Day: March 6, 2020

Crying by the dumpster outside of Olga’s

I just have to relay this story a patient told me the other day. Let me set up the scenario. So, this patient has a large family. Her children’s ages range from elementary school to college. Some of them are still at home. Some are off at college. She has always had a close relationship with her kids. You could even say that she values them even more than she values herself. She is a perimenopausal woman with let’s say more than her share of hormonal and mood lability, as all of us perimenopausal and menopausal women do. To say that she can be oversensitive at times is probably true. We all can. Let’s add to that the fact that college age kids who have moved out have a very different sense of what is appropriate and acceptable with regard to conversation and “house rules” than elementary age kids do. It’s a recipe for absolute peace and harmony right? That was rhetorical. Of course it isn’t.

Ok now that I have the stage set, let’s look at what happened. The college kids came home for the weekend, one of whom had not been home in months. The whole family goes out to dinner. My patient is super excited to see everybody and hang out. She has already had an emotional day and she can’t to hug the college kids and maybe even play with her daughter’s hair like she used to. She gets totally rebuffed. Now she is already hurt and trying to hide it while they are all sitting there eating, but the hurt is slowly welling up, threatening to take over just the same. Then the conversation starts and she hears her older children making conversation that is just plain uncomfortable for her. She is not sure if they are just trying to be sarcastic and funny or just plain hurtful. When she tries to interject, they just look at her like she is from another planet with that “What’s the problem” expression. Finally, she feels herself losing emotional control and announces that she is going to just go home rather than cause some sort of fight during what was supposed to be a nice family night out. They look at her and laugh and remind her that she doesn’t have a car because they drove. By then she is really embarrassed but can’t back out now and leaves the restaurant, only to find herself crying outside by the restaurant dumpster.

Oh the humanity. That story completely sucks right? It embarrassing. It’s humiliating. There is miscommunication everywhere. The kids probably didn’t realize that the mom was already emotional. The mom probably didn’t realize that the kids were just trying to act grown up and show off their intellectual prowess. It’s just a no win scenario. You are thinking to yourself, I would never do that. I say au contraire! I am willing to bet that there are a lot of moms out there that have been in a similar situation. C’mon you can admit it. Being a mom to college age kids or any kids that have moved out of the house is way harder than you think. Whatever scenarios you thought you had handles when they were teens living at home have paved the way for a whole new set of scenarios to slog through best you can. They have been living on their own without supervision.( Yes that’s right. I am saying that dorm resident advisors are not all they are cracked up to be.) They have been setting their own rules and curfews. They are probably having sex. They have linked up with all kinds of kids from all over the world with all kinds of opinions that you probably don’t share. On top of that, those opinions may or may not be based on any known facts, but they sound cool to spout out with their friends. You as the mom are no longer their primary influence and you are definitely not as cool as they once thought you were now that their horizons have widened. Ugh! Now add on top of that the fact that you are probably at least perimenopausal if not postmenopausal with hot flashes, labile moods and fluctuating hormones and, even on a good day, you could rocket from singing with the radio to screaming or bawling your eyes out in less than 10 seconds. These are the kinds of elements that lead up to the story from above. These are the kinds of elements that foster miscommunications and misunderstandings of epic proportions if you are not conscious of what’s at play. My poor patient and her family were set up from the start from both ends. She was all emotional and ready to bond ” with her babies.” . The kids were ready to joke and act like their interpretation of grown ups. It was set up to fail.

Raising college age kids sounds like a misnomer doesn’t it? A lot of people think that once they are 18, your job is over. Likewise, a lot of college age youth think that they are ready to be fully in charge. Well, neither perspective is really accurate. Our kids will always be our kids and we will always be their parents. We will always have some level of investment in how they end up in the world. That being said, we also have to be ready to modulate our mutual roles in a way that is acceptable to both parties if possible. Sometimes it is not possible, but we have to at least try. As much as I miss picking up my kids and tossing them into the air or playing with their hair and cuddling, I realize that they are just not as up for it as they used to be. I can try to resort to emotional blackmail, but it won’t get me anywhere. I have to realize that these things don’t mean that they don’t love me or love me any less. They are just evolving in how they chose to bond with me. I can sit there hoping that one of them is going to jump into my lap one day and want me to read them a story, but it is not likely to happen. Instead, we might have a conversation about politics(yuck) or what’s going on at school or I just listen to long, what they think is eloquent, speeches about what is important to them at the time. I am just kidding, I love hearing about what is important to them an I love to watch how their thought processes change over time and the evolution of their responses to certain situations. What I don’t love, is if those speeches turn snarky, satirical and hurtful without purpose. If they do, it is up to me to remind them that no matter what opinion they have, it is still their responsibility to voice it responsibly and remain a good human being. Sometimes, as they are espousing away, they don’t even realize that the person listening might think they are just being a jerk, rather than impressing the with their intellectual brilliance. In terms of voicing things responsibly, I also realize now that I am better off if I give people a heads up if I know I am having a perimenopausal emotion buffet day before I head off to any family outings. This system is not fool proof, but it is worth the effort, if you want to still bond with your kids as they get older. The old adage by Khalil Gibran says that ” If you love somebody, let them go for if they return, they were always yours. If they don’t, they never were. ” I think this means that we have to loosen the reigns and adapt a bit within reason as our kids get older. Then hopefully, they will come back some day, realizing just how cool we really were the whole time! Have a fantastic day everyone!

Dr. Katz

Mom you’ve got 4 eyeballs!

Well that’s not something you hear every day! Nope. Only when your poor child is post anesthesia from oral surgery and is laying there somewhere between laughing and crying and begging for chicken nuggets….which you know would be an absolute disaster. Sometimes you get lucky and they also start spouting about how much they love you and that you are the best mom ever. So, it must be true right? Yup, those are the times ripe for future blackmail material. The temptation to pull out my phone and take a quick video is strong. I just want a few minutes to save for later maybe when all hope seems lost in the middle of a teenage argument devoid of reason. What harm could it do? Well, no harm except for your teenager vowing to never speak to you again, but how many times have you heard that one only to have them yelling at you about something else moments later? Oh yes. Empty threats at best. We have all been there.

So, let’s talk a little bit about anesthesia for a minute. Anesthesia is somewhat of a magical and frightening creature at the same time. It allows us to drift off to another place to allow necessary and painful procedures to be performed safely. It allows us as physicians to get a glimpse into the uninhibited treasure trove of thoughts that are racing around in a patient’s mind, the things that we never get to hear at the office. Sometimes these anesthesia ramblings help physicians with a diagnosis or help us uncover a stressful social situation for the patient that we didn’t know about. As patients, it also somehow absolves us of any accountability for what we might say or do under it’s effects. On the other hand, it is kind of a frightening thought that you could have carried on a whole conversation, done terrible things and had no idea that it even happened. I have been under anesthesia many times for different reasons and each experience has been a little different. I have felt like I was thrown abruptly back into my own body from somewhere in the hinterlands while struggling to rejoin a conversation that I had apparently been having for the last 20 minutes. I have woken up bawling my eyes out for no apparent reason. I have woken up surrounded by staff members looking really somber, thinking that I must have just been diagnosed with something terrible, only to find out that they were just disappointed that I wasn’t funnier under anesthesia that time. (Apparently I am quite the cut up usually.)

I have to admit, I have heard some juicy tidbits over the years from patients that could fill a whole book of memoirs. And yet, all their secrets remain safe with me. It’s a code of ethics and honor man. Sometimes I get lucky with patients and they say wonderful things about me and about the staff and how much they love me. I have to admit, these are pretty great moments. I stand there thinking okay! This is what they really think! Yes! I must have done something right! Whoo! I already said that anesthesia was like truth serum right? Then, those same patients wake up fully and are as crabby and onerous as ever and you think to yourself, ” Oh well. We’ll always have Versed. “

Have a fantastic day everyone!

Dr. Katz

Hey Doc! You can borrow my shoes!

Sweeter words were never uttered. I was in the office the other day. It was very busy with a combination of aesthetics patients and obgyn patients. We were bustling along when we found a potential baby in trouble. The ultrasound didn’t look good and imminent delivery was required by c section. This, of course, puts everybody into full on spring into action mode as it should. I realized that I had seriously miscalculated my fashion choice with my wardrobe for the day. High-heeled shoes were not exactly conducive to performing a c section. We quickly and safely got the patient over to labor and delivery so that they could get her ready. I rushed around the office notifying the other patients and directing the staff for a minute. I made a joke at the front desk about my “Sunday Best” attire for c sections and that I did not bring any spare emergency shoes that day to the office. One of the other ob patients sitting in the waiting room hears me and yells out,” Hey doc! You can borrow my shoes! I like being bare foot!” She was dead serious. She was willing to sit there barefoot, pregnant as all get out, in my office until I was done with the c section so she could lend me her sneakers. Ladies and gentlemen hold your horses. Those words were music to my ears. They were kind, loyal, altruistic and just good stuff. This is the kind of happy and kind patient that you dream of. This is the kind of patient that actually thinks enough of you to want to help out in any way that they can. This the patient that comes along just in time to remind you why you are practicing medicine in the first place. You may only get a little sprinkling of them here and there. Enjoy them and appreciate them. You just don’t see that every day.

Of course, I couldn’t take her up on her offer, as amazing as it was. I just couldn’t leave her pregnant, shoeless, and stranded in my office. I thanked her and told her how awesome her offer was and that she was one of my favorite patients ever! I meant every word of it too. She smiled and then left….with her shoes on….and I went clicking down the hall to do my c section.

This patient really is one of my favorite patients, not because she offered me her shoes, but because she is a genuinely nice, kind, grateful patient who seems to understand the value of the care she is given. She seems to appreciate the time that we spend with her. She is also nice to the staff. That is like gold right there. There are way too many patients out there who take some sort of sick pride in treating the staff horribly and then gliding into the exam room without missing a beat and kissing their doctor’s proverbial butt to get what they want. The less astute physician then blithely goes along thinking they have this great patient, without realizing that the staff either cringes in horror or swears under their breath whenever that patient comes to the office. Here is where the communication piece potentially breaks down. I insist that my staff communicate to me immediately if they are treated poorly by a patient.( Yelling, screaming, cursing, etc) I can only fix what I know about. If they continue suffering in silence, there is nothing that I can do. When I am made aware of such behavior, I have an immediate conversation with that patient. I carefully and directly outline the behavioral expectations of respect in our office. I explain to them that I expect each patient to treat the staff and myself with respect and we will do the same. Otherwise, my office may not be the right place for them to seek medical care. I even have a phone script ready for my staff to deal with a belligerent patient. They are allowed to say,” Dr. Katz has given me the authority to terminate this conversation. Should you wish to call back when we can interact in a more civil manner, I would be more than happy to help you.” Then they are allowed to say have a good day and hang up. Yes that’s right. I do not feel that my staff should have to be some sort of whipping post for patents to unleash upon. It is just not right. I will actually dismiss patients for that. I don’t care if they have one of the few great insurance plans left on this earth. There is just no good reason to put up with that. Those couple of intolerable patients can bring down your whole office morale.

There is another species of patient that is difficult to understand. This is the one that somehow has to let you know that you are unnecessary. I see this more often with my ob patients. There are certain ob patients, who really secretly want to have a home birth by a lay midwife before they even come in for their first visit. These are the ones who already resent me and what I represent as soon as they come in to the office….even before we have met. These are the same patients that will shake their finger at me and point out that women have been delivering babies for thousands of years before people like ME came along….complete with raised voice and the whole works. Those are the patients that I just look at them and smile politely…and then I point out that that same thousands of years strong group of women that delivered on their own had a 50 percent mortality rate during childbirth. I encourage them to play those odds to their heart’s content if they desire to. I am not here to get in their way. I also inquire at that moment as to who forced them to come to my office? I politely point out that I do not see any ligature marks from the rope that tied them up and dragged them in and that I did not actively recruit them with a sandwich board and a bell. I remind them that they are free to leave any time. Sometimes, if they are particularly belligerent and out of line, I remind them that my practice will go on even if they leave. This sort of dialogue usually results in one of two things. They either storm out or they sit back down on the table and actually allow me to do my job. Of course, it took me over 20 years to finally summon the cajones to actually have those conversations and to some of you, it might seem a bit drastic, but I don’t regret them. Sometimes they are just necessary. Have a fantastic day everyone!

Dr. Katz