Thursday, June 23, 2016

Gross

So I pay a cleaning guy $80 every other week to clean our apartment. Lately, I feel like he's been doing not as good a job as he used to do. He probably spends less than two hours total cleaning our three-bedroom apartment. But this is one thing that kind of bothers me:

Every week, he does a load of towels in our washing machine. Not the laundry, mind you, just towels. So today I was putting clothes in the wash and I noticed the machine looked like this:



Obviously, he must have noticed that it looks so cruddy and chose not to clean it. Is this something I need to specifically ask him to do? Like, do I need to tell him each individual thing in my home that I want cleaned?

Monday, June 20, 2016

Muffins

About a year ago, I had an elderly patient who I will call Sally for HIPAA purposes. Sally suffered a pretty severe stroke and was very impaired. That’s not the funny part, obviously. Anyway, her husband Harry was a really sweet guy. Despite the fact that he was in his eighties and looked it, he visited her in rehab every single day. We all agreed he was one of the nicest family members we’d ever met.

In case you didn’t know this, if you want to suck up to the hospital staff, the best way to do it is to bring them free food. Either someone told Harry this tip, or maybe he was just raised right, because every single time he came in, he brought us food.

The first day he came in, he brought us three boxes of muffins from Dunkin Donuts. We were all elated. Muffins! In three different flavors! We were fighting over those muffins, diplomatically dividing them into quarters so everyone would get some muffin.

The second day he came in, he brought us… three boxes of muffins from Dunkin Donuts. We were still excited. Muffins. But they were somehow a little easier to distribute that day.

The third day he came in, he brought us… three boxes of muffins from Dunkin Donuts. Ugh, muffins. Suffice to say, we were all a little sick of giant muffins by then. I took a single muffin and brought it with me for my kids to snack on during the car ride home.

The fourth day he came in, he brought us… well, you get the idea.

Sally was a patient at our hospital for well over a month. Every day, Harry came in and brought us three boxes of muffins from Dunkin Donuts. By the end of the first week, we couldn’t even look at those muffins anymore. My kids begged me never to bring them muffins ever again as a snack. We felt bad throwing them away, so we just let the boxes and boxes of muffins accumulate in our back room. The room was being overtaken by these stupid muffins.

“We have to tell him,” a nurse said. “He can bring us anything but muffins. Bagels, donuts… whatever. Anything but muffins.”

We discussed the morality of the muffin situation. I mean, Harry was being nice by bringing us anything. How could we say to him, “Hey, your muffins suck. Bring us something better.” But at the same time, we felt bad he was spending time and money every day bringing us a present that we were basically just throwing away.

Eventually, Harry made the difficult decision to transfer Sally to a nursing home, because he couldn’t care for her on his own. Even though we were sad to see them go, we were a little relieved that there would be no more muffins. (Except for the chief attending, who inexplicably never got sick of the muffins, and was totally bummed that his supply would be coming to an end.)

Several months later, Harry dropped by our unit to say hello. A lot of times, former patients will come by just to say hello. But on this visit, Harry had some sad news to share with us: Sally had passed on.

He cried a few tears and we took turns hugging him and telling him how sorry we were. Then he flashed us a brave little smile, and showed us a large paper bag he had been holding. “I brought you all a little something,” he said.

It was four boxes of muffins.

But something amazing had happened. In the few months since Sally’s discharge, we had miraculously stopped being sick of muffins. So we were able to bring the boxes of muffins to the back room and enjoy eating them. Still teary-eyed over Sally’s death, we laughed about muffins one last time.

Thursday, June 16, 2016

Help with cover?

I've never loved the cover of my book Baby City. It looks cool as a paperback, but I never liked it as an ebook cover. So for that and other reasons, I decided to redesign the cover.

But we're having some issues. Kelley, my coauthor, and I can't seem to agree on what we like. So I recruited some other opinions, and there's a lot of disagreement there too. So I want to get a larger sample size. Please tell me which cover you like best... or suggest an alternative:

NUMBER ONE:



NUMBER TWO:



NUMBER THREE:



NUMBER FOUR:



I am horrible at making decisions, so please help me. I'll refrain from telling you my favorites. Note that I will actually buy the high resolution version of which image I choose.

To Yoga or Not to Yoga

I've been doing yoga classes for the last year or so, and I've been contemplating quitting.

I'm taking an hour and fifteen minute "relaxation yoga" class where we spend most of the class on the floor, doing vaguely sexual poses. I started taking it because I wanted to improve my flexibility and decrease my musculoskeletal pain. I'm not entirely sure if it's done those things. Maybe a little?

The thing is, I hate the class. I dread it every week. I don't enjoy it when I'm doing it. I occasionally injure myself in the class. During the meditation at the end, I am completely unable to turn my brain off. But at the same time, I feel like.... I don't know, maybe it's good for me. Maybe I should try harder. Sometimes I feel really good after the class.

I also do yoga during the week. I have the Yoga Studio app on my phone that one of you recommended. Maybe that's enough.

Wednesday, June 15, 2016

Please review

If you haven't already, please please PLEASE put up an Amazon review of my latest book, Brain Damage!!!!

Review it here!

Monday, June 13, 2016

The End of Your Life

I've mentioned before on here how frustrated I am that health insurance is willing to pay for things to prolong a person's life, but nothing that will improve their quality of life. This is an example I recently saw that made me really angry:

I was consulted on a woman in her eighties who had metastatic cancer. She had decided against further treatment, which the insurance would have covered. Unfortunately, her husband was nearly 90 and could not care for her at home, considering she couldn't do any of her ADLs without a lot of help.

However, even though the insurance would have paid for cancer treatment, they would not pay for her to go to a nursing home. They would not pay for the home care that she needed. Hospice services could not provide the care she needed. So the only option was for her elderly husband to deplete their life's savings to pay for her care, and have nothing for himself after she died.

I feel like there's something wrong with a system where this could happen.

Thursday, June 9, 2016

My doctor, the waitress

Me: "Is there anything else I can do for you?"

Patient: "Yes. Can you get me a ginger ale?"

Me: "Um. Okay."

Patient: "With ice."

Me: "Okay."

Patient: "But not TOO much ice."

I do spend a lot of time fetching drinks for patients. They ask for drinks and what am I supposed to say? No? Am I supposed to track down the nurse who is impossible to find and, in all honestly, busier than I am? It's easier to just fetch them their drink. I'm not some sort of diva who is above helping out with some menial tasks. It's just one of many jobs I do for patients that really don't require a medical degree or even a high school diploma.

To be honest, I sometimes feel guilty that I don't do more of the menial tasks. Sometimes I feel like we should all pitch in, and who am I to say I'm above it all?

Monday, June 6, 2016

Becca

Patient: "What did you say your name was?"

Me: "Dr. McFizz."

Patient: "Becca?"

Me: "No, Dr. McFizz."

Patient: "Becca."

Me: "No. It's Dr. McFizz. M-C-F-I-Z-Z."

Patient: "..."

Me: "Anyway, what did you want to ask me?"

Patient: "Well, Becca..."

Even though my last name isn't actually McFizz, I swear it doesn't sound anything like "Becca."

Thursday, June 2, 2016

May I please...

Recently, I made a post in Mothers in Medicine about Why I Fired My OB/GYN.

The reasons ran the gamut from a rude doctor to painful blood draws to ridiculously long waiting times for visits. But the straw that broke the camel's back happened about a year after I delivered. I was having my annual exam done by a male OB/GYN that I’d seen a few times before and liked well enough. After he finished the speculum exam and the bimanual exam, he said to me, “Now I’m going to do a rectovaginal exam.” And then two seconds later, he just DID it.

I’m sure somebody could present me with a body of literature on the importance of the rectovaginal exam. But I don’t care. He didn’t give me fair warning. He didn’t ask if it was okay. And it was certainly not something I ever expected, considering in my 15-odd years of annual exams, not one doctor ever deemed it necessary to perform. Plus he was a man.

I’m not saying I’m traumatized or anything. I’m not having recurrent nightmares over it. I wouldn’t report him. I mean, let’s be real here--rectal exams happen. But I didn’t like the way it happened, and I would never go see that doctor again. And since I hated the practice so much, it gave me the impetus to finally leave.

When I posted this to MiM, there were variable responses, but one in particular struck me from a recently retired physician:

The rectal examination is not ridiculous. It is not done just to detect rectal cancer but as a part of the overall evaluation of the pelvis. It allows a better feel of the uterus and ovaries and can detect conditions such as endometriosis in the septum between the vagina and rectum. In women who have had children, it allows an assessment of the muscular support of the pelvis, identifying defects in the muscles of the posterior pelvis.

I have found significant pelvic pathology, ranging from a pelvic kidney to ovarian tumors, during "routine pelvic exams" for women with no symptoms at all. Women with fibroids commonly have no symptoms. Serial exams can monitor for growth and direct the need for imaging.

Pap guidelines take into consideration many factors for an individual patient which result in a considerable fraction of the population who will not be well served by a five year screening interval.

In my practice, a patient coming in for her *annual* examination completely undressed, had her vital signs taken, thyroid, heart, lungs, breasts, and abdomen examined, and the pelvic exam, including the rectovaginal exam. I even did fundoscopic exams, finding some conditions justifying referral to an ophthalmologist.

The writer of this article was obviously already unhappy with her care. Her physician obviously had no idea she would object to the rectovaginal exam. Personally, I would have *expected* it to be done.

For goodness sake folks, if you do not understand a medical procedure of any kind, just ask. The gynecologist would have been happy to explain why he did the exam.

Fizzy, your "privates" were not "violated". Sheesh.


I think this is a perfect example of the difference between the way old school medicine was practiced versus now. For starters, saying "sheesh" and mocking me for having an exam performed that I did not consent for is not what I'd expect from a physician. You don't do whatever you want as a physician and say the patient can ask about it later. Hell, I ask permission before I even listen to heart and lungs!

I also maintain that the rectovaginal exam was NOT something I should have necessarily expected. But either way, I believe he should have asked.

Tuesday, May 31, 2016

Anatomy of a Brownie

Recently, I baked a tray of brownies. I put some on a plate for work, then left a few on a smaller plate to leave at home. My husband wandered into the kitchen while I was doing this.

Husband: "The ones you put on the plate for us to keep are all edge pieces!"

Me: "Right. Is that a problem?"

Husband: "The edge pieces aren't as good. They're not as chewy."

Me: "What are talking about??? The edge pieces are the best pieces!"

Husband: "I don't think you understand chocolate."

Me: "I don't think you understand chocolate."

I know I'm not alone on preferring the edge pieces. But I also once met a woman who told me that for years, when she made brownies, she actually threw away the edge pieces because she thought they were garbage. What a terrible, terrible waste!