When the doctor really f—– needs to see the doctor

That f — can mean many things… freaking, finally, or… other things.

I showed up at my primary care’s office yesterday waving the white flag. It was two weekends ago that Babygirl woke up with 102 degrees temp and exploding snot; it’s been ten days since Babyboy and I got it; it’s been ten days that I’ve been wheezing and coughing like an eighty-year-old-lifetime-four-pack-a-day-smoker.

I’ve continued to see patients in clinic, fever be damned. I’ve been escalating my own treatment to ridiculous levels.

Why?

Hey, this is what doctors are EXPECTED to do, what we are pushed to do throughout training, what we are admired and congratulated for as tough-as-nails, badass attendings.

No one wants us to cancel. Not the patients who will be massively inconvenienced, not the staff who will have to make all the calls to reschedule, not the department who will lose out on revenue, not me who will have to make up ALL those visits.

So last week, when I was feverish, chilled, woozy, congested, and COUGHING ALOT, naturally, as per normal ingrained doctor culture, I sucked it up and did my clinic.

I wore a mask some of the time, but not all the time… I made it through the week, and I saw ALL my patients.

But by last Friday, my breathing was so bad, I couldn’t make it through an encounter without leaving the room to use my Albuterol. My patients were reaching into their purses to give ME cough drops, and offering ME sips of their water. My nurse set me up with a neb mid-clinic, and that bought me some time; I got through the day and got home.

All weekend I was using my puffer waaaay too much: three, four puffs every two, three hours, including multiple awakenings overnight.

By Sunday my chest felt packed tight with steel wool. It HURT to breathe. And of course Hubby was traveling, at a conference, and it was storming snowing out, to boot. I was alone with the kids and I realized I needed a higher level of care.

So naturally, as per normal ingrained doctor AND MOTHER culture, I called my friend and colleague who very kindly called me in a course of oral steroids.

I took more than she prescribed (of course) and went to bed. Monday dawned and I felt 75% better.

But it started creeping back, the steel wool in the chest, the coughing spasms, the nighttime awakenings and desperate puffing…

So yesterday, I showed up at my Primary care’s office waving the white flag, and she put me through my paces. She pointed out several things: I had a fever. My oxygen saturation was abnormally low. I was using accessory muscle of breathing. I was wheezing. My peak flow was lower than normal.

I got a chest xray. A flu swab. A neb.

The flu swab came up positive. Influenza A.

We realized: I’d been seeing patients (and taking the train… and going to church…) while infected with Influenza A and coughing all over the place, spewing viral particles.

It’s been a bit of an Occupational Health disaster. We had to notify all the staff. They’re going to notify the patients. I had to notify my church. If people develop a febrile illness, they need to know that it might be flu. They can get tested, and can get Tamiflu. Or, they may want to take prophylactic Tamiflu.

What a mess.

Me? I’m on mega-high-dose steroids, nebs, inhalers, et cetera, and I feel great.

Dumb, and guilty, but great. Because I f—- f—- saw the f—- doctor.

Lesson learned.

Serendipities and Vicissitudes

I’ve been acutely aware that this blog has been sorely wanting of an updated post. But I’m struggling with what to write about, what to reflect upon… there’s just so much.
Yes, of course, the climactic followup of my last post: Hubby’s long trip to Houston with his dream team culminated in an improbable, impossible, yet absolutely definitive win, and he got to call it.
I witnessed this miraculous comeback (and career highlight) from our yogurt-stained, crumb-filled, Lego-littered sofa, by myself (unless you count the cats). We were under quarantine most of the weekend: Babygirl had had her twenty-four hour fever, and Babyboy and I were coming down with the same thing. Chills, aches, fever, cough: A mini-flu epidemic.
Even so, I threw myself into the game with everything I had: I swore and cursed and threw things when it looked like an inevitable loss, then cheered and whooped and jumped up and down when Hubby declared “It’s a touchdown! And a title!
Babygirl woke up and called out and insisted on coming down to see what all the fuss was about. She sat cuddled in my lap in her footie pajamas, and we watched the confetti and the speeches, until she fell back asleep.
But Monday morning is relentless, and I got everyone cleaned up and fed and dressed and out the door: Babygirl (who was reasonably healthy by then) to school and Babyboy (who was miserable) to Nana’s and myself (who was REALLY miserable) to work.
A cocktail of Aleve, phenylephrine, dextromethorphan, albuterol, various steroids, and a face mask got me through a thankfully light clinic afternoon. But Hubby’s flight was later than I had planned for, and no one would be home for the ridiculously huge grocery delivery I had ordered.
Nana to the rescue, as always: she scooped up the kids and swooped to our house in time to not only let the grocery guy in, but tip him, too. (Yes, we know, we owe Nana.)
I made it home, thanked Nana profusely, fed and watered the kids, got them upstairs and into the bath…. and all my drugs wore off. The chills, the aches, the fever, the cough… especially chills. Like a zombie, I went through the motions, pulling together whatever to get us through bedtime and into the next day….
Then Hubby walked in the door. I almost collapsed, with relief, with happiness… and illness. “I’m done!” I announced. “I’m done, I need to go to bed…” Which I did, and thankfully, the kids did as well, thrilled to have Daddy read the bedtime stories.
There’s been more ups and downs since:
Painful politics: Many of the political events of this week hit me hard, a sad/mad feeling that’s been fairly constant since, oh, November. The only good thing? A motivating, activating cadre of friends and colleagues who feel the same way.
The Parade: Hubby took Babygirl on the team’s Duckboat victory parade, with me checking the live feed on my exam room computer between patients, hoping to catch a glimpse of them. Babyboy was sick, but luckily, he hates parades, and so he didn’t seem to mind when Babygirl came home glowing and gloating about The Bestest Day Ever.
Endless Illness: My fever’s down, but the horrible hacking cough I had JUST beat last week is back and then some. I’m back on max inhalers (and praying on the train).
Blizzard: I thought a snow day would bring us the quiet time we needed to re-bond as a family, but we spent most of the day either trying to ignore or dealing with the fallout of multiple sibling dustups. Babyboy now has a gouge down his left cheek, and Babygirl needs her nails filed.
Family Crisis: Word came today that my cousin, a very experienced outdoorsman, has been missing in the Maine woods for some days. Today and tonight, with the snow and wind, we’ve said many prayers hoping that he’s holed up somewhere safe, and will march out when the sun’s up tomorrow.
Tomorrow: Hubby has spent most of this late evening shoveling and clearing the cars so I can leave extra-early and get to work on time. Very thankful! It’s supposed to be below zero around dawn. Not looking forward to it, but thankful nonetheless.
ser·en·dip·i·ty
ˌserənˈdipədē/
noun
plural noun: serendipities
  1. the occurrence and development of events by chance in a happy or beneficial way.
vi·cis·si·tude
vəˈsisəˌt(y)o͞od/
noun
plural noun: vicissitudes
  1. a change of circumstances or fortune, typically one that is unwelcome or unpleasant.

A Voice of Integrity

There should be some sort of recognition for those successful people who came by their good fortune by honest means. After all, that is the American Dream. Hard work, conviction, and persistence should be rewarded with career advancement and achievement, right?

Too often that is not the case. Nowadays, the world is abound with rich and famous folks who flagrantly trounced upon basic societal mores and ethical standards, all the way to the penthouse… as well as the White house, for that matter. Drama and deception is portrayed as the norm on TV… and in our government.

It’s heartening and refreshing to see “one of the good guys” make it big. So much so, that we need to shout it from the rooftops, tell our kids, pass it on… it’s big news, especially nowadays:

You can keep your integrity, your word, your soul and still make it to the top.

That’s why I want to call attention to one of the best people I know: my Hubby, Bob Socci, who’s now living a sports broadcaster’s dream, and deserves to enjoy every second of it.

I’m slightly biased, of course, but trust me on this one. Here’s a guy who spent over three decades toiling away in relative obscurity, with no clear path upwards and no guarantee of any success. Here’s a man who often saw gossip, betrayals, and shady behind-the-scenes maneuvering rewarded with promotion, but never resorted to that crap himself. Here’s a total sports nerd who carted around a library’s worth of sports history and nonfiction books wherever he moved to work with whatever team, constantly reading and studying for some unknown but monumentally important test.

Football, basketball, baseball, lacrosse… Days bouncing along dusty midwest roads in a converted yellow schoolbus, sharing rooms in roachy roadside motels; nights spent in small towns out west, knowing not a soul… He moved from contract to contract, stringing together a living, no benefits and no vacations, for literally, decades. Slowly, slowly, the buses came with reclining seats and movies; then there were chartered planes, his own hotel room, comped meals… But still no guarantees.

Hubby strived to surround himself with colleagues of equal caliber, holding on to positions at the Naval Academy for sixteen years, proudly calling Patriot League basketball and Navy football games, while also covering AAA baseball for the Norfolk Tides, and any other work he could find.

I dragged him up North so I could take my current job at Massachusetts General Hospital and we could be close to my family, and here he re-established himself. Bob Costas had advised: “Politely but persistently knock on all the doors,” and so he did, and always with great humility (probably too much).

Ongoing relentless travel and calling all sorts of games, endless painstaking hours spent making audition CDs, and much tentative door-knocking resulted in the right ears hearing the right calls at the right time. First, from a field of God knows how many hundreds of hopefuls, Hubby was pulled to call the Pawsox (Red Sox AAA team) games, but for only half a season.

Then, legendary Patriots play-by-play announcer Gil Santos retired, and with that announcement came a rare opening for a long-shot, career-pinnacle position.

The decades of study matched by hard-earned experience, plus his well-established integrity and uncommon work ethic, put Hubby at the top of the short list for the job. The rest is history: four years, to be exact.

Right now, he’s in Houston, about to call his second Super Bowl. I’m so proud of him, I’m so glad that he’s a role model for our children, and I want everyone to know:

Sometimes, the good guys win.

img_8109
Babyboy and Hubby in the broadcast booth at Gillette Stadium, 2016

A Miraculous Cure for a Cough?

I’ve been coughing for three weeks now, gross gacking fits productive of thick wads and plugs of mucous.

Lovely.

It’s a combo of postnasal drip and reactive airways, a cough triggered from above and below. I’ve learned that I better stay on top of the decongestants and inhalers, or it’s going to get ugly. The day I forgot to use my Symbicort before work, I muddled through my clinic with my rescue inhaler (always on me) and a ton of cough drops.

That didn’t save me on the train ride home, which is where I DREAD having nasty coughing attacks. So, of course, that’s where I had a nasty coughing attack, and, of course, the outbound car was packed with exhausted, irritable commuters.

I could feel it coming and I tried to breathe shallowly, swallow it back, clear my throat…

No use. I erupted into violent hacking, face flaming, tears streaming, boogers dripping, every breath IN a horrible high-pitched WHOOOP and every cough OUT spewing spit and particles. I started sweating under my down coat, the prickly heat making things worse, so I frantically unwound and pulled off my scarf, unzipped a bit so I could BREATHE. I was bent double, still coughing in forceful spasms, on and on and on…

Let’s admit it, it was the kind of wracking heaving cough where the TOP priority is on maintaining continence of urine and flatus.

Which I managed to do, but still. I was jammed in between two young, healthy, HORRIFIED businesspeople. Everyone stared and tried to move just a little bit further away.

The attack continued and I tried, best I could, to locate my stupid Albuterol inhaler in my purse, while simultaneously (and desperately) holding in the contents of my bladder and rectum. It’s like trying to pat your head while rubbing your belly, under duress.

One of the businessmen finally asked “Are you OK, can I help?”

I almost handed him my bag with the intention of croaking out Inhaler… Must… Find…Inhaler

But then he said “If you need me to, I can stop the train. Do you need me to stop the train?” and I was thinking, Does this guy think he’s Superman or something?

Then I realized he was pointing to the lever behind a little plexiglass door that says “PULL IN CASE OF EMERGENCY” above his head.

Oh, dear. I shook my head NO NO NO and dove deeper into my oversized purse that’s cluttered with kleenex and baby wipes and hair clips and HERE IT IS THANK GOD and I stuck that inhaler in my mouth and sucked in one, two, three, Hey, why not four? puffs for good measure.

Even though the fit subsided almost immediately, passengers were even more horrified, and the guy persisted: “Just let me know if you need me to stop the train, okay?”

I kept thinking What good is that going to do, buddy? After all, we were on the long stretch of a few miles between stops, where the tracks sit directly above a shallow bay, just silty sand and salt marsh. No roads. No ambulance would have been able to reach us.

I nodded. smiled weakly and quietly apologized but mostly tried not to talk or move or do anything that might trigger another fit.

When I got home and told the story, someone suggested: “Maybe he wanted to throw you off the train!” and we all laughed. “Yeah, that would REALLY cure the coughing. A miracle!”

I will never forget to use my steroid-and-long-acting-beta-agonist inhaler before work again, but to this moment, I am still wondering:

What would have happened if that guy had pulled the lever?

 

 

 

Quality American Civics Lesson

“Mama, this is a very pretty march! So many people are wearing pink, and so many signs are pink, and even have kitties on them!”

So observed my five-year-old girlie-girl daughter yesterday, Saturday, January 21st.

There were marches in support of women’s rights (and everyone’s rights) all over the world yesterday, and one of the largest was right here in Boston. The organizers had planned for about 25,000 demonstrators on the Common; they ended up with 175,000. According to the Boston police, there has never been such a huge gathering here.

We’re proudly left-wing liberal, social-justice-oriented Christian folks, and we’re raising our kids as such. Not to mention, I’m a primary care physician with a focus on women’s health, and a working mom to boot. Of course I was going to march, and naturally, I planned on bringing both our kids.

You know you’re in the right community when multiple members from all your domains- family, friends, church, work- share the same passion and resolve. Every place I frequented last week was filled with planning chatter: people organizing their travel to Washington D.C., sending emails and texts arranging meeting points for one of the other marches, figuring out if/ how they would bring their kids. Or, if they were unable to travel, discussing how they could throw their support behind the cause: calling and emailing representatives, signing petitions, making donations. (Hubby had to work Saturday, and so spent some of his downtime pestering the Secretary of Education nominee hearing committee members.)

At home, we’ve been emphasizing the concepts of equality, justice, and human rights. We live free in a wonderful colorful collage of a country, and we want our kids to understand that. It is an amazing and precious thing that we, the people, can gather and demonstrate, speak our minds, disagree, argue, and write about it, make videos, carry signs and yell about it… They need to know how important it is to keep it that way. The kids picked slogans, penciled in big letter outlines, then colored their signs. They were so proud.

Babyboy has been sick, and the turnout was projected to be quite large, so Nana offered to take him for the day. He doesn’t do well in crowds, even at his best. But Babygirl was charged up, announcing to everyone we ran into that we were headed to the Big March.

So I didn’t stress about all the pink pussy-themed signage. After all, Babygirl can’t read that well, yet. Let her think it’s all about her favorite color, and kitty cats. Yes, the crowds were massive, and at points we were so many people so packed tight shoulder-to-shoulder that I was afraid she would get stepped on, and I had to carry her. I shlepped this kid up the endless steps from Park Street to the Common.

Later, when she fell asleep, my aunt and I took turns cradling her 38 pounds in our arms, as we waited, and waited, for the actual walking part of the march. Except the route was completely filled in with marchers, and no one could move. After a couple of hours we made a break for the side streets, Babygirl woke up, and we got ice cream.

It was a beautiful day; this is a beautiful country.

“Love Trumps Hate” and then, backwards: “Yes Love” and “No Trump”. Why backwards? She explained: “If I see myself in a mirror, I’ll be able to read what it says.”

Heroic parenting win or just a huge pain in the ass?

My five-year-old daughter shoplifted today.

It’s a January Saturday. I’m feeling crappy and need to puff my inhaler every four hours or I get nasty coughing fits, but I keep forgetting. Hubby has a huge game so it was just me and the kids for a matinee movie, Cub Scouts, the hardware store, and the grocery.

It’s freezing out and I’m admittedly dragging. Hubby hung around this morning because he thought I would want to get in my Saturday morning run, the four- or five-mile loop that is my precious weekly “me-time”.

But today, I passed. My large airways are full of slime and my bronchioles are twitchy. I just needed to get through the day, thanks.

I had promised Babyboy last week that if he was good with school dropoffs and homeworks, we would see this movie as soon as it came out, and so, there we were in the front row for Monster Trucks. The kids always insist on sitting in the very front row for everything. Thank goodness the seats reclined. The movie was perfect for five-through-seven-year-olds, and so, it was a hit with the kids.

Cub Scouts was also a hit: they’re making wooden race cars. Today was carving and sanding, next step is painting. So when we swung by the hardware store, we made sure to pick up acrylic paints.

Our local hardware store has a gumball machine. I hate gumballs. All I can think is “choking hazard”. But the kids love turning the quarter and watching the primary color deathballs spiral down this kinetic sculpture-type contraption, and so, they got gumballs. And me hovering over them demanding that they chew.

At the checkout, Babygirl begged, begged, BEGGED for one of those fancy lollipops, you know, the big round ones with gourmet flavors like “strawberries and cream” that cost two dollars. I said no, reminding her that she’d already had a gumball. Plus, I will not pay two dollars for a lollipop.

I paid for the paints and other stuff and we were on to the last (finally) errand.  I was getting tired of being sick and out and about in the cold, navigating streets and parking lots, getting into the car, buckling buckles over winter coats, getting out of the car, unbuckling the buckles, navigating more streets and more parking lots….

We pulled up to the grocery store and found a decent parking spot, a feat considering the playoff game tonight. I grabbed my purse and just happened to glance down into it.

There it was.

A big round “strawberries and cream” lollipop.

I picked it up and stared at it.

“Where did this come from?” I asked Babygirl.

She was silent.

“Honey, did you take this from the hardware store? Did you slip this into my purse?”

Pause. Then, matter-of-factly: “Yeah. I wanted it.”

Pause. “Honey! We did not pay for this! You can’t just take something without paying for it!”

Her: “But I really wanted it! I really, really wanted a lollipop.”

We were still sitting in the car. I was beat, spent, ill.

The right thing to do, the correct parenting/ teaching/ discipline thing to do, would be to drive all the way back to the hardware store and make her return the goddamned lollipop.

But it would be so, so easy to just confiscate the goods and impose some other punishment.

As we sat there, I had a flashback to forty-odd years ago, and a Rubik’s cube keychain.

I must have been six years old, and I was with my mom. We were in the toy store for some reason. I saw this adorable miniature-but-fully-functional Rubik’s cube on a keychain, and I had to have it.

I begged and begged. But the answer was no.

Of course the cube found its way into my pocket, and of course my mother found it when we got home.

She made me return it.

It must have been a huge pain in the ass to drive back to the mall and walk all the way to the toy store, especially because I’m pretty sure I sobbed, negotiated, and begged for mercy the whole time.

But eventually, I did meekly approach the counter and hand the precious item to the store clerk with a lame admission of guilt: “Um, I accidentally took this. Sorry.”

The clerk was an older lady who gave me a most disapproving look and said (I will never forget): “You know, I could call the police right now.”

Looking back, I’m sure this was a wink-wink effort to reinforce the lesson and be helpful to my mom.

But oh jeez, I was HORRIFIED. Humiliated, contrite, and HORRIFIED.

It was a lesson that stuck, and that probably informs my character today. Totally the right thing to do.

And so, back to the present, and the grocery parking lot. The key went into the ignition, and back to the hardware store we drove. On the way, I explained: “That was stealing, and it is wrong. You need to learn a lesson. You will return the lollipop, and you will apologize. It is not a choice.”

Babygirl kept asking, “Can we just pay for it? Because I really want it.” Babyboy kept asking, “Can I just stay in the car? I already know this lesson.” When we got to the door, Babygirl stopped short and refused to go any further, breaking down into tears, sobbing, “I’m scared! I’m scared!”

This is where things went a little less smoothly from a discipline/ lesson standpoint. The hardware store is a small one, and always busy. People were trying to get in and out of the doorway, and I had this obstinate little sobbing mule-child right in the middle of it.

So I picked her up and carried her to the counter.

The lady who had checked us out was gone, and there were two young men working the registers. There was a line of people, alot of activity. I thought we could catch the eye of one of the clerks and get this overwith without waiting, but after an awkward few minutes with me sending the telepathic message Do you seriously not see us standing here, Bub? we ended up in line.

When it was our turn, the freckled kid greeted us with a smile and asked, “How can I help you?”

I nudged Babygirl, who buried her head in my neck.

I cleared my throat and turned so she couldn’t avoid seeing him, but she shmooshed her face farther into my down coat, murmuring “I’m scared! I’m scared!”

Acutely aware of the shuffling and sniffing shoppers behind us, I snatched the lollipop from her sweaty grip and handed it to the guy, explaining: “She took this without paying, and we’re returning it.”

Babyboy, ever trying to be helpful, chimed in: “She stole it, and she’s learning a lesson. I already know it. I don’t steal things.”

The clerk cracked up. I swear he was about to say, Oh, that’s OK, no big deal, she can have the lollipop, but I knew I would scream if he did, so I cut him off with a curt Thank you and we headed back to the car.

We got through the grocery store and then (thankfully) home. Tonight, I tried to reflect with her:

“Honey, what did you learn today? The whole lollipop thing?”

She was quiet for a bit. Then she said, without looking up: “I never did apologize.”

I thought about this. “You’re right, you did not. I did it for you because people were waiting.” I didn’t know if she was sad that she didn’t apologize, or pleased that she managed to she save face. “If it happens again, honey, you will apologize. Is that clear?”

She nodded. “Yup.”

In the end, I’m not sure if this was a heroic parenting win, or just a huge pain in the ass.

 

Primary Care Specialist

A physician colleague posted about what being a primary care doc means to her. I read this on my morning commute, and was moved to tears. Though I’m internal medicine and she’s family practice, how she describes all the different types of little things we do every day resonates with me.

She granted me permission to share:

“I am a full scope Family Medicine Doctor. By choice. It is challenging. And frustrating. And wonderful. I AM A SPECIALIST! Every day, I try to master my skill. My skill is Empathy. My skill is Listening. Compassion. Providing reassurance. Knowing when to be concerned. Knowing when I need help interpreting labs, and when I don’t. Knowing when to refer. Sometimes that is when a patient demands it, even if I know they will be told the same thing. Knowing how to work the system, knowing how to get the worrisome ones into another specialty quickly when needed. Knowing how to wade through insurance forms and the magic words to get necessary physical therapy covered. And MY GOD getting your new wheelchair that you’ve needed since you were a child COVERED even if I have to send the forms in 3 times. My specialty is knowing how your mom’s alcoholism affects your anxiety, because you are both my patients. Knowing that you need reassurance about your cold symptoms because your 20 year old sister died of a PE. Knowing that today Mr X needs to be hospitalized because he is beyond his “normal” shortness of breath. I am a specialist at keeping people OUT of the hospital too. Even if I have to see you weekly for a month. Knowing when my normal healthy pregnancy turns into something more. Knowing when it is time to stop treating grandma’s cancer, or heart failure, or dementia. I am a specialist in humanity, and emotion. Disease and death. Living and living well. Every. Day. It is a privilege. To all my PCP momma docs out there…you are awesome at your specialty! Don’t let anyone tell you otherwise! You are valuable! You do the job others don’t want to do, because it is HARD! Keep your head up! You are AWESOME!”