Wednesday, March 29, 2006

The Devil Is In the Details

AngelBaby reached a new record last night: 106 degrees. We were expecting seizures or something, but he just sat quietly and ate tomatoes. Today he's much better, though TrophyHusband is now ailing. I'm importing my mother on a frequent flyer ticket tonight to take over from the saintly in-laws. I am spoiled, I know.

So: patient stories. The trouble with stupid patients is that they make me sad. You can't laugh with them, so if I'm laughing, I'm laughing at them.

Wacky patients are another story. I'll tell you about one of my favorite wackos, the Pirate. We call him that because he wears an big gold earring in one ear and has wild woolly hair, a fanciful mustache, and a dramatic limp. He can't read or write because he spent most of his childhood in juvenile detention. He's in his sixties, and his main health problem is diabetes.

A couple of months ago the Pirate showed up for his regular visit looking rather different. The earring was gone, the hair was tamed into a sort of pompadour, and his mustache was trimmed. I commented on his new look, and he said rather shyly, "I had to clean up, because I joined the church."

"The church!" I said. "What made you do that?"

"Well, my sister's been on me about it," he said. "And I know that if I don't repent before I die, I won't go to heaven. So I figured I might as well do it now."

I was a little disappointed to see the Pirate civilized, but he seemed happy.

A week ago he returned for his follow-up visit, still looking relatively spiffy. His blood sugar, on the other hand, was much too high.

"It must have been all the soda I drank today," he said.

"Must have been," I said. "How are things going at church, anyway?"

"Oh, it's going good," he said. "You know, at my church they talk in tongues."


"Yes, when you're feeling the Spirit, you start speaking in a language that only Jesus can understand. And I've been getting there. Yesterday I felt moved, and I went down on my knees, and pretty soon I started doing it -- I opened my mouth and all these sounds came out. But then I stopped. Afterward the preacher asked me if I stopped because my leg was hurting, and I said no, that wasn't it. And the preacher said, 'It was the Devil that made you stop. You were listening to the Devil.' And you know, he was right."

"How do you know?" I asked.

"Well, I was jib-jabbering away, feeling the presence of Jesus, when my mind just started to wander," he said. "It started to wander, and I fell silent, and all of a sudden I was thinking about ... soda!"

"That WAS the Devil!" I said.

Wednesday, March 22, 2006

Doctor's Holiday

I had my shoulder injected today, to treat biceps tendonitis brought on by hauling around the World’s Clingiest Toddler. I was a little nervous, but it didn’t even hurt, and afterward I felt like the Tin Man coming back to life.

I like to be a patient from time to time just to see what it’s like on the Other Side. Of course I don’t get to see things from a true patient perspective; I’m treated somewhat differently when people know I’m a doctor. You might be surprised to know, however, that the treatment is usually worse.

Not intentionally so, of course. See, when treating a fellow health care worker, everyone gets very kid-glovey and hyperconscious of everything they’re doing. So some slightly unpleasant things might not get done – rectal exams, say, or questions about substance use – and some unnecessary things – extra tests that do more harm than good – do. In addition, people tend to assume you know more than you really do. For instance, when I was doing the infertility thing, I missed some important instructions up front because everyone assumed I must know all about this stuff.

Whenever possible I hide the fact that I’m a physician. I got away with this for two days after I had my baby. The second afternoon, one of the aides came in looking a little odd, and finally said shyly, “We didn’t know you were a doctor – you’re so nice.” (Which made me feel good about myself but lousy about my profession.) But because I’d kept it secret, the nurses had felt free to give me very helpful instructions on how to care for my stitches and my baby, information that I might otherwise have missed out on.

Does this happen in other professions?

Wednesday, March 15, 2006


4 Jobs I've Had

I've had so many jobs in my life that I can think of twenty while hardly trying. I guess I'll list

4 Jobs for Which I Was the Least Prepared
  1. Au pair in Switzerland. This was the summer I turned sixteen. I was reasonably good with kids; the main problem was, I didn't speak Swiss. Now, German, I spoke—and this was the motivation for doing the whole thing in the first place, to buff my German (that sounds kinky, doesn't it?). But Swiss is to German sort of what the heaviest Jamaican is to English. You know the movie The Harder They Come, how they're supposedly speaking in English but there are English subtitles? Swiss is kind of like that if you speak German. I think the kids thought I was a little slow. I ended up learning a lot of Swiss babytalk (also sounds vaguely kinky).
  2. Cocktail waitress. I was bad at this not simply because of my dearth of physical assets, but because you don't make good tips from drunk people when you have a look on your face that says "Not only do you disgust me on a personal level, I find your choice of beverage risible."
  3. Kaplan MCAT teacher. On paper, it looked like I should be good at this—I had made excellent use of the Kaplan materials and scored very well on my MCATs. In reality, I was hopeless. While I had used the written materials, I had never found the classes to be helpful, and I didn't see how they could help someone else much. Sitting in a classroom a couple of hours once a week was not going to change anyone's score. I was supposed to go through questions with the students, but I would typically read a question and say, "The answer is B, because ... because ... well, it's just obvious it's B, isn't it?" And they would stare at me, thinking, "Bitch." Mostly the students made me sad. They came to class carrying bottles of "Brain Power Amino Acids" and chewed their fingernails and asked me too many questions about their chances of admission to medical school.
  4. Grand Rounds organizer. This is a duty that I managed to unload recently, thank god. It involved lining up speakers for our weekly educational conferences. It's a job for a schmoozer, which I am not.
4 Movies I Can Watch Over and Over

Hmm. I can't really watch any movie over and over. Here are some movies I've definitely watched from beginning to end twice:
  1. Office Space
  2. This Is Spinal Tap
  3. The Matrix
  4. 12 Monkeys
4 Places I've Lived
  1. The hospital. I've never had my mail forwarded there, but sleeping someplace every third or fourth night for years adds up to some serious time.
  2. With four different men. (No, serially, not all at once!) No one ever lived with me, because when I had my own places, they were aggressively mine—no room, no shelf space, no special chair for anyone else. After the third guy, I swore I'd never do it again; I loved my own space too much. Then I met my now-husband and weakened. I'm glad I did.
  3. In a state of despair. Added up over the years, I'd say I've spent about ten to twenty percent of my life there. I do not plan to ever go back.
  4. In a quasi-group house, when I was little. I say quasi because the house had more than one apartment, so it wasn't really communal living, except for the hangers-on and boyfriends my mom would occasionally collect. I loved it. I wish I could live that way now.
4 Places I've Been on Vacation

A long time ago I found a list in a travel magazine of The World's Top Ten Islands. I'm crazy for islands, so I saved it, and I plan to visit them all one day. (The list gets revised every year, but I'm committed to the one I saw first.) So far, I've managed to get to:
  1. Kauai
  2. Hawaii
  3. Santorini
  4. Puerto Rico (ok, not on the Top Ten list, but I think it should be)
It seems like a "four" meme should only have four categories. So I'll give in to my OCD impulses and stop here.

Monday, March 13, 2006

My Marathon, Part 3

Lesson 6: Remember to Read the Fine Print

The night before the marathon, I finally sat down with the information that had been mailed to me weeks before along with the number to pin on my shirt. I hadn't bothered to read it when it came because my friend was handling all the details. I hadn't bothered to read it when she dropped out because I didn't think I'd go. I hadn't bothered to read it when I decided again to go because—I don't know why. I was busy, ok? I was an intern on a call month, which meant that every fourth day I went to work in the morning and didn't come home again until I staggered out of the hospital in a sleep-deprived altered state the next evening. I had scheduled my day off to coincide with the day of the marathon, but that meant I was working right up until the night before.

When I did finally read the information, I found it rather confusing. Remember, I had never been in any kind of race before, and I didn't know any of the lingo, any of the routine. This was a smallish marathon, run by a charitable organization, and the logistics were clearly being handled by enthusiastic volunteers. There were pages and pages of information. Stuff about how to train, what to wear, what to eat. There was something in there about where to go if you wanted to catch the bus to the starting line, where to leave your bag of clothes, what time the race started, what time to meet the bus ... it made my fatigued head spin. So I tried to focus on the bottom line: where do I have to be, and at what time? I finally located that information. Then I went to bed.

The race didn't start at an absurdly early time, so the fact that it was an hour and a half drive wasn't too bad. I turned the radio on loud and sang along with Sarah Maclachlan and drank my coffee and cheered myself on. I arrived at the start with time to spare. It was a cool spring day. I pinned my number on my shirt, tied my car key to my shoe, tucked a couple of granola bars and a banana in the pocket of my jacket, and lined up with everyone else.

And we were off. People screamed and cheered. I felt happy and excited and proud, and not lonely at all.

My goal was simply to finish the marathon, and I knew that the best strategy for finishing was to run a negative split—that is, run the second half faster than the first half—and to do that, I needed to rein myself in for the beginning of the race, force myself to go as slowly as I could possibly stand. There were timer at each mile marker, and to begin I kept myself to a geriatric pace of 12 minute miles.

The first couple of miles went smoothly. I chatted with the folks running near me. I enjoyed the scenery—the race started in a remote area, and it was lovely.

Until. Until I started to notice an awful lot of cars going by with people leaning out of the windows and cheering people by name. Where were they going, I wondered? I trotted on for another mile or so, and it finally dawned on me. One of the things that the information packet had said was that this was a "point-to-point" race. I had thought that this was an odd thing to mention; unless they had figured out a way around the time-space continuum, of course the race was from one point to another. Weren't all races? But now it came clear to me that they meant point-to-point as opposed to a circle. That we would be starting and finishing in two different places. Two places that were, oh, 26.2 miles apart from each other. And that when I was done, I would be at Point B, and my car would be waiting for me waaay back at Point A.

That's what they'd meant by the taking of buses to the start thing. You could park at the finish and take a bus to the start if you didn't have someone to drive you. If you'd been abandoned, say, by a friend with a broken hip.

For the next mile I felt a little sick. How on earth was I going to get back to my car? It wasn't like this was a place you could cab to. This spot was probably marked on a map as Off the Beaten Path. And I'd already run five or six miles away from it.

Then I decided, fuck it. I'm here, and I am running this race, and I'm going to worry about getting back to my car when I've finished, and not until then. I ate a granola bar and kept on.

Lesson 7: Stick to Your Plan

The miles floated by. Eight, nine, ten. People stood at crossroads and clapped. I stuck to my plan. Running this slowly meant I had plenty of time for bathroom breaks (I took three) and food. I managed to clear my mind of everything and just sail on. Almost before I knew it, I had reached the halfway point, and I felt great. So I started to speed up. Each mile I went a little bit faster—11 minutes, 10 minutes, 9 minutes, 8 minutes. I passed one guy at about the 25 mile marker who muttered peevishly, "Where's the fire?" I wanted to say, "On my feets!"

And there it was: the finish line. I smiled for the photographer as I went under the banner. It had taken me four and a half hours, which meant that I averaged about 9 minute miles for the second half of the race. And I really, truly felt good. Heck, I felt like I could keep running.

Which was a good thing, because my day was far from over. There was still the little matter of my car waiting forlornly back at the starting line.

Lesson 8: Sometimes You Have to Ask for Help

I received my medal and t-shirt, and then asked the race volunteer who gave them to me, "So, is there by any chance a bus going back to the starting line?"

She stared at me as if I had just said "Is there by any chance a monkey climbing out of my ass?"

"A what?"

"A bus ... going back to the starting line ..." at this point I started to get very embarrassed, because clearly I was the only person in the history of running who had ever misunderstood directions. "My friend was supposed to drive me back, but she got hurt ..." I didn't lie, but I sort implied that my friend had dropped out that day, after the race started.

"Oh my god," the girl said. "No, there's no bus. Wow. You need to get back to the starting line?" You could see her tracing the 26.2 miles in her head. "Stay here," she said. "I'll see what I can do."

So I sat and waited. And waited. And got stiff. And got cold. And realized why people left bags of warm clothes at the finish.

Finally a woman appeared. "You need a ride back to the start?" she said. I repeated my pathetic half-truth.

"Well, I live sort of near there ... I can drop you off. But you'll have to wait until the end of the race."

Which is how I came to see all of the lame, halt, and old come over that finish line, as I sat and shivered, my knees tucked under my race T-shirt. Finally, finally the last person staggered across, the banners were rolled up, and I climbed into a rattly, rusty Datsun that smelled strongly of dog and drove forty-five minutes trying to make small talk with a saintly stranger who took me 15 miles out of her way. The sight of my little car sitting all alone in the vast parking lot made me shrink in embarrassment, but it was a welcome sight indeed.

At first my legs felt almost too stiff to work the clutch, but I cranked the heat and started to thaw a bit. At the main highway I found a McDonald's, where I got a cup of coffee and a fish sandwich. I ate while driving, and as I warmed up, the proud and happy realization came over me:

I had done it.

Thursday, March 09, 2006

My Marathon, Part 2

Lesson 3: It’s Not a Great Idea to Run on a Belly Full of Cheese Fries, but It’s Not Impossible

Despite my misgivings, training for the marathon was really not too hard. We gradually increased our weekend runs until the final training run, which was supposed to be 20 miles but ended up being 24 because we didn’t check the distance carefully enough. Fortunately, there was a diner at the 12 mile mark. Unfortunately, I lost all control and scarfed down cheese fries and a chocolate milk shake. I came to regret this on the slow trot home because I had to taste them the whole time as I belched away, but I managed. We walked the last few miles, but I really felt pretty good.

My training partner, on the other hand, did not.

Lesson 4: Don’t Overdo It

On the last training run, my partner came up lame. At first she tried to hide it, but pretty soon she was swaying like a peg-legged sailor, and I said, “Er, don’t you think you should see a doctor about that?” She finally agreed. We still had a couple of weeks until the marathon.

You see, my running partner had started running relatively recently. Although she was running about as much as I when we started, she had only been doing it a few months. She didn’t have a deep base upon which to train.

Which is how she developed a STRESS FRACTURE of her frickin’ HIP. And was ordered to put no weight on her leg for three MONTHS.

I felt really bad for her, but I have to confess, I felt a little annoyed, too. This whole thing had been her idea; she had researched it, and she knew that she was pushing it. Also, it was her friends and family who were supposed to drive us to the race, which was an hour an a half away. Once she dropped out, she wasn't interested in even going, and they weren’t interested in driving me. Which I guess is understandable, but it made me feel a bit abandoned. I’m still not sure if I should have felt that way, but I think that if I were in their shoes, I would have at least offered. I asked around, but not surprisingly, I couldn't find anyone who was a) free that day and b) willing to spend the whole day at a marathon for me.

So, I decided I wouldn’t go.

Lesson 5: Don’t Be Such A Wuss

After a week or so of feeling sorry for myself (and a little guilty about feeling sorry for myself when my friend had a BROKEN HIP), I realized that I shouldn’t waste all the training. I knew I’d regret it every time someone asked yet again, “You run? Did you ever do a marathon?”

So, I decided I would go by myself.

To be concluded.

Monday, March 06, 2006

My Marathon, Part 1

I managed to reach my twelfth year of running without every entering so much as a local road race. This was partly due to the fact that I don’t enjoy running in crowds, but mainly because I hate to run in the morning, and just about every race takes place at an ungodly early hour. But whenever people find out that you’re a runner, the most common next question is, “Have you run a marathon?” This gets tiresome after awhile if in fact you have not. So when an acquaintance started bugging me to train for a marathon with her during my internship year, I eventually agreed.

Internship year of residency is not thought to be an ideal time to be doing something so time-consuming as training for a marathon; the job itself sucks up most of your free time. But I was already running a fair amount. I found it to be an ideal stress-reliever, and something I could do almost no matter how late I got home. I also used it to explore my new city. (Which worked well, except that I would then drastically underestimate how long it might take to walk someplace, resulting in a few annoyed acquaintances who just wanted to go out for a beer, dammit, not walk all the hell over Creation.) It didn’t seem like such a stretch to put a longer run in on my one day off a week. So I agreed, although secretly at first even I wondered if I would really follow through.

I’m a sucker for birth stories – funny, overdue, traumatic, last-minute – yet I don’t think my own is particularly interesting or enlightening.* But I do feel like I learned a lot from my marathon.

Lesson 1: I Accept that I Am Powerless Over Candy

I have had a bad candy habit since childhood. Not candy as in chocolate (which I consider food, not candy); candy as in as close to straight sugar as possible. I had to have it available at all times. It got me through many stressful periods in my life – like, say, internship. I didn't feel safe unless I had a stash in my pocket, like some starving beggar child from Dickens. I never hit the stuff before lunch, but from then on out was happy hour. I ruined my teeth. I didn’t get fat, but that was because I substituted candy for real food.

After about a month or so of training, I realized that I needed to improve my diet if I was really going to do a marathon. When I forced myself to think about it, probably half of my calories were in the form of refined sugar. But I knew I couldn’t cut down. I’d tried that before. No, I’d have to go cold turkey.

I set a quit date, finished the stuff I had lying around, and steeled myself.

It was baaaad. In the beginning, I thought about candy near-constantly. I was twitchy as a gerbil with Tourette’s. I had to take a circuitous route through the hospital to avoid the gift shop, where I often used to get a fix. I couldn’t go to drugstores either, which was inconvenient when I ran out of antiperspirant. But I did find that I suddenly had an appetite for real food again. And gradually, as the weeks went by, I thought about it less and less, and then hardly ever. It felt so freeing, not to have the shame anymore. And as a bonus, I became much more sympathetic toward people who had a hard time quitting smoking.

Lesson 2: I Can Make Friends When Forced To

The person who invited me to train with her was a resident in a different specialty. My initial impression of her had been slightly negative – she seemed a little, I don’t know, rigid? Unforgiving of faults in others? But running with someone is like taking a long car trip; it’s enforced togetherness, and conversation eventually happens. So it was that I learned that we had a great deal in common. Similar off-kilter type of upbringing; similar circuitous route to medical school; similar interest in the arts. She was even born the same week of the same year that I was. Soon we were hanging out all the time, talking on the phone, shopping. It was like the pictures I used to pore over in Seventeen magazine when I was thirteen and just wanted to be normal.

To be continued.

*It can be told pretty well in a single paragraph:
Water breaks at midnight. Husband freaks out despite being a doctor. Hospital, pitocin, epidural, blah blah blah. Weather channel on TV. Phone calls to wrap up loose ends at work. Sneaking a cappucino. Getting bored. Finally pushing and PUSHING and pushing and PUSHING. Baby’s heart rate dipping. Vacuum forceps, aka Baby Head Plunger, after 21 hours. Baby fine; unutterable relief. Embarrassed re: unable to birth 5 lb 14 oz baby without assistance (his head was big, I swear). Many many many stitches. The End.