Saturday, December 18, 2010

Time Waits For No One

We sold it. Katie and I. Leila's Crib.

It had been sitting. Stuffed in the corner. For the last year. After Leila got her "big girl bed" and learned how to awake in the middle of the night and wreak havoc on the household.

At first it was just laziness. We kept planning to sell but never got around to it. Then finally the add was placed on Craigslist. And the days passed and no interest. It was a beautiful crib. Pristine condition. Stylish.

So eventually we dropped the price and re listed a few times. Nothing for days....and then an email. They wanted to see it. They would be right over.

A young couple. First child. Last few months of pregnancy. They eyed the crib up and down as Leila tried to initiate conversation and Cameron ran to get his pottery. But it only took a minute to decide. They would take it.

Quickly I got the tools and started to disassemble. Leila's home. For the first two years of life. There was a flurry of activity. Unscrewing....lifting...carrying. Money was exchanged and we wished the couple well.

As they amble slowly through our front door carrying various pieces of furniture it hits me. We sold Leila's crib! My mind flashes forward to a much later time. Nursing home bound my addled brain struggling through dementia's cobwebs. I become agitated from time to time and the nursing staff hands me a baby doll. The studies show that it calms demented people to care for a pretend child.

I will hold the doll thinking that it is Leila and wander aimlessly through the nursing home. Searching for a crib to lay her down for her afternoon nap. Except that I won't find it....because I sold it. On Craigslist.

And as I stare out the window at the young pregnant women carefully placing the deconstructed crib in the back of her truck I feel great regret.

Because even now before my brain ages and becomes entombed in the plaques and tangles of senility I can't escape the basic fact:

No matter how bad I want it to....

time waits for no one.

Friday, December 17, 2010

Memories of College

I gently brushed the moisture from my brow and relaxed happily in the grassy field. The campus was barren during the summer and only a handful of students were living in the circle of dorms that surrounded the athletic center and adjacent track and soccer fields.

I just finished working out. My muscles twitching and the sweat causing my shirt sleeves to stick to my arms. As I cooled down I gently laid in the grass and allowed the sun to wash over me. Out of the corner of my eye I noticed a figure approaching.

He appeared in his forties. Wearing old tattered shorts and a t-shirt. His facial hair overgrown and unkempt in distinct contrast to his balding head. He walked without particular haste or direction. His eyes glassy. His gait unsteady.

I may have noticed the distinct odor of alcohol. Or maybe it was my preconceived notion of the homeless people in the area. The mind is highly suggestible.

Hey buddy...can you help me out?

I paused, calculating...How about something to eat?

He nodded and I beckoned him to follow. We walked down the hill to a convenience store. I only had a few dollars. We agreed on a turkey sandwich and a few drinks. I handed him the change at the register.

And then we walked back to the field and sat down. I unwrapped the turkey him one half and keeping the other for myself.

We ate. Silently. Enjoying the summer day. The sweaty college student and the unkempt homeless man. We exchanged some pleasantries. Nothing too deep. Eventually he finished...thanked me...and walked off.

Years have since passed and I am a doctor. Now I spend most of my day "helping" people. But for some reason it doesn't feel quite the same.

It was like something magical happened that day.

And for a moment I felt a sense of oneness.



I find it so hard to recapture those feelings nowadays.

Monday, December 13, 2010

No Respect I tell Ya

Sometimes I non primary care physicians respect our opinions? Do they believe in us? Are we piers or inferiors? And in general....what do we deserve.

I was rounding in the hospital on my partners patients when I came upon Mrs. S. She was having progressive hip pain and her rheumatologist ordered and MRI which showed a joint effusion. The patient developed low grade fevers and anemia and was sent to the hospital to rule out infection.

A quick review of the labs showed the esr and crp were moderately elevated. She was anemic. Her rheumatoid factor and lupus testing were normal. The joint fluid from the hip was tapped and was not consistent with infection.

So I sat down with Mrs S and started to take a history. Upon further review she had also developed bilatteral shoulder pain. Worse in the morning upon waking. Better with activity. She had moderate fatigue.

Based on the clinical history, labs, and radiology findings, I felt the growing suspicion that this was Polymyalgia Rheumatica. So I called the rheumatologist and discussed with her my findings. I felt pretty certain. The conversation went like this...

This looks like polymyalgia....

No I doubt it...probably viral!

But what about the story doesn't fit for PMR?

It just doesn't...lets keep her off steroids and see what happens!

The patient was discharged from the hospital and later followed up with my partner and the rheumatologist.

A few weeks later I ran into her in my office. Upon asking her how she was doing I got this response:

Wonderful Dr. Rheumatology realized that instead of an infection I have Polymyalgia Rheumatica...I am doing so much better now on steroids!

No respect I tell respect.

Friday, December 10, 2010

Snapshots of Childhood

The cabin was rustic. As camp cabins go. The walls lined with bunks on both sides. I was twelve years old. At sleep away camp. It was a cold rainy day and all activities had been cancelled. The counselors were nowhere to be seen.

So a bunch of us walked over to the girls cabin. I was the last of the boys to enter through the screen door. So Jordan you really like that Natasha girl don't you. I looked up to see a mousy face peering out at me from one of the many top bunks.

I began to flush and my heart race. Natasha...of course I liked Natasha. She was the only thing I thought about the whole school year between camp sessions. The previous summer I hung out with her constantly. She was much older then I and thought of me as a little brother.

I, on the other hand, was completely smitten. I basked in her attention the year before....but this year was different. She had little use for me now. She no longer sought my attention. She was busy with the older boys. I was forgotten.

I guess I was not very good at hiding my puppy dog eyes. But to be called out in public. Standing among my friends and all those girls! I looked around the room from face to expectant face. I vacillated tell the truth and gush my feelings so publicly....or to deny, make a joke, blow it off.

I smiled sheepishly and my eyes shot to the ground. Yes...yes I like her.

Silence. And then the crowd parted and standing behind the bunk beds hidden out of sight was Natasha. I looked up and caught her beautiful eyes...all I saw was embarrassment. She sputtered a lame excuse...I was just looking at a poster in the corner...

But I barely heard the rest. I turned and left quickly through the front door. The tears brimming in my eyes...set up, I was set up!

And after all these years...

the emotion returns...

still fresh in my chest like it was yesterday.

Long...long after the memory

of those eyes

have faded.

Wednesday, December 8, 2010


I awoke around midnight to the sound of my daughter screaming. As I leapt out of bed I felt the fatigue wash over me. She was standing. In the middle of the room with her pajamas half off. She had wet herself again.

We have been potty training for the last few months. We left diapers long ago. But every few weeks....I drag myself out of bed and change her sheets and cloths. And I usually don't think twice about it.

Except now. I was finding the manual labor in the middle of the night to be more tiresome then usual. I kissed my daughter and then ambled back to the bedroom. I collapsed in bed. A wave of nausea came over me. Then a feeling of uneasiness in the pit of my stomach.

I had an inkling something was wrong.

For the next few hours I tossed and turned. Waves of mild nausea coming and going. I grasped my abdomen hoping to calm the tumult that was brewing inside.

Around 4am my wife turned to me...why don't you just go throw up already? I guess my mental moaning had become verbal. I stood up unsteadily and made my way to the bathroom. And that's when the odyssey began.

Gut wrenching...body shaking...mind numbing retching. For hours. Uncontrollable. Belly pain...nawing...the kind that won't let you sit still for a moment. Finally followed by relentless joint and muscle pain.

I spent all day in bed. I cancelled work. Cancelled thought. Cancelled any meaningful activity. Every moment became an epic battle concentrating on getting better. Each attempt at raising out of bed was met with dizzying nausea and unsteadiness.

Now this morning. After sleeping 12 hours straight. I feel better. Still tired and achy...but alive. A little warn for wear.

And I wonder. After feeling so defeated after just a measly stomach flu...what it must be like to deal with real illness. Cancer, heart disease, emphysema........the pain my patients live with every day.

Maybe this should be a gentle be a little more kind...a little more empathic.

And oh yeah...a little more thankful.

Friday, December 3, 2010

Things Have to Change

So I evaluated the patient in the nursing home. Chest pain. She needed to go to the hospital. So I sat down at the computer and quickly wrote a progress note. The ambulance came and took her away.

An hour later. Call from the ER.

Do you have a medicine list on Mrs X? She wasn't able to tell us.

Didn't the nursing home send anything?

They said since they converted to an EMR they have no written med lists

Well I am looking at my EMR in the office and it is not up to date. A number of med changes have taken place since the last time I charted. What does your EMR say?

Oh...this is like from 2 years ago... the last time she was in the hospital! big the ER has to call the nursing home and verbally take the med list and transfer it to the hospital EMR. I, in turn, have to update my own EMR from the hospital list. Each of these actions take time away from the doctors and nurses. Time that could be spent on patient care.

By the's Mrs X's chest pain?

Chest that what she's here for? We've spent the last hour figuring out her med list. She hasn't been evaluated yet!

Thursday, December 2, 2010

In Memorium

I loved him as far as patients go. He was warm, and friendly, and needy. His thick accent always pleasant. Often he spoke in a mix of languages, intertwining one with another. Some I understood...some I didn't. His culture was different from mine. But very respectful. Physicians were held in high esteem.

The diagnosis was horrendous and of course the expected lifespan was short. Often he circled life's drain but usually found away to pull himself back. Long ago he had entered hospice but the truth of the matter was that I never completely accepted it. At least not emotionally.

He had been doing poorly for the last few days. I tried the few tricks that usually worked. Then I got the call this morning that he took his last breath and died..... just like that.

And as per usual I feel a great tinge of sadness and guilt. If I had done something different. Been more aggressive....been less aggressive. Could I have managed things better?

I picked up the phone to call his wife today. She said that she saw him last night. That his stroke induced garbled language cleared for a few minutes and he became very aware. He told her that he was dying and then preceded to give her a series of instructions. Then he said goodbye.

And so he died. And now I sit at my desk and try to discern what I learned from him.....

Maybe as physicians we give ourselves too much credit. That this strange dance of monitoring, measuring, and tweaking is all for naught. That maybe those who are going to live....we help recover faster. And those who are going to die...we help prepare for death.

And sadness, guilt, and blame are all just crutches we use to help maintain the illusion...

that we actually have one iota of control over our lives.