Ghost

“You should fire her. “ Peter says on Friday morning as I get into the shower.

 

I hear his voice – clear as the water from the showerhead.  My shower is a telephone booth to the nether world.  Peter doesn’t seem ethereal or dead when I speak with him.  It feels like he is on the other side of the door without the apparition.  My brother-in-law did well in business and he gives me advice regularly about the small business I own.  I am the boss to ten employees and as the cliché goes – “it’s lonely at the top.”  Learning about all of the ins and outs of human resources has been on the job training.  I am ambivalent about dealing with Carla, an employee who has worked for me for two years.  “I’m not sure of my legal responsibilities as an employer.  She’s had several chances to change. Is that enough?” I respond.

 

The tension from the office has spilled over into home – another sign that something needs to change.  “I don’t know what to do.  I’ve talked to Carla three times and she only seems to get about ten percent of what I say each time.” I say as the water massages my tight neck muscles.  “Maybe I need to talk to her again, and tell her that she is responsible for keeping inventory in check again.”

 

“She’s really good at making up excuses and not taking any responsibility.  That’s alienating the other nine employees.” Peter challenges.  “She called Jim “her little man” in front of your client last week “

 

“I know. I know. Somehow, Jim doesn’t see it the way the rest of us do.”

 

Jim, my partner, didn’t seem to notice the comment, but the client and I did.  Somehow Carla has gotten the idea that now that she has been promoted to manager she can sit and wait for the work to come to her. Lately, I’ve seen her manage more of her own life – her husband’s vasectomy appointment, dentist appointment for her children, and grooming appointments for her two dogs and one cat.   Meanwhile the rest of us are running like crazy to get it all done.

 

“I feel like I am in some sort of life challenge.”

 

“Well, that sounds a bit melodramatic.”  Peter says. 

 

“I don’t think I can change her.  I’ve tried and it’s not working.” 

 

“I don’t think you can change Carla either, and you need to think about the other employees that she is making miserable.  Think about when Janice and Frank quit last month.  Don’t you think she had some role in that?  Are you willing to lose any more people?”  He says frankly.

 

“I need to let her go.  She has been a thorn in my side – arrogant, flirtatious, and loud.” I say.

 

Peter is silent now – I have no body language to read in this conversation. – no shrug, no eye roll, no head shake when I say something.  It’s time to stop waffling, and do something the silence says. 

 

I step out of the shower and quickly towel dry.  If I am going to remedy this situation, I’ll need to be in the office a little earlier than usual.

 

 “I can do this.”  I tell myself as I set my bag down in my office and take a deep breath.

 

“Carla,” I say, “can you step into my office, please.”

 

 

 

 

 

 

 

 

 

Losing My Religion

“You need to give those boys a chance to go to church.  Take one hour from your week to go.”  My mother-in-law admonishes my husband before she hangs up on him. 

“Where did that come from?”  I ask half-knowing.  We’ve been absent church members for a while now.  We have also never baptized our children which is another thorn in the side of my devout in-laws who attend the local Associate Reform Presbyterian church.

“I have no idea.”  States my husband who also half way knows what this is about.  “She wants to take Will and Harry to Sunday school and church tomorrow.”  We stew on the conversation for a few minutes.  I can tell my husband is pissed about being hung up on – given no chance to defend himself.  This well worn difference of opinion with my in-laws is like an itchy wool sweater I can’t take off. 

“Okay.”  I have never had a problem with my children attending church with another family member.  I am ambivalent about my role as religious educator for my own children, though.  Raised as a Roman Catholic with parochial school, nuns, priests, confession, purgatory, heaven, and hell, I am part of the 28% of American who have left their childhood religion according to the Pew Forum on Religion and Public Life survey released this past February.   I get downright ornery when well meaning family and friends try to pigeon hole me into a religion these days. 

I left Catholicism for a number of reasons.  Marriage was my primary reason.  I met and married a Presbyterian, but it’s more complicated than the blending of two families.   Catholicism has taken some big hits in my book with corrupt priests, pedophilia charges, and the unyielding all male hierarchy.  Not that other religions have fared better.  I have also left the Presbyterian Church I got married in. New leadership in that church turned our once accepting church into a dogmatic and evangelical place.    As a relative newcomer and reared in Catholic tradition, I was willing to learn, but I didn’t like being force-fed.   

“My ideas about religion don’t fit neatly into the box called church anymore.” I prod my husband who’s giving my mother-in-law the silent treatment as he tries to rationalize her behavior. 

Another in-law, Peter, my husband’s brother and ironically a Presbyterian turned Roman Catholic, is one of my spiritual catalysts.  He showed me that religious life is a journey not a destination.  Chronic illness only strengthened his daily resolve to continue on a trek towards understanding and inspiration largely through meditation.   When Peter died from HIV, he left me his Christian meditation library, and this has pushed my own door to other faiths and traditions wide open.  My search for common threads in all religious traditions continues.

 I have undergone a paradigm shift, and it continues to shift.   This process is like standing at the edge of the beach watching the tide bury my feet deeper and deeper in wet sand.   Because I don’t know where it will end, I don’t feel I can educate my children about religion or God.  I can only encourage them to go look.  Look for God wherever and whenever you want to.  I want to instill in my children that religion is very important, just like it is to the 60% of Americans in the Pew study, me and my husband.  I am fortunate to live in an era of religious freedom where I am able to pick a “flavor” or flavors without fear of reprisal or inquisition. 

So that leaves me with the question of how do I teach my children about their own journey.  Do I lead by example?  Do I invite them to a smorgasbord of traditions  - gefilte fish and matzoh @ Passover, Hindu deities, goddess rituals, nightly prayers, Christmas nativity scenes?  I am afraid that I am so caught up in my own journey that I fall short of showing my boys how to start or where to look. I still feel I have so much to learn.   I’ve tried to teach them some basic truths about life, love, and beyond.  Having integrity, doing the right thing, treating others with respect are paramount values in our household.  We also try not to lead such a harried life that we ignore the beauty that surrounds us or that just being quiet can bring answers to questions we send out to God.  How would David teach my boys about meditation?  Does giving them avenues to explore their creative talents in art, writing and music count in the journey to the divine?  Will they hear God if I turn off the PS2, ipod, TV, and computer?  Some of these questions are TBD .  The relatively short time I have to raise these children seems to be mostly devoted to molding them into functional human beings.  Maybe the God part comes next as adults.  Maybe they will teach me.

I’ve allowed my children to accept this challenge of religious freedom as they have accepted their grandmother’s invitation to attend their church fellowship whenever they choose.  I have made a tentative and unspoken truce with my mother in law.  I feel I have extended my open religious journey to my children as well because they have the opportunity to decide. 

 

How to Live in Harmony with Your Pediatrician

 

1.        Be prepared for your visits.  I love a list!  A parent that walks into a check-up has thought about that appointment ahead of time just like my staff and I go through the child’s medical information prior to walking into the exam room. A list of questions sets the agenda for the appointment.

2.       Let’s have a conversation.  I enjoy being asked medically related questions – even things that are controversial.  The to and fro of conversing with patients and parents is the highlight of my day. 

3.       Please remember your child is not my only patient.  There are times when emergencies or crazy, busy days occur when it is next to impossible for me to stay on time. If your child has an emergency, I will take all the time your child needs, too.

4.       Filling out forms, medicine refills and sports physicals are not emergencies.  Sometimes these things need to be planned for in advance.  Please ask what about office policies regarding these events. 

5.       Unblock your phone.  My staff and I spend a large amount of time on the phone – only to get an answering machine, a “we’re not accepting your call message”, or voice mail.  Give us a chance to relay information or answer questions by taking our call when we call back.

6.       Let us know if you’ve waited more than 30 minutes anywhere in the office.  You deserve an explanation about the wait time and we need to know you are here.  Please refrain from letting your children roam the halls (it may be a violation of another patient’s privacy) while you are waiting. 

7.       Doctors are humans, too. Sometimes we get sick.  Sometimes our children and family get sick, too. Your understanding is always appreciated as we try to balance our home and work lives.

8.       Being on call is not an easy part of our job.  Having a sick child at nighttime or over the weekend is not an easy thing for a parent, either.  We try to give the best advice possible over the telephone, but nothing beats a face to face visit.  There are times that I refer patients to the Emergency Department because a fresh mind can evaluate problems better than a tired, been on call for 48 hours mind.  Also, life at my house still goes on even when I carry my beeper.  My children still scrape their knees, the dog gets out of the yard, and I still get flat tires. 

9.       Stalking.  That’s a strong word, but that’s what it feels like when parents watch my every move either coming into the office from my car or shopping in the local discount store.  This typically happens when a parent walks into the office without an appointment and wants to be seen because they know I am here.  Sometimes I am here early to catch up on paperwork or phone calls.  Sometimes I am calling other physicians.  Sometimes I am trying to schedule my own dentist, doctor’s appointments.

10.   My feelings can be hurt, too.  Transferring without an explanation, not following the recommended plan, telling me I’m fat, pale, have yellow teeth.  I have pretty thick skin and children will say almost anything, but think before you make personal comments about me, my staff, or my family.

Father’s Day

Some favorite quotes about fathers.

“He who is taught to live upon little owes more to his father’s wisdom than he who has a great deal left him does to his father’s care.”  William Penn

“There are three stages of a man’s life:  He believes in Santa Claus, he doesn’t believe in Santa Claus, he is Santa Claus.”  Author unknown

“Good parents give their children Roots and Wings.  Roots where home is, wings to fly and exercise what’s been taught them.”  Jonas Salk

“The words that a father speaks to his children in the privacy of home are not heard by the world, but, as in whispering-galleries, they are clearly heard at the end and by posterity.”  Jean Paul Richter

“If you learn a single trick, Scout, you’ll get along a lot better with all kinds of folks.  You never really understand a person until you consider things from his point of view…Until you climb inside his skin and walk around in it.”  Atticus Finch in To Kill a Mockingbird by Harper Lee

Scholasticus terminus

I am borrowing KC’s epidemiologic outline for this newly described psychiatric condition:

Scholasticus terminus

Clinical manifestations:  Scholasticus terminus is a common disorder characterized by giddiness, peals of laughter, outbursts of giggling, uncontrollable activity including dancing, water play.  Affected patients are fatigue resistant until 11 pm, and can be difficult to arouse prior to 10 am. 

Etiology:  The cause is early dismissal from the last day of the school year.

Epidemiology:  Effects primarily children from 5 to 18 years of age in the late spring and early summer.  Can also affect those employed in schools, pre-schools, colleges and universities.  Spring Fever is a distantly related illness.  Parents suffer from scholasticus terminus anxiety disorder sometimes as a result of their children’s manifestations of Scholasticus terminus.

Diagnosis: Based on historical information only.  Noise level of the effected patient, level of activity, time of year can be helpful in making the diagnosis.   Ear to ear grin is common.

Treatment:  Enrollment in summer camp, vacations to the beach, mountains, relatives (although less effective) for 8 – 12 weeks prior to the onset of boredom officialis in the late summer.

Isolation:  Please, no. 

Ps of the week

 

 

This week has been full of them: parenthood, patienthood  (my own journey into the world of medicine), and pediatrics.  After six weeks of coughing with frequent nocturnal episodes, my husband surrendered me to a Pulmonologist who happens to be a friend.  In the meantime, I spiked a 103 fever – confirmed by husband and oldest son.  Early Monday morning I drag myself to friend doctor with pain in my right mid back. 

 

Frienddoc:  What’s going on?

 

Self:  Allergies, reflux, cough for 6 weeks, waking up at night

 

Frienddoc:  How bad is the reflux?

 

Self:  Bad.  A good night is 2 Tums.  Bad night is 4-6 cough cough

 

Frienddoc:  Have you tried a PPI?

 

Self:  Prevacid, Nexium, H2Blockers, too.  Worked for a while, but now they make me feel worse. Cough cough

 

Frienddoc:  How bad are the allergies?

 

Self:  Bad, 4 + to trees, grass  Cough cough cough

 

Frienddoc:  You have asthma? 

 

Self:  Maybe?  Ventolin helps. Inhaled Steroid helps some.

 

Frienddoc:  Here’s what we’ll do….More stomach meds including a GI cocktail (I’m liking the sound of this especially if it comes in a martini glass), newest leukotriene antagonizer, chest xray, cough med with codeine.

 

Self:  Don’t need it. Cough cough cough cough

 

Frienddoc:  Don’t need what?

 

Self:  Cough med with codeine – rather have something less potent

 

Frienddoc:  OK. I’ll call you this afternoon with the chest x-ray results.

 

Here’s where the Ps start.  Pneumonia in the right chest confirmed by Pulmonologist.  Prescribed big gun antibiotic to go with GI martini.  Pissed at myself for getting to this point where I have to become a patient and wondering what I could have done to prevent this.  Pissed at this annoying cough that I’m beginning to wonder if it is psychosomatic.  Try new cough medicine with pseudoephedrine – now I’m a meth junkie, too. Pseudofed has me so wired that I am writing this at 2 am in a sweat. Perimenopause or polypharmacy?  I’ll let you know after I go pee. 

 

 

 

 

Blister in the Sun

The patient was a prototypical tween girl. Over the beautiful, sunny, southern weekend, she attempted to tan her porcelain skin with little to no sunscreen.  The result was a beefy red sunburn over her shoulders and chest. On day 3, a large blister developed on her right shoulder and ruptured.  She came to me for burn care and a sunscreen lecture.

I am amazed at the number of people who still regularly tan.  Maybe it is because I live near a body of water that people feel the need to be brown in the summer (sometimes year round). Maybe it’s a southern thing.  Maybe there is conflicting information about harmful sun exposure and getting enough for vitamin D production.  Maybe putting sunscreen on daily is just an oily pain in the neck.

I debrided the blister on the shoulder of my patient – angry, wet, fragile skin beneath it weeped. My patient wept, too.  Cleaning burns is no fun.  it is preventative pain.  Taking off the gooey dead skin prevents further problems and jump starts the underlying skin to heal.  Looking over the rest of her shoulders I feared that she would loose the whole top layer of her skin all the way across her shoulders.  She was at risk for a big infection to go with the big burn, too. 

In the end, I didn’t need to lecture this young patient about skin care.  Her experience spoke volumes. I believe she will be diligent about sunscreen at least for the rest of this summer.  Next summer, who knows? Her follow-up visit revealed a nicely healing burn on the shoulder with intact skin over the rest of her shoulders.  I gave her the name of my favorite sunscreen, Mexoryl, and told her I would see her for a physical in the fall.