Saturday, January 14, 2017

Art Museums.....

Thursday was a medical travel day.  Nephrology finally got word to us (at the extreme last minute) that they were fitting us in at 8:30 AM. Since Neurology was at 3:30, it left us a big gap.  The trip between hospitals can take an hour in tough traffic, but even taking that into account, we had 9:30 - 2:30 to do as we pleased with.

We've had the Philadelphia Museum of Art on our list for a long time.  Babygirl loves museums of all kinds, and I'm game for just about anything, really.  The weather in Philly yesterday was amazing for mid-January, a balmy 60 degrees.  We took a look at all our transportation options (subway, bus, taxi), checked a map, asked the locals and opted to walk.

Philly has a lovely riverwalk up the Schuykill river.  The hospital is only a couple of blocks from the river, so we crossed over and hiked the two miles to the museum.  We watched dozens of people try to sprint up the stairs and then take photos a la "Rocky."  We chatted about how, in some ways, the view down Ben Franklin Ave felt a little bit like Paris (side note:  The steps up the museum are in 5 rounds of 13 steps.  Since that number is considered unlucky you almost never see steps set to that number if it can be avoided, and it certainly could have been on an outdoor flight.  There has to be some bizarre Masonic historical context there).

Admission to the museum was more affordable than to the museum at U. Penn, surprisingly.  I asked the desk whether the museum had a Van Gogh on display, and was delighted to find out that they had several.  I've never really seen one.  He was surprised when I (shamelessly name-dropping LOL) told him that the Louvre doesn't have any, nor any Monet/Manet paintings - they are all in a separate set of museums that we never got to.

Babygirl had no specific interest in those artists, however, and on learning there was to be a guided tour of the South Asian art section decided that we should go with the tour.  It was admittedly fascinating.

"A soul outside the cycle of time." My mind is still a bit boggled.

The ever-popular lay-on-the-floor-to-get-the-ceiling shot:

The tour thankfully left us enough time to swing through the impressionists wing as well.  Seeing great art in person is completely different than seeing a photo.  Brushstrokes, layers, lighting, movement.  Amazing.

This is one I had never even seen a photograph of, called "Rain" by VanGogh.  Sorry for the odd sizing.


This gives a pretty extreme closeup of one of the sunflower series - it ALMOST does the brushstrokes justice.....

And then there is this oddity, by Toulouse-Latrec, a portrait of his dog painted on a random piece of cardboard (seriously, I suppose there is only so much Moulin Rouge to paint...):

The locals had recommended downloading the Uber app and catching a ride if we needed one.  I was truly surprised at how easy and affordable that was.

The ride from Philly to Wilmington was complicated by a handful of accidents on I-95 south (one apparently involving a truck full of carpets?), and Google rerouted us through an urban neighborhood where we saw a man come out of his rowhouse with a white german shepherd and a pig.   Not a little Vietnamese potbelly, a 400 pound white pig.  Sideshow, as it were.

Medically all is well.  The kidney is happy, Botox is helping the headaches at least for half of the time it is supposed to and we have marching orders for the next few weeks.


Wednesday, January 11, 2017

Things Unforgotten.....

While taking down the Christmas tree on Saturday, I reflected (as I always do) on the origen of each ornament.  Some I can't recall, some are a bit generic ("I bought that box to go on my first tree after medical school") but many more than you'd imagine have specific memories associated with them.

Most of my grandmother's have been broken or gone missing, but there are real pinecones with glitter that were maybe hers? Or Mom made them because they were like hers?  There are at least a dozen made by hand by my children over the years. There are gifts from college friends, long gone from my life but not my heart. There are ornaments that move me from far past to present, each a memory of love and caring:  Gifts like gentle voices from Christmas past.

There is one that always makes me pause each year, both in placing it on the tree and removing it.  It's a sweet little gray tiger china cat, sitting on a real satin pillow - odd for a Christmas ornament, really.  It was given to me by a patient more than 25 years ago.  He was the first of my patients to die entirely in my care.

Robert had suffered from severe depression his entire life in the era before Prozac. Treatments were limited to medications so sedating that people sometimes drooled; or to electroshock therapy.  Long-term hospitalizations were common.  He had done these things, and survived them all.

I asked him how he managed.  His answer remains one of the most haunting I have ever heard.

"Well, Doc:  Every morning, the first thing I do is decide whether or not today is the day I am going to kill myself.  When I decide it isn't, I put it out of my mind and get on with my day."

Every. Morning.

What kind of courage is required to look yourself in the eyeball every single day of your life and make a conscious decision to keep fighting a lifetime of accumulated despair?

He died at home only a few days after a cardiac workup.  I'll never know if I failed to find the problem that was causing his symptoms, or if his having symptoms gave me a way to put 'natural causes' on his death certificate for his family when he maybe made a different choice.  Those who found him found no reason to suspect that he had taken his own life.  I know he was intelligent enough to not leave evidence behind.

I've given it more thought as years have gone by than I did at the time.  This is very complicated:  Am I uncomfortable because I might have missed a treatable cardiac problem (I certainly was at the time!)?  Or because I think I could have helped more with his depression?  Or because I might be happier thinking he harmed himself than that I might have missed something?

Uncomfortable thoughts indeed, for a young doctor.  No less uncomfortable for time passed.

Doctors in general are realists.  We know that things happen, we know that we have the barest illusion of control, we know that our patients' lifestyles matter more than what we do much of the time.  I am good at compartmentalizing:  Separating home from work, head from heart.

But Robert thought well enough of me to give me a gift.  So each Christmas I spare a thought and a prayer for my many patients like Robert, who make the choice daily to live against the forces of despair.  And I remember those who haven't survived my care but whose courage lives on in my heart, inspiring me to always, always try my best for the rest.


Thursday, January 5, 2017


Generally speaking, I am a full-fledged grownup.  I am the one who manages Babygirl's medical appointments, medications and day-to-day needs.  I am the one who organizes vacations, family gatherings, big meals. I am the family CFO, paying (or juggling, as needs must) the bills. I am the one who manages the household stock of toilet paper.  You know, The Grownup.

Babygirl needs to see her specialists every three months, and have blood work every six weeks.  Her last appointments were in October.  We saw nephrology first, and then rolled out of Philly to go to Delaware to see the neurologists.  Since I didn't know when we would be following up with neurology, and they are harder to get appointments with, I told nephrology I would give them a jingle when I had more information about when I was coming back.  They gave me orders for blood work in six weeks and I sashayed out the door.

When I flipped the calendar to 2017, I realized two things:  1)  I had failed to take Babygirl for her six week blood work, and 2) I had never scheduled a nephrology appointment to go with the neurology appointment, which is upcoming on a Thursday. 


Adulting is hard sometimes.

Since the nephrology clinic is booked full on the day we are going to Delaware (and the day before AND the day after!), this means that I am going to have to make two separate four-hundred-mile round trips this month to the Philly area. 



Monday, January 2, 2017

Start the New Year: Clash of the Titans.....

Yesterday morning, despite a no-alcohol New Year's Eve, I was a little fuzzy in the morning.  We have three dogs, and I let them out in shifts, since Larry really can't focus on getting his business done with Capone's hyperactive intrusions into

Curlygirl and her roomate live in the apartment next door, and they each have a dog.  Capone (well-named little criminal that he is) doesn't want to make friends with Titan (a Pit/Boxer sweetheart) and Opie (a demon-possessed poodle/chihuahua mix), so we have to really watch the back doors to avoid conflict.  To add to this, Titan has been known to slip his collar on occasion and take himself for a stroll.

So when I opened the door to let Larry in, and a biggish Pit Bull hopped in through the door, jumped up on my chest and gave me a Titanic kiss, all I wondered was how the HELL he'd gotten out AGAIN and WHY is wearing a bandana instead of his collar??

I let him into Curlygirl's apartment, and let Larry in our side and put Capone out.

A couple of minutes later....some sleeping section of my brain got a hit of caffeine and thought, "Wait, what?  Titan isn't quite tall enough to kiss my cheek, is he?  And what color was that dog??"

I slipped into Curlygirl's appartment to find THREE dogs happily playing.  Oddly, Opie did not object to the extra Pitty, and Titan never objects to anything.  Yeah, it was a BIG dog, gray, not brown and white.

That explains the bandana vs collar thing.

Curlygirl was asleep on the couch through this entire thing, mind you.  Gray Doggie gave her a good sniff and a tail wag.  Lucky for her he didn't jump up and join her - I'm guessing he was a solid 50 pounds of muscle.

I snagged the bandana and gently led him to the front door, figuring that he could just walk himself back to wherever he came from, right?  As I opened the door, I spotted a neighbor with a leash and collar headed for my back yard (where Capone was raising a mighty ruckus), calling "Blue!  Blue?"  Good name for a gray dog I guess.  She was dogsitting for her son and Blue had snuck out. She was happy to see him, if somewhat puzzled by his indoor visit with us.

Oh. My. Goodness.  Thank God he was a peaceful dog.


Friday, December 23, 2016

Family Medical Leave.....

Today is my mother's 79th birthday. Last year at this time, Mom was actively dying.  Babygirl's health is always precarious. Citygirl had gotten married just a few months before, and my Dad died less than a month before THAT. All in all, I was running out of paid leave.  So, for the first time, I put in paperwork for FMLA.

The Family Medical Leave Act is a legacy of the Clinton years.  The rules are (relatively) simple.  If your employer has more than 50 employees within a 50 mile radius, they must grant FMLA time to their (usually full-time, been-on-the-job-at-least-a-year employees).  FMLA time is time off without pay (up to 6 months/year) for personal illness, illness in a family member where the employee's presence is needed to provide care, or the birth/adoption/foster placement of a child.  The employer is required to hold the employee's job for them while they are off.  Leave can be continuous or intermittent.

I applied for leave on Babygirl's behalf.  I could just have easily used my mom, or myself, but my office manager played rock/paper/scissors for me and picked Babygirl.  To get the leave, I had to fill out paperwork with  human resources, and send papers to her doctors.  It was a pain, because they didn't do it right the first time and I had to send them back, and I was crazed between work and home and hospital and grief and family and... Well, you get the idea. (Side note:  One of my elderly patients mentioned to me this week that I look much better this year than I did last year.  I wasn't sure if I was flattered or horrified.  Needless to say she passed her dementia screening.)

This year, around the beginning of November I had a flash of foresight and checked to see when my FMLA was due to expire, realizing that after having been ill much of the summer that I was in the same situation I was in LAST year in terms of remaining time off for the year.  There was less than a month left, so I sent in an application.

Within a day I got an email denying my request for leave because I had to wait another two weeks (until just two weeks before the old leave expired - which, given how complex it is to set the leave up in the first place just seems rediculous in my opinion but nobody ever asks me) and reapply.

Needless to say, I totally forgot all about it.  Until this week.

Last week I had noticed that out checking account balance seemed a little low.  Since Hubby and I both have access to the account, and both of us have been known to make purchases (pharmacies and gas stations being the most common) without recording them, I have a habit of keeping a pretty large balance hidden in the account.  I assumed that Hubby (or I) had paid something and failed to write it down. But when I got our bank statement on Tuesday, I realized that my last paycheck was substantially less than it should have been.  Since it is direct deposit and there are no paystubs, I had no idea at all that this had happened.

When I got to work on Wednesday I checked online and discovered I had been paid for only part of the two weeks I worked.  There was no obvious explanation in the pay document as to why, so I called my manager, and she discovered that I was no longer on her payroll. AT. ALL.  Awesome.

It turns out that despite being denied FMLA leave, despite having no medical documentation of my need for FMLA leave, and despite having applied for intermittent FMLA leave, I had mysteriously been granted continuous leave, beginning when my old leave expired.  I had unknowingly been working full-time without pay for about three weeks, and was less than two days away from my next paycheck, which was officially set to be $0. That's a FABULOUS paycheck to get two days before Christmas, aye?

My office manager worked on this frantically for two days, but at the end of it all, I'm not paid.  Merry Christmas, indeed.

Thankfully that built-in buffer that I leave in my account kept us from bouncing things all over the place. But it isn't big enough to catch everything that is going to start pulling out of our account at the end of next week, so here's hoping they get this figured out.


Tuesday, December 6, 2016


It is no surprise that I am still mourning.  It was about a year ago that mom took the fall that was, in the end, The End.  (I instinctively looked back to find the blog post about the fall, her hip fracture, and all of the rest but....there is a massive gap from December 1, right before she fell, until February 4, just days before her death.)  A lot happened in between there.  I guess, in a way, that is what this post is about.

December is Mom's birth month. Last year she spent her birthday in the hospital while they worked out doses of pain medications adequate to manage an irreparable hip fracture.  She was oblivious to the time of year, and had entered that phase of dying that includes visits from long-departed loved ones.  It was clear she would never come home, and decisions had to be made about her belongings, her kitties, family photos, trinkets and jewelry.  I had to work.  I had to make Christmas merry for the grandkids.  I had to manage her finances, figure out nursing home paperwork, visit her in the hospital and still attend to the usual miscellaneous medical needs of Babygirl and the rest of us.

It was a whirlwind.

My brothers came and sorted through thousands of pictures.  Curlygirl used her internet savvy to get a lot of furniture sold and moved out.  And as Curlygirl and family had already planned to move in and help, they went forward with the move, directly into the chaos.

January was hardly better.

Sorting/selling/settling continued.  Mom was moved from the hospital across the street to a nursing home 10 minutes away.  Hubby had massive back surgery.

February brought baby BamBam, followed immediately by a run to Philly for Babygirl.  We arrived home, exhausted as always, late on Wednesday evening.  I debated a run to the nursing home but was just too tired.  As I was getting ready to go in the morning, I got the call that she had just passed.  And not even one minute later came a call asking me if I could come pick up Squeaker at his school because he was throwing up and they couldn't reach his parents?  I'm not kidding, not even a little.

Just writing this down brings on a head spin.

We live in a crazy, crazy world. And we live at a frightening pace.  And while we did have really good family time at Thanksgiving with Mom before her fall, and good family time at Christmas before she died, AND good family time at her just didn't seem like enough, you know?  I look back on those three months and it's like looking through a kaleidescope of shifting, bright brittle colors:  Beautiful, but difficult to interpret.

What triggered all this, you ask?

At the end of yoga class today, because the room was chilly, the instructor came and covered each of us with a blanket during shavasana, the final quiet pose of the class.  The act of having someone 'tuck me in' was so intensely evocative of my mother that it made me weep.  And while I was lying on my back with tears trickling into my ears I was flooded with memories, each and every one of them of my Mother's laughter.  Monopoly at midnight on New Year's Eve.  Girl Scout Camp.  Makeshift living-room plays about Bible characters (did the Bible mention matzoh ball soup??).  Seriously, my mother once laughed so hard at us that she crashed the car into a tree (low speed, no injuries).

I'm already 30 years older than EVERYBODY in this class.  The last thing I need is to have the lights come up while I'm trying not to simultaneously laugh and cry for no obvious reason.

It's amazing how much emotion you can begin to process in three minutes, and how much time you can compress into that space.  This is, by the way, entirely against the point of shavasana as I understand it.  But the soul needs what it needs, right?

My Christmas cactus is blooming.  Right or wrong, I believe my Grandmother makes flowers bloom for me when times are tough.  It started blooming on my Dad's birthday, and I'm thinking it may still be blooming on Mom's.   Hugs come from heaven to us from all different directions, be it a flower, or a blanket from a stranger.


Thursday, December 1, 2016

People Look East....

One of my favorite Advent hymns is People Look East, although it was new to me just a few years ago.  Written in 1928, it has a more ancient sound to it, and it has an awesome alto part (always a plus in my book LOL).  

But the appeal is very deeply rooted in the things that are most important to my heart:  Being prepared, being hospitable, making life as lovely as you can with what you have been given with what strength that you possess. The hymn calls us to prepare, to endure, to grow, to shine.  It calls us to be excited, VERY excited!

Guest, Rose, Bird, Star, Lord - they are ON THE WAY!  Get cracking, people! It IS the crowning of the year.