family practice issues and general life events

Posts tagged ‘family’

Slowly fading away

It is Alzheimer’s awareness month, along with any number of other disease processes and statements.  I focus on Alzheimer’s because other than a paralytic stroke, I think that this disease scares me.  Why?  Because I can’t imagine the fear and terror of slowly losing your ability to remember anything short term.  To know that you once we highly functioning, to being trapped in a world you no longer recognize.

I see it almost everyday in my office.  Patients brought in with their caregivers (usually a daughter or son) who don’t understand why their caregiver keeps telling them what to do, why they can’t drive, and any other numerous complaints about some function of their life that for safety reasons their loved one has stopped them from doing.  Things that we take for granted, going for a walk, running to the store.  And they haven’t done it out of cruelty but out of love.

And I see the fatigue and tireness in the eyes of the caregiver, as their parent is now yelling at them for being so bossy.  As they calmly explain “Mom, we haven’t had that cat in 10 years.” Or the fear in their eyes when the patient asks for a motorized scooter so they can go where they want to go.

It is heartbreaking, and it is personal.  And it is very real.  I can’t remember when I really started noticing my grandmother’s memory loss.  It is a slow insidious process.  It is not that one day they woke up and couldn’t find their keys- I can never find mine, and no I am not experiencing dementia.  But I remember when I realized that the process was really taking hold in my grandmother.  I had gone home for the funeral of my aunt (not her child).  She and my grandfather (dad’s parents) had come to the funeral to support my mom (it was her sister).  I had brought my son, who was not yet a year old (so this would be about 8 and a half or 9 years ago).  She remembered me, and I am sure that she realized that the baby was mine, but there was a statement she made that stuck out to me, and I tucked it away.

“Surely I can sit here with him and he won’t mind.  I always seem to be in the way anymore.”

In of itself, not too major of a statement, but it was.  My grandmother was not someone I had ever thought of as in the way.  But at that point she was worried about it, and then when added to this comment

“This is your baby right?”

That is when I knew my kids would never know the grandmother I knew.  The one I went to visit almost weekly since I was eight years old, and they moved close enough to visit.  Well until I went to college anyway.  But she was aware that her mind was leaving, and it made her sad.

Since then I have seen her when I have gone back to visit my parents.  And each time, what my parents see in real time I see in big leaps and jumps in decline.  I remember the Christmas where she sat in the corner, no longer actively preparing food, or taking part in the conversation.  I remember when I went back for graduating from an online MBA class, and at the dinner, re-introducing her to my children, and her asking the same four questions over and over.  I have seen my grandfather order for her in the restaurant, and watched him coach her as they walk in the door who everyone is, and where they are.

But last year, I saw that the coaching cannot hide it anymore.  The questions have stopped other then the polite “How are you” and “Look how big they are”  She sits they quietly at dinner, in what I imagine is her own private torture.  She remembers my dad, most of the time.  But he says, now he is not sure that she really remembers him or if it is because grandpa has coached her and let her know when he is coming.  Though there are moments of clarity, they are fewer and farther between.

This disease is sad and disheartening.  There are only tests that suggest it, with the definitive diagnosis only being available on autopsy.  But for the patient and the family, it is very real.  There are medications that slow the progression, but they don’t stop it, no matter how much we would like it to. Instead we try to keep them as safe as possible, and try to remember how they were with love.


When did my career become a secret?

A couple of days ago I noticed something. When people ask me where I work, I don’t usually introduce myself as a doctor.  It was one thing, when buying a car, that I would off-handedly say, “I work at the hospital.”  You are always told adding Dr to your name adds zeros to every purchase, buying a car, building a clinic, buying a house.  Anyway, in purchasing, you just don’t do it.

However, this time it was different.  I was eating dinner with my children at the Olive Garden, when the waiter asked what I did for a living.

I was wearing scrubs, so the question was initially, “So did you work all day.”


“So what do you do?”

It was not the waiters fault, he was perfectly hospitable, taking care that our table had drinks and attention that anyone would appreciate.  We talked about the iPad 2, since I happened to have both children’s and mine with me.  And if I thought it would be a good deal to buy one, and if we liked ours.  All perfectly pleasant.  It was only when he came over during a discussion with my oldest, as to why I could not donate blood at his school’s blood drive the next day.  (Previous years, I have, but this year it was on a Wednesday, and most Wednesdays I barely have time for lunch much less time to drive 30 minutes to his school, donate blood, and return to work)  So I pulled up my schedule on the iPad, and showed him how full it was.  Still not overly impressed, he said, what about after work?  At that point, I promised him, if by some miracle of miracles, I were to finish by 4 pm, I would donate blood.  However, since I have yet to get out of the office by 530pm on a Wednesday in about 8 months, well it probably was not going to happen.  And this is when the above conversation happened.

I don’t know why I stuttered.  I am not really ashamed of what I do.  Obviously I would not be blogging about it online if I were.  But stutter I did, as I admitted that I was a physician.  Admitted, is this what the once noble profession I dreamed of being as a child came too?  Or maybe it was that I was caught off guard, since it was an early dinner due to having to leave work early in the afternoon to take my youngest to speech, and then kill time between therapy and a skate party.  And maybe that I was worried I would have to explain.

I spend a lot of my day explaining things.  Why I don’t take call, why I don’t go to the hospital regularly, why I have no desire to work in the ER, why I leave early on Tuesday and don’t see patients on Thursday.  And maybe that was the reason.  However, he did not ask for explanations, he actually was reassuring that my career was not equivalent to that of a drug dealer, even though some days, I think that is what I have become, at least in the eyes of some patients.

Maybe I spend too much time online, reading the terrible things people say about doctors, how they make too much money, they rush in and out of rooms too fast, they take too much time to get to their room, that they just don’t care.

I heard a joke once in training that the person who yells out first “Is there a doctor here?” is probably a physician themselves.  And sometimes, I wonder if that is true.  The days, weeks, months, years of fighting public perception as a money hungry individual willing to throw their patient under the bus for a dollar on one side, and the fighting for the dollars rightfully earned trying to provide the patient care that they deserve may have worn us down.  The time spent fighting against liability claims and fear of lawsuits despite no wrong doing, maybe those have worn us down as a profession.  The stories of physicians who have stopped to help someone on the side of the road and despite no wrong doing receiving a lawsuit for a bad outcome.  Maybe that is why we no longer stand up and say I am a doctor.  Or maybe, I just I don’t want to be chased through the grocery store to look at a mole.

And in my case, where my husband and I made the choice where he would take my call, so that one of us could be at home at night with our children, maybe I just didn’t want to explain one more time, why I don’t go to the hospital.  It is not that I can’t, it was that I put my kids before my career.  It is the years spent justifying why I don’t do shifts in the ER like my husband.  It is the time spent alone, at night, wondering if I made the right choice.  Did I do what was best for my patient?  Did I make a difference for the better?  Or what am I missing on that patient?

For the most part, I love my job.  I like that I am in most of my patients’ lives.  In many instances, after they get a recommendation from a specialist, they come back and ask me what I think they should do.  Or if they could have a second opinion, not necessarily that they disagree with the first, but that it is a major decision and they would like to have another perspective.  I don’t make as much in my clinic, as my husband makes doing his shifts in the ER.  I see the reports as to doctors not choosing primary care residencies, and I understand.  The money is not as good, and most of us graduate with a large amount of debt.  And you have to spend a large amount of time fighting, fighting insurance companies, fighting for payments, and watching the general population equate your training with that of a midlevel.  Even though you have twice as much training, 4 times as much debt, and way more liability.  And then at the end of the day, you notice the pile of paperwork- not visit notes, but other paperwork.  Prior authorizations, home health messages, home health certifications/re-certifications, various forms for patients regarding why they cannot work, disability questionnaires, and random notes that the patient wanted you to write for them yesterday.  Add to that orders that the specialist decides that they want done, but don’t want to obtain the prior authorization themselves, despite having the pertinent data needed to get the test approved, and yet they don’t send it to you.  So I understand why students are not choosing a career in primary care.

And maybe it is just a combination of all of those reasons that I don’t introduce myself as doctor out in public.  At maybe, just maybe that is why I stutter when asked what I do for a living.

My grandma doesn’t know who I am

This post is both sides of my life smashing together. Last night, I went out to dinner with my grandparents. Since I have moved away, it has been a little over two years since I have seen them. Two years ago, I noticed a significant change in my grandmother’s memory, but she knew who I was. Last night, she no longer remembered me.

I know this for sure, because when my father went to get her in the front of the restaurant (My grandfather had dropped her off up front and went to park the car), while she probably recognized him, she talked to me like anyone would to someone they didn’t know coming up to them. And it broke my heart. It wasn’t that I didn’t expect it, it is just when reality slams you in the face, it does hurt even being a clinician. As a clinician, I watch the heartbreak of families as their loved ones drift into a world where they might or might not be remembered. Where something as simple as ordering can no longer be taken for granted. I noticed that my grandfather took care of that for her, ordering both her meal and a drink. And through dinner, I noticed flashes of the grandmother I remember. The one from 10 years ago, when I stopped coming home nearly as regularly.

She seemed to enjoy seeing my children, but she enjoyed them as you would children in a park, distant, without any other connection to them. As for me, I know she was coached somewhat, and related me to my father, when she realized that connection she became kinder, but I could tell despite mechanisms she had in place, I was not in her current memory. Probably because I am not the same as the grand daughter in her memory of 20 years ago.

Two years ago, I am fairly certain she knew who I was. Didn’t have a clue regarding my youngest. But did seem to remember I had one child, and was pleasant and talkative. Last night, she was fairly quiet. Didn’t say much. I can only imagine what kind of world she is living in.

She was well educated. She went to both college and graduate school I only found out about the graduate school because when I was waiting for acceptance to medical school, I had started applying to graduate schools and chemistry. And when I mentioned that I was applying to the University of Michigan, she said “That’s where you grandfather and I met in graduate school.” She went back to school throughout my junior high and high school years, learning Japanese, and I don’t really know what else, but education was important. Which only makes this sadder and more terrifying.

I don’t know what my grandfather goes through on a daily basis. He seems actually a little more to me, than he has in recent years. He also is quieter. Whether it is due to watching his wife of 61 years slowly lose all of their memories or if it is that his children have grown up and moved away as their grandchildren have, I don’t know. But it is a sad story. It was sad when I talked to my patients and their families. IT is sadder now that I see my once vibrant, happy wonderful grandmother become only a shadow of what she used to be.

Dogs, tumors and denial

It is funny, as a doctor you wonder sometimes how can one deny conditions to themselves.  Sometimes though, it is not a denial, but a gradual enough appearance, that when you see it everyday, the growth does not appear to change the appearance.


Something similar happened with my chocolate lab last week.  For those of you saying that a dog is not human, my dogs are almost as important as my children and husband.  In fact, Sara my lab, provides me a measure of comfort the nights which my husband works.  Anyway, when we took her the vet for a check up and they asked “How long has she had this mass?”  What?  First I thought, it was one that we previously saw, but no, it was on the other side.  And then we noticed it.  How awful.


Sara, who while a little overweight, (OK, maybe quite a bit) is my active, happy dog.  My companion.  She swims in the lake beside me, while I am in my paddle boat.


Sara and Brandy taking a snooze on the couch

And she provides some measure of comfort due to her size, even if she is snoozing on the couch.  So we scheduled he surgery for today.


All day, I have been scared that the vet was going to call saying something went wrong with the surgery.  Or that they were pretty sure it was cancer, even though the sample before surgery appeared to be just a fatty tumor.  But none of that happened.  Instead when I got to the vet to pick her up, they asked if I wanted to see what they took out, and said “Yes”  So they brought it out.  And here it is


Lipoma (fatty tumor from Sara)

Largest fatty tumor I have ever seen, and apparently same goes for the vet.  He said it took it out in three pieces.  And when she came out, she looked in pain, and I felt horrible, since how could I miss a tumor that size.

Poor girl.  It hurts for her to even walk.  Even worse, later when I tried to give her amoxicillin and aspirin, she refused the hot dog I tried to give her.  I had to force it down her throat, and even then she refused the hot dog.


A little later, she seems to be moving a little better.  Maybe in a couple of weeks she will be swimming in the lake again.  Beside me



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