Silence

I'm sitting up late, in my parents' front room, surrounded by the glow of Christmas lights. They have a remarkable amount of lights, for the size of the room. It can't be more than 15x15 feet. They have 4 little snow villages on the various end tables and shelves. They have lights around 2 different windows, along with the plastic - but tasteful- Christmas tree. My folks are in bed. My little brother is out visiting friends. The other 2 siblings are at their respective homes. It's very quiet.

It's a nice quiet. It's the kind of quiet that I don't get often. I am usually wearing a pager, and even on my days off it seems to chirp any way. My cell phone often distracts me with various chimes and rings. Sometimes the TV is on in the background. Sometimes my fiance is playing is guitar. The train whistles by at least once every night. When I am at my parents' house, it's usually for an event or holiday, so everyone is coming in and out at various times. My niece and nephew are usually here, laughing and begging us to toss them around. Even growing up, with 4 kids in this house, it was not a quiet house.

Tonight, it is. Tonight, I'm waiting for the lights to flip off, when their timer hits midnight. Sometimes it's nice to get recentered, amidst the bustling rush that is Life. To take a minute or 16, and just sit with your thoughts and your heart. Not thinking about the past or wishing about the future. Just sitting in the present. It feels good. I think I'd like to do this more often.

Merry Christmas to All...

This year I am taking a week off, between Christmas and New Years, to spend time with my family. I'm looking forward to spending time with my family, eating some good food, and visiting Chicago to go ice skating. I love hanging out with my family, we have so much fun. I anticipate a lot of laughing til my sides hurt and keeping milk from coming out of my nose. Even as we get older, my siblings are some of my favorite people to hang out with.

I hope everyone out there can find at least one person to enjoy spending some time with this Christmas season. Merry Christmas everyone!

You've Got All Year

One of my New Year's resolution this year was to be able to do a pull-up. All by myself, unassisted, like the big boys. Anyone that knows me knows that I am ultra-organized. In school, if I had a project due in 2 weeks, I had it done in 2 days. I hate procrastinating, I hate having things hang over my head, I want to be able to check it off my list - quickly.

So, when I made this resolution, I was hopeful that I could have it done by March. I rarely pick resolutions that are ongoing, like "be nicer to people." I pick things that I can count and finish. I started the year in pretty good shape, so I thought with some specific training, this would be achievable fairly quickly. I got a few sessions with a personal trainer at the gym, to help me learn how to workout my upper body a little differently.

Every week or so, I'd mosey on up to the pull-up machine and see if I could do it. It's a machine that you can add supporting weight on, so that you aren't lifting your whole body weight up. I couldn't do it alone, I'd need 40lb of help, then 25lb of help, and finally 10lb of help. I couldn't budge from there. I was using the overhand grip, because it uses more of your back muscles, and I figured those were stronger than my puny biceps.

Well, this past weekend, I walked up to the pull-up bar we have at home. I tried the underhand grip this time, and I exhaled. And then I did a pull-up. All by myself, unassisted, like the big girls.

It took me over 10 months to achieve this resolution, and I realized that that's the point of a resolution. You have 12 months to reach that goal. So if anyone else out there is thinking it's too late to check that resolution off your list...Sister, you've got 2 more months to go.

Give me the Med

I have a hepatitis C patient with cirrhosis who recently started treatment. He's doing great, his viral counts went from 3 million to less than 43. It's working! Then I got his blood counts back, and his red blood cells were low. In following the guidelines, I reduced the doses of his medication. His next counts were still low. I tried to prescribe a red blood cell boosting shot, but the insurance company said no. My nurse has been more than 4 hours total this week talking to his insurance company to get it approved. They said no again today. I will have to fill out more paperwork to petition them again, and I will try to get someone on the phone to explain that if they don't choose to cover the medication, he will need to be hospitalized weekly for blood transfusions and all the risks that numerous transfusions entail.

Hopefully I can convince someone. I refuse to stop his hepatitis medication; he is undetectable and if he remains that way his risk for liver cancer and transplant drops substantially. I'll fill out any amount of paperwork it takes to get this approved, it's just sad that I have to try and explain this to people who know nothing about medicine let alone the nuances of hepatitis C treatment.

My sister

Today is my sister's birthday. I only have one sister. I have a lot of respect and admiration for her. She has 2 wonderful and beautiful children. She is the strongest person I know. Literally. She can bench like 300 pounds. She works as a strength coach and helps people achieve their own fitness goals. She is passionate about exercise and health, and if I could only clone her and put her in every clinic I think we could have a fitness revolution in this country.

Happy birthday, little sister. I hope it's a great year.

A Trip Home

I spent last weekend in Chicago with a friend from LA. We went on a river boat tour, architectural and historical, and it was awesome. I learned a lot about Chicago that I had never heard before. It was cool to have the city revealed to me in a new way. We also went to see The Bean, aka Cloud Gate, by Anish Kapoor - my favorite thing to go see in Chicago. We had a late lunch at The Purple Pig, which was great. The corn relish was fantastic, and the beets were phenomenal. We had an even later cocktail at The Aviary. They had some of the coolest, most innovative drinks I've ever seen. They had one called "in the rocks" which was an ice ball (about the size of a cue ball) that you broke open to find the ingredients for an Old Fashioned mixed up inside. Pretty neat.
Next we went to...Next. For dinner. It was fantastic. They had the Thai menu, which was awesome. It's only around for another few days, and then they are putting one together with the inspiration of "Childhood." There's a pretty good article that will make you want to come out and see what they put together. I know that if my friend comes back to the Windy City, we'll definitely be trying for a table!

Maybe I Don't Know

I have a 30-something-year old patient with 3 children. She got pregnant young, never went to college, and I'm not sure that she actually has a job. Her children have various ailments, some of which are real and some I think she might make a big deal out of because that's all she knows how to do. Anyway, life has not been easy for her.

She came into my office the other day, and she said, "I'm so stressed, I'm having panic attacks, and you keep telling me that 'it's going to get better' well it's not better and if you don't give me something to help me we are going to have to fight!" Her speech is usually fairly pressured, and it's difficult on a good day to get a word in edgewise. I could tell this visit was going to be beyond the 15 minute limit that follow-up patients are given.

She was smiling, but tearful, as she burst out that first sentence. I heard again about her daughter with the seizure disorder who has to go 2 hours away for her specialist. I heard about the dog that is dying and the one that died last year. I heard about the children's daddy and about her mom who doesn't help out. She told me how she tells her 16-year-old daughter to go to college so she doesn't have to rely on Medicaid like my patient does. She told me that despite me telling her at the last 3 visits that "things will get better," they just haven't and she feels like she is at her wit's end.

Then she looked at me, and she said, "You don't know what it's like. You went to college, you have a good job, you don't have to worry about money like I do." She sniffled. "I can't handle it any more." I felt her honesty and her humility.

I wanted to tell her that she really needs a therapist to help her deal with stress and time management. I wanted to tell her that no pill can make her life less stressful or put food on the table. I wanted to tell her that there is no quick fix for having 3 children, no job and no support. I wanted to tell her that looking to a drug to save you is never the answer. But, I know that she can't afford a therapist, and Medicaid doesn't pay for them. She can't force her mom to watch the kids. She can't find a job that will let her off once a week to bring her daughter to the specialist.

I felt that perhaps an anti-depressant/anti-anxiety/mood stabilizer might help keep things a little more even. I did tell her that I think she is handling things very well, and that she shouldn't be so hard on herself when she needs a break. She is actually a very good mom. Once again, I told her to be strong, and we'll meet again in 4-6 weeks.

She doesn't know that I grew up with very little money. She doesn't know that I stay up at night sometimes, second-guessing my medical decisions. She doesn't know that I go in to work even on my days off, because I am a control freak. She just sees me now as her doctor, someone with privilege and no worries. I'm not saying our lives are similar, because they aren't. She has struggles that I cannot begin to imagine. I just didn't know how to tell her that her life isn't going to change because I give her a pill to take every morning. Some people just need a break, and I have nothing that will help with that.

The Other Foot...or Shoe...Whatever

I took my boyfriend to have sinus surgery last week. I appointed myself his designated nurse/caregiver for all post-operative needs. I thought to myself, "I'm a doctor, I care for patients all day. I can do this."

There is a difference, though, when you're caring for your patients. Yes, I care about them. Yes, I often go home and worry about them, call the nurse later to check in on them, and check my home computer to make sure their labs are OK. But, it's very different when it's someone you really care about.

It was awful to see him in pain. It was heart wrenching when there was nothing I could do but pat his hand and wish that the clock moved faster so I could get him another pain pill. It was horrible to wonder if all that blood he was spitting out was normal.

I think I'm a very empathetic person, and this experience has taught me to be a little more patient with family members who are struggling with how to do dressing changes, how to give insulin shots and how to help care for someone who is in pain and hurting after a procedure. If I had all of those feelings of doubt, how much more will someone with no medical background wonder about all that bloody spit.

Reminder

I have a patient with metastatic cancer. She's in her 40s. She just got married, after knowing her diagnosis and poor prognosis. Her husband always accompanies her to her visits. He is very attentive and pushes to make sure she's comfortable.

Her chemo is only sort of working. Her numbers are going in the wrong direction but the tumor itself seems to have shrunk. She's got liver metastases that are not getting smaller; rather they are getting very painful. I think the liver cells are starting to die.

The husband is really hard to understand, he has a very thick southern accent. She usually has to translate for me. My patient has no hair, is in constant pain, and has no source of income. She is usually in thrift-shop clothes, but dressed like she's going to church. No jeans and T-shirts, always in the nicest clothes she has. Her husband wears a trucker hat (probably because he's actually a trucker), jeans with dirt stains, and socks that used to be white. But they are proud, and they are always smiling.

And they are clearly in love, he spends more time doting of her than she cares to admit, and he makes sure all of her concerns are heard at each visit. She actually apologized to me this past visit, because it was an unscheduled acute appointment. To watch them together is to see two people who are living in the "now." They are not worried about how much time she has. They want her to continue to laugh. They want her to be pain-free enough to go to Memphis for a honeymoon. I have learned a lot from my patients, and I have learned a lot about the importance of Today from this one. It's good to plan, but it's not good to lose sight of what's going on today.

Spring Cleaning

I hate to clean. I love when things are clean. I just wish they'd magically get that way.

I broke down today and did a top-to-bottom cleaning. I plan on going through my closet this weekend as well, to donate some old clothes that I don't want any more. I love the anti-clutter effect of spring cleaning. Even though I hate the process.

One big benefit to spring cleaning is that I will have to replace all those clothes I get I rid of.

...Shopping trip!

105

I just admitted a wonderful, coherent woman with a low heart rate. This lovely little lady is 105 years old. One Hundred and Five!! She is totally with it. She was telling me stories about when she was in her thirties. That was in the 1940s. Amazing. I've never met anyone that old before. As a resident I met some Holocaust survivors, some of them might be getting up that high.

This woman told me about when she fell and broke her leg 3 years ago (when she was 102). She fell in the evening and couldn't move due to the pain. Oh, I forgot to mention - she lives alone and still cooks for herself. So, she grabs some nearby pillows and lays down for the night. The school bus driver goes by the next morning and notices that her shades are open, which was unusual for the patient. So, the bus driver calls the patient's daughter, who lives 9 houses down, and tells her to go check on her mom.

Do you remember a time when bus drivers know everyone on the block, when families all lived in the same town, when people looked after each other? Living in this small town reminds me of what I've seen on The Andy Griffith Show. It's quite amazing.

P.S. I ate the antibiotic-free, hormone-free chicken and it was quite good! My belly hurt a little bit later on, but I don't know if it was from the chicken. No one else got belly pain, so maybe my system was a little shocked by the real chicken. Overall, I give it an A+.

Antibiotic Free Meat

Anyone that knows me knows that I don't eat meat. Most people don't know the reason I don't eat meat. I don't agree with people adding hormones and antibiotics to my food. I know why they do it - so they can pack millions of chickens in a tiny warehouse, grow them big without letting them run around and keep them infectious-free despite getting pooped on by every chicken stacked above them. However, there are dangerous side effects to this, and as an infectious disease doctor I feel that antibiotic resistance is a huge issue that I tackle on a daily basis. I refuse to feed that fire by supporting companies that promote the reckless use of antibiotics all so they can make more profit.

Now listen to this: I am about to eat my first REAL CHICKEN NUGGET in years.

I found a company, Applegate, who sells antibiotic- and hormone-free products. I was looking through the aisles at my grocery store, and I saw this box next to the veggie "chikin" nuggets. I bought them today, and I am looking forward to trying it out.

I encourage you to read a little about the use of antibiotics in food. Applegate has a great page on their site about antibiotics in food. Check it out.

In the meantime, I'm gonna eat my real, antibiotic-free and hormone-free nuggest. I'll let you know if they are any good!

New Resolutions

Every year I come up with some resolutions. I think it's important to share them and be specific about how to achieve them. I have a few this year, so I thought I would put them down here.

1. Do more art projects. I am settling in to a new town and a new job, and I think it's time to put some hours aside each week to doing some projects. I'd like to finish 4 by the end of the year.

2. Do a pull-up. I know this sounds silly, but I've never been able to do a pull-up. I always attributed it to being a girl, but my sister can pump them out like nothing. It's time to face the facts: I am too weak. Along with this goal is a second one, which is to fully rehab my hip. I did the typical runner's mistake of just running and not working out. Thus, my hips and gluts are not strong enough to support my running any more.

3. Call my mom more. This is a no-brainer for most people, but I can go weeks without calling my mom. It's not that I don't like talking to her. I don't talk to most people as much as I would like. However, before I commit to calling other people more, I think mom should be at the top of my list.

So, we'll see how I do with these 3. I tried to pick very specific things that I could continue to work on all year. I'll try to update periodically. And you know I'll be running right back here as soon as I'm able to do that pull-up!