Friday, January 16, 2009

It May Be Frozen Over, But It Isn't Hell (It Just Feels That Way Sometimes)

One little cold snap, and you maggots all take cover? OK, maybe a few of you are on a treadmill in a warm gym somewhere, but I know there are a lot of you sitting in front of the computer eating cookies and whining about the cold.

Get your mewling asses out there. If little old ladies could wait for hours in the cold for the inauguration, you can bundle up and run for 30 freaking minutes.

After all, these days they can bring you back to life even after you freeze to death.

Just remember: synthetics, layering, a 20 dollar bill for emergencies, and maybe a toe tag (I bought one after nearly perishing under the wheels of a cell phone infested pickup truck).

Let’s hear some inspiring stories of your cold-weather running. If there’s a really good one, I’ll ship out another shirt – long sleeve this time.

Wimpy Changing of Subject!

How about some more “kids say the darndest things,” since it won me an award last time?

HB, bringing me the doll he calls his “little sister”: Criss-cross applesauce, sit down on the floor and close your eyes!

[I obediently sit cross-legged on the floor. HB lifts my shirt and tucks the doll under it.]

HB: OK, now, you’re going to feel something a little weird, but don’t worry, it’s just your va gina stretching as the baby is born! [Pulls the doll back out.]

Me: [muffled horrified laughter] Is everything okay?

HB: Oh sure. Your va gina is already going back to normal—look down! Now say, “What’s this white stuff in my breasts?”

Me: … what’s this … white stuff ... in my breasts?

HB: Did you forget? It’s milk! For the baby! Feed her!

I swear I haven’t been drilling him with inappropriately detailed info on where babies come from. Don’t all the books say to just answer the questions asked? Well, he asked how babies get out, and then he kept probing and probing and probing … and clearly remembered it all. At least he didn’t seem freaked out by it. He knows more about the process than some pregnant people.

Changing the subject yet again: I got this for my husband (the Pro version), and I’m astonished to report that it works—I no longer have the distasteful task of nagging him out of bed.

(I did respond more on the last post, if you want to look in the comments.)

Wednesday, January 14, 2009

The Problem with Lists (Updated)

A while back, I made mention of doctors’ dread of lists. Now, I love a good list. I make them all the time. For example, here is a list I made for one weekend day last month. (And I wonder why I feel pressed for time. The ones on the side, by the way, were the “possible if I magically morph into a superhero,” so I don’t feel too bad about all the blank boxes. I’m not sure why “side tables” merited an exclamation point, unless it was because I was unlikely to attend to them, as evidenced by the glaringly unchecked box next to that item. And yes, Aaron did come.)

I don’t mind most patient lists either. A list like this one is quite helpful.

But. A list like this one will give any clinician an overwhelming sense of being sucked into a vortex of negative energy. I have removed anything that might identify this patient in any way, but I will tell you that this patient is in their 20’s and is remarkably healthy, despite having had these symptoms for years.

Healthy, but not well. When you see a list like this, you know that you are about to embark upon one of the least satisfying clinical relationships in the world. Because this is a person who, for some reason, must be a Patient. This is a person who has no interest in being well, because they feel so rewarded by being sick. Why? I have no idea. Personally, I find being a Patient absolutely horrifying; I will deny that I need help until I am lying on the floor, and even then I’ll refuse to go to the ER.

Wanting to be a Patient has no relationship to how sick you are. I have one patient with a terrible neuromuscular condition who comes to my office on a ventilator, in a motorized wheelchair that he steers with the one finger he can still move a tiny bit. When I ask him how he’s doing, he has to wait for a puff from the vent to answer, “Great!” (I doubt my aversion to being a Patient would take me quite that far, but I like to think it would.)

It’s very hard not to take these list-writers by the shoulders, shake them, and shout “Get a life!” Maybe I should, because what I do—nod sympathetically, gently suggest exercise and possibly antidepressants, and try my best to avoid the unnecessary testing that will involve random false positive results that will then engender more testing—doesn’t seem to help much.

It seems a miserable kind of life, but then again, how would I know? Perhaps this feels like fun for them. Perhaps what they need is a Patient Theme Park: giant stuffed medical personnel walking around and giving injections, an MRI Tunnel (with Realistic Banging Noises!), a 24-Hour Urine Collection Log Slide, lots and lots of blood draw concession stands, a place to pose for overpriced photos of yourself that make it look like you’re intubated, and people hawking baseball caps emblazoned with Another Sufferer of A Really Rare Disease Whose Doctor Totally Dropped the Ball* and t-shirts that read I MAY LOOK FINE, BUT I KNOW MY BODY.

*Not that this does not ever happen, OF COURSE. I have dropped a few balls myself. However, most bad things will “declare themselves,” as we say; they get worse and become diagnosable. Not-bad things usually go away, and the less you test for, the better off you will be. As I teach my residents, “follow” is not a dirty word.

UPDATE: To all who are saddened/angered by this, let me say a few more things:
  • There are many, many crappy doctors, I know. Believe me, I know. I do not excuse any of them. They’ve messed me up too.
  • Most of us have had frightening, unexplainable symptoms at some time or another. That doesn’t make us Patients.
  • Yes, most people just want someone to listen carefully and, if appropriate, reassure. I love listening to people, watching them, finding out what it is that frightens them about their symptoms. I’m not talking about those people here. I’m not talking about you here.
  • There are a few diseases that have multiple seemingly unrelated symptoms that can be overlooked. I test for these where appropriate. That patient who wrote the list? Had had multiple tests already.
  • These folks can get sick too, and that’s frightening, because they do fall victim to the crying-wolf problem. It’s part of what makes them so tough as patients.
  • There are also, I am quite sure, many diseases that we cannot yet diagnose no matter how many tests we do. We doctors must remain humble about this.
  • And know this: if you’re suffering, I wish I could help you.

Friday, January 09, 2009

And In the Summer, He Wears Toenail Polish

Thanks for your wise counsel and perspectives. I’m feeling much better now (at least, as long as I don’t think too hard about another Tom Cruise in the making). I was also heartened by the result of the recent (and I am sure scientifically very accurate) Glamour poll of men: when offered the choice of being 6'2" with a 3-inch pen is or 5'2" with a 7-inch pen is, 68% chose the latter. I will not discuss my son’s package even on an anonymous blog, but I do not expect the former to be his fate.

I think my freakout was a combination of contemplating kindergarten starting next year and having a visit from Nana, who truly, truly believes that HB would be taller if we fed him more. But when I think about HB’s personality, he could not be more temperamentally impermeable to the taunts of others. For instance, these were his favorite holiday gift:

Yes, those are tights, and he has coveted them for a long time. He’s been making do with tight-ish long johns (always paired with colorful shorts), but has been begging for the real article. I had told him, “I will probably have to buy girls’ tights,” and he said, “Girls’ tights are fine!” Then a pause. “But not pink.” Another pause. “Hearts are okay though.”

This past Monday he wore them to preschool for the first time, and that night I asked him if people had liked them. “Oh yes,” he said. “Jacqueline and Emily said, ‘What are those?’ And I said, ‘tights,’ and they laughed together and said that only girls could wear tights.” Yet he said this in a quite gleeful way. “Did you tell them that wasn’t true?” I asked. “No,” he said as he wandered away. “A teacher did, though.” Then Tuesday he wore the second pair to school. Wednesday, he was upset that I hadn’t done the laundry yet so he could wear them again. Clearly, this is a kid to whom the only opinion of importance is his own. He reminds me a little of those tiny dogs who don’t know how small they are and run up and challenge gigantic Cujos—successfully.

(He says he likes the tights partly because they’re like his father’s cycling tights, but partly because they’re … “tight.” He has not worn regular pants since last year.)

(He does run around shooting things All. The. Time. with anything that could remotely be interpreted as a weapon, so I doubt the tights are an expression of gender confusion. Actually I know they’re not, because this kid is never confused about anything. If he wanted to be a girl, he’d be a girl, and nothing anyone could say would stop him.) (Not that I would try to stop him, FYI.)

(Click here for a picture of the toes.)