vision and the way things were changing around us in 1976?

The first time I re-read Hamlet after med school, I thought "why didn't anyone ever point out that Hamlet is depressed"? It was so obvious. I felt the same way this week as I read Vonnegut - how did I not know this was misogynist?

I wonder how much I still have left to learn.

A Room of One's Own ~ by Tigermom

I have a new desk at home.

Long and spacious and with drawers and cubbies just where I need them.

I have waited my whole life for such a space.

Oh, the bills were late because I do not have a good place to keep track of everything I need.

Oh, I misplaced that document because I do not have a good place to keep track of everything I need.

You get the idea.

I spent most of today paying bills and filing and I felt happy.

A place for everything and everything in its place.

You can quote me in a month if the place is a mess.

I Don't Think I'm Superstitious ~ by Jay

I really don't.

So why is it that when I have 14 posts in my Google Reader and I only have time to read one, I don't read one - I wait until either there are more than 14 posts or I have time to read a bunch at a time. Anything to avoid having 13 posts.

Diagnosis: triskadekaphobia.

A Meme Pour Moi ~ by Jay

I admit it, I love memes. I especially love memes about me, because I'm just that sort of egotist.

Here's one I swiped from Zuska.

5 Things I Was Doing 10 Years Ago:

1) Practicing primary care medicine
2) Teaching in a community hospital residency program
3) Studying in a facilitator training/certification program
4) Living through a kitchen renovation
5) Singing in a community choir

5 Things On My To-Do List Today:

1) Five home visits (or are those five separate things themselves?)
2) Take Eve out to dinner at Friendly's
3) Pay the overdue parking ticket
4) Arrange for a patient to enter the psychiatric day hospital program
5) Give the dog his Prozac

5 Snacks I Love:

1) Peppermint stick ice cream with hot fudge sauce
2) Cinnamon Mentos
3) Junior Mints
4) Brie cheese on Bremer crackers
5) Cheddar Goldfish

5 Thing I Would Do If I Were A Millionaire:

1) Renovate my bathroom and bedroom
2) Work part-time instead of full-time
3) Fly first class whenever I fly
4) Donate enough money for our synagogue to have a building
5) Replace all the windows in our house to get rid of the storms and have windows I'm not afraid to open

5 Places I've Lived:

1) New York city suburbs
2) SF Bay Area
3) Colorado Springs, CO
4) Our Town, where I live now
5) Paris, France (OK, it was only a month, but I was living there, and if I don't include it I won't have five. I guess I'm not very transient)

5 Jobs I've Had:

1) Receptionist at my father's office
2) Medical resident
3) ER/urgent care doc
4) Primary care doc
5) Hospice doc
(not a very varied resume....)

I won't tag anyone, but feel free to take this meme and run with it. I'm betting most of you have more interesting things to write for the last two categories.

We Have Nothing To Fear ~ by Jay

Except everything.

We're all worried these days, aren't we? We childproof, we use fancy car seats, we keep our kids indoors on sunny days, we don't let them eat unwrapped Halloween candy, we never let them play outside by themselves. And then, as Lisa Belkin writes, we have to let them go into the big, wide, unsafe world, and stuff happens. Sometimes it's really bad stuff.

I've spent much of my personal and professional life looking at the really bad stuff. I look when I have to, and the rest of the time I avoid it. I don't watch the local news. I deliberately skip the kids-in-peril section of the paper. I bring my book and my iPod to the gym so I don't have to watch some kidnapped-child hysteria on cable TV. Mostly it works. I worry about Eve, but mostly about her psyche, not her body. I'm not worried that she'll be snatched by a stranger or seduced by her gym teacher or injured by a badly-fitted booster seat.

I may not be worried about Eve's safety, but the other parents in my community are worried about their kids. Their worry makes it harder for me to help my daughter learn the independence she wants, and the competence I think she needs and deserves. If I let her walk to school alone, I'd get calls from concerned parents on her route. I can't let her walk into the building alone for dance class - never mind that she's had classes in the same rooms in that building for three years. I have to walk her to the classroom and pick her up from the classroom. My daughter has been at the JCC for some part of every weekday for seven years, but they won't let her walk up one flight of stairs alone for religious school on Tuesdays, or down the hall to the pool by herself on Mondays and Wednesdays. She has to be signed out of her classroom by an authorized adult. Now I can't even walk into the JCC building without pressing my thumb on a screen to open the door, and I can't go up to the classrooms where her religious school class is held because my thumb isn't authorized.

None of this makes her safer; it just makes her more dependent. I'm not an idiotic optimist. My approach comes actually from the opposite perspective, although I call it fatalism rather than pessimism. I don't assume the worst will happen, but I do assume it's out of my control. I have no faith in my ability to actually keep Eve safe, not where it counts. If I can't take care of her, then I want to help her learn to take care of herself.

My friends say "the world is different now. We can't give our kids the freedom we had". I don't buy it. I was born in 1960. My parents didn't even own a car with seat belts until I was 8 or 9, and we never wore them anyway. We used glass thermometers, rode bikes without helmets, learned to cook on a gas stove with pilot lights, ate lead paint, played with the old-fashioned kind of Easy-Bake Oven with the exposed light bulb. My daughter's world is safer. She's safe in part because we are privileged by class and race and nationality and by simple luck, but I grew up in the same kind of upper-middle-class bubble and her world is still safer than mine.

Now it's accepted wisdom in the suburbs that kids can't be allowed out to play with other kids. One of my colleagues explained recently that her kids have twice as many activities as she did because "it's not safe to just let them play outside". There are no drive-by shootings in her neighborhood; she lives in a more expensive and less urban area than I do. But she's convinced it's dangerous, and so she has to pay for and shuttle her kids to planned and protected activities.

If the world our kids live in is safer, why are we more afraid? We hear more about the terrible things that happen, and we hear it faster and from farther away, and we hear it over and over again. Some dangers we hear about don't actually exist - remember the McMartin preschool scandal? Far as I can tell, no children were actually assaulted. Susan Douglas and Meredith Michaels write about the McMartin mess and related media sensations in The Mommy Myth. I agree with their explanation for the explosion of media attention to child molestation in the 1980s. In the 1970s, as women entered the workforce in large numbers, political support grew for widely available, even subsidized daycare. And then it was the 1980s, the Republicans were in power again, and suddenly it was DANGEROUS to leave your children with strangers. Poof, no more party planks calling for daycare.

I'm not suggesting we should let our children play with matches, or that we should return to the days when kids traveled lying down on top of the cargo in the back of the station wagon. We should do what we can do - what we can reasonably do - to protect our kids from real danger, and then we need to figure out how to let them out into the world, one apron string at a time.

Realizations ~ by Jay

Last night I met with the palliative care learning group I've been co-facilitating for the past 18 months. As we reflected on our process and shared the ways in which that team has been important for each of us, I had a moment of grief for my primary care practice. I don't feel I'm part of a team there. I feel isolated, marginalized, unsupported.

The talk swirled around me, and I thought "why can't those people be more like these people"?

Why can't they be more like me?

Hmm.

I am different because of my gender, my size and my religion, but I'm also marginalized because I hold myself apart. I don't want to be like them. I sit in judgment. I choose to remain outside, and then I am angry because I'm not invited in. I judge my colleagues and then dissolve in tears when I am judged in turn, and found wanting.

I don't judge my patients, even when I find their behavior inexplicable, even when I'm angry with them. I don't hold myself apart in that relationship. I don't feel superior to my patients. I also never feel invisible with my patients; how could I? I'm in the position of power. But in the hospice settting, I'm not in the power seat, and I still don't sit in judgment. I have more empathy for my colleagues and co-workers, even when I disagree with them.

I have known for a long time that I can be my better self most effectively when I choose environments and relationships where I feel supported and seen, where I feel I belong. I can't yet let go of my primary care work. I don't want to give up the salary, and I still love being with my patients. I can't force my colleagues to be more like me, but perhaps - perhaps - if I can hold onto my own sense of worth more effectively when I'm in relationship with my primary care group, I can then extend to them some of the unconditional positive regard I find for my patients. If I can be myself and let them be who they are, maybe that will, finally, be enough for me to find peace.

Grateful to Have Choices ~by Tigermom

I am a lucky person. Healthy, happy, employed, I got to spend today shuttling children from here to there, make sure they got fed, play games with the ones who spent the day with me, and even clean out parts of my desk.

I have been able to choose where and when I work. A private practice psychiatrist, I have so far had the luxury to practice in a quiet office and, most of the time, have medical care decisions stay between me and the patient.

My hat is off to my friends, colleagues, and fellow men and women who do not have choices. To the people who get up and make it through each day even when they are not healthy, or happy, or working in an environment that sustains them.

Dispatches from The Working Weekend ~ by Jay

Life in a small town: one of the patients in our inpatient hospice unit is the wife of a patient of mine; her husband has a question about his own care and wants to talk with me, but can't come in the office because he's spending all his time here. So I'm waiting for him to come in after church. I've been here for four hours, attending the weekend interdisciplinary team meeting, seeing the patient who came in last night, following up with the other two I admitted this weekend, adjusting medications, talking with family members who are upset or worried or grieving, signing death certificates, catching up on the notes from my home visits last week. It's quiet here, the pace is comfortable, and it's a nice, slow day at work.

Except it's Sunday, and that meeting started at 7:00 AM, so Eve was still asleep when I left. Sam took her to religious school and went to the grocery store and will pick her up and bring her home when she's done. If I don't get back in time, he'll take her to swim practice. I promised Eve we'd make pumpkin bread this afternoon, and I will keep that promise, but that won't entirely make up for missing the french toast breakfast we usually have on Sundays, and the giggling over the comics, and the cuddling in pajamas. I also missed chatting with my friends as we leave the kids at religious school and hearing about Eve's latest encounter with the Hebrew alphabet.

This building is full of women who are also working Sunday. Some have kids who are grown; some have husbands who work during the week while the wives stay home, and then they flip; some are single moms who have left their kids with grandmothers and aunts for the day. We're all figuring this out, doing as much as we can of everything on our lists, and hoping our kids understand.

This Is a Test ~ by Jay

Got to work early this morning to do some paperwork. Find our office coordinator, usually unflappable, looking crazed. She has just returned from retrieving all the morning's charts which were not pulled yesterday when she was off. She is Not Pleased.

Find two messages on my desk. There's a chart with one of them.

Begin seeing patients; have to arrange a hospital admission for my first patient and am disconnected twice trying to reach the hospitalist on call.

Think I have a break between patients only to discover that the chart pulled for my next patient is not her chart; it's a patient with the same initials. Listen to the coordinator wrangle with the file clerk over where the correct chart might be.

Check messages again. Four this time. One is with the wrong chart (Sr, not Jr). One is not my patient. One is a refill that was requested on Monday but didn't get to me until Friday.

Tell my assistant that of course she can go pick up her sick kid from day care, and reassure her that I'm done because my last two patients didn't show up anyway. Glance into waiting room while I am talking to her and see one of those patients sitting there smiling at me. He had arrived on time (half an hour ago) but no one put his chart in the rack.

While I am seeing him, my other patient arrives from the main office, where she was checked in and left to sit for ten minutes before anyone told her I was at the satellite.

Turned to the coordinator (who is the only one who knows about The Meeting) and say "This is a test, right? To see if I can stay calm?"

Start laughing, because it's about the only response that makes sense.

You've Got to Be Taught ~ by Jay

We have a new babysitter. Trish is a delightful young woman who attends college nearby and has all the attributes I adore in a sitter: she uses Email, she has her own car and my daughter adores her. Plus she washed the dishes last night. What could be better?

Two weeks ago, Trish and Eve spent most of their evening watching the musical version of Hairspray. Eve has been watching it every spare minute, trying to memorize it before I send it back to Netflix. Tonight Eve turned on the CD player and we heard "Good Morning, Baltimore", and she said "Trish brought me the CD!" That seemed fine, until she added "She made it for me from her own CD".

Sam and I don't steal music. We pay for everything we download. Yeah, I know, we're stodgy old fun-sucking legalistic squares who are hopelessly out of step with The Real World. When I first found Pandora Radio, Sam asked me not to use it because he assumed it was illegal downloading (it's not; they license what they play). A few years ago, Eve received a bootleg copy of the High School Musical soundtrack as a favor at a birthday party. We threw it out and purchased an honest copy for her.

Sam said "What if you took a picture and you wanted to make money by selling copies? What if you sold your first copy and then the person you sold it to made a whole bunch of copies and gave them away to everybody else? Then everybody who wanted your picture would have one, but you would only have the money from one person". She got it, at least for the moment, and I'm downloading a paid-for copy as we speak, but I have this feeling we're fighting a losing battle.

I'd Write More If I Were Awake ~ by Jay

But I'm not, really.

The short version: the cold I've been harboring turned into an ear infection at 2:00 AM today, so I was up for a while before my 7:30 meeting. The meeting went better than I expected; in particular, Boss agreed to solicit feedback rather than have his entire understanding of my functioning driven by a few complaints. He also agreed to ask people to come to me directly rather than complain to him without attempting to resolve issues with me first.

Then I did three home visits and wrestled with the idea of going to my office. I didn't really want to go, but I needed to do paperwork, and I needed someone to look in my ear and confirm what I thought before I started antibiotics. I'm glad I went. Everyone was happy to see me, my ear feels better after two doses of antibiotics and some ibuprofen, and I can go to work tomorrow with a little less anxiety.

And I went to my final home visit of the day to a hospice patient, to check on the results of some med changes we made last week. The patient's daughter said "You don't know, Doc. You just don't know how much better she is. She slept through the night for the first time in three years. You just don't know". At the end of the visit, she looked at me and said "You are such a wonderful doctor", and hugged me tight.

Sometimes the patient heals the healer.

Good night. Sleep well, everyone.

Anger Management - Edited Version ~ by Jay

So I have this issue. I've struggled in almost every work setting of my adult life because I lose my temper and yell at people. I do this when care is at risk, when I feel my ability to do my best for patients is compromised by the system or by incompetence of others. I also do it when I feel unheard and unappreciated, and that feeling is terrifying. I don't intend to yell at people. I feel awful about it afterwards. It's a lot better than it was. But it hasn't stopped.

UPDATE: I have deleted the rest of this post because a) I don't want to reread it, ever and b) it's a bit too raw and personal to have floating out there in cyberspace. I didn't just delete the post wholesale because I wanted to keep the comments, which have warmed my heart over the past 24 hours. Update on the meeting in the next post, and thanks to all of you who have reached out to remind me that I don't need to be defined by my struggles.

A Better Day ~ by Jay

Yesterday did, in fact, end. Finally, and at long last, the kid was in bed and the work was done and I got to cuddle up in my cozy flannel-sheeted bed and sleep - and Eve let me sleep until 8:30 this morning. Unprecedented. While she was waiting for me to wake up, she wrote a picture book about friendship.

Aside from a complete internet outage this morning - probably from last night's rain doing something funny to the cable connection - today was a delight. Eve finished ballet class, came pirouetting down the stairs afterward bright as sunshine, climbed into the car and we set off for Claire's, stopping at Subway before we got on the highway for nearly twin turkey subs (olives on hers, onions on mine). Had a lovely afternoon with Claire and her daughter and then drove home listening to "Wait, Wait, Don't Tell Me" podcasts. Now I'm off to have a cup of tea with Sam and feel restored to face tomorrow, which begins with a committee meeting during Religious School and moves on to High School Musical 3.

This is Being a Day ~ by Jay

My new pants are too long. Even with heels on, and I don't usually wear heels to work. I'm wearing them anyway (the pants and the heels). Why do people think that just because I'm fat, I'm also the height of a redwood tree?

Sam is sick - finally saw the doc today and is now on antibiotics for sinusitis - and realized on Tuesday that he'd inadvertently deleted the media files for a DVD he made from a bunch of videotapes. Has spent every spare moment since then with our VCR and videocam and his computer on our kitchen counter trying to recreate it. Is not in a good mood.

Eve didn't do her piano homework until the last minute. Again. And did not take kindly to being told that if she couldn't do it herself, she'd have to tell her teacher it was too hard for her. Pouted but then finished in about ten minutes, which gave her 20 minutes before school to whine at me for making her the only kid in the entire third grade - no, the country. No, the world - who hasn't yet seen High School Musical 3.

I have his cold. Sore throat, dry cough, probably low-grade fever. Forget to take anything before I left and don't have any ibuprofen at work. Because this is a doctor's office. Why would we have ibuprofen?

The presentation to the hospice nurses this morning went well, and I got to the office early, but then...

First patient is not sure she wants to continue with his current cardiologist because he doesn't entirely trust him, and is probably having active angina and doesn't want to see anyone until he's had a chance to think about it. Sort of agrees to go to the ER if the angina gets worse, but I'm not convinced.

Second patient (squeezed in) does not have a cold, as I thought when I agreed to squeeze her in; instead is having significant complications from chemotherapy for breast cancer, isn't sure she wants to continue chemo, and isn't sure she wants hospice. Symptoms suggest possibility of pulmonary embolism which I probably can't treat because the chemo has wreaked havoc with her platelets. Sent off for study anyway because prognostic info may help. Put off calling patient's son, who lives out of state, until I have more time to talk to him.

Now an hour behind.

Next patient has been seen by the ER three times in two days for a rash. They don't know what it is. I don't know what it is. The only dermatologist in our area who takes Medicaid doesn't have an opening until February.

Next patient may need her BP meds adjusted. Or maybe not. And has hip pain which is probably bursitis, and isn't sure she wants a flu shot, and wants to tell me about her latest fight with her granddaughter.

On Tuesday I had at least 8 patients cancel or not show up. Today everyone is here.

Two blessedly quick and straightforward visits, basically healthy people here for follow-up visits, who get less of my attention that they usually do but are philosophical and even nice about it. "Seems like you're having a rough day, Doc. Hope it gets better".

And then the teenager who I have seen three times before for vague and minor problems comes in this time with her sister, who has been her guardian for reasons I've never understood, and after a few fits and starts finally tell me the unspeakable thing they've never told anyone before. Not something I can make better. Probably not something anyone can make better, ever, although we spend about forty-five minutes trying to figure out how they can pick up some pieces of their shattered family. They also have Medicaid, and it's probably easier to find a dermatologist than a family therapist.

Then I call the out-of-state son about the patient with breast cancer and discuss hospice.

It's 2:20. I haven't written any of my notes. I haven't had lunch. I have to be at a home visit in 40 minutes and then go to a meeting at the hospice and then pick up Eve from Sam's office, where she'll be waiting because he has an evening event. If I'm lucky Sam will manage to feed the dogs before he picks Eve up. If not, I'll have to go home and do that after I pick up Eve. I'll take her to the synagogue potluck (still not High School Musical 3, and I'll hear about that) and then home, and I'll finally finish my office notes after she's in bed.

This is being a day.

Did You Hear That ?! ~ by Jay

I just finished watching last night's Law & Order on TiVo. At the very end, Jack McCoy is holding a press conference, and he turns to walk away as the reporters continue to shout out questions. None of the questions is intelligible except one, faintly, over the noise:

Mr. McCoy! Is it true you've been offered a position in the Obama administration?

I swear, I heard that.

Public Service Announcement ~ by Jay

The sore throat and cough and incipient fever I have developed this evening are not related to the flu shot I received this afternoon.

Repeat after me: It is not possible to get the flu from a flu shot.

(What I have isn't the flu, anyway. It's undoubtedly the same cold Sam has been harboring for nearly a week. But still.)

Conversations with Patients ~ by Jay

How's your knee feeling?

Well, it's the oddest thing.

Oh?

Remember you told me that physical therapy would help?

Yes.

Well, I went to the physical therapist and I did the exercises and I had the treatments you recommended and then the strangest thing happened.

Strange?

The pain just went away, all on its own. I wonder why.

With All Due Respect ~ by Jay

I am delighted that Barack Obama will be President. I voted for him with enthusiasm and watched the returns and his acceptance speech with tears in my eyes. But...

....to all the people I hear saying "Now our kids know that ANYONE can be President", I respectfully say this.

What we know is that ANY MAN* can be President of the United States.

Eve is excited about Obama, but not bouncing out of her seat the way she was for Hillary.

It's not yet open to ANYBODY. Or EVERYBODY. Obama's election is a wonderful thing, but there is more work to do.

______
*I don't really think it's ANY MAN, actually. It's the very, very rare man who has the stomach for politics at a national level and the credentials to get there. And, as Sam pointed out, it's unlikely a payess-wearing Chasidic Jew would have much traction.

A Long Way, Baby ~ by Jay

In my lifetime, we have come from this


to this.

What will be possible in Eve's lifetime?

Conversations With My Daughter ~ by Jay

Can I vote when I'm 16?

Nope, you have to be 18.

Wow, ten years.

A friend of mine says her 8-year-old thinks kid should be allowed to vote. What do you think?

I can't vote because I don't have an ID card. I have a Pokemon card, though. Will that work?

Check That Off My List ~ by Tigermom

Just took all three kids to vote.

They did rock, paper, scissors the whole time we waited on line in order to pick who would get to press the button.

Luckily there were a multiple of three buttons to press.

Plan For Today ~ by Jay

We're having a slow morning. Eve doesn't have school, and I don't start work until this afternoon, so we're all sort of dawdling around. At some point soon, I will make lunch for Eve to take to the JCC, remind her to pack her bathing suit and towel, and then take her with me to vote.

I have no idea how long that will take.

Then drop Eve at the JCC, pick up some lunch, stop at hospice to sign paperwork, and head over to the office, where I will spend the day and evening avoiding any mention of the election, if I can. I'm the only one of the four docs who is voting for Obama.

See you on the flip side. Hope I'm smiling.

UPDATE: It took about 40 minutes to vote. Got to shake hands with both the local Congressional candidates and listen to a (blessedly) only partly-audible "Obama is a socialist" conversation behind us in line. Longest line I've ever seen in this polling place. And for the first time in our very white-bread district, I saw a few African-Americans voting, including one older woman who needed a lot of assistance from her companion (I'm guessing it was her son) to stand up for 20 minutes. After we got inside, the line, by general consensus, moved aside so he could take her up to a spot with a chair and shorten her overall waiting time. I saw her inside as I went to my machine; she couldn't stand up at the machine, so he was helping her fill out a paper ballot, likely a provisional ballot. I hope like hell it got counted.

Conversations with Patients ~ by Jay

I haven't seen you in a while.

I know. I missed an appointment a while ago. I was having a hard time.

Oh?

There was..a tragedy.

A tragedy.

My niece was murdered last spring.

Oh, how terrible.

I just...I couldn't talk about it then, you know? I couldn't come in here and say the words. But now...now I wanted to. I knew I could talk to you.

How can I help?

Tell me why.

Why?

Why God did this. You know I am strong in my faith. I have been arguing with God for months. What is God's plan? I need to know. And I knew I could ask you, because you are one of God's chosen people. You are closer. Please tell me why. What could God want, to take her now?

Overheard ~ by Jay

I can take off my shirt by myself!

Not here.

Why not?

Because this is the grocery store.

But they want to see, Mommy!

Darn, No Video To Embed ~ by Jay

Thanks to Feministe, I found The Righteous Mothers, four female folksingers with cool harmonies and lyrics so funny I've been choking on my wine.

So go to their website and click on the sample for "She Shanty". Trust me. Just go.

Conversations With my Daughter ~ by Jay

Mommy, is this where Laura lives?

No, honey. She doesn't live in Our Town; she lives near Big City.

But you said I was born here.

You were born in this state, but about 2 hours away from here, and Laura doesn't live there any more.

I've been telling everybody that she lives here.

Everybody?

All my friends.

Ah.

They all ask me about it. About being adopted, and about my birthmother.

How does it make you feel when they ask you about being adopted?

I feel important - like they really care about me.