Doctor, Doctor.

Well here I am with another day in the books. It's been a pretty busy summer for me, but I'm beginning to realize that my life is always busy. On the bright side it is a very full life. As I sit here listening to Daddy tickling one daughter while the other plays "Twinkle, twinkle" on the piano, I am reminded again how lucky I am.

On the diet front, things went well today. I ate well and on plan. I drank all my water. It's not hard with this heat to be reminded to drink often. At lunch I went to TKD class. It was pretty rough today. I woke up with a splitting headache and felt like crap. I told my friend that I felt like I had a hangover and that was extremely unfair since I had none of the fun.

My asthma is acting up today and I had a rough time breathing all day. There were times where I got very winded in class.  Ozone is up around here and that definitely effects my breathing. Plus I'm not the most compliant patient with my inhalers. I know, I know. I always pre-medicate before class, but I've been bad about taking my daily medication. I use it during this time of year, or at least I'm supposed to. Also I'm wondering if my airway issues are back.  It's been 2 years since I had the laser surgery for my subglottic stenosis, which is a condition where you get scar tissue in your airway causing a blockage.

I was diagnosed with this several years ago and I've had to have the procedure 3 times, a year apart, but this time I've gone 2 years. I don't really want to go back to the ENT because I know he's going to look down in there. Ugh I hate that. He sprays this nasty numbing spray in my nose and down my throat and then he threads a small scope with a video camera through my nose and down into the back of my throat so he can see below my vocal chords. It doesn't hurt, but it's really uncomfortable and then I can't swallow right for a few hours. It's yucky. However, the phsyician part of me is telling me I'd better go.

I learned my lesson the hard way trying to second guess and treat myself. For years I thought my asthma was just really bad and was treating myself with medications. After the birth of my 3rd child when it was really severe, I couldn't climb the stairs without severe shortness of breath. Even for a fat lady, it was ridiculous. I couldn't read out loud to my kids at night. I went to see an allergist thinking I needed allergy shots. He said I do have some allergies and asthma but that the breathing test showed a blockage in my airway. He recommended I see an ENT.  The man saved my life, I'm pretty sure.

I saw the ENT and he diagnosed the blockage. He said my airway was the size of an infant's. It was like I was breathing through a coffee stir stick. He said if I'd been in a car accident and needed to be intubated, there was no way anyone but an ENT could have gotten an airway in me. He sent me to a sub-specialist who confirmed the diagnosis and said I could either have the laser procedure which wouldn't be permanent and I would need it repeatedly or I could have a big surgery where they cut out that portion of the airway. That surgery would require at least a week in ICU on a ventilator, and 8 weeks recovery. No thanks. I went for the 15 minute laser procedure done by my ENT.  Yes, I had it once a year for 3 years, but I can have it on Friday, be back to work Monday with no more pain than strep throat.

It's a really rare thing, usually seen in people who have had trauma to the airway or in small children after severe infections. Sometimes it's seen in people with connective tissue disorders like lupus or Rheumatoid arthritis. I've been tested and my tests were normal. But, there is a lot of these types of problems in my family so who knows.  Seems it is more common in women of child bearing years when it happens spontaneously like it did with me. They think there is some kind of hormonal trigger and it usually just stops on it's own at some point. I was hoping it was gone for good, but I think it's back.

And it's starting to affect my ability to exercise which I will not allow. The inhalers don't help as much now when I'm really doing strenuous cardio, like at TKD. So despite my not wanting to see a doctor, I'm going to have to.

It's a very weird thing for a doctor to see another doctor. Knowing more doesn't help me or my treating physicians. I think it makes doctors nervous to know they are treating a colleague. They never want to insult my intelligence by over-explaining and they certainly don't want to miss something on a friend.  I really hate being a patient. But, we all have to see a doctor sometime or other.   I think it helps that I know how to navigate the health care system. I speak the language at least, but sometimes I think knowing all possible outcomes of a situation is a detriment.

This experience and the one with my gallbladder last fall certainly give me an empathy for how my patients feel. If I get scared and I understand all the lingo I can certainly imagine how someone feels when they can't speak the jargon.  I always try to watch for that look of, "I have no idea what she just said" in my patient's eyes when I'm explaining something technical. And there is a definite and obvious look. Usually it is accompanied by an uncomfortable nod and patients will not always tell you that don't understand for fear of looking stupid. It's really important for doctors to ask if the patient understands things. Even then sometimes they will say they do when they don't.

As a doctor, I will tell you that I do not mind questions. I would much rather answer any questions you have than have you run home and google something and end up with a lot of misinformation. The internet is great and horrible for us doctors.  I have to spend all kinds of time de-bunking stuff patients have read on this site or that. But, the good news is that in a computer savvy person, I can refer them to websites for credible information.

Tomorrow I'll be working out in the morning since I have an appointment to get my hair done at lunch. We must have our priorities, right?  I still have some work to get done, so I better get on with it. Night All!

The call.

"Doctor, the medical examiner is on  the phone for you."

Words you never want to hear. Especially on a Monday morning. After being in practice for the last 12 years, I've gotten many calls I'd rather not. These calls are never fun. They mean someone has died, either at home or in unclear circumstances. It usually means that the medical examiner either needs me to sign a death certificate or provide insight on the medical problems of the deceased.

It also means I've lost a patient. This elicits a whole host of emotions. You feel sad for the family. Sad for the loss of the patient. Sometimes you feel sad because the patient was someone you liked, enjoyed, bonded with, a "favorite".  Sometimes there's relief. You know that patient was suffering and very sick. and you know that is finally over for them.

Sometimes there is shock because it was unexpected. Unfortunately this can lead to guilt. Sometimes as a physician there are patients that no matter how hard we try, we just can't establish a relationship with. You can't relate to them. Or frankly, there are patients that are just plain annoying. Either because of their refusing to follow our advice or because they are just plain an unpleasant person to be around. You find yourself wondering if there was something more you could have done or said. Some other way to break through to the patient.

And then there's the shame because on some level you are relieved that you won't have to have yet another visit with that patient that is confrontational or just plain ignores what we say.  This is usually followed by a smidgen of fear. Medical examiner=patient death=possibility of a law suit. It may seem crass or mean, but these calls always include a little fear for me. Did I do something wrong? Did I miss something? Did I document all those times I told her to take her insulin and see the specialist and she refused?  Did I prescribe the right meds? Did I try hard enough? Did I make a mistake?

It's a fear we live with everyday as physicians. And to be honest a fear that drives many of our actions. It is a fear that is healthy in some ways. We have to remember that the decisions we make have huge consequences. We have to be careful and thoughtful and educated. But, we can't let that fear be paralyzing. We can't be so afraid of making a mistake that we do nothing. Sometimes this is much worse.

Twice this week I've gotten that call. Twice too many. Luckily it's not a call I get often. And whether I like it or not, these calls won't be the last. One was a patient that was too young. It was sad, but not surprising. We tell patients that if you don't take your medicine or follow advice you will die, but I don't think they always believe us.

The other patient was old and it wasn't a surprise. But, I had just seen her last week. She seemed good, getting better, on the mend. She had a fall and with her blood thinners this resulted in a fatal injury. I was sad to see her go. And I am ashamed to admit that I was glad that I was not the one managing that blood thinner.  I was relieved that I don't have to sign the death certificate since the death included a trauma.  But, so sad that she seemed better the last time we met. Is there something I could have done differently?

It's OK to work through these feelings. We have to. We're human and we have to let ourselves feel. In my opinion good doctors are in touch with how they feel and this helps us relate more to our patients. We can't be robots. We can't be super-human either.

I joked with the guy on the phone letting him know that I liked him fine, but I'd rather not hear from him. And then I felt bad. Can't be any easier to be on the other end of that call, can it?  But that is life. We do the best we can. And sooner or later we will all be the subject of one of those calls.  Until then, I'll keep striving to be the best physician I can be. The best mommy. The best wife. The best me.

Of course all that doesn't mean I won't cringe when I hear, "Doctor the medical examiner is on the phone."

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I wrote this post a few weeks ago, long before my cousin died this week. I hadn't posted it yet as I had written it and then didn't know if I wanted to. I stumbled across it today and was struck that this week I'm experiencing that call from the family side and not the medical side. Waiting on the death certificate and cause of death and all that.  Understanding how the system works helps at least a little.   I ate dinner last night, but realized just about an hour ago that I ate nothing yet today. I had a couple of cheese sticks. I'm trying not to give in to the cravings and the old crutches of food, particularly sodas. I made myself drink some water this morning. I am trying. I will not give up.

I realized today that it was exactly one year ago today that I started this life change.  I started logging my food and such.  In that time I've lost about 55 pounds (assuming I haven't gained any the last few days. I have not weighed and really can't face doing that yet.).  I started blogging 9 months ago. It was the best thing I've done for my health. No joking. Stumbling across this blog world where I have support and can find inspiration and ideas and recipes has helped so much. Of course I had to do the work of diet and exercise.

In the wake of what's happened this week, I have been struggling. I have not worked out. I didn't go to TKD. I am honestly too tired and I haven't slept. But......I will. I will get back to balance with exercise and diet. I will move forward toward my goals. I will get through this terrible time.  I am stronger now than I've ever been, mentally and physically.  I will not quit.