Saturday, November 19, 2016

16 months. (Posted Late)

While the boys were all downstairs watching a movie, I snuck away to give Diana a bath. I can probably count on two hands the number of times I've bathed her alone. She actually got to play at her leisure, relaxed and happy. Normally, you can tell she's on edge because of all her maniac brothers swirling around her. I let her linger in the tub much longer than I normally would. By the time I took her out, her lips were a little blue and her lips quivering. I took her down to the changing table and got her in some warm PJs. I then sat her in my lap to trim her nails and comb her hair. She sat stone still, yet at ease, the entire time I was combing. She seem to even enjoy it. In my previous experience, she would run away the instant she saw the comb in hand. I combed her hair for longer than I normally would. When I finally finished she didn't seem to want to go anywhere. So, I just sat with Diana on my lap, in her room. Just the two of us. She laid her head on my chest. She never fidgeted or tried to do anything but sit with me. She was simply content.

It's like she knew that just hours earlier I had packed away the last of her size 3 shoes. Like she knew that I was struggling to deal with her aging. Becoming a toddler, growing out of her clothes. Like she knew that I had a tough day dealing with knowing she's my last. I teared up a little and hugged her tighter and sat there for a lot longer. For the first time, in a long time, I felt just completely at ease. My baby Xanax. Perhaps, it's OK she's the last. Perhaps, I'll get these sneak attack precious moments for the rest of our lives together. I'm sure they will evolve into something else, as I don't see my 20 year old daughter enjoying me bathing and combing her hair, but we could do pedicures together. Needlepoint with a glass of wine. Maybe, I'll get to sit with her infant someday. I know that I have loved every phase of life so far, so, life beyond pregnancy, infant and toddlers will be wonderful. But I just love them so.

Diana, in physique, started out like George. Big cheeked, soft, pudgy, so squishy. Slowly, she has evolved to become more Brock-like, only not quite so tall. I am not sure she will ever grow out of size 3 diapers. Her hair gets longer and thicker by the day. Her little personality continues to resemble most closely her brother Curtis. Who also happens to be her best friend in the family. Her big helper, guardian, and buddy. This personality is one full of smiles. Smiles for me, and smiles for strangers.

If I had to choose the single-most unique thing about her versus her brothers (and I think it's strictly because she's a girl) it's her communication skills. She both positively gestures and says "ya" if she wants something, and does the same for "no" if she doesn't. It's accurate, every time. The boys NEVER did this. I think they were all 3 before they ever uttered a "yes". They had "no" down, and otherwise, they just enjoyed the constant opportunity to throw a temper tantrum because I'm not giving them the thing that I don't know they want. Barring exhaustion or extreme hunger, she even has the ability to wait patiently for me to get these items for her (another distinction from the 4 before her.) It's quite impressive. She seems to think before in, she has yet to fall off a chair, bed, table (yeah, I don't know why she'd be on a table either), stool, slide, stairs.

Diana had a 1st birthday party. It was a tea party. It was beautiful, elegant, extravagant. So many lovely and perfect flower arrangements, with tea cups for everyone, and tea pots for the arrangements. It was well-attended with a photo booth too. But, as things typically go for a fifth child, I'd imagine, I've yet to document it. I don't think I've even loaded the pictures from the photo booth. In fact, I don't even have the pictures from her baptism well over a year ago! Where she wore my baptismal gown, unlike her brothers who all wore Matt's. Except Mitch, I think we got him his own, seeing as he was too big. Diana's go-with-the flow, laid back personality will serve her well as a 5th. She honestly has no choice.

If you turn on music, she will dance. She will smile, and twirl. She will shove her brothers away. She likes to be bossy with them, and she likes to have the stage. Though she be but little, she be nosey. As in, she wants to be EVERYTHING. She will eat anything. Though, she has been known to refuse the heel of the bread loaf. How do they all know this is less desirable!? She is also extremely possessive of her food (again, I'd imagine this isn't unusual for a 5th.) Once, as I opened for her the last yogurt from the fridge, Mitch asked if he could havea  yogurt. Diana became insane, repeating "no, mine" over and over, grabbing the yogurt from me as if it were the last in the world and we were all to starve soon. She loves salsa. Will eat bowls of it, like soup. Her tongue will hang out of her mouth, due to the spice, and she will keep going, even after the mid-meal, momentary screaming and crying due to the heat in her mouth.

She likes to choose her own bows. And shoes. And socks. Luckily, she still leaves the outfits to me (though I imagine this is changing any day now.) She can repeat most any word, and also thinks she talks in sentences (shhh...don't tell her, but it's complete jibberish.) She will sing "bing bong bing bong" when she hears iton the movie Inside Out while riding in the van. If you start a sentence with "Who...." she will consistently be the first one to respond with an emphatic "ME!!" often long before the rest of the sentence it uttered. I believe the first time she did this Matt had said, "Who clogged the toilet!?" She loves her blankies, 2 of them, they're really soft. She loves her Jelly Cat bunny and a paci. She goes right to bed when put down and wakes up sometime about 12 hours later, and that's all there is to say about that...for the past 12 months (or more #sorrynotsorry.)

I mean, all around, I'm not sure you can ask for a better baby. A cuter baby. A happier baby. So, none of you all can blame me for kind of being sad about no more. Then again, I am thrilled I get to end on SUCH a high note. My little Diana Bede. Stay happy, little girl, and be strong.

Monday, November 7, 2016


15 minutes. This is the typical amount of time allotted for any single follow-up or acute type appointment in Primary Care. 30 minute spots are reserved for new or complicated appointments. Now, I just want that to sink in for a minute. I want everyone to sit down and think real hard for a moment, about how much they can get done in 15 minutes.

How long does it take you to unload and load the dishwasher? How organized, nearby and accessible are your cabinets? If your house is like mine, half the cabinet doors have locks on them, so there's that obstacle as well. Are all the dishes already rinsed off and in the sink? Or do you need to walk about the house gathering them? Do some need to soak? Some need scraping? Does it always take the same amount of time? Is every unload and loading of the dishwasher the same? Or are some meals harder to clean up after, requiring a bit more time and effort?

Tonight, when I asked the 26th patient I'd seen today, a patient I have never met, mind you, if they had any allergies to antibiotics, they crassly replied, "It's in my chart."  This comment doesn't shock me, as I hear it near daily in some shape or form, but it does piss me off. Every. Single. Time. Now, let me preface this to say that I have very consciously chosen not to bring a computer in with me when I see patients. I cannot focus on the patient when I have that thing in front of me. Period. So, I am unable to reference patient charts while in the room. This sort of response to my simple and straight forward question, that every patient should reflexively be able to respond to in an instant, absolutely encompasses ALL that is lacking in patient education and awareness of how a doctor and the office where in they work, functions.

Oh. It's in your chart!? Silly me. How did I miss that? It's only one column of a chart with no less than 15 columns. And having met you for the first time, to discuss your one urgent problem, in less than 15 minutes, how on earth, have I not managed to memorize your ENTIRE chart? I must be a completely negligent and idiotic doctor. I must be incompetent. How rude and irresponsible of me to not know your entire life, inside and out. To not know every med you've ever taken, every surgery you've had. What you've tried previously for your high blood pressure. That you've had an xray of this same knee before.

If you have guests and they offer to help you clean up after dinner, when they ask, "Where does this spatula belong?" Do you reply, "In the kitchen." If you do, you're an asshole. Unless, of course, your kitchen literally has one drawer. Otherwise, they need to open every cabinet door and every drawer until they find where each item belongs, when you could have simply guided them.

Somewhere along the way, people have gotten the impression that doctors have super powers. That we can read and interpret hundreds of pages of "past medical records" in minutes. How far into a novel do you get in 15 minutes? That's just reading it. That's not discussing it, giving it a grade, then writing a review about it. Which is what seems to be expected of us at nearly every visit. We get nasty messages and reviews when disability paperwork doesn't get faxed in a timely manner. When their calls aren't returned same day.

We are supposed to see patients. Document about it. Send in medications. Order labs. Interpret labs. Call patients. Fill out their work physical forms. They're sports release forms. Send in their proof of vaccinations. Refer them to specialists. Talk to pharmacists. Re-explain problems to loved ones. Schedule them. And people wonder why they feel like "they only see their doctor for 2 minutes." Because they do!! That's all there is time for. Literally. It's math. There are only so many minutes in the day. There is no time left to talk to the patient, get to know them, actually listen and enjoy patient interactions. There is simply no way to live up to patient expectations in the current climate.

I'll be the first to admit, I love the people side of patient care. I spend way too much time in the room. I like to problem-solve with the patient and include them in the decisions about their health. I like to educate them. I force them to tell me names of meds and allergies, because I think it's important they know these things. But, you know what? All of this takes time. A lot of it. So, if I am in the room talking to you, that means that something else is getting pushed down the totem pole. For me, it's paperwork. Anything paperwork. Your short-term disability papers, your letter to your employer, it's going to take a while, because I am inside a patient's room, talking to them. Connecting. If your labs are normal, you likely won't hear about it for a couple days. To trade off, if you're scan comes back showing cancer, I have personally called the oncologist already, I've set up your appointment, I've made all the plans for you and I am on the phone calling you immediately.

Trust me, I know everything is important to each patient. Even normal labs. If it could be any different way, I would do it. But it can't. We all have priorities and we all have the same number of minutes in a day. So, quit making snide remarks to your doctor. Quit having super-human expectations of your physician. Take charge of your health, and if you haven't gotten the call back that you wanted, keep calling. But don't be mad that you've called us 3 times to ask if the MRI has been scheduled, and we've already told you once that insurance hasn't responded yet.

Just stop for a moment, and really think about 15 minutes. You might start to appreciate all that we get done, and perhaps even be amazed. Maybe you will be more prepared and thankful during those minutes you have face-to-face with your doctor. Maybe you will forgive those moments where they ask redundant questions about allergies or previous medications. Maybe you will take ownership of your own health and drop forms off earlier than the day they're due. Request refills a week in advance. Schedule follow-ups more regularly. Maybe you will make, what is currently a very rushed and somewhat stressful interaction, a completely functional and enjoyable one.

I mean, a doctor can only hope.