Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

Archive for March, 2019

The Other Side of the Stethoscope: Sunday musings…3/31/19

A physician is no more or less human than any other person.

It’s comical to watch the reactions when a doctor calls in sick for whatever reason. A lovely minority of patients rally to the side of the physician, offering words of caring and affection. Of course that means that the majority of others who share a particular doctor’s professional orbit exhibit some degree of displeasure, at least on first blush. Annoyance at the inconvenience of one fewer hand on deck from the co-workers all the way to personal affront on the part of some patients. It’s an extension, at least in part, of the well-known (to healthcare workers) phenomenon whereby patients and non-provider workers such as insurance operatives and various managerial types feel permissioned to treat medical staff members of all levels as if they were some sort of lesser version of the species.

The stuff people say to a medical receptionist laboring under the added challenge of being short-staffed due to illness would be considered hate speech if directed at the cashier at a 7-Eleven.

With this in mind I’ve been trying to observe and feel every bit of my experience now that I find myself on the other end of the stethoscope. As I’ve gotten older I’ve had all manner of run-ins with the world of medicine as a patient. Most of them have admittedly been pretty short trips over which I’ve been able to exert quite a bit of control as a physician myself. Even my carpal tunnel surgeries in 2003, potentially career-threatening for a micro-surgeon, didn’t really seem like all that big of a deal. Maybe it was my relative youth (43) at the time. I don’t know.

A couple of years ago I had a triple hernia procedure performed by a hot-shot 30-something general surgeon who could have been my time-traveling surgical soul twin. Literally every step of the way was choreographed by the docs and nurses in such a way that I was barely even inconvenienced. I was escorted to a private area pre-op where I was visited by pretty much everyone I knew as if we’d just happened upon each other at a restaurant. Back at work after a long-weekend off. In all honesty the only time I felt like a patient was when I woke up to some incisional pain.

Perhaps that’s why my upcoming hip replacement seems so different. I’m older, and unlike both my carpal tunnel surgeries and hernia repairs, a hip that’s worn out from a lifetime of use can’t be shrugged off as genetic misfortune like you can do with, say, a family history of weak pelvic floors. Nope, for whatever reason this particular medical adventure is the first time I’ve really felt like a regular patient. This is as close as I’ve ever come to being just another person putting on one of those ridiculous gowns that hang open in back.

My age-worn old man’s flat ass looks just like anyone else’s in one of those stupid gowns.

Because I am the only surgeon in my eye group choosing the date of my surgery was a pretty big deal. I’ll be out of the OR for about a month. The date made the best sense for us as a group and I made sure to vet it with my orthopedic surgeon, a personal friend. Our entire year’s schedule for all 4 doctors was now tied to April 8, 2019. My first clue that I was now more or less a regular patient came a couple of weeks ago when the surgeon’s office called to let me know that he’d changed his schedule and would be out of town during the week of my surgery. My first reaction went something like “NO NO NO! It’s GOTTA be THAT day”, among other (non-profane) strong statements about why.

But I’ve done that a ton of times over the course of my career. Changed an OR day or week that is. My friend would never have done that if he’d remembered that he and I had chosen that particular day, and just like me it never occurred to him to check his records to see who might be on the schedule that morning. I can’t ever remember doing that when I’ve made a change in my schedule; why would anyone else do that just because it’s my date? Is there really any difference between the effect of a schedule change for surgery between a doctor and anyone else? Of course not. Such a change, for whatever reason, is hard on a patient and everyone around him who will be affected by his need for care and his hiatus from whatever it is he will not be doing because of the surgery.

But my doc is human, too. He needs a bit of a break and saw a window of opportunity. Trust me, once I got over the shock of the potential upheaval in my own schedule I totally understood what had happened and what was going on. In my case a little bit of creative manipulation of the calendar will make everything turn out as it should. My surgery will go off as planned and my surgeon will jet off to care for his own well-being as he should. My lesson is two-fold. First, I am a patient and as such I won’t control the process. Second, all of the efforts that my colleagues and I have made to improve how being one of my patients feels are more than worth the time and expense we have dedicated to them.

Little stuff is interesting. Although I’m pretty healthy for a middle-aged guy I still had to go to the hospital for Pre-Admission Testing or PAT. Everything could have been handled by mail or on line, with a quick trip to the lab to have some blood drawn. The likelihood that anything would be uncovered that would derail the surgery is really, really small, but one must always remember the two-pronged priority of hospitals in the U.S.: mitigate any risk possible, and maximize the payday. A hospital gets paid for PAT and makes a profit on it. So there I was on a Thursday morning meeting a series of quite lovely people, all of whom could not have been nicer or more efficient. In and out in an hour, much to my surprise and delight.

So where am I now? A week out from surgery with standard issue instructions on how to clean my buttox before reporting to the OR at 0Dark30 and a promise of meeting the PT wizards who will visit my home and shepherd me back to functionality. There are still some questions floating around, but I’m kinda reluctant to call my buddy, or even his staff, to ask. I have this little nagging feeling that a lot of folks probably have similar questions (for example, can I poop before surgery that occurs so close to my pooper?), and I know that because I’m a doctor all I have to do is pick up the phone. Still, it seems like if I did I’d be invoking a kind of privilege that any other patient might not have.

Then again, maybe not. It’s Sunday and I just got off the phone with a patient of mine who’s had a concern for 4 or 5 days. They “hated to bother me at home on Sunday” but knew that there’d be nothing between me and them but a good story told to the answering service. While this kind of thing doesn’t happen to a lawyer, accountant or stockbroker, it does definitely happen in healthcare. No, I won’t be calling my surgeon to ask him my silly questions, and I won’t be calling anyone at all on a Sunday to ask them, either. But I’ll for sure ask someone sometime this week, because that’s what I’d want one of my patients to do, and I want to be a good patient.

As I spend a week being mostly a doctor in preparation for a few weeks as mostly a patient I’d very much like to thank my surgeon, his staff, and the folks at the hospital for making my journey to the other side of the stethoscope a pleasant ride. A thank you as well to all of my patients who have wished me well, and to my own staff for not telling me any stories about those folks who forgot that their eye surgeon is gonna have to be human, too, for a little bit.

I’ll see you next week…

 

 

Unsought Solitude: Sunday musings…3/17/19

1) Irish. Happy St. Patrick’s Day to all, Irish or otherwise. Legends abound about Patrick of Ireland. Was he a monk as told by the Church? A heathen who did so much good that he was beatified regardless? A scholar who was in the vanguard of scholars who escaped the Dark Ages and “saved civilization” by decamping to Ireland?

Who cares? Slainte.

2) Gueridon. The little table upon which rests a basket, candle, and decanter to be used when decanting older (usually red) wines. Confession: I do not own one, nor do I own a random wine bottle basket or candle holder for decanting.

Who cares? Slainte.

3) Luddite. A young author was quoted in yesterday’s WSJ as preferring to read and write on various electronic utensils. No biggie, really, until she tossed shade at those of us who prefer pen, paper, and the various reading materials that come in the form of ink on stock of some sort. Something about not “offending luddites” by her comments. Does my preference for holding a newspaper or turning the pages of a real, live book when consuming the written word make me a luddite? At the moment I am typing on a ludicrously powerful laptop and bemoaning the fact that the best voice recognition software is not supported on my digital platform of choice. Two days ago I did laser surgery utilizing a couple million $$ worth of ridiculously complex software and hardware. Can you be a luddite if your daily existence is intertwined with tech that is just a tiny bit shy of quantum computing?

Who cares? Slainte.

4) Sears. Yesterday’s WSJ also included a lengthy treatise on the demise of the once dominant Sears company and brand. If you are of a certain age Sears was as important to your family’s commercial life as any bit of the internet is today. The Christmas Catalog was informally known far and wide as the “Wish Book”; as a kid you looked at the catalog and dropped hints (along with turned down pages) as the Holidays approached. Without knowing so, Sears was the Amazon of its day. Every small town had a little storefront Sears on main street long before the advent of the strip mall mega-store. You ordered your merchandise by phone and picked up up at the delivery store. Pretty much anything other than groceries could be bought that way, including your house.

So what happened to Sears? The catalog was shut down in 1994, right when the internet was getting its start. All it would have taken was a single visionary to see that moving the catalog online would have protected the singular power of Sears to define what it meant to be a department store in the internet age. Instead Sears remained mired in the old-school business model of bricks and mortar behemoths, merging and cleaving along various entity lines with a plethora of like-minded companies that will in all likelihood share its fate. Kmart, Ames, and others are but a memory. How long before they are joined by the likes of Khol’s and J.C. Penney?

All for the want of a single visionary in a company that employed hundreds of thousands of people. It makes one wonder about other bricks and mortar businesses. At least it makes me wonder. What of education, specifically college education? Will we have all of these colleges and their campuses in the future? Do we need all of those administrators whose ranks have swelled in response to a government regulating the physical space occupied by 18-22 year olds? Who knows. What of healthcare? Having just had a totally new way of delivering eye care shot down by an organization whose administrators could not see past their new bed towers, could not see past how the bricks and mortar paid their salaries, I wonder how long it will be before an internal visionary makes a move. Health care is the biggest rent seeking economic sector in the U.S. (with education not too far behind), one in which lobbying the government to maintain the status quo appears to be the most important job of senior administrators. Will this save healthcare from a Sears-like fall, or are we just one visionary away?

Slainte, indeed.

5) Solitude. Beth has been away this week tending to her filly on the winter show circuit and fitting in a bonus visit with “Lovely Daughter”. While she is away I have been mostly at work or traveling for work, and thus have been surrounded by other people for the bulk of my mid-week waking hours. Indeed, weekdays are easier on my soul because the alone hours can be shortened by simply going to bed early and sleeping them away. No, it’s the time off, the weekend time that I otherwise so cherish that is hard. Beth knows this, and so these trips are fewer and further between than they should be; she enjoys her barn and horse time immensely. Even typing these words makes me feel a bit guilty.

There is an “uncle” in the Hurst family, one of those people who has been around the family in a lovely and loving way for decades and is such a part of the scene that all of the grandchildren were astonished to discover some years ago that he is not a “real” uncle at all. Jay is an artist, a sculptor, and by necessity his has been a life of mostly solitude when he was working. This always seemed a bit odd to me because Jay was always such a full participant in all of the family dialogue at holidays and the like. How could it be that such a social creature spent so much time alone while creating? As much as I enjoy writing I couldn’t imagine hours upon days sitting alone at a keyboard. Indeed, my favorite writing times are when I am cocooned in a corner surrounded by the activities occurring just outside my sight. I know they are there if I need to jump in for a fix.

Jay has retired with his wife to a thriving community of like-staged folks and is thriving in the bustle of a little micro-society. His is a tale to sow optimism in the face of the lonely later life of another of Beth’s (real) uncles, also an artist, whose illness drove a wedge between him and most everyone else. Much, much later in life the solitude that he sought and which sought him began to ebb. His presence at family gatherings both sad and gay brought enjoyment to all of us, himself included. Both men lived decades in which they spent the majority of their hours alone. There is a significant difference however, and it is the difference that makes my little sojourn in solitude bearable: Jay emerged from solitude at the end of the work day into the embrace of a loving wife with whom he shared his evenings and weekends.

He wasn’t truly alone, he only worked alone.

Beth’s uncle, The King, passed away this week. He suffered a catastrophic stroke a few months after losing his sister, my mother-in-law, and gaining a daughter-in-law. While still more alone than not he was nonetheless close to two grandchildren, and seemed to be moving closer to his children and their varying degrees of happiness. There had been a rapprochement with his brother, words of kindness expressed between the two older men after decades of estrangement. The King had lived a mostly solitary life for years. Unlike Jay (and me) he seemed to be lonely for many of those years. How wonderful that he was able to shrug off at least some of that cloak in his last months, to replace it with the embrace of children, grandchildren, nephews and nieces.

I am lonely this weekend and I confess that it is a selfish loneliness because I know that it will be short lived. Beth will return tonight. My Man Cub and his sister The Nugget might be healthy enough for me to drop by, or their little family might swing by for a sunny dip in the hot tub. There will be corned beef and cabbage tomorrow night at dinner for us all regardless. Solitude for me is partly the side effect of obligation (I have a job) and partly choice (the kids were sick and I stayed home).  Jay and The King teach us the lessons that there is a difference between being alone and being lonely. One can be alone if one has love to look forward to when the solitary hours have passed.

Long live The King. Slainte.

I’ll see you next week…

Goodbyes on Time and Too Soon: Sunday musings…3/10/19

Dinner last night with Beth, her sisters and their husbands was typical of the wonderful times we’ve all spent together over the years. Not unlike our relationships with my siblings and their spouses, Beth and I share a very comfortable friendship with my brothers and sisters-in-law. Laughter, gentle teasing, and a sense of warmth is the typical fare when we dine together. Our bonds have been strengthened through our time spent shepherding Beth’s folks through the last stages of their lives, not unlike the journey we all travelled in the last few years of my Dad’s life.

We were all far from our kids and grandkids, so while we had our phones mostly pocketed we did take brief glances when alerted to emails and texts. So it was that we learned of the dire illness and hospitalization of an elderly uncle and the passing of a dear friend. It’s amazing when you think of it how often we are drawn to this well in mid-life, isn’t it? My close friend lost his wife to a cancer that kills roughly 95% of those afflicted no matter what age they are when they get the diagnosis. There are no known risk factors for her cancer; bad luck afflicts indiscriminately.  Beth’s uncle was felled by a particularly severe stroke; his biggest risk factor was having the good fortune to live long enough. At the moment he lies on the razor’s edge between life and death.

My dear friend and his sons have had many months to prepare for yesterday. Knowing them, and knowing his wife, those months have been jammed with life and living and love. “Goodbye” has been there with each parting, with each night’s retreat to the peace brought by sleep, if that is sleep was to come. Goodbye yesterday was too soon–too soon by decades–the peace that came with “goodbye” notwithstanding. Much too soon and yet they were ready. Or as ready as one can ever be might be a better way to see it. They were not surprised and because they were not surprised they’d left nothing unsaid. “I’m sorry.” “I forgive you.” “Thank you.” “I love You.” The air around them was filled with this and more these last many months.

Nothing was left unsaid. Peace surrounded the family and their closest friends.

I find inspiration in many of the comments of my good friend Bill, the surgeon. Unlike me, the eye surgeon, Bill  deals in disease that causes death on a daily basis. An inherently kind man (his protestations to the contrary notwithstanding), Bill encourages his patients and their families to live in a way that allows them to know that they are at peace with one another long before the end is nigh. He has often professed amazement at the heroic efforts made by family members to be at the side of a dying relative so that they may “make things right”. Why, he wonders, wait? Even in the healthy elderly death is but a moment away. Why wait until the end? Why not be at peace with one another in life before death?

Beth’s uncle lies at the precipice. His children are arriving from near and far. Was his “lifeline” any different from my that of my friend’s wife? As unknowing as we all may have been, as we near the end of our journey we must all be aware that our time becomes short. Sitting in the airport after our brief but wonderful visit I am comforted by another recent visit to celebrate the marriage of Beth’s cousin and our time spent with her uncle around the wedding festivities. There was love. Love and understanding and forgiveness where it may have been necessary, but mostly love. I sit here hoping that it is that, the love, that his children will remember. That they will convene at his bedside simply because of that love, with little else left to say to him or to each other but “I love you”.

It’s always too soon to say goodbye to someone you love, even when goodbye arrives on time.

I’ll see you next week…

Connections: Sunday musings…3/3/19

No man is an island. True? Unlike so many animals who share parts of our space on the rock and only convene when it is time to propagate a species, I do think for humans that the old saw is, indeed, true. We are who we are, but we are expressed in many ways by how and with whom we are connected.

At the moment Beth and I are winding down a visit with my Mom in Rhode Island. She still lives in the house in which my siblings and I grew up, bouncing around like a ping pong ball in a gymnasium. She remains in place because of connections in both the present day and the past. I have no idea if she feels this way, but whenever I visit my primordial bed the house seems oddly full, even though only Mom lives there. It’s as if I’m surrounded by ghosts, connected to the past lives of everyone who ever lived here, myself included.

None of us lives in Rhode Island any longer. My brother and two sisters each live a couple of hours away, and we live a flight way in the Midwest. One could reasonably ask why Mom is still here. Not just in the large home from we which were all spawned, but in Rhode Island at all. Again, it’s the connections. Being near family is the logical choice as one ages, but sometimes the connections are simply strong enough to age in place. Such is what we find each each time we visit, and each time we rediscover this it is that much more lovely.

When my Dad was sick Mom pretty much withdrew into the house to become his primary caretaker. The extensive ties to the community my parents enjoyed did not disappear however, but rather just faded back a bit, remaining there, ready to reappear when Mom emerged after Dad died. Being out and about town this weekend we were impressed again and again by how many people were connected to Mom. Church, club, neighborhood, friendships from the days when she was a part of a couple, our classmates from school, all there and keeping her safely in place.

There’s really nothing new in this observation. Well, maybe the discovery of a few connections that I still have here in town was new, but seeing once again how connected Mom is wasn’t really new. Will it last? Will those connections remain strong enough to continue to stay here, at home? Who knows. For now it’s enough to see and feel the connections that we all have to our hometown, and to see how our hometown continues to connect with our Mom.

Let no Mom be an island.

I’ll see you next week…

You are currently browsing the Random Thoughts from a Restless Mind blog archives for March, 2019.