More healthcare haiku December 22, 2008

So full of sugar,

Increasing visceral fat–

Thanks, christmas cookies!

Complaint: stomach pain.

Doctor thought “Patient’s crazy.”

Nope, she has gallstones!

Top 10 Reasons to Practice in a Boring Area December 19, 2008

Despite the family stress, my recent trip left me homesick for the big cities of the opposite coast. At times, my decision to do idealistic work in an underserved, crumbling city seems like the nail in a coffin labeled “BORING.” To cheer myself up, I’ve been compiling a list of the top reasons to practice health care in an economically depressed, small city.

1. Traffic moves along at 60mph during “rush hour” on the freeway
2. I get to be known as a sassy dresser, by virtue of wearing clothes I didn’t buy at the local mall
3. Never have to parallel park in a tight space again!
4. Don’t worry about hitting someone or something backing out of your driveway–there’s never any traffic on your street
5. There’s still beauty to be found in the rolling hills and old farms outside of the city
6. Apples…lots of local apples in the Fall
7. I get to be the crazy, out-of-the-closet queer in the office!
8. 2-bedroom house with large yard for rock bottom price!
9. Local airport check-in time: 15 minutes from ticket counter to gate
10. Lots of patient appreciation

Attention Sherwin Williams… December 17, 2008

…I’ve got some ideas. But first, a little story.

Recently the other NPs and I moved down the hall, to a new office. Our previous office was painted a lovely warm color, which made its cell-like accommodations a little more bearable. Our new office was white. Our supervisor asked us if we would like to have our new office painted. “How sweet,” we thought, “how surprising!” As a group, we decided on a nice, soothing-but-fun color. We informed our supervisor. We looked forward to the new, soothing-but-fun cell-like accommodations. We returned to the office one morning and found it painted…beige. Apparently, our supervisor called the maintenance supervisor and told him to override our request! She thought “it would take too long, and you all will never be able to decide on a shade anyway.” So she thought she would just speed up the process and choose a color herself. Beige?!? WTF? Nothing says “trapped in a small, windowless office in a bureaucratic system” like beige.

My coworkers and I spent some time trying to guess the name of the new color. Suggestions included “Mussolini Mist,” “Dry bones,” “Reform school,” “Psychiatric ward,” “Dusky dictatorship” and “Bland.” I like “Reform School,” but “Bland” has a certain elegant simplicity, too, doesn’t it?

Family–we DONT put the fun in dysfunctional December 14, 2008

This week, a family emergency necessitated an unplanned trip home. Spurred by stress, my mother was in rare anxious, nagging form. This sounds like your average “my mother drives me crazy” story, but my mother really drives me crazy because she is crazy. Not “put bells on your doorknob so the neighbors can’t sneak in” crazy (like some of my patients), but crazy nonetheless. My mother has Generalized Anxiety Disorder, Major Depression, chronic pain and a personality disorder. For my entire adult life, almost every conversation with her has included a discussion about her pain and/or depression. She has gone through more than 15 years of psychotherapy, over 10 years of pharmacotherapy, 2 partial hospitalization programs and several friends and acquaintances who couldn’t deal with her anymore. And the sad thing is, I don’t see many changes. I’m writing about this not only because I need to vent (and after a few days with family, I do need to vent!), but also because I can speak firsthand about the effects that chronic illness can have on a family. It is not fun. It is soooo not fun.

There has never been a time when my mother was perfectly healthy. During my childhood, the problem was constant headaches, back pain and insomnia. Luckily for me, the depression was less severe. As I left for college, things got worse. My mother’s job was lost due to depression. The house got dirtier. Mom stayed in bed at all hours. There was an awkward episode involving my mother sobbing to me that she wished she were dead. Then, partial hospitalization #1. There was some improvement after that. There was also a scary event when my mother’s meds interacted and she fell down a flight of stairs, hallucinating. In the intervening 10 years, there have been peaks and valleys of the depression. Mostly valleys, though. And through it all, her personality disorder makes it very difficulty to be empathetic.

I came to realize that serious depression causes a certain navel-gazing narcissism. It’s hard to be a good parent, friend or partner when all you can think about is how miserable you feel. And if you’re the friend or family, it’s hard to remain supportive upon hearing the 5,000th variation of “My life sucks.” I spent a lot of time dealing with the uncomfortable combination of anger and pity. Compassion is something that’s easier for me to give to my patients than to my own mother, as sad as that is. And there are other emotions that wait beneath the surface: jealousy, grief and anger. And worst of all, the sneaking suspicion that part of me may feel relieved when she dies. These emotions aren’t pretty. Though I am sure I’m not alone in my feelings, they’re not the type of thing I drag out at a cocktail party, either. (“Gosh, your family member has a mental illness? OMG! Mine too! Do you ever feel like smothering them with a pillow when they start to complain? No? How about slapping them and shouting ‘pull it together!’?”)

It’s interesting to me–and maybe pathological?–that I chose a job in which most of my patients have mental health issues. Perhaps I am attempting mastery over my own emotions by recreating similar stressors. And it’s easy to play the “Well, I don’t have it as bad as so-and-so” game when you work at my clinic. Sure, I may have a mother who is almost incapable of an authentic human interaction that doesn’t revolve around her needs, but at least I’m not that patient who had to quit his job to be on 24-7 suicide watch for his wife! My mother may drive me crazy with her constant litany of pain, but at least she can see a specialist with her private insurance plan! See, it’s easy to find the positives when you’re surrounded by negatives.

On the bright side, I like to think that my personal experience has given me a little bit more understanding of the complexity of depression and chronic pain. I may not win any awards for compassion (especially not after this post!) but I do understand how mental illness and chronic pain wreak havoc on both patients and families.

Another installment of the Totally Inappropriate Comment December 4, 2008

• The scene: me, beginning to do a digital rectal exam. Me: “Now, this isn’t very comfortable but it shouldn’t be painful.” (sliding finger into patient’s rectum) Patient: “Actually, it feels good.” Actual comment: “Ummm…it should feel clinical.” Totally Inappropriate Comment: “EEEEWWWW! Eeeww eeww eeww! Finishing now! Ew!”
• Mentally ill patient that I see frequently for multiple health problems: “You’re my best friend. You’re the only person I can talk to.” Actual comment: silent, empathetic eye contact–no comment. TIC: “Please don’t say that. It makes me feel sorry for you and also makes me want to back out of the room slowly.”
• Patient with chronic itchy skin (and bad body odor), who was only bathing once a week: “Since I’ve been taking a bath every night, my skin feels so much softer!” Actual comment: “That’s great! It looks good!” TIC: “You don’t say? Who would have thought?”

More healthcare haiku December 1, 2008

Forty notes to do

Finished only ten so far

This shit really drags

Ultrasound report:

Confirmed thyroid nodule…I

can’t feel on exam

My piece of advice

to myself for the next year:

Don’t work on birthday!