Not such a tame world....

10 Years....

 

Wow. 10 Years since 9.11....

It hit home to me a couple of days ago that time has passed. The Today show had a segment on Friday where they revisited with five young adults, who all had parents who died in the Twin Towers. 10 years ago they were all very much young, shaken & scared children. Now, they were "grown up".

So 5 years ago I blogged about my own events for 9.11 - the link to that blog is here. I'd still write the same version of events, just using "ten years" instead of "five years."

"Our lives begin to end the day we become silent about things that matter."

Martin Luther King, Jr.

Story-time....

January 1st found the welcome e-mail from Ali Edwards in my in-box for the Big Picture class that I'm taking called One Little Word.

I was pretty darned excited to sign up for this class because I've been following along and choosing a Word of the Year for a while now. The first couple of years, I didn't do much except select a word and meditate on it intermittently through the year. The last two years, I made a concerted effort to having visual reminders around me of my word, and more often than not keeping my spirit open to that word's influence. It's amazing what a little tuning in mindset can do....

• 2007 Hope
• 2008 Faith [ed note: I had picked Trust, but didn't really "feel it" and within a few days ended up picking Faith instead.]
• 2009 Trust
• 2010 Joy
• 2011 Story

I really like the idea of having a "theme" or a "focus" for the year. And for whatever reason, Story just really resonated with me this year. I'm not sure exactly how Story is going to incorporate itself into my year. Yes, there is the tangible or writing and blogging more. But under the surface, I'm still not sure how this will work. My other words have all been virtues or values or concepts. Story feels a bit more concrete.

Some thoughts I have on how this may impact me this year:

• Well, I may end up making some very needed changes and that will help me tell my story better; i.e. better time management, habitually taking the time to actually write instead of just thinking about writing
• taking better care of myself a) so that my story lasts longer and b) so that I have more energy to actually tell my story.

Time will tell....

 

Fresh starts....

"Don't put off for tomorrow what you can do today, because if you enjoy it today you can do it again tomorrow."    ― James Michener

I'm pretty sure that I'm not alone in the surge of hope & motivation I feel at the start of a new year. It's a blank slate. A chance to start fresh. Make changes. Grow. Evolve. Improve. And for the moment, all of the potential is bright and untarnished.

But then, after a few weeks, life happens and enthusiasm fades. It is so much simpler to return to familiar routine patterns. And slowly I feel myself settling back into the comfortable ruts that I've traveled before.

Anyone else? Yeah. I thought so.

And as always, January 1 marks that day to take stock and make resolutions. Even more so this year since the date happens to be 1/1/11. That doesn't happen very often, does it? January 1 just feels more significant than most other days because it very obviously is the start; the very first day of a brand new year.

So last night in the company of family & friends, I started a discussion about resolutions. Ahh....and from the mouth of babes came this wisdom from Tabitha: "I don't do that resolution stuff -- it just doesn't work for me." This coming after only five years worth of New Years celebrations. The consensus was though, that goals might be a better choice than resolutions. Of course the group list had the common ones: "work out more", "get in shape", "get organized", etc.

But there were some originals. Tabitha ended up choosing two: "1) improve my grades and 2) be more responsible." One of my friends voiced that she plans on finishing writing her book this year. That goal espcially resonated with me because I keep saying that "one of these days I'm going to write a book!" So how cool to hang out with someone who really wants to do the same thing. Maybe this will be the year that we inspire each other?

Reviewing my brainstorming list of what I want to accomplish this year, I've got some very concrete goals and then some that are a lot more nebulous at the moment. This year I would like to:

• Work on myself some more . I'd like to focus on my writing/blogging and grow as a photographic artist. I'd like my muffin top and its 30 pounds to go away. I'd like to feel stronger and healthier and more energetic. I'd like to continue to update & revamp my wardrobe, including my shoes. I'd like to continue to evolve my style and condense down to the really key components. I'd like to be able to do more with less.
• Complete some projects.As I look around my office right now, there are scores of projects in multiple stages of development, but none of them is DoNe! I'd definitely like to fix that
• Replace my kitchen table & chairs with something "Sam-proof". I love that dog, but he'll chew anything that doesn't bite him first. I'm thinking that this year, the kitchen will get more of a wrought iron, vintage metal motif in the decor department. I'll keep you updated....
• Continue to purge the clutter -- Simplify!!
• Redecorate the guest room (after de-cluttering, of course)
• Finally decorate the master bedroom. I've started to get some inspiration and now I have a direction to work in. Let's hope Michael is ready for some changes.... (It's all good Sweetie! I promise!) Let's face it, anything will be an improvement if it gets rid of the baby puke colored paint on the walls!
• I'd also really love to travel more this year. I've already got a good start on this one, since later this month I will be taking Tab back to New England to visit family she hasn't seen since July 2007 & April 2008.

I'm sure there are other goals that will come into being as this year progresses, but this seems like a good start for now.

So how about you? What are you hoping for in 2011?

Word of the Year - 2010

Just to keep up with the annual tradition that I've got going, I'm please to announce that this year's word will be....

JOY

I finally decided at about 1139pm, Dec 30th after discussing via text with Mrs. K what her WOTY would be. Turns out that independently, we both had thought about using Joy -- even though I was still undecided. After checking to make sure she didn't mind sharing, we decided that it would be fun to share. So joy it is!

Here's the bible verse to go along with my/our WOTY: [Notice I also managed to keep WOTY 2009 "Trust" in the verse too....]The LORD is my strength and my shield;
   my heart trusts in him, and I am helped.
   My heart leaps for joy
   and I will give thanks to him in song.

Psalms 28:7

 

And from Merriman Webster's on-line Dictionary:

Main Entry: ¹joy

Pronunciation: \ˈjȯi\

Function: noun

Etymology: Middle English, from Anglo-French joie, from Latin gaudia, plural of gaudium, from gaudēre to rejoice; probably akin to Greek gēthein to rejoice

Date: 13th century

1 a : the emotion evoked by well-being, success, or good fortune or by the prospect of possessing what one desires : delight b : the expression or exhibition of such emotion : gaiety
2 : a state of happiness or felicity : bliss
3 : a source or cause of delight

— joy·less \-ləs\ adjective

— joy·less·ly adverb

— joy·less·ness noun

I'm thinking that this will be a good word for a good year! Happy New Year everyone!!!

Fall has arrived and I'm contemplating the current condition of medicine....

In the past 2 days the temperatures have dropped into the 50's.

In our household, it's the start of Fall when Michael officially declares it's time for "Marshmallow Deployment" AKA getting the down comforter on our bed and into the duvet cover. Last night I thought aliens had replaced him because he started talking about adding flannel sheets. This is my husband the polar bear, right? Now that I know the joys of my low voltage electrical blanket -- I'm roasty-toasty no matter what. And after this week, I needed the sleep.

Fall weather in North Texas brings the start of Mountain Cedar Season, aka "Cedar Fever". Allergies go "boom" and asthma kids start wheezing out of the wood-work. Add to that, my region is now in the fifth week of widespread flu activity, primarily with the H1N1 strain.

I filled in at a clinic out in semi-rural Texas west of here all week. Drove 2 hours a day hither & yon. The practice recently moved to a new building & I like the new place a lot. So much easier to see people without tripping over the staff. Of course, I know I'm in the boondocks when the baby girls come in dressed in camouflage. In a week where I saw about 80% flu, the most memorable patients this week were:

• the 3 year old with the broken collar bone. Happened the week before when he tripped exiting a large plastic play car and then it fell over on him. Definitely a fluke event. Got seen in the ER the night this happened & since the parents were focused on the kid not moving his arm, apparently that's all the ER x-rayed. When I saw him, I poked all over his spine, shoulder, chest & back. And sure enough, part way down his collar bone he started howling and I could feel the ends of the bone crunching. Always a delightfully squeamish physical finding. Got the chest x-ray done & mystery solved. I felt pretty good about that one, just because I picked up the fracture without the x-ray.
• 13 year old with 2 week history of intermittent, escalating abdominal pain. Seen in the ER x2 already with a "normal work-up". On exam this patient was very obviously overweight and had classic signs of gallbladder colic, especially a positive Murphy's Sign. I got all the blood work & belly ultrasound ordered, but the week ended before I found out results....
• 13 year old with 6+ months of intermittent, escalating abdominal pain. Already worked up and treated for reflux/chronic heartburn. Skinny kind of patient and very firmly denying that the reflux meds helped at all. After multiple doctors & multiple visits, I guess I was the first person to ask "What makes the pain worse & what makes the pain better?" Seriously. I was floored at the answers and this is yet another example of "if you listen to the patient, 80% of the time they'll tell you what is wrong." Turns out the pain hurts more upon getting home from school (where there's a lot of fighting: between sibs, between parents, between kids & parents, etc....). The pain is better with distraction like TV & movies, hanging out with friends, not being at home, etc. A little more probing reveled that this was a "Yours, Mine, Ours, blended family" and that the chronic stress and anxiety were wearing on this kiddo. No wonder the reflux meds didn't work -- that wasn't the problem. One referral to counseling and some in-office encouragement and on to the next patient....
• 7 year old with classic flu symptoms and a loud heart murmur that sounded like an unbalanced washing machine. I noticed a very faint surgical scar at the top of the breast bone and over the big neck veins, paused as I thought "hmmmm" to myself, and then looked at Mom to ask "Exactly what kind of heart surgery did this kiddo have?" At which point Mom was gracious enough to look bashful with "Oh Yeah! I meant to mention that at 11 days old, they did a truncus arteriosus repair and there is still a leaky valve...." Good to know these ears of mine won't miss the obvious....
• 7 year old with classic flu symptoms, who had been seen by me on Monday and diagnosed clinically with the flu. Tuesday, the patient still had a fever, so Mom took'em to one of those new "Minute Clinics" that are showing up around town. They brilliantly diagnosed a fever and a cough and prescribed a codeine based cough syrup. [In my book, generally not a great idea since kids have this odd little idiosyncratic reaction to codeine and it can cause them to stop breathing. I always tell parents the reason I won't give them one of these cough medicines is because "I lose style points if I kill off my patients with cough medicine." Of course, I guess that is one way to stop the coughing....] Mom decided that on Wednesday, since the fever was still there, the patient needed to be seen again. Since she didn't feel real confident about the Minute Clinic, she came back to the Pedi office. Still looked like the flu, although now the patient actually had an appetite. Turns out Mom hadn't even filled the cough syrup prescription and that really, all she wanted was a test to prove that this was the flu. One snot covered q-tip later -- and Yes it was Influenza Type A positive. Then Mom wanted me to do something to "cure the patient" so they could do some school outing on Thursday. Needless to say, this is an example of the unrealistic expectations that run rampant today. And just so you know; back on Monday I had told Mom to expect about 5-6 days of "off & on fever" and cough, and to stay home from school until next week. And the office had given a school note to that effect.... Some days I LoVe parents!
• 7 year old with classic flu symptoms, who had been doing well and then 7 days out came down with a productive cough & 104 fever. On exam, the chest was dull to percussion at the bases, there was less movement of air, and there was egophony. 1+2=3. This was a clear case of pneumonia setting in. I didn't need the chest x-ray to start antibiotics, but the parents wanted it done. And sure enough, early infiltrates bilaterally in the bases. I'm sure that my professors from 1st year med school would be thrilled that I still know what egophony is, but this 7 year old & parents thought I has lost my mind when I instructed her to keep saying "e" over & over....

And this was how they did medicine "back in the day" before everyone got scanned & radiated for every complaint....<sigh> Sad isn't it, that I expend the brain power and use the physical diagnosis skills and generally don't run up a huge lab/radiology tab -- but still, as a Pediatrician, I am at the bottom of the food chain for health care reimbursement because I don't "do" things to patients. Same thing for most of my Family Practice & Internal Medicine colleagues, 'cept they have much bigger, more complicated patients to deal with....

Numbers-wise, I saw between 20-30 patients a day in an 8 hour day all 5 days this past week. I also managed another 25-50 patients per day by telephone daily at this same practice. Roughly that was about 50 to 80 patient encounters each day. I ate my sandwich, from the lunch I packed each night, in about 10 minutes each afternoon while I tried to write in charts & catch up on billing sheets. Most days, I had a chance to go pee once in that 8 hours. The phone calls, by-the-way, were all at no charge. Since really, who these days actually pays for medical advice they receive over the phone. Patients expect that doctors will provide that as a free service.... And at this practice, the nurses told me this was slow for them. This doc routinely sees 40-60 kids per day in an 8 hour day, with about the same number of phone calls. In order to pay the bills, the typical pediatric practice needs to see a minimum 25 patients a day. The more staff  and the higher that number goes. Most of the practices I fill in at routinely see 50+ patients per day. Honestly, I'm pretty appalled that's the standard of care in my region. But insurance reimbursement and economics are the main forces that have created this situation.

I never went into medicine "to get rich". But I certainly never went into medicine expecting that the patients & parents would value my services & time at  the $15-$25 copay. They would gripe & complain about waiting more than 20 minutes to be seen, and that some days it would feel like the plumbers & auto mechanics of the world get more respect than I do....

Is it any wonder why there is a shortage of primary care doctors? Any one surprised that the shortage is expected to get drastically worse over the next decade? And frankly, based on what my average day sounds like -- would you want to do my job?

In contrast to the above, evenings this week I've been fairly steady with my house calls practice. I do see families with multiple kids. When I visit the first time I try to get my baseline data for all the kids. That way when I get a phone call that so & so's brother/sister is sick I already have a physician/patient relationship and can provide telephone advice. In my own practice, right now I don't charge for phone calls. I may have to change that. If I come and see the child, I charge $150 up front. Cash or Check, no credit cards. If over the phone, the problem sounds like I really need to examine the child, I say so. If the problem sounds like it is outside the scope of care I can provide, I say so. If I think an ER eval is needed, I call ahead & talk to the ER triage on duty to facilitate care, but typically I'm seeing the child at the time and conveying my findings directly to the doc on the receiving end.

So far, I have yet for any parent to tell me that my fee was was too high. A few have even said I should charge more.... [Hmmmm????] What I'm finding in that with the standard doctor visit lasting 7-10 minutes or less, most of my parents are absolutely starved for time to spend with a doctor, have all their questions answered, and receive insightful feedback on issues related to their child. And to them, $150 is money well spent. One family I've seen recently, most of my visit was spent explaining blood work results for their child, that had been ordered by a different doctor. I routinely go through medicine cabinets and help parents decide what to keep, what to toss, and what doses to use for their children. I'm a firm believer in "cheat sheets" i.e. legible notes left for Mom & Dad with written instructions on what to do and what to watch for in their kids. 

So am I a-typical in the Pediatric world? -- Yup! So do I wish I could provide this standard of care to every child I see, even on my locum tenems assignments? -- Yes, but only if I were compensated appropriately for my time. Do I mind being so directly accessible to my patients, i.e. Mom & Dad have my personal cell phone number. -- Not so much. The latest anyone has ever called me was 2145pm and the earliest was 0830am. Once they realize that they really do get me and not some phone triage message with three layers of nursing/receptionist staff to go thru, most parents really won't call unless they are extremely worried.

Eventually, I hope that in my local area, my practice will build big enough that I can just do this full time. The intangible reward I get for sitting down & spending that hour with the kids & parents is the gratification that comes from really knowing them well and being significantly helpful to them. For example, in one family with two children, I've visited twice. Talked to Mom on the phone 4 or 5 times, and I can tell you that I know both their medical/family/social histories considerably better than their regular pediatrician. Sum total of time spent? About 3 hours. Income made? $300. Work stress? Zero. Do I enjoy what I do? Absolutely love it! No insurance hassles. Very minimal paperwork. But most of all, to me, this feels like the way medicine should be.

I was in a mood to celebrate today....

For starters, it was Tab's first day back to school & she's now a big ol' 5th grader. We had "Meet the Teachers" yesterday & this year she rotates thru 4 different teachers during the day, just to get prepped for middle school next year. She grudgingly allowed me to tag along & take photos yesterday, although I was "seriously embarrassing her!" Today required major "Mommy-guilt" to get our traditional photos in front of the front door, but I did. Haven't downloaded them yet, but I'm certain there's some doozies.

All-in-all, she's a social girl who views school as a necessary evil that puts a crimp in her social life. Still she was in her element seeing old friends today -- which is what I mostly heard about this afternoon. In general, she reported that her teachers seem nice (because there wasn't any homework for today), her stack of textbooks seems huge & her box od PTA-ordered school supplies were complete but lame.

Moving right along....

Today marks my one-year anniversary as a Pulmonary Emboli SURVIVOR!

Pardon my shouting, but in my world -- this is a big deal. 30% of all PE patients die before they ever get to the hospital or receive care. Mid-way thru my internship, I had a mid-20s patient who coded, suffered a cardiac arrest, and died after an unremarkable abdominal surgery, all while she was an inpatient at the hospital. If anyone should have had a chance to survive, based on location alone, it would have been her. Her autopsy revealed that her lungs looked like Swiss cheese from all of the clots/Pulmonary emboli that showered them & ultimately killed her. So as I was being diagnosed & hospitalized -- her story was the one in the forefront of my mind. Not exactly confidence inspiring, if you know what I mean.

I revisited my blog entries from last year & you can read the most relevant ones here & here.

Long story short, I spent a very long, difficult 6 months on "Rat Poison" AKA Warfarin/Coumadin. After being off the medication for a month I had extremely academic/esoteric blood testingdone to search for a causative factor. Turns out that I have a defect of my MTHRF-type II gene -- which my hematologist has never seen be clinically significant before. [I.E. insert here "Looks like those bilateral pulmonary emboli really were the result of dumb, bad luck...."] He & my cardiologist wanted me to go on a daily baby aspirin. So I tried that for a while but my stomach couldn't take it, and given my history of stomach problems-- well let's just say I wasn't feeling adventurous. Turns out that my bizarre body chemistry responds to Vitamin E as an anti-coagulant as well as or better than aspirin. So I've just gotten religious about remembering my Vit E daily & my stomach is much happier for it.

It was May of this year before I started to feel back to my "new normal," but through this process I've had some profound changes in my thinking:

I still tend to still be a perfectionist -- but I cut myself some slack. I work hard at being less judgmental and lots of those "little things", the daily irritations of life, are much easier to blow off than before.

In general, I spend a lot less time worrying about almost everything. Through all of this experience, I've managed to get back to work, made income as needed, been home for the family when needed, and stayed connected to my support network. It is the people in my life who matter the most and just about everything else has a way of working itself out with enough time & prayer. I continue to learn lessons on Trust....

I've learned to listen to my body, and when I'm tired -- I don't feel guilty about sleeping for 10-12 hours. The world has managed to get along just fine while I'm asleep. By the same token, I'm getting better at saying "no" and choosing to do what I "want to do" as opposed to what I "should do".

I've been reminded of the pure joy & devotion that living with dogs brings -- as well as a new appreciation for the destructiveness of bored puppies....

I am genuinely happy to be here & alive. I'm trying to spend more time "doing" & less time "thinking". I'm trying to focus on living in the moment and that has helped me be a happier person this year. As the opportunities arise, I am embracing them. For instance, the last time I went boogie-boarding was in 1999 -- until last week. That's when I taught Tab some of the finer points of boogie boarding while we were at Port A. I also took advantage of riding the Zip-lines in the mountains when we visited Utah. Not just once, but about 3 times in rapid succession. [Got a cool Flip video that I did on one of the rides. Truly the most fun I've had so far this year!!]

I am grateful for last August because it allowed me the opportunity to fine tune my priorities, and at 39 years old, I'm finally getting a grip on what I want my life to be.

 

So I am completely exhausted....

I saw 36 kids in clinic today. While I'm thrilled that I kept up, I cringe at the number because I personally feel that is too many to provide any modicum of quality care. I tried my best but this was essentially one of those "cattle-call" clinics and this is the way they run. My purpose in being there was to just see as many as possible and not to fix the system. But physically, I hurt. My feet hurt. My joints hurt from standing up 8 hours on a very hard floor. And I am tired from the 1.5 hours spent driving from home to clinic back to home.

But when it comes to my itty bitty practice -- well I enjoy the hour I spend with my patients & their parents. I feel some emotional satisfaction that I have really taken care of them when I ask "What else?" and Mom or Dad shrug and say "I think you answered everything." In my mind, that's how medicine should be. But time costs a premium. I charge $150 per house call. Once I've visited once, most parents realize that it's money very well spent.

But the kids I saw today -- yeah, not so much. My style of practice would clearly not be an option for them. I had one mom begging me to write a prescription for ibuprofen for her son (something that's over the counter, that most of us would go buy for $4) because she didn't have any money and she'd left her other bottle in the womens's shelter and it got taken. This family is on the state Medicaid plan and fortunately so. My writing that prescription today, probably saved the state a $200 ER bill for a trip in for fever that could be treated at home.

These are the people who are at the very last, of the very last, of the safety nets in the American health care system. NEWSFLASH: The System is seriously broken. If you think that this can't happen to you, let me introduce you to one of my family members who got hospitalized without insurance this past Spring -- and is a contributing member of society, holding down a steady job, but one without benefits....

If I hadn't had health insurance, then my little medical adventure down "Pulmonary Emboli Lane" would have cost me about $30,000, and still going because of all the follow-up I have to do. As I look through all the EOBs ("Explanation of benefits") that come daily in the mailbox, I experience mixed feelings of relief & disgust. Relief because I have the coverage & disgust for what I find on nearly every statement....

Nearly every charge has been "adjusted"[read a euphemism for "Insurance company decided to not pay the full value of services rendered & decided to pay what they wanted to pay."] This is analogous to if I went into the grocery store; loaded up with fruits, veggies, some nice steaks, and a really great cheesecake -- and then at the checkout register I told the clerk that "That's nice that the bill is $89.93 -- but I'm only going to pay $47.36 today. That's my offer. Take it or leave it." That's pretty much what the insurance companies do to doctors. And frankly, we're so happy to get anything, since most companies will abuse the system and drag out paying a claim to 90 to 120 days after the services were rendered. How many small businesses do you know that could continue to run, if their customers almost always paid them 90 to 120 days late; and only a fraction of the value of their service/product? I could go on & on & on about other games the insurance companies play, but in general, they get away with "It" so it just feels like futile whining.

NEWSFLASH #2: Most doctors know that the system is falling apart, and we really, really want to fix it-- but we want to practice medicine & take care of patients -- we don't want to have to become the politicians & business minds to find the solutions.  I belong to two large internet forums that are strictly physician only. To join one's credentials must be verified. Each group numbers 60,000 to 70,000+ physician-members. And let me tell you, there are some extremely heated discussions taking place on the state of health care, the state of the election, and which candidate really might find some solutions.

And so far, the main gist of most discussions boils down to:

1. We went into medicine to take care of patients.
2. We worked very hard to acquire the knowledge to do so. Many of us sacrificing the earning years of our 20's & 30's in order to be trained well. Not to mention the sacrifices of self & our families....
3. We graduate from medical school & residency usually $150,000 in debt, and we'd like to work in our fields long enough to pay that back.
4. In the real world, we spend more of our time fighting with insurance companies and bureaucracies than we do really taking care of patients, and then there are the days where we look at each patient with the question "Is this the one who will try to sue me and wreck everything that I've tried so hard to accomplish?"
5. We keep being asked to do more, work harder, see more patients, put in more hours -- and to do so for less & less money. Often times at amounts that do not meet our overhead.
6. The latest statistics are dismal. We're not generating enough primary care docs (Family Practice, Internal Medicine, Pediatrics, Ob/Gyn) to replace the ones who are retiring or opting out of medicine all together. In Texas alone, recent studies show that currently we're short by 5,000 docs NOW! Especially in primary care, and especially in rural areas. And if you think that your doctor hasn't thought about jumping ship & just leaving medicine all together -- well you'd be pretty darn surprised. One informal survey on one forum alone had a 70% response rate that if given the chance to just "walk away" these physicians would. Frankly, I consider it on a regular basis -- but I still have $150,000 hanging over my head, and I enjoy taking care of kids. I've just had to figure out some creative ways to balance my financial needs with my need for mental balance. Thus locum tenems & my small concierge practice. That being said, should I ever win the lotto, I'm outta' here!

I was asked this evening which candidate did I think had a better grasp on the health care situation. I can honestly say, "Neither!" As of yet, neither one has addressed doctors directly about what we'd like to see in an "ideal world" and frankly, I think that since doctors are going to be the ones expected to provide the health care, we should at least have some input into what the final picture will be. I sat down and read each candidate's plan in detail back during the primaries, and ultimately, either way costs will likely go up and care won't change substantially. I'm not impressed with either party and I have no idea whom I'm voting for -- But I will be voting. This issue, like the economy, is one that has been created over time, is extremely complicated, and can not be easily fixed. In all likelihood the situation will get much worse before it gets better.

That's my two cents worth. I'll get off my soapbox now and go toddle off to bed. Catch ya' on the flip side!

So I'm feeling a little discouraged tonight....

Honestly. Isn't it amazing how a great day can tank in seconds just based on something as simple as a phone call?

So at 16:30pm today, as I was finishing up charts at the urban clinic, I received a phonecall from the Locum tenens recruiter that had booked my job for the upscale suburban clinic that I was at last week. It was my second time to fill in there and other than I was working with a different nursing staff from the first week, and that the doc's spouse was around as the office manager, and that the office was about 25-30% busier than in March, I really didn't think that much was different.

Keep in mind that back in March, after I left, the feedback I got from my recruiter was akin to I "was the next best thing to locum tenens as sliced bread" based on the reviews that the doc gave to the recruiter. In fact Doc #1 acted as a reference for Doc #2 and clinched Doc #2's opinion that I was wanted to cover that rural clinic.

So imagine how I felt when the recruiter (same gal I've worked with the entire time) called this afternoon to let me know that she'd gotten a list of complaints from Doc #1's office about me.

Yeah. Sort of felt like a serious punch to the stomach, especially since I was my usual self both times. Practiced pediatrics the same way. Didn't change anything up....

The complaints really feel like picking at nits just to "nit-pick" and consisted of "I spent too much time with the patients," "that I was running an hour or more behind every day" [Really? You think so? Then why did you tell me everything was fine when I'd ask????] and that I wore jeans on Thursday & Friday. Considering that most of my patients had on shorts, t-shirts & flip-flops, I was generally over-dressed in jeans, closed-toe shoes, and sweater sets. But as much as I rationalize this "stuff", I still can't get over how hurt I feel. As I left on Friday, the staff was all telling me thank you for being so easy to work with, and for taking good care of the patients -- so really, I did not see this coming.

This kind of stuff has happened in the past in that to my face I'm told one line but then behind the scenes something completely different is at play. I guess that I just never really get used to the fact that people have their own agenda and they really don't care if & how they affect someone else when they decide to be hypocritical. And fundamentally -- that's what bothers me the most. That I haven't been dealt with fairly, and that I really am a WYSIWYG kind of person. [What you see is what you get....] If you ask my opinion, you'll get it. Depending on how long a day it's been, will determine that amount of filters it goes through first, and you may not like what I have to say, but I'm not going to lie and I'm also not going to try to obfuscate the truth either. So it really, really, really bothers me that someone or some two that I dealt with last week chose to make complaints about matters that they never discussed with me, or when I directly asked for feedback, they told me it "was all OK."

So because I feel threatened & on the defense, I just spent the past 1.5 hours drafting up an e-mail to the recruiter hitting all the highlights of our conversation earlier. I suppose it will be interesting to see how this all plays out over the next few days. But personally, my stomach has been tied up in knots, I have a migraine headache, and I've been on the verge of tears pretty much all evening.

And what so sad is how quickly one short 10 minute phone call toasted the "warm fuzzy feelings" that I had from three sets of patients at the urban clinic this am. One Mom & Dad want me to move to Fort Worth so that I can just stay there at the clinic and not drive 2 hours a day. Another Dad kept complimenting me that my Spanish really was very good from the visit I had with their infant. And lastly I'm 98% sure that I solved a terrible dermatology mystery for a 15 year old who was first seen last week & needed to follow up today.

So [Happy thoughts] + [phone call] = totally sucky evening....

Why I blog....

So a number of months ago, one of my cousins wrote to me with a few good questions. In trying to answer her questions, I got started really thinking about why and how I blog. What is my purpose? Why bother? And how do I write the way that I do? So allow me to be self-indulgent while I describe the gestalt for my TAME WORLD....

First, the question: Hey! I wanted to ask you something. Obviously I love reading your blog and really think that it keeps us in touch with one another. That's really why I started my blog.... I wonder, do you ever get s*** from people about what you post on your blog? ...Everyone thinks I should discontinue the blog but I really love having it. What to do?

And now my essay of an answer:

Tough call Kiddo. [editor's note: I tend to use "Kiddo" as an endearment for the people whom I really like/love. It's one of the few nicknames that my dad uses with me, so it makes me smile to use it myself. And interestingly enough, you don't have to be younger than me for me to call you Kiddo....]

When I first started my blog, my original intention was to have a single place that family & friends could stay up-to-date without me having to e-mail every single one of them. We were just getting ready for trip #1 to Russia and I knew that ultimately I wouldn't have time to e-mail absolutely everyone on a regular basis. And I was fairly worried about what, if any access I would have to my e-mail. So I was looking for something web-based that I could use to communicate. When I started I didn't know a darn thing about blogging. I had to read & re-read the help sections a number of times on Blogger just to get a post to actually publish. Now I can change text color & size & banners & photo widths, etc, etc, ad nauseum....

Next, I've always enjoyed writing for the sake of writing, and according to some people who read the stuff I put out there, some people do (amazingly) like what & how I write and seem to appreciate my somewhat sarcastic take on the world.

I cannot express in so many words, how I was mentally traumatized by my medical training. And I was at a fairly decent program (which I've never identified on the blog btw), but starting to write now about what I experienced then, is very cathartic for me. I'm finally getting a chance to "let go" of the negative emotions from that period of my life, so in that way my blog is "cheaper than therapy" for myself. It also turns out that people love to get a peek inside the head of doctors & see how we're trained to think. It's why medical dramas are the #1 genre of TV show.

I also truly love photography, and wanted a place where I could "show off" or share some of the amazing shots that I've gotten. And sometimes I put up the not-so-good photos, just because it's real. And now with some of my scrapbooking layouts it's like I have this gigantic virtual refrigerator door that I can display my artwork from.

Lastly, I wanted a central repository for me to track the events in my life. Amazingly enough, in just 18 months, the trials & tribulations of getting everything accomplished to get Tab home -- yeah, well the memory fades and re-reading what I've written brings it all back into clear focus. I also thought that since I usually do the journaling for my scrapbooking on the computer anyway, that sometimes just printing out a blog entry could save me time in the scrapping arena. [editor's note: Great in theory, not so true in execution....]

Generally, most people who read my blog tend to follow the "if you can't say something nice, don't say anything at all" principle. I'm sure that there are folks who don't agree with me, and were turned off by the photo of the 25 weeker preemie that I posted for instance. But what I do write, I try to have an overriding theme or story or message that I'm trying to get across. I focus on telling *my* stories from *my* perspective. I tend to write a lot about how I feel, my reactions to events, interesting stuff that happens, or the weird stuff that happens. Some days, I'm just trying to catch up on what all we've been up to and I usually say that up front, so that if someone doesn't want to read a tedious laundry list of my daily stuff, then they can skip it & try again tomorrow.

That being said, I do have some ground rules: I will use my, Michael's & Tab's names but I have not ever posted our last names. I have not posted our location. I refer to my friends & acquaintances by first initial only, and only occasionally use a full name if I have permission to do so. In the stories about other people or patients, I never name names and usually I change other details to maintain privacy. I do however adopt descriptive "nicknames" that I'll use if the person may become a reoccurring character. If I post a photo then no identifying name bands or markers are in the photo and usually I try to make sure that any identifying info is absent. I may write the stories of my patients, but it's from my perspective. Believe me, I've got some humdingers to tell if I could just figure out how to maintain the privacy. And I too, have honored requests to either not put in links to other people's blogs (i.e. one family's concerns regarding privacy for their adoption situation) or pictures.

Topic wise, you won't ever see anything about our sex life, our finances, or our arguments. [I know. You're so disappointed....] I think it's just rude to air dirty laundry in public -- and the one time I did when I posted a photo of the mess M & Tab made of the sink in "I live with Slobs...." I caught grief from Michael for a week afterwards. Lesson learned -- not a good idea. My rule of thumb before I hit the save & publish button is -- "Is there anything here that I wouldn't want my mother to know, or have reported to the State Board of Medical Examiners?"

There are in fact a number of entries I've written that are still in draft format because after I let them sit for a few hours, I've gone back and decided that the topic was either too personal to be on display, or inappropriate in some way, or just not interesting enough to be "blog-fodder". That's a personal choice. So far in two years of blogging, only once has Doug or Michael come to me and said I needed to edit a post after it had gone up. So I think that shows that I'm doing a pretty decent job of policing myself. And I think that it's funny that "blog-fodder" has now become a descriptive term in my family's vocabulary. As in, I'll start telling them about an event from that day, they'll stop me & tell me that I have some good "blog-fodder" that I should post.

The other "thing" that I do, is that I'm selective about who I give my blog address to. I don't announce to people whom I work with that I have a blog, and if I e-mail them then I erase the websites out of my signature. Friends & family were sent the address originally, and some folks have passed it on to other people they know, but for the most part you can't Google my name or my blog name and just "find me". I'm "unlisted" on type pad which means that they don't list me in their directory publicly.

I took a fast glance through your blog just now, and IMHO I didn't find anything that I thought was too "out there". I think that how you write on your blog is pretty much how you present yourself in real life. You're a forthright individual who "tells it like it is" or at least how you perceive it to be. Nothing wrong with that. I do the same. I'm not saying that you need to present a 100% rosy picture, because life is not that way; but you might need to strongly define what your boundaries are. And if you choose to write about something that might be misconstrued -- do so in as unbiased a way as possible. I actively try to write the way I think & speak. I have a large vocabulary & I like to use it. My medical training has taught me how to be very precise in my descriptions & choices of words, so I use that skill as well. If anything, I have a love affair with run-on sentences, semi-colons, ellipsis marks, italics and brackets.... What can I say? I'm a punctuation geek!

When I've surveyed the family about what they'd like to read more of on my blog, universally the Tab stories rank high. Photos are appreciated. Some of my medical stuff is entertaining. Some of my commentary is amusing. But the dry, listing of the day's events -- not so much. Grammar & spelling count too, so with that in mind, I usually proof what I post 2-3 times before it goes up, and then once more after it's already posted.

So there's my course on BLOG 101, for what it's worth. I have to say that now after 1.5 years with TypePad, it's well worth the $8/month to have a blog that is stable for posting photos & publishing posts (i.e. doesn't crash & take my writing with it.) Considering my scrapbook addiction, blogging is a very cheap hobby. And who knows? Maybe one day I'll have enough material that I can turn the whole kit & caboodle into a book....

One Little Word....

So after dinner out with one of my best buddies, Mrs. H, I came home & meant to just check my e-mail and then head to bed a bit early. The Canadian front has hit and the temperature is dropping, so snuggle time with my flannel sheets & down comforter sounded really good....

Naturally, it's an hour past that point, the e-mail has been checked and I just had to start catching up on some of my favorite scrapbooking blogs. I cruised by Ali Edward's blog tonight and there was this post from last week about the "One Little Word" challenge. I did this for 2007. What I mean to say, it that I chose a word for 2007. I didn't actually get around to doing anything craft-wise or scrap-wise to honor my word. But hey! I took the first step and my word for last year was HOPE. So when I saw the entry with the list of words, I decided to look for one for this year. I have to admit that HOPE really summed up 2007 well for me. It was something that as a concept I needed to focus on and restore in my life. And even though it is now 2008, part of me feels like I'm not quite ready to let go of that word and move on to the next. But in the spirit of a new year and time for a change, look though the list I did. Last year HOPE just lept off the page at me. This year, not so much. I had a short list of contenders. I really liked "be", but wanted something a little juicier. I liked "Clarity" and "Commit" but honestly wasn't really feeling like I wanted to work for either of those words. Maybe I needed to try another year of "Hope"? I really liked "Persistence" but wanted to shorten it to "Persist". And finally, I came across "Trust". So right now, I'm trusting that "Trust" is meant for this year's word. It just resonates with me more than the others.

So? What's your word for the year?