The Lottery of Life: Have You Won?

“We’ve won the lottery of life,” I declared. 

It was a typical workday evening. Hubby and I were sitting eating leftovers reinvented into a beautiful southwestern salad: roasted veggies, corn, avocados, cheddar. The kids had finished their dinners- a pile of sliced honey ham for Babyboy, Pirate Booty dipped in a mango yogurt for Babygirl- and were playing what looked like “Lego/Matchbox car/Pony Adventure”. Both of our big cats lazed out, unmotivated, on the other end of our dining room table, having figured out that we were eating vegetarian. 

Hubby surveyed our domestic landscape and agreed: “I know, hon, I know. And I thank God every day.”

We have an understanding of how lucky we are… but not of why

Why us? Why do we get so much, and other families, every bit as deserving of a peaceful, loving life, get this:

Another bombing in Alleppo. This time, the reality of the experience for this family is starkly illustrated for us to witness. The family so like us, the kids so close in ages to ours, this boy who looks so much like Babyboy:


He’s quiet, dazed, and very likely in shock, as rescuers pull his siblings and parents out of the decimated building. 

Sometimes when I see an image like this I feel so guilty and helpless, my first instinct is to skip over it, and find something intellectually and emotionally easier to read. 

What can I do to help this boy? It’s both a question said with a shrug and with a purpose. I can’t do anything immediately material for him. But there’s a long list of  quality, vetted NGOs who would use my monetery donation to immediately help another boy like him. International Rescue Committee, Doctors Without Borders, Save The Children, International Red Cross, Oxfam… A fairly recent New York Times article reviewed these and more organizations doing good work for Syrian refugees. 

But right now, at the end of a busy, lovely August vacation weekend, I feel like the best thing I can do is again thank God for all that we have, and say a prayer for all those who are suffering. 

I’m adding a prayer: that we don’t forget how blessed we are. It’s easy to lose perspective, to gripe and complain about things that, in the grand scheme of things, are not significant. Fretting and stressing only creates negative energy that no one needs. 

When I start to get caught up in my own or someone else’s drama, I ask myself:

“Anyone shelling your home, trying to kill your children, rape you on a daily basis? Are you risking drowning to survive, suffering from thirst or starvation? Are you living in a tent with one outhouse per thousand people? Do you have minimal access to medical care? Wonder when your children will ever go to school again?”

Uh, no. None of the above. 

“Well, then:

Got love, a safe home, functional infrastructure (electricity, water, sewer, schools, emergency services), food on the table, decent healthcare, a comfortable life?”

Check, check, check… Got all that. 

“Alrighty then! You, ma’am, have won the lottery of life!”

After all, what good is winning the lottery, if you don’t realize it? 

I’m So Lucky I Get To Be a Nerd

glasses

The firstyear medical students are here! Today was the first day of the Interviewing and Communications Skills course that I co-teach. Last year, I wrote about how amazing this course is: Amazing that it exists (I never had a course like this) and amazing how practical it is (I found myself utilizing the techniques in my own clinic).

Our job is to review that week’s teaching materials with the students, locate appropriate patients for practice interviews from the wards, observe the interviews, read the writeups, and provide constructive criticism.

And man, our job is fun. I’ve missed running around the inpatient wards. Well, sort of. I don’t miss the late evenings and weekends spent rounding, especially as inpatient medicine continued diverging into its own complicated specialty, and keeping current felt like a Sisyphean task…

This setup is perfect. We seek to interview only patients who are awake, alert, and not in pain. Most are thrilled to consent to a twenty-minute interview. They’re bored or anxious, and hungry for some light, pleasant interaction, a welcome distraction from their surroundings.

Because I am not part of the patient’s care team, I cannot access their charts, so the patient’s history is only revealed through their responses to the student’s questions. Often, one has to ‘read between the lines’ to understand the underlying medical  pathology. Patients don’t always know, or they have their own explanatory model. It’s a mental exercise to interpret the actual hospital course without the ‘cheat sheet’ of the chart, the labs, the imaging…

Today we had lovely patients, all with fascinating stories. We saw and heard about conditions and treatments that I have not seen or heard about since my own training. Fournier’s gangrene (a can’t miss diagnosis!). Saddle pulmonary embolus (and they survived!). Enterocutaneous fistula (will it ever close?). I even went back to my desk and read up on some of these diagnoses, at the expense of doing other paperwork.

I’m in a wonderfully appropriate profession for nerds.

To Fly a Kite


It took a physician and an engineer two hours, twenty tries, and one lost kite before we succeeded. 

It was a prime beach day here in Kennebunkport, Maine. Goose Rocks Beach at low tide, a vast expanse of sparsely populated hard- pack sand, sunny and yet ocean breezy…. Perfect for kite- flying. 

But the two hawk- shaped kites required assembly, and as is often the case, lacked instructions. 

No problem. My uncle’s an engineer, and I’m a doctor. Surely we can figure this out in a jiffy…

The first few flyings, the pink hawk kite nose- dove repeatedly. Despite tweaking the angle of the string attachment and adding a tail, it persisted in attempting suicide.

Finally Uncle figured out that the wings needed to be tied in a “V” shape, with the smooth side facing down. And finally the wind pulled the pink hawk up with a triumphant and powerful lift… So powerful, the handle ripped out of his hand and the hawk flew down the beach. 

We sprinted after that thing for a half mile, until we saw it go down in the dunes. But a concerted search over coal- hot dry sand yielded nothing. The pink kite was gone. The kids cried. 

We applied our lessons learned to the green kite. After much cutting and reattaching of strings, we got the angles right,  and the green hawk lifted off! 

But the string hadn’t been anchored to the handle in the factory, and just as we achieved maximum height, this kite also went flying down the beach, right into someone’s multimillion- dollar beachfront home, lodging itself in a second- story balcony. 

We ran after it, of course, only to hesitate shyly on the perimeter of the fine landscaping. Dare we enter the yard and attempt to salvage the subject of all our efforts? 

Finally, we agreed that if the kids came along, our trespassing would be forgiven. We told them to look really sad if anyone yelled at us. 

The darn thing was caught between the railings pretty tight, so I ended up yanking the string and snapping it, so the kite fell to the ground. 

We grabbed it and ran, then tied the broken ends together. And, we flew it again. 

The green hawk kite remained in the air, happily floating and flapping, for at least an hour and a half. Everyone got to hold the handle. People strolling by complimented it and stopped to chat. We shared the whole saga over and over. 

We ended up having to reel it in and pack it up when we left. 

McGyver would have been proud. 

Case of the Week: Mumps

people_mumps
Clinical image from the CDC’s Public Health Image Library

Until this week, it had been a long time since I’d seen a case of the mumps. The last was in Central America over a decade ago. And until this week, I had never personally diagnosed a case.

I can’t go into clinical specifics, other than to say that despite the classic presentation of painful swelling of the salivary glands, mumps was not at the top of my list of possible diagnoses for my patient. After all, almost everyone is vaccinated nowadays, and we just don’t see it anymore.

But I sent the test anyways, and was shocked when the Health Department called: Positive.

So I’ve been reading up, and I’ve learned something: the mumps vaccine isn’t 100% protective. At best, two doses of the MMR (mumps, measles, and rubella) vaccine is 88% effective in preventing infection. This is, of course, better than nothing: an unvaccinated person is about nine times more likely to contract mumps than a vaccinated person. Still, outbreaks can and have occurred within highly vaccinated populations.

While mumps is rarely fatal, the complications that can occur are not pleasant: pancreatitis (inflammation of the pancreas causing abdominal pain, nausea and vomiting); orchitis (painful swelling of the testicle); mastitis (inflammation of the breasts); oophoritis (inflammation of the ovaries causing fever and pelvic pain); meningitis (inflammation of the spinal column causing fever, headache and a stiff neck); encephalitis (inflammation of the brain that can cause headaches and confusion, and can be quite serious).

I have to admit, until studying up on this case, I had never heard of oophoritis, and I know that most clinicians may not think of mumps at all when caring for a patient with acute pelvic pain. I wonder if some cases of mumps are simply missed.

So of course, now I’m sitting here wondering if I’ve seen mumps and missed the diagnosis, since it usually resolves on its own. And, I wonder if I’m percolating the mumps virus, and if I’m going to pass it on to my family…

The CDC has a very good, brief summary of mumps, as does the Mayo clinic. If you’re a nerd like me, you’ll enjoy reading and learning!

When You’ve Got the GI Bug and You Could Truly Care Less That Your Kids Are Painting The House


Ugh. We grilled chicken Thursday night, and realized some pieces were undercooked… It could have been that, or our trip the the Children’s Library earlier that day. Whatever the reason, I’ve had this low-grade temp and nausea thing going on since the wee hours of Friday. 

Following my own rule of “If you’re not throwin’, you better get goin'”, I dragged my sorry self to the train, found a seat, held my breath, and got through my clinic without anyone noticing that I felt like crap. 

I left early, and went to my mom’s to pick up the kids. Thank you mom for getting me Alka-seltzer and letting me collapse on a lounge chair for two hours. 

When I knew Hubby was on his way home, we packed it up and trucked over. He handled bath and bedtime, and I slept for fourteen hours. FOURTEEN HOURS. 

Now, he’s at a special Saturday media thing at the stadium (football season has started, my friends!) and I’m home with the kids. 

I feel pretty much the same as yesterday, but immensely thankful that A. I’m not on call and B. We have these huge bottles of Crayola Tempera washable paint. 

Hubby won’t be happy, but right now, these two have been completely and blissfully occupied, while I sit on my ass. 

Pretty colors, huh?

Healthy Stress- Busting

This was my first full week back at work after a glorious two- week vacation. It’s summer and the schedule’s been light, but there’s still lab results and paperwork to catch up with. And, we had the orientation for the first year medical  student interviewing and communications skills course I help teach. 

So when my Thursday home with the kids rolled around, I felt guilty. 

And, the news. Lord, the news. Horror after horror, heaps of hate and ignorance and violence, and I’m not only referring to the Republican National Convention. 

We protect our kids from the news nowadays. We also want to model for them how to manage stress and anxiety, how to clear the mind of noxious thoughts and negative emotions. They’re going to need those skills. 

And so we headed to a nearby bike trail for some scientifically sound, evidence- based, free and effective medical treatment. 

These kids blew me away. They are essentially novice bicyclists (these “real” bikes are brand- spanking new). It was 88 degrees and sunny, and they had never ridden bikes for more a few blocks. 

They biked a total of 4.5 miles! Midway, there’s a wonderful little watering hole, a fountain park for little ones to run through and cool off. They scooted joyfully in and out of water shoots laughing, so happy, rejuvenated. 

How I SO wanted to scoot through the shoots too (I ran alongside them as they rode). But just watching them,  I felt so much better, knowing we were doing the exactly right thing for a Thursday in July in the world today.