Conversation piece

I drove into work on a particularly chilly morning, as per usual, and parked in my assigned lot, which is no less than a mile from my building. I picked my way across the icy city streets and strategically landscaped walkways. Every morning and evening I am accompanied by hundreds of hospital staff doing exactly the same thing. But this morning, I was halted mid-trudge by a crowd gathered around a patch of those urban landscape evergreens. On a low bending branch was perched a very large red-tailed hawk, staring down a petrified squirrel in the bushes below. The hawk was at eye-height and completely ignoring the professionals in suits and scrubs snapping photos with their cell phones. His long tail feathers ruffled a bit in the wind, but he was rock-still, intent, and kind of frightening. The muscular heft of him, really surprisingly TALL, flexing and extending his scaly claws, biding his time… It stopped me and almost everyone in our workday tracks. Most of us onlookers were giddy, chatty, offering explanations and admirations, and actually making eye contact. But many folks marched right past, either with grim purposeful faces, or texting. I waited to get a spot up front so I could snap my phone photo, thinking of all the people in my life who would get a kick out of the story of the scary city hawk.

The Virginia

I had a temporary medical assistant that day. She checked in my patient Gina, and wrote the complaint “rash in the virginia area” on the vitals sheet for me. All day I had been noticing her interesting spelling on the vitals sheets, but this was pretty darned funny. How can any woman in the medical profession not know how to spell vagina? I thought. Gina herself was miserable. She is a college student, who was diagnosed and treated for Chlamydia twice last year. The first time, I told her that her boyfriend at college needed to get treated also. “I know, I know,” she had said. The second time, six months later, her gynecologist had treated her. The gynecologist and I had communicated, and realized that the college boyfriend was never treated before he and Gina started having sex again. Goodness. Anyways here she was with that rash in the Virginia area. “It’s so itchy, especially at night,” she said, “it’s driving me crazy. I’ve never had anything like this before.” It was an impressive rash, red welts with little pustules in the groins and under the armpits, and all criss-crossed with fresh deep scratches. I asked her if she was still with that same boyfriend. She laughed, “Oh no, that was ages and ages ago! I’m with someone new now.”

Companionship

Sherri S. came in for palpitations. She was agitated, tearful. “I think it’s stress…” she wrung her hands. Her nails were bitten to the quick. “It’s been a terrible year. I bought a house and I hate my neighbors, I have to commute now and I hate it, I gained fifteen pounds, and… Kitty died…” Here she put her face in her hands, fingers to her eyes as if to plug the tears, grimacing. I remembered I had seen her months earlier for grief, when her longtime pet companion died of cancer. Sherri had no close human ties; she was estranged from her family after decades of alcohol abuse. She has now been sober for eight years, but new connections did not come easily. “It may be stress, Sherri, but we should make sure,” and I outlined some tests that might be reassuring if they were negative. I added, “Have you thought about adopting a new cat?” She suddenly sat tall and exclaimed, “Oh! I didn’t tell you! The one bright spot in my life. Salvatore. I met him at the local animal shelter. He was this big, huge, orange tiger, almost too big for the cage. They said he’d been abused by some kids in a family. I knew he was the one for me right away.” Her hands went to her heart and she smiled. “He greets me at the door, he sleeps on my bed at night… Oh, he’s a prince!” Later, when I had to call Sherri with test results, her answering machine came on: “Hi, this is Sherri and Sal, we’re not in right now, please leave a message…”

AWOL

My patient Janet’s therapist sent me an e-mail: “Janet cancelled her appt w/me and texted that she won’t be back. Very concerning.” I realized that Janet had also cancelled her last appointment with me… She first came to me a year ago, for a physical exam. As soon as I had closed the door, introduced myself and asked her if there was anything in particular on her mind, she had dissolved into tears. “I drink every night, I drink a lot, and I can’t seem to make myself stop. My kids started asking me to please stop. And I can’t do it, even for them, I can’t do it, I’ve failed so many times… I need help.” I learned that she is highly educated, she has her own consulting business, a large home in a fancy suburb, two ace-student pre-teen kids, and a supportive husband. At that first visit I had outlined a plan, including outpatient rehab and Alcoholic Anonymous. She had declined. “I don’t want people to know. My business, my clients, if they knew…” She wanted a Pill. I steered her to individual therapy. Her therapist and I had been following her with staggered appointments for a year, trying to guide her to sobriety. She tried antidepressants, acupuncture. She managed to quit for one, two, tops three nights, then would binge. The past few months it became apparent that inpatient rehab would be more appropriate; she declined. “I’m not like other alcoholics. I can’t be in a room full of those people. It’s just not me.” Last month, she came to me with a plan to do a week-long “Detox Spa” in California. It was a holistic program aimed at “ridding your body of modern-day toxins” and had nothing to do with addiction. “This is not likely to help you,” I explained, as she deflated. “We’ve been playing with this for over a year now, Janet… Your alcoholism is a real problem for you, and you need real help.” And that was the last time I saw her.

Pinkie toe

This whirlwind of a patient was the last person scheduled. She was tall, well-dressed, and desperately in a hurry. She had scraped her left pinkie toe against a grate the weekend before, and had a small cut. The whole toe was now a painful pink sausage, and had been all week. “I work in finance, and it’s just so crazy, I didn’t have time to come in,” she explained, matter-of-factly, as if this was a completely sufficient explanation for ignoring a hot sausage toe. I explained to her that the toe was infected, and if it wasn’t treated, could be quite dangerous- she could develop blood poisoning, or gangrene. She explained that she had a ski trip planned and was leaving in exactly 1 hour. “I’ll do anything to be able to ski this weekend,’ she begged. “There’s no way I can get this foot into those boots tomorrow, unless you help me,” she added. She had a cellulitis, and ideally would soak her foot in Epsom salts every few hours, and then elevate her foot and heal while taking her antibiotics and taking it easy. But she wanted to ski. “Well,” I said, “at least take the antibiotics, and take lots and lots of Ibuprofen too.” She was in a rush. She wanted me to call the prescription in to a pharmacy in the ski town, but a search proved that there were no pharmacies in that town. We checked the nearest larger town, but those pharmacies closed well before she would be arriving. The closest CVS to me would probably take 3 hours to fill her script. So we decided to try the mom-and-pop pharmacy near my office.  At this point she was standing over me at my desk, trying to pace. I called the mom-and-pop pharmacist, who answered on the first ring, and I sheepishly asked if there was any chance he could rush-fill an antibiotic prescription for a patient who was leaving town in an hour. “I’ll have it filled in 10 minutes!” he boomed. He jovially took her information. The patient beamed. “THIS is how we get things done,” she stated, as she pulled on her coat.

Baby Blanket

My husband was traveling for work, and it was just me and Babyboy that evening. I was so glad to see him when I got home from work. Also because his Nana had fed and bathed him, and it was my job to simply enjoy him and put him to bed. He was a proper baby, smiley and playful, giggly and lovey. By 8 pm he was just starting to act a wee bit irritable, so I rocked him and gave him his warm milkie bottle. He fell asleep on me, and I let him just sleep there, feeling the length of him nestled in against the front of me. He in his fuzzy fleecy footy pajamas, and me in my sweats. Of course I had work to do: charting to catch up on, labs to check, emails to answer, writing projects to think about. But it was such a peaceful time, nuzzling into his puff of sparse hair and smelling his sweet baby shampoo-and-formula-and-maple-teething-cookie smell. And I thought a lot about  the choices we all make everyday, the choices that make us who we are.