Doctors and Sickness do NOT mix...

As I begin to pull myself out from the Black Death that nearly enveloped me over the Christmas holiday, I have come to many a realization. Take for instance, nothing except infomercials are on during the day and all are snake oil salesmen, save one. I am intrigued by the UGlu product. How can they say something is permanent then in the next frame say it easily peels off surfaces? But I digress. I awoke on Christmas Day to be met by racking chills and a fever of 102 degrees, body aches like I haven't felt in ages and a dry hacking cough that with each non-expectoration sent pain throughout my body. I was sure that it must be Ebola and I would be dead in 48 hours (of course, I thought Ebola, I am a doctor.) Let me let you in on a little secret about doctors. We are either the biggest deniers or hypochondriacs. I try to keep myself just in the middle but tend to lean more to the former. Don't ask my wife about this because I shot those estimates out of the water with this doozy of a sickness. Again, I digress. I suffered through waves of chills, headaches, fevers and total body sweats for a full 72 hours before giving in and taking antibiotics. Sparing you the gory details, I will just say that I thought I must have everything from pneumonia to Tsutsugamushi Fever (that's Scrub Typhus for all of my medical friends). I am on the mend but must make a few comments about my time in the Infirmary.

1) I am a total wimp when ill. Unlike my wife who trudges on because stuff has to get done, I suffer in my own way and make everyone else's life miserable. It truly is pitiful.

LESSON: Male doctors make terrible patients. Wives and women with children are the true heros. As a physician, I will take this knowledge and use it when a sick mommy comes to see me. Because when mommy is sick, NOTHING gets done (or a least not done correctly). Antibiotics all around!

2) When you are relegated to the bed, it really isn't all that it is cracked up to be. I used to dream of a day where all I had to do was lay in bed. Careful what you wish for. No position is comfortable, the room takes on a certain funk smell to it, and again, nothing is ever on TV. If it is, your eyeballs or head hurts to much to watch it.

LESSON: A wise Sleep Medicine physician told me in residency "Bedrooms are good for only 2 things. Sleeping and Sex. Nothin' else." Trying to move around more and change scenery is necessary when stuck at home.

3) Having an illness is a great way to lose weight, especially around the holiday season. My pants haven't been this loose in ages. Then again, my face has never been so pale, my cheeks so drawn or my appetite so crappy.

LESSON: Sometimes the way things work out aren't necessarily the way you would have wanted them. Again, see above #2-Careful what you wish for. There may be something to medicinal tapeworms, but again, I digress.

4) During my acute illness, I came very close to saying "Get me to a Doctor!" I never say that. I think because I was feeling vulnerable. Sickness tears away all of the pretense, the pomp and the attitude that people build up and leaves you naked emotionally, open for all to see. Knowing someone is in your corner, watching your back (insert whatever cliche you like) is vitally important.

LESSON: I will not take for granted the trust patients put in me nor will I ignore the fact that patients that feel infirmed should have my empathy and my best medical 'A' game.

You may wonder, "You have been in practice for almost 10 years. Shouldn't you have figured this out already?" You would think so, but I am not lying when I say the last time I was this ill was with the Flu in February 1999. I felt like Walking Death then, and was revisited by this ghoulish specter this past weekend. As a physician, having to be the patient is not a bad idea for some good old fashioned perspective but I highly discourage it. It sucks to be sick...

Christmastime and Tortoise Shells

At work today I got to have the dubious honor of handing out some of the Christmas bonuses to the staff. It was monetary and not cheap like a subscription for the Jelly of the Month club so I was received fairly well. To help with the festive occasion, I donned a very large, very tacky Santa hat. It truly is amazing the feeling that one has when handing out presents. This is what the season is all about-that warm sensation in your gut that is just a fantastic feeling. Oh wait, that's the Eggnog....
Becky is in full party mode. We have the First (and possibly last) Ugly Christmas Sweater Party this weekend. Over 100 people are expected and for the life of me I am not sure how in the hell happened. I didn't think I knew 100 people, let alone invite them to my sanctum sanctorum so they can silently judge me and my house (like I do when I go to parties). Just kidding, but this is the most people we have every had in the house at one time and certainly enough alcohol to soothe the most chapped of Holiday moods. Can't say I am not nervous but it will be good to branch out from my introverted self and suck down a few brews with over 100 of my closest friends.
The kids are on their way to Henderson for the weekend with my folks. Thank God for Mom and Dad stepping up to the plate to help out. Couldn't imagine doing this party with three wee ones around. The pooch is headed to the Spa (aka Vet) for the weekend where she will be far away from our guests' crotches and the the allure of the onion dip. That dog just doesn't have any social graces, bless her little heart....
What I have discovered about planning a party with my wife is that the party takes on a life of it's own. I thought "hey, put out some chips, beer on ice...we got a party". Apparently that is not the way it is done. There are "considerations" to be had, varying from who mixes well with whom, the amount and quality of beverages, the food and the prep/presentation of the food and so forth. This thing went from a small soiree to a major undertaking. Don't get me wrong, I am not complaining. I am just amazed with the amount of planning that goes into this. It will be a success-for the simple reason that my wife IS in charge of it. She thrives on this shit. Me? Not so much. The more planning/elaborate the party, the more tortoise like my personality becomes and I shut down. Not sure why, but it does. Oh well, time to break out the Holiday Tortoise shell and prepare for what appears to be a kick ass party. Cheers!

Abby and the Sign

Today was an interesting day. It started with a call from Becky laughing hysterically because Abby had taken a "triple dog dare" from Jack and stuck her naked tongue on a very cold sign. Flailing, crying, bleeding and absolute hilarity ensued because everyone knows how the story goes. Tongue warm, sticky...cold metal, poignant...ouch...A Christmas Story revisited. Either way, Abby is ok, Jack feels bad that he had her do it- lessons learned.
Another full day kept me busy...Good Lord, if the paperwork doesn't end I may shoot someone. I start to get hives just thinking about it. I think it is one of the biggest reasons for my Carpel Tunnel Syndrome. Oh well. Daddy has to bring home the bacon for his little chitlins...
My tar baby patient showed up in the ER with a broken hip. I have put Humpty Dumpty back together so many damned times I just don't know how much more tape and glue he can withstand....
We are supposed to get ice/snow/sleet tonight so not sure whether the kiddos will have school. I love seeing the excitement in their eyes from the possibility that they may be able to play hooky tomorrow. So cute.
Prepping for our "Ugly Christmas Sweater Party" this weekend. Man, this thing has ballooned to over 100 people. I didn't think I knew 100 people...Should be fun as we have spent an ass load on booze and redneck food. Hope the old house can take it...
Well, that is it for today. Boring I know, but deal with it.

Writing and Blogging

December 14th, 2010

This is the first entry in several months. Some of my lack of activity has been because of a nagging carpel tunnel syndrome in my left hand that has plagued me for darn near 10 months now. It truly is a pisser when every time you want to use your dominant hand it falls asleep on you. Wake up!! I got shit to do!! Anyway, most of the reason that I don't blog more is because I think I have the rules down all wrong. I feel like I have to produce an insightful piece each time I do an entry and I can tell you, that ain't gonna happen. I suck at writing. Okay, I said it. I suck at the written word. Always have, always will. I just don't seem to have the ability to expound upon things in a flowery way (another way of saying "bullshitting"). My worst grades in school were in English. I still remember my 7th grade teacher giving me my worst grade I have ever received just because I couldn't diagram a sentence. Really? Does anyone really remember how to diagram a sentence?? Part of the reason I am a doctor is because I didn't want to write papers in medical school. All the tests were multiple choice. No 10 page paper about why I thought the patient had a bleeding disorder or why I felt the need to write for one antibiotic instead of another. Anyway, the whole point is that I have been intimidated by writing for as long as I can remember. I have felt that I needed to put something worthwhile down on the blog for it to be enjoyable to others. But I realized today that if I worry about my verb tense or grammar then I will never write anything. Also, I need to write for me and only me. As therapy...to get all of the crazy shit out of my head and onto something solid that I can deal with and analyze. If I worry that what I write won't make sense then I will never write. What I really want to do is to have a record of my thoughts for that particular day- no holds barred. Like a literary snapshot of what was occurring that day, this will be a time capsule for the future. Who knows, maybe the more I write, the better I will become....nahhhhh. Won't happen.

Getting the ol' Screwgie again this year....

Over the weekend, I picked up the latest Louisville Magazine and I was treated to the annual "Doctors Issue". This is the issue where all the doctors in town get to vote on their favorite (read 'most referrals') brethren. The categories usually include all the subspecialties as well as primary care. Most of the time it seems to be just like high school, with the popular east end docs getting the votes while the lowly downtown docs get snubbed (correction: Dr. McClellan gets snubbed-but no...I am not bitter about it). This issue was different. It had the top surgeons in town with rankings of everything from boob jobs to toe nail removal. Need butt implants? We have you covered. Nose job? Here too. Even a category for emergency appendectomy. Really?? I don't know about you but I have never had a patient in the throws of an acute appendicitis say "Who is going to be doing my surgery? Were they listed in the most recent Louisville Magazine? No? Well, I think I will wait it out instead...".

I tell you what you won't find. You won't find rankings about the little things, the things that really matter. So here is a partial list that I would like the magazine to consider for next year's publication:

1)MD who is most on time-we all have crap we need to do and the last thing you want is to spend 4 hours in the doctor's office just to have them see you for 3 minutes then charge you an arm and a leg.

2)MD who will actually listen to what your complaint is-many times patients have their list of problems to cover and the doctors have theirs. I can't tell you how many times a patient will tell me that they mentioned something to the subspecialist only to have them receive a blank stare followed by a completely unrelated series of questions dealing with medications, how their hemorrhoids are doing, anything but the answer to their question. Irritating to say the least...

3)MD most likely to examine you-believe it or not (I didn't when I heard it from some of my patients), when you go and see a doctor....they are actually supposed to examine you! As a doctor that examines patients, it is my lowly opinion that some sort of touching should occur (not bad touches, just healthy touches). My wife gets mad at me when she has an ailment of some sort and the first thing I do is touch it. "Why are you always touching and squeezing on me? It's just a mole!" It is called examining and I believe that something CAN be gleaned from using all of the 5 senses...

4)MD with the most patience with your parents-for all of my friends that are now caring for their elderly parents, you know exactly what I mean. For those that don't understand, you probably still have someone caring for you...

5)MD who is best at filling out forms from insurance companies-good gravy, I am getting so good at doing this I should pimp myself out. Still hate it though...

6)MD with the best office staff-needless to say, having a good office staff is one of the true keys to a successful office practice. Some offices are good, others are horrendous.

This is only a partial list. I am sure there are quite a few more categories that are worthy of notice but I can't think of anymore at this time. I am sure I will think of more, that is, unless I am in the Louisville Magazine next year for being a "Top Doc" in which case I will think this blog entry is frivolous and nothing but a bunch of "sour grapes" by an overlooked, frustrated by "the man getting him down", under appreciated internist from the hood (aka downtown Louisville). Thanks for your time and don't forget to vote next year!

Excuses, Excuses

I love my patients. I really do. I empathize with what they have to put up with in regard to their chronic medical disease. Their pain and suffering, both mental and physical, can take there toll over time. I love that they come to me and ask my medical opinion regarding their treatment and prognosis. However the thing that I especially love is when they think that their doctor takes everything they say at face value. It is amazing that people will lie right to my face about why they haven't done what I have asked them to do when last I saw them. Here is a smattering of the excuses followed by the true interpretation. We will start out with some easy ones, then gradually get to the more ridiculous....Ready? Here we go...

1)Me: Why haven't you taken your blood pressure since I last saw you?
PT: I haven't been anywhere that I can have it done.
Me: You haven't been to the pharmacy? Grocery store? You can even come here to our lab...
PT: Well, I don't get out much...
INTERPRETATION: I don't want to get my blood pressure checked. It may be high, then you will put me on medicine.

Get the picture? Alright, let's move on...Here is the EXERCISING/WEIGHT LOSS edition:

2)Me: Are you exercising?
PT: Yes. But probably not as much as I should...
Me: How much?
PT: I do a lot of walking at work.
Me: That doesn't count.
PT: Well, it IS a long distance to the copy machine...
INTERPRETATION: I am way too lazy to do any exercise, and I don't want to do any exercise. I like my TV and Cheetos more. Can we change the subject?

3)Me: Any luck with losing weight?
PT: No. My wife is just too good of a cook.
Me: Well, it is about portion control...
PT: I just eat what my wife puts in front of me. If I don't eat it, she will be pissed at me.
INTERPRETATION: I don't want to push my fat ass away from the table, close my pie hole and show some restraint.

4)Me: Any luck losing weight?
PT: No, and I don't eat that much (says the 300# woman). I have yogurt for breakfast, a Fiber One bar for lunch (God forbid she get backed up) and a salad for dinner.
Me: How MUCH salad are you eating? (Just kidding, I wouldn't say that...)
INTERPRETATION: I really don't know how to count calories OR I am putting twinkies on my salad for dinner...

5)Me: How are you doing with the Overeaters Anonymous classes?
PT: I have eliminated sugar, wheat and flour and I still can't lose weight. *Stern look in her eyes* What are YOU going to do about my overeating? I don't want a bunch of medicines either. How are YOU going to fix it?
Me: Sew your mouth shut. (of course I didn't say this but I almost lost control of my inner monologue...)
INTERPRETATION: There is a hell of a lot more going on with you than not being able to control your voracious appetite, lady.

All of these conversations have occurred at one point in my 8 years of practice. I have heard it all, but really all I want is the truth. Is that so hard?

Monday!

I gotta say, I am beat. Today was a rough one. Not only was it a Monday, but it was a Monday with a catastrophic blunder. Here I am in clinic, bee-bopping along when I go in to see my 86 year old patient who is accompanied by her daughter. Without thinking, I say "Well hello there! Where is your husband? He decide to stay home today?" Complete silence and a confused look on my visitors' faces. "Daddy died in April. Remember?" Oh Snap! Talk about awkward! I am still tasting my shoe polish after my foot spent the next 30 minutes in my mouth while I apologized profusely for my major gaff. I haven't felt this bad in a loooong time. Instead of moving slowly through my day, methodically reading the chart before entering the room, I feel confident enough to roll in and start what I thought was a lighthearted icebreaker. Wrong! This is Monday you are dealing with! It doesn't fuck around....It is out for blood and if you don't watch it, it will pounce on you and beat you to a useless pulp. Needless to say, Monday had the upper hand the rest of the day, making me watch everything I did, worried another ignorant statement would come flying out of my mouth. Luckily I am home now, where my mistakes are not noticed by my children and if they are, they forgive me with a smile and a pat on the back. Curse you Monday! I have been foiled again by your sneaky, brain draining ways! I will not be so easy to defeat next time, I guarantee!

Confessions of an Addict

Hi, my name is Chris and I am an addict. That's right. The first step in the healing process is admitting you have a problem, right? Well, I do have one. It is a big one too. I find myself thinking about it at least a dozen times an day, longing to be with it and not where I am at the time. I find myself not able to devote any time to myself lest I feel guilty for not spending an ample amount of time on my addiction. I have come to the conclusion that I will probably never excel at anything again. Oh sure, I may dabble in things and may even be good at some point, but the drive to truly master something will never be there. It just takes too much time away. For this I blame my addiction. I purposely put things out of my mind that don't pertain to this ever present fixation. At times, I need to have my wife force me to get away, to remove myself from this invisible bind I have and to surrender completely and focus on only me. It seems so utterly foreign to contemplate and even while writing this I am feeling guilty. For you see, my addiction is my family-my wife and kids. I can't seem to get enough, and when I do, I feel horrible that I desire to get away. I once was able to spend hours upon hours focusing on studies, reading, and even athletics but fortunately I have been cursed with the unwavering desire to be "A Family Man"... Wow. This catharsis has helped soothe some of my internal anxiety regarding my problem, but I am going to need everyones' help to force me to take a little time for myself. All work (in this case, family) and no play makes for a dull boy and I must remember that I am expected to be a well balanced, happy and productive member of society, even as I nurse this extremely dark and private addiction...P.S. when is the next FA (Family-aholics Anonymous) meeting? Will there be childcare provided?

My ego surrenders (and it is a wonderful thing...)

Well, it has happened again. I have had to yield to my wife. As a man, I feel the need to be correct about most things, even when it comes to tiny issues. I, like my XY chromosomed brethren, choose to put pride before acceptance and continue to believe that the blame must lie elsewhere, that I am certainly not responsible for the crummy situation that I have landed myself and loved ones into. Of course, my wife, being the caring, nurturing woman that she is, tries to put up with it as long as humanly possible until she cannot take it anymore and must break out the big guns, shooting me down where I stand and quickly putting me in my place. She assumes that I will come to my senses and clarity of mind will prevail but that doesn't always happen. My fall from grace is well deserved and needed as my simpleton male brain cannot fathom that the ultimate culprit in the current debacle is none other than the one staring back at me in the mirror...For this, I am forever grateful...that someone has my back, and that my ego will be kept in check...
I sometimes think that my job has ill prepared me for marriage. I have been molded through my 12 years of post high school education that I must be the best-the smartest, sharpest and most competent student and caregiver. Then I start in private practice and I am expected to be on an "island", separate from my partners and able to care for my patients without asking for help. To ask for help, in my male mindset, would be considered a failure in my training...I spent countless hours studying, practicing, and training for life on the "island" and damned if I let that training let me down. I would do it on my own because it was what was expected of me.....
Fast forward to now. I must come home from my "island" and re-enter society, interacting with my wife and children. This, I can tell you is not as easy as it looks. I have found that I bring my "island" home with me and expect everyone to conform to my life on the "island" even when that is not what I intend to happen. My hard wiring as a male and as a doctor are a synergistic duo that can make me a pain in the ass sometimes. It is not intentional I can assure you. However, my wonderful wife, after nearly 12 years of marriage has me figured out (while I am not even close to solving her cryptic puzzle). She lets me think that I have come up with the answer when it is actually her idea and solution. It is quite Machiavellian and supremely effective, however sometimes it doesn't work and the direct approach is necessary. Confrontation is required and I can tell you it is tough being on the receiving end of this. It requires self evaluation and my pride must take a back seat. She is sharper than many psychiatrists and therapists I know and much more to the point. It cuts and hurts at first, but after "objective" evaluation, I see the utter correctness in it all.
She is beautiful and deadly at the same time and I realize that she is the Mama Bear, gentle and nurturing until something threatens her family-in this case her husband's inability to see past his issues-then the claws come out. Luckily as the Papa Bear, I am getting a thicker coat from the occasional, but definitely needed swipes from very loving paws...

Of Medicine and Nonagenarians...

Today I saw two of my nonagenarians. I love when they come to see me. You want to know why? It's because I have discovered a very intriguing lesson with these jewels of humanity. The more I do to them (ie treat them), the worse they become. That's right. I try to do as much nothing with these patients as I can. I figure that they have reached this far without me, who am I to step in and ruin their day? Case and point: Mr. L came today and complained of being tired. His wife says that he spends "20 out of 24 hours of the day in bed. I think he is depressed..." No. He is just 92 years old. I decide I will placate his wife by saying that I will try to adjust a few of his medicines to give him some more "oomph". After 10 minutes of screaming at him (he is hard of hearing of course), trying desperately to explain to him that no, the 20 mg pill will no longer be used but instead 2 and a half 10 mg pills will be substituted, I give up. I say, "Mr. L, there is more of a chance of you hurting yourself by taking the wrong dosages thereby obviating the benefit I was trying to provide. Stick with the red pill in the morning and the green pill at night." He was perfectly happy with this. You see, he didn't want me to change anything...he LIKED it just the way it was, even though his wife didn't. Some physicians would say that this isn't the way to practice medicine, but I beg to differ. After age 90, folks are on borrowed time so it all becomes more social during our quarterly visits. "Oh, what a beautiful walker you have, Mrs. J and might I add that your great grandchildren sure are getting big...." It is this artful dance we do, enjoying the conversation, knowing that as long as we don't stray too far from the current treatment plan, they may just make it another year closer to being featured on the 100 year old birthday Person of the Week by Willard Scott (if he hasn't already died himself). This way of slowly rearranging the deck chairs on the Titanic is what I call the Art of Medicine. Knowing what to do is elementary, it can be learned from any medical school. But knowing what NOT to do, now that is something all together different. That my friends, is truly the Holy Grail of medical knowledge...

I learn something from Coach tonight as well...

Tonight was Jack's 4th baseball game in 4 nights, and all of them have started after 7 pm. Never mind that I personally find this reprehensible, we pulled on our Red Sox and dutifully took the field. Jack has been having problems with his fielding. The game just hasn't clicked for him yet. The ball is hit, he watches the play and forgets at times that he is actually IN the game and the game speeds by him. It has been getting frustrating for me to watch this as I want my son to succeed at whatever he chooses to do-up until baseball it has come naturally to him, no real learning curve needed. Watching these past 4 games, I have come to the realization that he just doesn't get it. He plays in the outfield and he doesn't know where the ball goes once he has it. He plays second base and he doesn't move to the bag to cover it (despite my continued shouts and urging for him to do so). It has been getting so I spend more time telling him where to go rather than following the flow of the game, enjoying the beauty of a boy's game with friends. That is, until tonight...

Jack continues to struggle, and I continue to slowly turn into THAT Dad, you know the one, constantly correcting his son from the sideline. Jack was up to bat, gets on base but because of a miscommunication with his coach gets caught in a double play. I do my usual "Good job, Jack" as he runs without looking at me into the dugout. During the next inning as Jack is in the outfield, the coach comes to me and says "Bring Jack over when he comes in. Give him some encouragement. He sat and cried in the dugout after the mistake with the base running. I told him it was okay and that he was doing a great job, but it may be better coming from you." UGH. My heart broke at that very moment. My son had been listening to everything I had been screaming to him and he just felt bad that he didn't do the "right" thing. My inadvertent attempts to make him into the player I never could be caused him to think that I was somehow disappointed in how he was playing, somehow a failure. I felt and actually still feel like a heel-a piece of absolute feces for causing my son to feel this way. And it wasn't just tonight. I vaguely remember seeing streaks of dirt in tear tracks on his face last night as well. When the game was over, I took him aside and gave him a huge hug, told him how proud I was of him and that I love to watch him play. Gone are the bleacher coach remarks, the yells to cover the base, the screams to get his elbow up in the batting box. All gone-all to be replaced by only positive remarks, no criticism, constructive or otherwise, will be uttered again. I realized tonight that my comments toward my son, while well intentioned, fell onto already struggling, self deprecating 8 year old ears. I was the failure tonight, and I hope in time my boy forgives me.

I would like to thank his coach, for being so caring to my son, supporting his efforts and his emotions. I would also like to thank him for dressing down his father without saying a single negative thing to him... His comment made me feel 6 inches tall and I deserved every bit of it. I am relieved to have a saint for Jack's coach...Lord knows, we need someone to guide us through the Hell of Little League baseball....

Mother's Day and Power Tools

Ah, Mother's Day...A day devoted solely to the fertile females of the species, the women in our lives that have cared for, are caring for or soon will care for us or our children. Our Mother's Day began with the kids desperately trying to gather the proper accoutrements to serve their Mommy breakfast in bed. This was so darn cute but pathetic at the same time. It consisted of 3 cookie sheets each with a croissant, homemade picture frame and a card, respectively.
My wife did the noble thing and ooh'ed and ahh'ed over the makeshift breakfast and kisses and hugs were had all around. When her children asked what she wanted to do for Mother's Day, she said "spend the day with you!" then she turned to me and said "and work in the yard. Do you think you could get the weed eater to work? I also want to go to Home Depot and price the composite decking so I can redo the deck in a few weeks...and if the weed eater doesn't work, maybe I can just get a new one. Yes, that is what I want for Mother's Day. A weed wacker...I just LOVE powertools!" Yep folks. That is my day ahead. Watching the kids while my wife indulges herself in the thing she loves most-handy man/landscaping activities! Hope everyones' Mother's Day is as productive as my wife's...and if not, sucks for you....

Saturday Morning Musings

So it is Saturday morning and I am inhaling black coffee like it is my last meal. Nothing I love more than relaxing on a weekend and slowly feeling my body start to vibrate. It truly is a joyful experience...

The girls are upstairs, playing with their Barbie dolls and giving them a bath. This is their new thing-not sure I understand it but whatever. I do have a problem with their Ken dolls dressed in drag....


It is a beautiful day here in the Derby City. A bit chilly but who cares. My pooch is consistently on the wrong side of the door. In. Out. In. Out. In. Out. She is driving me up the wall. She is too damn big for a doggy door nor would I trust that my youngest daughter wouldn't use it as well to enter/exit the house...She was all up in my mug this morning, desperately trying to get me out of bed. She will try anything. And I mean anything...


Well, have a good day. Just a short entry as my fingers are shaking. Must mean I need more coffee...

Vacation Rumination

Vacation allows me plenty of time to spend with my children. One of the things that I am able to reflect upon is what characteristics and traits that my wee ones have that I don't have. I will recount my observations thus far...

Jackson Robert McClellan: 8 year old boy, chess master, baseball slugger, and all around cool dude. My first born is one of the coolest little guys that I have ever met. I know that I sound like a homer because he is my kid and all but it is true. He just has an air of "cool" around him. It is hard to articulate but I think everyone knows what I mean. The person walks into the room and immediately fits in. He engages people in conversation, is polite and just doesn't have a worried or concerned bone in his body. He just has it. It doesn't hurt that he is tall for his age, tans like a native, and is very athletic....He is also smart. Very smart. Case and point: My wife went to check on him in his room because he was still asleep. He actually was awake and said, "Oh hi Mom. I was just laying here doing math..." REALLY? What kid does this, let alone on vacation?

Abigail Grace McClellan: My 5 1/2 year old daughter that is my little fashionista. She was my fattest baby and now is light as a feather. I believe the appropriate term is petite but she is so darn tiny she reminds me of little Cindy Lou Who from "How the Grinch Stole Christmas". She has taken up art and I believe is one of the most prolific artists since Picasso. She can whip out 10-15 pictures an hour. She is sweet as can be, just like spun sugar. She will do things for her siblings without even asking and sometimes gets taken advantage of but that does not stop her. Altruism should be her middle name. She is also my most quiet- casually watching, observing, and taking it all in before engaging people she doesn't know. She will be the one that takes care of her dear old dad in his old age, changing his diaper and taking him to his doctors' appointment to get his Viagra prescription...

Catherine Cassidy McClellan: My 4 1/2 year old daughter. Wow. Not sure what to say about her but wow. She is my spitfire firebrand of a redhead. Completely full of life from the time she wakes up to the time she goes to bed, she COMMANDS a room by literally stealing all of the attention. Her red hair, ice blue eyes, tannable skin make her extremely striking from a distance but it is her personality that hooks you. From her laughing to her flirting, she just mesmerizes. She however has a nasty side to her that you don't want to get on. She can go from sweet to bitch in under 3 seconds and she loves to push the limits of discipline. She truly is a roller coaster of emotion, a ball of intense psychic energy...

So I sit here and think-why can I not be as cool as my kids? I can only hope to strive to be as smooth as Jack, attentive as Abby and as unpredictable as Katie. But please don't tell them I idolize them. I don't want them to get big heads....

My Roman Holiday- the Final Entry

As I write this I am currently 35,000 feet above rural Virginia, and I have had plenty of time to reflect on this amazing vacation. What I have come up with is that Italy and the US are completely different countries. News flash, I know, but I mean it in terms of our culture, our social expectations, our mores. I feel like such an idiot saying that but it’s true. Because the US has vast amounts of different landscape, culture, urban/rural living all with the added benefit of having one language, one common set of laws and one monetary system binding us together, the desire to leave the country and explore is not as great as it may be in Europe. Problem is, however, that when these said Americans decide to travel, everything is compared to the “way it is at home” and the expectations are that everyone speaks “their” language and likes to eat “their” food. Not so oversees and the locals, while happy to take our Euros, hate the general attitude. Problem also comes with the local kids listening to American music (they love it), eating American food (McDonalds is everywhere in Rome) and generally doing all the things to piss off their parents who are tired of the tourists. Odd. Really it is. So much confusion among the masses. Oh well, enough of that. Time for my final observations from Italy….

1) Clothes and clothes styles are very unique. I have seen the future, folks and for woman it involves tights under short shorts with old school Chuck Taylor high tops. Boots are big too-even the "Captain Morgan over the knee" pirate boots. Just wait….As for men, nobody cares what you wear. Truly. A toga would be just fine, as long as you also wore very skinny tight jeans, hideous flat white puma shoes, a large purple puffy jacket with fur around the hood and white Elvis sunglasses. Not the wayfarer 60’s shades but the fat Elvis- dying while on the shitter shades-rhinestones included.

2) Apparently it is more important for woman (of all ages) to be fashionable than to have an ounce of self esteem. Ladies in their sixties with bulges in places I care not to describe should not wear tights, short skirts and generally look like a mistress of the night. I don’t care if it is the latest trend. Act and dress your age. I am begging you…

3) The bidet has still bamboozled me but I could definitely see its utility. Just can’t bring myself to sit and give my undercarriage a good scrubbin’…

4) I love the ruins of Rome and I love the Vatican. It is difficult, however to see all of the gold, silver, pomp and circumstance at St. Peter’s only to be faced by beggers hoping to get a euro or two from spiritual pilgrims (and generally failing) on their way to the Holy City. The contrast is striking. Just a humble observation…

5) My mother in law is convinced that she and I have the exact same nose. A "nose twin" to be exact. At first, I thought this to be crazy, but the more I look, I don’t know…Probably too much time with the mother in law…

6) There is nothing better than landing in the States and knowing that warm smiles, hugs and kisses from the children await. The warm bed and comfy clothes don’t hurt either.

I have had a great time blogging my adventures and observations from Italy and hope it has provided as much levity to you as it has to me. Now, back to the grindstone....

My Roman Holiday Day #7

We have traveled to Amalfi, on the southern coast of Italy. It is a gorgeous tourist town with the city built into the rocks and grottos on the sea. It is sunny today, surprising since our trip has been marred with crappy weather. It took longer than expected to get out of Rome secondary to a city wide strike aimed apparently at the present Berlusconi government. The Prime Minister is just too powerful and too corrupt to really give a rat’s ass so we sat in traffic for an hour and a half. No big deal because I had nothing else to do. I am just enjoying the trip, not worrying about the destination (in a literal and figurative sense). So we arrive late and have dinner. Wow. The food is delicious and the locals seem to have a thing for lemons. There are lemons, pictures of lemons, drinks made of lemons (limoncello is extraordinary and worth the taste if you see it in the States. From what I can tell they make it with fresh lemons and pure grain alcohol. No way to screw that up.) The size of the lemons are also gigantic. They grow ‘em big here, boys....



We went to Pompeii at the foot of the enormous volcano, Mount Vesuvius. To say that I was blown away is truly an understatement. Our tour guide, Gaetano Manfredi, was phenomenal and really knew his stuff. The ancient Romans really were stupendous engineers-especially when it came to plumbing and running water. Why some countries still don't have these basics is beyond me. If people figured it out 2500 years ago, no need to go and invent the wheel again. Just pick up a history book and follow the path of the Romans....

A few more of my observations on Italian life thus far....

1) Lunch in most places is ala carte. You order, they give it to you and you stand at the counter and eat it. It is called “take away” and they charge you less for take away than if you plant your butt down and have the same thing sitting. Interesting... I also apparently stick out like a sore thumb here because I caught a worker behind the counter making a face at me. Luckily I caught them and gave them a hard stare knowing that they knew that I knew that they were busted. They tried to cover up with a broad grin. I was not amused.

2) The advertising for political posts is out of control. Posters go up along a wall and they assume you didn’t see the first one because they plaster 12-15 more, exactly like it, along the wall next to it.

3) The drivers here deserve some sort of award for their prowess behind the wheel. There are lanes but no one uses them. They pass people in other cars and miss hitting them by a fraction of an inch. They don’t even do the typical American “I am going to crane my neck and say a prayer that I don’t hit them” look. They just zoom by at the same speed....And the interesting part is I have yet to see a traffic jam because of a fender bender. In fact, I hardly see any dents on peoples' cars. Truly amazing.

4) Dinner here doesn’t get going until at least 830pm or 900pm. My tummy is not happy with me...

5) Speaking of food, I seem to swear off eating every time I finish a meal, saying “I am so full and bloated, I never need to eat again.” Somehow, I end up bellying up to the table and gorging myself again a few hours later. Not good for the old waist line....

6) For a true coffee lover like myself, I find it comforting that I can get coffee, I mean good coffee, anytime, anyplace. Even McDonalds (Not that McLatte shit. The good stuff. Espresso. Short and neat.)

7) I still have yet to try the bidet but am considering it everyday.....

8) I stopped at the Autogrill on the Autostrade (rest area with a mini grocery store/restaurant on the highway) and they were selling beer by the bottle. Now I am not saying I don't like a cold brew every now and then, but to pick one up for the road may be a little much, especially considering my comments from #3...

9) The restaurants in Amalfi had their fish on display in a cooler case at the front of the store. Big freakin' fish with eyes staring right at you. Glad they didn't have the meat specials there too....Creepy....

Well, good night all. I head to the Roman Forum tomorrow as well as the Colosseum. I gotta say that I am pretty stoked about being in the Forum on the Ides of March. I will be extra careful when there and make sure no one tries to knife me through the toga I'm gonna wear...

My Roman Holiday Day #3

Well, it has hit me. Jet lag is officially here. Suck. Body tired, mind racing, and generally feeling discombobulated. Yesterday was cold. Real cold. And rainy. Not just any kind of rain, but the pouring down, get under your skin, generally feel like poo rain. We visited the Borghese Museum with a very large collection of Bernini sculptures-pretty amazing stuff considering he did it all in his 20-30's and all in marble. Went to the symphony last night and then came home and had pizza/wine (too much wine) and stayed up until 1230am. Not smart as I was awake 4 hours later with a headache and gastronomic distress-wondering why, oh why I made the decisions I made. Today I went to the Vatican and was overwhelmed by the sheer enormity of it. Great time but exhausting all the same. Some more general observations of my past 2 days...

1) The Vatican is the only place in Rome that I don't feel the glare of the locals gawking at the tourist. I think that is because EVERYONE there is a tourist.

2) Apparently if you talk during the symphony you get the same looks by Italians that Americans give you if you talk during the symphony.

3) During the symphony, there was a male flutist that would have given Ron Burgundy a run for his money (for all those unfamiliar with Mr. Burgundy, he was the character portrayed by Will Ferrell in the movie "Anchorman"). Wondering again why the jazz flute hasn't taken off in the States....

4) Italians do not like eye contact. Don't try it.

5) Tipping is frowned upon in Italy. Apparently this gives waiters in restaurants a free pass to act like assholes....

6) Italians like the bubbly mineral water. Just can't get into it.

7) Apparently they sell extremely warm scarves here in Rome. All the young men wear them with very flimsy, tight fitting jackets. Not sure, but I think it is more fashion based than function based. Me? Give me a big ass parka any day over a jacket only slightly thicker than a rain coat.

Well, thanks for reading. Off to battle the nausea and sleep deprivation/circadian confusion. Can't complain. I am on vacation after all....

My Roman Holiday Day #1

So I arrived in Rome, ragged and tired and ready to beat the bugaboo called jetlag. I had all intentions of following the textbook on beating the travelers' curse but it didn't end up that way. I first came to our amazing apartment on the Tiber River just down from the Piazza del Popolo. Not only is it the sight of not only the obelisk from the Circus Maximus but to my surprise, the visiting World Cup trophy prior to its trip to South Africa. After a lunch of slumber inducing pasta and brew at an outdoor cafe on the Piazza, i actually got my second wind. Not sure how this happened but I grabbed it with gusto and off I went. If you have looked at my pics on Facebook, then you could see that my wife, MIL (short for Mother in Law- the best substitute for a mother I could ever ask for) and I ventured out into the City of Emperors and saw quite a bit on my first day. Here are a few of my simple observations of my time in Italy so far:

1) No one, I mean NO ONE, drives in any one lane-buses, cars, vespas alike. The rule: you look at the car, they keep going. You step out into traffic without looking, they stop. Simple game of Roman Roulette....

2) One does not tip in Italy. Why that is? No clue.

3) The small toilet next to the big toilet is not a small toilet. Trust me on this one.

4) The big toilet has two settings. One for number 1, and one for number 2. Environmentally friendly yet considerate, I suppose, for those folks who need just a little extra oomph, when you want to really "haul the mail"....

5) No matter what you do, you already have two strikes against you. You are American and you are a tourist. A double whammy for those Italians who need any excuse to be pissed at somebody...

6) I can't walk 16 feet without hitting a church...

7) I can't walk 16 feet without hitting an outdoor cafe...

8) The obsession of Italians with super skinny jeans and these hideous white, flat leather Puma sneakers is one I will never understand. Then again, the Italians probably can't understand why I must wear my obnoxious royal blue UK hat so far from the SEC tournament...(GO CATS!).

9) Everything in Rome is within walking distance. Coincidentally, the only fat people were tourists...

10) I can't help to laugh every time I see a sign for Peroni beer...It reminds me too much of a urological condition of the same name but spelled a bit differently...

Well, it is now 9:48pm here in Rome and I have yet to sleep. I must pay the Sand Man at some point and there is no time like the present. Good night, sleep tight and don't shit in the bidet...

Daughters

My Man Jack

My Fatal Flaw

I am a bit conflicted. I leave for a 10 day trip to Rome in a little less than 1 week. I should be pumped, psyched, juiced- and I am to some extent. But then the angst sets in. The anxious guilt ridden feeling of leaving my children for this long. I know most people that read this will say "Are you kidding me? I would leave my children right now, in their beds, without saying goodbye because they are driving me out of my mind!!!" I have been like that, really I have. I am in need of a vacation in the worst way. I am grumpy at work, the mounds of paperwork are increasingly pissing me off, and I am tired. Just so tired. So we plan the vacation, but the leaving is the hardest part. I am so damned attached to them, I don't even want to leave them for a night. Sick, isn't it? However, I know the best thing for our family is a rejuvenated Daddy and Mommy, because I can feel both Becky and I are getting to the end of our collective ropes. We need those batteries recharged- juice to fight the drudgeries of daily life with 3 children (oops. Sorry Ruby, 3.5 children). However....

There is truth to the classic saying-You can't live with them, you can't live without them. I feel like I am some character from a Greek tragedy, cursed by the gods with a need to get away for his SANITY, but never able to because of his own fatal flaw~his unyielding desire to be with the ones causing his INSANITY....

I am not expecting answers from this blog, but it does give me a place to put down what I seem to have a hard time verbalizing...Time to hit the sack. Maybe my subconscious will fix this faulty brain wiring while I snooze...

The SGR S-U-C-K-S!

So as I transition to my PJ's I realize that there is nothing finer than this feeling. At home. Resting. What a long week it has been. Not sure why it has been so tough, aside from the fact that I need a vacation and really didn't want to be at work. My day was capped off by realizing that my government truly has let me down. Congress today failed to stop the SGR (sustainable growth rate) formula for Medicare reimbursement. So as not to bore you with the intricate details of Medicare regulations, the SGR calls for roughly a 5% cut in reimbursement to physicians per year. Nevermind that Medicare only pays roughly 35 cents for every dollar I bill. Problem is that Congress has been putting this off for the past 3 years so the effect is cumulative-by inaction today to change the SGR, I am now going to have my reimbursement from Medicare cut by 21% on Monday. Because what is good for the government must be good for private pay insurance companies, I am sure that they will follow suit soon and I am looking at probably a 21% pay cut across the board. Tell me what other business would allow this to occur? I am not sure where healthcare is headed, but pissing off the ones who deliver it is NOT a good idea. Trust me. I expect doctors to still do well, don't get me wrong. I just expect it to get ALOT worse for the patients-all because partisan politics and public grandstanding is more important to politicians. I expect elderly patients to suddenly lose their doctor because the Medicare population has now become too much of a financial liability, too much work for not enough reimbursement. I expect doctors to begin to take cash only and let the patient file their insurance-trust me, that is a nightmare physicians deal with daily and it is not for the faint of heart.

Sorry. I just got carried away there....Just really not sure what is going to happen with Medicare and this silly SGR. I do know that what Washington doesn't want is a bunch of pissed off octogenarians that still believe in their individual right to vote. Politicians know that it is political suicide to f*ck with social security and with Medicare, yet they continue to play this game of political chicken. Good luck with this one Washington. It's an election year, and I see a lot of Medicare patients....

The Fire List

It is freezing here in my office. That is the one good thing about being busy-too little time to be cold. I have been moderately busy this week which is concerning since I leave for Rome in less than 2 weeks. If papa ain't working, papa ain't gettin' paid and I won't be getting bank for 3 of the upcoming 5 weeks (10 days in Rome then 10 days in La Jolla, CA for Spring Break). I am busy enough however to fire a patient. Yep. That's right. I fired my Arch Nemesis. And it felt GOOOOD. This woman has been a pain in my side for over 3 years, requiring countless hours of busy work and rearranging my schedule to fit her needs. She was never appreciative, never said thank you-she just expected me to drop everything and fix her issue, right then, right there. No concern that I had over 3000 other patients that I care for....HER issues came first. I found the opportunity to cut the strings and I did it, and I felt and currently feel great. No remorse. No second thoughts. In my opinion, maybe I should fire more people that absolutely terrorize my day, get under my skin and make me want to quit medicine and work as a Walmart greeter. I think it would be good for everybody to fire those in their life that weigh them down and jettison the baggage that is dumped on people daily. Life would be better, anger and frustration would diminish and depression rates would take a nose dive. I am not saying piss off everyone by telling them to take a hike. No, I am talking about a dedicated few, lets say less that 5, people that really agitate the remaining nerve you may have left. We all know who they are, and if you don't, you may want to make sure you are not on somebody's "fire" list. By decreasing the drama in your life, maybe, just maybe, you can get up out of bed again tomorrow...

After reading the above blog I realize how pessimistic I sound. Geez. I need a vacation I think. Good thing I have a bunch coming up. I think sometimes just the act of writing out the frustrations calm the demons and cooler heads prevail...

I hate waking up in the morning....

So I haven't blogged in a while. It seems I have to be struck by the moment...Anyway, today was busy. It started off with my normal misery of crawling out of bed at 6 am. Mind you my wife was already up exercising (she is THAT good) but 6 was plenty early for me to roll out of bed. My dog seems to have an alarm clock in her tummy. 6 am-Daddy wakes up. 6:10 am- FOOD. 6:15 am-back to sleep. For her. Not me. Her alarm clock has no bells or whistles, buzzes or music. then paw Daddy's face. Nice...

I proceed to groom myself then head out the door to the hospital. It is always an interesting visit with my patients. They act as if I am visiting them in the dead of night, bringing with me news they can't understand, words too big to comprehend. I examine them, tell them the plan for the day, leave the room then wait the standard 2 minutes it takes for them to realize that they just dozed through my entire conversation with them. I then have to go back in and go over it all again. What a waste of time. I have considered going into their room, turning on all the lights, pulling back their covers and saying "WAKE UP! Now I will be back in 5 minutes to talk to you. Just wanted to give you some prep time...." That, of course, doesn't happen as that would be considered cruel and unusual punishment....That reminds me of a story from my days as a Nurse's Aide...****Harp music accompanied with dream sequence inserted here****. It was 430 am and the charge nurse said "Hey Captain O (story behind that name for another blog entry), go give Mr. Jones his enema this morning to prep him for his rectal surgery." I get the bag, fill it with water and soap (it was a SSE after all-soap suds enema), get the tubing all set up next to his bed then turn on his lights and say "Mr. Jones- wake up please. It's time for your enema." Mr. Jones responds "what's an enema?" I just smile and say, "Just roll over please..." ****Cue the harp music and dream sequence again****.

I guess what it boils down to is that no one really likes to be awakened from their deep, unencumbered slumber-Not me, with a paw to the face; not the patient with the early morning rounds; and certainly not Mr. Jones by the freckly red headed sadistic Nurse's Aide wielding his sudsy bag of ass cleaner...

Boredom at work on a Snowy Day...."Live Blog"

9:17 am: My printer is being a bitch. I am going to treat it as such...

9:23 am: Listening to Squeeze's song "Black Coffee in Bed". It is exactly where I would like to be at this moment. Damn sick people...

9:38 am: Waiting for my 1st patient. Excitement abounds...

9:59 am: My pants are intermittently vibrating. Probably a good idea to stop drinking coffee now...

10:03 am: Getting to a point where I may have to ask people walking by on the street if they feel sick and want to be seen. SLOWWWWW.....Or should I say SNOWWWWWWW....

10:41 am: Hooray! Just saw my first patient! Although I am a little sad that I missed the no hitter...

10:47 am: Reading up on the latest treatment for Hypertension. Man, this sh*t never gets old...

10:59 am: Just received this picture from my sister. It is of Abby, my middle child...So cute...It has just made my day...



11:42 am: Just had a patient say that they were watching Nash Bridges the other day and had to fast forward through the commercials. I call foul on 2 points: Watching Nash Bridges in the first place, and second, setting your DVR to record it....

12:05 pm: I wish I were home sledding with my children...

12:40 pm: This "Live Blog" thing is taking its toll on me. I think I will sign off for the day....I am sure everyone would agree that this has gone far enough...

My Little Greek Tragedy...

My daughter Abby is being a bear. Not to me, but to my wife. It seems there is some sort of personal angst directed at my wife but not at me. I know people say "Get used to it. Mother/Daughter relationships are like that" but good God, this is near schizophrenic. Example: Abby: "Don't look at me!." 2 minutes later: "You didn't wait for me! Hold me!" Really? What is going on in that little brain is beyond me. She is fine at school but saves it for my wife. I don't seem to be invited to her own personal vendetta/love affair. I wish I could help but I am not the target...Very frustrating and irritating....Oh well. Will just keep plugging along and making myself available if Abby ever decides to change her focus...

Random News and Views 1/30/10

Today I used a snowblower.  It was a life changing experience.  We really didn't get enough snow to use it but I did all the same.  Wow.  It made short order of the driveway and kept me from busting my back (that's  right- I can say that now that I am an old man of 38).  If you ever get a chance to use one, I highly recommend it....

The snow we did receive today was great for my dog.  She has been going ape shit in the house and now she is a pooped pup.  It is a good thing....However for a dog that may have the worst nose on the planet she still was able to sniff out the snow covered dog turds.  Apparently she enjoys a frozen snack while playing...

The girls went to a birthday party today.  They were supposed to dress as fairies.  Hmm.  I didn't have themes for my parties growing up...Just cake and presents and if I was lucky a trip to Skateway USA.  Oh well.  Not sure I would have liked having to dress like a fairy, especially if I had to go rollerskating too....

My son had a birthday party with the family last night.  We asked him what he would like to eat on his very special day and he said "Raman Noodles".  Nice.  That kinda left the rest of the family out in the cold but it WAS his birthday.  The kicker was he wanted a cookie cake.  Who thought of this sorry excuse for a cake?  Birthdays are supposed to have cake.  Period.  You don't have Birthday Pie, or Birthday Flan, or Birthday Cookies for that matter.  I do make an exception for ice cream cake because it is soooo tasty as well as for cupcakes (these are just miniature cakes anyway).  As nasty as the cookie cake is, it has practically disappeared already....

I love my girls, but they really can be aggravating at times.  Abby was throwing a fit before she left because who knows why...all I know is that she got this scowl on her face and was stomping her feet out the door.  We had to use the "if there is one more fit, you don't get to go to the party" line (even though we wouldn't have enforced it at all.  Please. Two hours of free babysitting...SWEET!).  Oh well, I am just used to Jack who is so easy going and never decompensates....Here is a picture of the girls when they are acting sweet...

Ugh.  They are so cute I can't stay mad at them for long.  This parenting thing is getting old real quick...

In case you were interested...

When I told my father that I was going to pursue a medical degree, I was a freshman in college.  It was just enough time between this revelation and summer vacation for my father to try to talk me out of it.  Before going on, I must reveal that my father is a General Practitioner and has been in private practice  for 50 years.  He has been my role model in my professional development and a colleague with whom I seek advice.  However, upon hearing that I wanted to be a physician, he wanted to make sure I had the intestinal fortitude to persevere in the rigors of medical training. So he did something that changed my life forever.  He arranged for me to work as a Nurse's Aide (NA) at my hometown hospital.  If you are not aware of the hierarchy on the wards from a nursing perspective, then let me enlighten you.  Top tier: RN's.  They are in charge of dispensing medicines, making decisions regarding when or if to call the physician and generally being in charge.  Then come the LPN's.  They also are in charge of dispensing meds and caring for the patient, generally doing everything a nurse does but getting significantly less pay for it.  If you want to know who the LPN is on the floor, look for the person with a chip on their shoulder.  If I did everything the RN did but got paid about half of what they received, I think my panties would be in a wad as well.  Then came the NA's.  That was me.  The NA had the distinct pleasure and responsibility of bathing, shaving, changing (both diapers and bed linens), disimpacting (that's right.  Disimpacting.  I don't think I have to tell you what that is because we all know that there really is only one cavity within the body that gets so backed up that manual evacuation is the only answer), enemizing (is this a verb?) and overall gopher and scut monkey.  Before I could begin, there was a training orientation that was required.  I had to learn the aforementioned hierarchy, learn to check vital signs (blood pressure, pulse, respirations), and generally have it drilled into my head that it is a privilege to care for the sick-I was literally an extension of the team and I must care for the patients as I would care for my own family members.  Well I can tell you that I took this VERY seriously.  I was going to be a DOCTOR by God!  This was what I was called to do.  Why did my Dad try to talk me out of it?  Of course I could handle this.  Please.  I was going to be the reincarnation of Marcus Welby or even better, Trapper John, MD.  So the day finally came to hit the wards.  I put on my uniform with pride (white shirt, pants, and shoes) and strut into the hospital.  I report to the Head Nurse and she tells me to go help a group of NA's and RN's that were having problems cleaning a mildly combative lady with dementia.  I stroll down the hallway and begin to hear moaning, squealing, and crying.  I then hear what I assume to be a nurse telling someone to "Be still!  We're almost done!"   I was appalled.  I must go and help this damsel in distress.  A white knight riding in to save her the humiliation being wrought upon her by the vile nursing staff.  I enter the room and there were 6 nurses/staff around a bed that contained a very tiny, frail, and wrinkly octagenerian.  One of the nurses yells to me, "Get over here and hold her hands down.  Watch out.  She is a mean old hag!"  I assume my position at her side and pick up her hand and slowly start to rub it.  I say in the most soothing voice that I can muster- "It's ok, ma'am.  I am here to help you.  Just relax.  Please.  Calm down.  Shhh...."  Her body seemed to relax, her eyes focused on me and became as big as saucers, welling with tears.  She then said "Oh, Oh, Oh. Please help me.  Please free my hands..."  I told her that I couldn't do that but that it was all for her own good.  She then said, in a not so nice tone of voice-"Oooo, I hope they pull your pecker off!"  BAM.  WHAM.  POW.  I was deflated. As the other medical staff just cackled and said "Welcome to the floor, boy!", I took a very valuable step in my development as a healthcare professional.  Never, never, EVER take yourself too seriously or have too high of regard for yourself.  There will always be a person there ready to knock you down a notch.  It became immediately clear to me why my father had wanted me to do this job.  If I could wipe butts, give enemas, change dirty beds and bathe paralyzed patients and still want to go into medicine, then there was no doubt that I could be a doctor.  He knew I could do the school work.  What he didn't know was did I have the drive and compassion to care for others, even when it was not the glamorous job of being a doctor.  I went on to work that summer and loved it so much I worked the following summer on the 11pm-7am shift.  I learned some great lessons those two summers but also experienced some crazy things as well-stories that I will remember forever.  For those that know me well, THIS is where a large part of my perverse sense of humor took root and blossomed.  In case you were interested....

A doctor goes to the doctor...

I went to the doctor today.  I must say I did not like the experience.  The anxiousness, the uncertainty, the paperwork, the WAIT.  Are you kidding me?  Good lord.  I show up 30 minutes in advance (because I was not going to be THAT guy who showed up right at or a few minutes late for his appointment) like a good little boy.  Filled out the reams of paperwork, paid my copay and then waited.  And waited.  And waited.  This time gave me the chance to fester and smolder with angst and fear about what may transpire if I ever make it back to the sanctum sanctorum. One hour after showing up, I was taken back to the exam room but first I was shown to the "Scale of Truth".  This inquisition-esque monstrosity should be relabeled the "Scale of Shame" as the MA (medical assistant) had to keep clicking the balance farther and farther to the right.  Suddenly the cinnamon roll I had for breakfast felt like an anvil in my stomach (maybe this is where the extra 8 pounds came from?).  I have to make the obligatory comment to cover up my nervousness-something like "I think your scale is wrong" or "I was ten pounds lighter when I weighed myself naked this morning".  My patients' always seem to utter these excuses so I felt that maybe I had to as well.  The MA did not find this humorous at all.  I was then placed in an isolated room with nothing to read.  There was not even an old copy of "Country Living" from 2004 that I thought was standard issue in doctors' offices.  The same MA then returned and proceeded to take my medical history and ask me about my medications.  One never feels as old as the medical history that is given but I think I aged 10 years at that moment.  Wow.  That sucked.  Luckily the appointment went well and I was on my way.  This foray into the "Other Side" gave me a lot of perspective into how a significant number of my patients must feel despite the fact that I try to put them at ease.  I get them back on time, I have up to date magazines for them to read, I see them quickly and spend a lot of time with them.  So what can I do to ease the burden of coming to the doctor?  Aside from offering free coffee and cocktails, terry cloth robes and mood lighting, I think I do a pretty good job.  It may be that this is just the "nature of the beast"- I am in a profession that makes people uncomfortable. They feel out of their element, anxious and without control.  What I can do for them I do- a smile on my face, an unassuming attitude and my full attention when I am with them.  After spending a little time being the patient, I realize that MY patients probably don't care how much I know as long as they know how much I care.  I was hypersensitive in that office today and I let everything affect me as if I were about to get a rectal exam by Andre the Giant.  Why should I think that my patients are any different?  A calming attitude and polite demeanor will most likely help my patients more than any prescription I can give them.  Unless the patient has herpes...in which case the prescription will definitely help them more.

Miracles?

So my first patient today tells me that he has experienced a miracle.  A miracle? Please.  However his conviction was almost scary.  He believed God spoke to him and told him to cast out the demons of his illness (in this case, 30 years of dizziness).  He said he prayed and eventually spoke in tongues.  He then looked into the sky and saw 3 hunched over lizard men/beasts in a clear bubble.  They looked at him and shot off at lightning speed away into the sky.  Instantly he was "cured".  Now I have to tell you I have known this man for going on 6 years and NEVER has he volunteered this type of information before.  He was much more animated than he has ever been with me and his excitement was palpable.  I must say that I cannot explain why his dizziness went away, just that it had.  If he had been talking about anything besides the notion of a miracle, I would say that he was a loony.  However, part of me really wanted to believe in his miracle-the idea that there are things that I cannot explain...that there could be some sort of miracle out there for all of us, just waiting to happen.  Part of the reason that I continued to listen to his fascinating story was that his intensity, conviction, and certainty was at a fevered pitch and I was amazed at this.  In this day and age of instant information, Google, and 24 hour news stations, almost any story can be confirmed or debunked in a matter of minutes and it is much harder to "stick to our guns" and be convinced of the unfathomable.  But here he was- as convinced as the day it happened.  From a medical standpoint I cannot explain his sudden burst of health although I have my suspicions.  But that doesn't matter.  To him, it was real and that was all it took to "cast out the demons".  I am not sure that I am capable of this type of faith but I wish that I were.  The problem is that I have to set aside my rational side and just accept what is in front of me and I haven't found a way to do that-save one.   The love that I feel for my children is irrational.  I love them all equally, fully and in different ways.  Before children, I would say that it is impossible- there must be a favorite.  It is human nature to choose the best and disregard the rest.  But that isn't the case.  So as I write this, maybe I have opened my eyes to a miracle that has been in front of me all along-one that I will continue to nourish, love, and cherish each and every day-my children.

Vomiting and Control

My son Jack is sick today.  Barfing.  There is nothing that makes me feel more helpless than when my kids are sick.  It's worse when they are barfing.  Vomiting by definition is an uncontrollable act.  Sneaks up on you and WHAM!  The only other bodily function that I can think of that does that is sneezing.  I don't mind sneezing.  Puking, however, I hate.  Probably because there is no control. Of course, there is the concern that like the Red Death (Poe reference) this bug is going to travel throughout the household, hitting each and every one of us so we go down for the count.  Ich.  Oh well, this is about my son, not me.  I hate that I am always at work when my kids get sick.  I wouldn't do anything but feel powerless at home as opposed to powerless at work.  At least at work, maybe, just maybe I can help some people feel a little less powerless and gain a little more control of their life as well as their illness.

Life happens. So does Death...

I admitted a man to the ICU this evening who for all intents and purposes should be dead right now.  He has large blood clots in his lungs and it hit him without warning.  He told me that he didn't think he was going to live, that this was the end.  He nearly died twice in the ambulance before reaching the hospital to receive treatment.  Odd thing though- It was nothing that the medical establishment did to "save" him. The treatment he received came well AFTER he stabilized.  He did this on his own.  His body recovered.  He just lived. Why?  Not sure.  It just happened.  I have seen younger, healthier people die from this sort of traumatic insult.  Why do some people live and some people die?  I have no clue but I can tell you that we are promised nothing.  Tomorrow it may all be over so please remember this when your day is rotten-the car won't start, you're late for a meeting, or the dog yacks on the oriental rug...We are lucky to be here.  Enjoy it. But clean up the dog yack first.

A new way to communicate....

So I decided to start blogging. Not sure why, just have. Sometimes I feel like I need an outlet to say what is on my mind without having to specifically have context. It may be about my kids, work (certainly if a story occurs from work, no names of patients will be revealed) or about the woman in front of me at Target. I occasionally need a way to decompress and only the beauty of the printed word will do...So, here we go. A new way to communicate...