Sunday, August 30, 2009

Special day

Twenty years ago at 3:17 PM this afternoon a blessing of unbelievable proportion arrived. My eldest child was born. After a mere 27 hours of labor he arrived by Cesarian section, looking wide eyed and wary of this big world. His place in my life is always one of welcome. It is like a cool breeze on an August morning in Texas. The promise even better things to come.

These two decades have passed at warp speed for me especially where N's life is concerned. Parenting, though at times tough, is a position I love. I believe both of us would admit I have not always done it well. My role as a mother has given me a perspective on this life and beyond I could not have gotten anywhere else. I am most grateful for this role.

Yet, more than my role as a mother, I am grateful for this person, who he is, and who he is becoming. His big brown eyes still look at the world warily but often with excitement and awe. It is always a pleasure when our conversations gives me a new view and this is often.

Birthdays are special days for those who own them either by entering the world on that particular day or by being apart of that entrance.
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Thursday, August 27, 2009

On leaving private practice

For many years I believed the private practice of medicine was what I was meant to do. I had great difficulty leaving. Now almost three months after leaving my office for the final time, sitting here in the artifical light of labor and delivery for twenty-four hours at a time, reading this quote is a fitting summary of the past year.

"You can take from every experience what it has to offer you. And you cannot be defeated if you just keep taking one breath followed by another. " Oprah Winfrey

Still here, still breathing.
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Tuesday, August 25, 2009

Deposition Day

I had the privilege of being deposed today. I am not a party to the lawsuit - yet. My goal today was not to be. I am not sure I made it. Time will tell. It goes without saying that it was a difficult day.
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Sunday, August 23, 2009

Capitalism or socialism

I am not in the habit of copying an other's material but this excerpt from Fox News is too good to pass up:

Democrats, realizing the success of the President's "Cash For Clunkers" rebate program, have revamped a major portion of their National Health Care Plan.
President Obama, Speaker Pelosi, and Sen. Reed are expected to make this major announcement at a joint news conference later this week. It's called... "CASH FOR CODGERS" and it works like this: Couples wishing to access health care funds in order to pay for the delivery of a child will be required to turn in one old person.
The amount the government grants them will be fixed according to a sliding scale. Older and more prescription dependent codgers will garner the highest amounts. Special "Bonuses" will be paid for those submitting codgers in targeted groups, such as smokers, alcohol drinkers, persons 10 pounds over their government prescribed weight, and any member of the Republican Party. Smaller bonuses will be given for codgers who consume beef, soda, fried foods, potato chips, lattes, whole milk, dairy products, bacon, Brussels sprouts, or Girl Scout Cookies.
All codgers will be rendered totally useless via toxic injection. This will insure that they are not secretly resold or their body parts harvested to keep other codgers in repair.

All of this speaks to the broader issue which is now being debated in our country. I keep asking myself why it is not socialism to bailout banks, insurance companies, automobile manufacturers, and brokerage firms but it is socialism to offer government subsidized health care? The answer must have something to do with the recipients of the government monies. If they are rich the government is preserving capitalism. If the recipients are poor or struggling middle class it is socialism.
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Friday, August 21, 2009

"Denial ...

"Denial gets you no where." The first time I heard that phase I had just transected a patient's ureter (tube from the kidney to the bladder) in an effort to stop her exsangunation. For those not in medicine, transected means cut in two. Exsangination is, well, simply bleeding that will kill you. All the blood in the body is moving outside the circulatory system rapidly. Usually the patient's heart is beating about 180 times per minute, which is only slightly faster than the doctor's. Neither patient nor physician can sustain this kind of stress for very long.

"Denial gets you no where" has become a motto of sorts. I try see things as they are not as I hoped they would be. I don't expect events to occur as I would like without an effort on my part to effect a positive outcome. My eyes are wide open and in my new position it is a good thing.

An average day is going to contain at least one case of syphilis, one cocaine positive drug screen, and a multitude of teen pregnancies. It is also very likely someone will be bleeding enough to need a blood transfusion. If we (this job is a team effort) are lucky no one will die, everyone will getting treated appropriately, and we will move on to the next day with at least some optimism intact.
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Sunday, August 16, 2009

Dr. Seuss didn't tell me

The street is hot.

The ER is not.

The result for me:

More patients to see.

Yet, I recall

It will soon be fall.

Cooler days, football
Will clear the halls.

A break will be great.

'Cause a similar fate

In winter I will find

As temperatures decline.
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Tuesday, August 4, 2009


Names are interesting. Some patients spend months searching for the perfect one. Others choose the name of a beloved parent, grandparent, a favorite aunt, uncle or sibling. Then there are those who have to have the most original name they can imagine.

Today I have two new ones. Definitely the most original I have ever seen.

"Ra-a" pronounced "ra dash a" and "La-a" pronounced "la dash a."

The 17 year old mother told me, "The dash don't be silent."

This may be just the thing to end standardized testing. Either that or there will have to be a new bubble for the "-" to be included.
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Monday, August 3, 2009

Cost or compliance?

August is here.

It is early yet but so far one third of my deliveries this month have syphilis. Syphilis is cheap to diagnose and treat. All these are new cases. The state mandates testing at least three times in pregnancy and I have been able to get records on patient showing negative test results with in the past year.

It is, however, a difficult job to make sure these women are adequately treated since follow is required and most of them do not return unless they are sick or get pregnant again. It is even more difficult to get their sexual partners treated. That is where the health department comes in. Babies have to stay for 10 days of intravenous antibiotics.

The greatest obstacle in any health care system is patient compliance. If the patient will not take the medicine, follow the treatment plan, return for re-evaluation, even the best attempts at treatment are futile.

So, while the rest of the country is debating the cost of health care, those of us providing health care know compliance is key. We also know compliance is not always tied to cost.
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