Priceless

His words penetrated like shards of glass; my face flushed and my eyes welled up. We were sitting in his dingy office in the entrails of the hospital, dirty coffee cups littering his desk, stacks of papers in disarray, photos of a family who must love him thumbtacked to the wall and all I wanted to do was to scream.  “I am not going to let him see me cry,” I willed myself.  I swallowed the lump in my throat and, realizing it was pointless, I navigated the conversation to the end.  I walked out of his office, down the corridor, to the chapel and then I cried.  It was a cry of sadness and anger.  I had gone into his office to ask for the same hourly salary earned by my colleagues; equal pay for equal work.  But he didn’t feel like dealing with me on a Saturday afternoon.  He wanted to work his shift and not be bothered by administrative duties.  “Personally, if it were up to me, I wouldn’t have any internal medicine doctors working in my department.”  His words reverberated in my mind.
 
Dr. Weiner, whose name matched his personality, was the acting chairman for his department; the understudy, temporary and replaceable. With callous detachment, he told me: a) not only did I not deserve equal pay, but b) I was inferior to his skill level and those of the other doctors in his specialty. He didn’t just hit.  He hit below the belt. When I asked him for a pay raise, you’d have thought I was asking him to wire transfer the money directly from his own account.  Hospitals and departments have budgets but he chose to respond to my legitimate request by ambushing me.
 
I’m valuable to his department, working there long before their program existed. As a student, I sewed up a dead guy’s chest in the trauma room before his family said their final goodbye. A year later, I met my husband, an intern, as he attempted a spinal tap on a large, obtunded woman.  I’ve grown up in that hospital over the past quarter of a century; first as a student, then as a resident and now as faculty. I’ve argued with anesthesiologists and orthopedic surgeons, told undocumented immigrants they don’t meet criteria for emergent hemodialysis and Spanish-speaking women that their pregnancy has failed, examined more body parts and heard more stories than there are words to a page. Since the new program began 7 years ago I have covered shifts so faculty can attend Wednesday lectures, retreats and I pitch in whenever they are short-staffed.  I’m a skilled clinician, respected by nurses, physician assistants, nurse practitioners, residents and other physicians.  I can quickly clear a busy waiting room and I see patients independently.  I don’t have to have a resident there to do the dirty work.  I do it myself.
 
To provide some background, my training is in internal medicine.  Internists are the thinkers, the problem solvers, the puzzle fixers.  I’ve practiced medicine for 19 years if you count since the end of my residency training, 22 years if you start the clock at the end of medical school. Though an internist, I still like to work in the acute care setting of our city’s large, public hospital.  This department is a relatively new field and as the new kid on the block, they are still trying to stake their claim.  Like a dog marking his territory, Dr. Weiner was pissing around the perimeter of his domain that afternoon.  I got too close to the boundary and damn near got bit.  
 
Theoretically, medicine is the noblest of professions, based on compassion to others.  However, to one another, physicians can be terribly cannibalistic.  Especially within teaching institutions, egos run amok and thinly veil insecurities., Asking a consultant for recommendations, because it’s in the patient’s best interest, often results in a dressing down.  Collaboration is perceived as a sign of weakness. If you can’t figure it out on your own, then you might as well pack up your bags and go home.  It’s a subtle form of shaming.  Internists do it to surgeons.  Surgeons do it to internists.  All specialties do it to emergency medicine doctors because they are the ones trying to admit patients to your hospital service. Finally, men will shame women and then women will shame other women or those inferior to them in rank.
 
This caste system, or hierarchy is not new and though it’s improved over the past 2 decades, it’s still pervasive.  I’ll complain to my husband, a white, male doctor, about this and, because he doesn’t fit the mold, sometimes he gets defensive or his feelings hurt.  He tries to understand the undertones of sexism and racism experienced by his wife or his colleagues and he becomes indignant on our behalf.  He offers, “If I had been in that room, I would have said or done this or that.”  But he’s always had the good fortune of walking into the patient’s room, the meeting or the consultant’s office in his white coat as a white man with everyone automatically assuming he knows what he’s talking about, deserving of awe and respect.  As the white man, even when you mess up, you are still venerated.  My kids have coined the phrase, “Dad Facts”.  Dad Facts are proclamations of truth based on nothing other than a father’s insistence that it is so. Once, my 17-year old son was asking me a serious of questions to which I had no answer.  My response was, “I don’t know” to all of his queries to which he sighed, “I wish you just had some Dad Facts.  Even if the answers don’t make any sense, they are still comforting because they are stated with such conviction.”  Dr. Weinerwould have never spoken to my husband the way in which he spoke to me.  If he had, my husband would have come after him with some Dad Facts and set the world back on its axis.
 
Let me offer a few vignettes as illustrations.  Recently, I accompanied my husband while he went to get his allergy shot.  Our middle son wants a cat and my husband is deathly allergic, as in throat-closing, epi-pen needing anaphylaxis.  But, because he loves our kids so much, he is willing, quite literally, to put his life on the line for our son.  When we pulled into the clinic’s 1970-style parking garage, the car across from us was being broken into by a young black male.
 
A young black male was breaking into the car parked across from us.  
 
I made a mental note to myself in case I needed to give a description to the cops:    He was about 30 years old, bearded, skinny, 5’11’ and he wore a yellow construction vest, jeans, a navy t-shirt and jandals with socks. We watched as he unsuccessfully jammed, in through the driver’s side window, a white, metal coat hanger twisted into a 2-foot long probe.  “Hey man,” he called to us, “you have a long piece of metal I can use?  I locked my keys in the car.”  We shook our heads and kept walking.  One of us mentioned to the other, “Do you think he really locked the keys in the car or do you think he’s trying to steal it?”  
 
Thirty minutes later when we walked back to our car he was still fishing through the window.  However, this time he had his wife, their 4-year old son and infant daughter, waiting patiently alongside him. The family unit changed our biases.  Suddenly he was no longer a thug trying to steal a car, but an unfortunate young man trying to get his family home. For the next 45 minutes he and my husband worked together on a common project, trying to open the car door while, I talked to the mom and entertained their little boy. Finally, a locksmith came along and opened it with a slim-jim.  We paid for the locksmith because they didn’t have enough money. We left with a sense of satisfaction that we had done something good but neither one of us addressed the underlying prejudice we had both brought to the table.  
 
So, a little bit of backstory: my mother had me when she was 19 years old without a shot-gun wedding to legitimize the situation.  It was quite the scandal.  Just before I turned 2 years old, she married the man who adopted me and who I consider my father. They had my little brother but separated and divorced by the time I was 13 years old.  Though she later went on to get a nursing degree after my brother and I left the house, she raised us on less than $20,000 a year.  Determined never to be in her financial situation, I decided I’d work hard and become a doctor, like her brothers, my uncles, whose monetary support helped us survive.  I also discovered, early on, that my brain was my biggest asset. The better I did in school, the more people paid attention to me.  I got noticed enough to get a partial scholarship to a private, 4-year liberal arts college.  
 
Most of what you learn in college is done outside the classroom. I had just moved into the dorm, classes had not yet begun, and one afternoon several handsome fraternity boys came through the dorms dropping off embossed invitations to the incoming freshman girls. The tea parties to which we were invited were supposed to be social gatherings intended to welcome new female students; at least this was the justification on paper.  In reality, they were sanctioned date-rape parties.  The night of the parties, a dozen of us from my floor, strangers just 2 days prior, put on make-up, party dresses, heels and walked over to fraternity row where these seemingly polite, young men poured us fancy drinks. I spent most of the night talking to a good-looking upper classman from New England.  I was 17 years old, still a minor, and ridiculously naïve.  When he asked to show me something upstairs, I wanted to be cool so I followed him to his room.  No one was present to tell me it was a bad idea and once we were alone, he quickly tried to round the bases.  When I told him he couldn’t put his hand down my pants, he became angry.  I lied and told him I was on my period.  This was not the night he had envisioned and he was pissed.  It was late and with the only shred of decency he possessed, he drove me back to my dorm.  As I got out of his car, full of shame, he told me that I shouldn’t have come to the party if I wasn’t prepared to sleep with guys and certainly not if I was on my period.  “That’s the only reason we have these parties.  To sleep with freshman.” It was 1986.  Welcome to college.
 
Six years later, I started my clinical rotations in medical school.  Up until that point, medical school had consisted of lectures in a large auditorium with all 200 of my classmates.  Clinical rotations took place inside a hospital and you were part of a team consisting of residents several years out of medical school, other medical students and a member of the faculty who’d come by for 1-2 hours a day.  Most of your time was spent with the residents who did the bulk of the patient care and teaching to the medical students.  The third-year resident on my team would keep me and my female student partner in the hospital till 3 or 4 am and make us listen to his narcissistic tales of driving in fancy sports cars with Wayne Gretzky and of the number of women he had bedded (despite being married).  Fred’s misogyny knew no end and he deftly wielded his power over us.  He was going to be a cardiologist, was chosen to be a chief resident and he gave us our grade and evaluation.  Anything to piss him off and we’d have a failing grade.  So Carie and I endured his inappropriate comments and endless rants.  “Are you wearing a bra?”, he once asked me.  On a separate day, he asked me why I dressed like such a lesbian.  Who was I going to tell?  All the faculty were old white men and there was no such thing as sexual harassment in the early 90s.  
 
Fred wasn’t the only guy to say horrible things during medical school.  One day I overslept my alarm and came in 20 minutes late on my surgery rotation.  The 5th year surgery resident, a loud and overly confident guy, told me in front of the entire team, I wouldn’t be late to rounds if I didn’t sleep with my boyfriend in the morning.  I was the only female on the rotation except for another female physician assistant student.  All the guys laughed and we were sent to change dressings on post-operative patients.  
 
Shaming doesn’t come from men alone. Women can be equally injurious.  Rather than support one another’s decisions, fear can get the better of us and we tear each other down, particularly when it comes to differences in work-life balance.  My decision to work part-time was a no-brainer.  I had breast cancer when I was 37 years old and my kids were 6, 5 and 3 years old.  I didn’t want my impending mortality to cheat me of time I had to spend with my family.  So, for the past 10 years I’ve put career aspirations on the back burner and driven a lot of car-pools, packed a lot of lunches, volunteered in many classrooms and done some doctoring.  Recently, in a professionalism workshop at my institution, a very senior female faculty member stated women who work part-time have been flailing in their careers. When I envision a person flailing, I think of someone drowning with their arms and legs akimbo, struggling to stay afloat.  I hadn’t been flailing at all.  I was navigating my career, my family and my disease with finesse.  Obviously, this woman has never met me or she’d be asking me for advice.  
 
In hindsight, Dr. Weiner and all the other phalluses have done me a favor.  Not getting that pay raise sucks but I gained something far more valuable; insight. You can be the smartest person in the room and yet lack wisdom.  I’ve encountered a fair share of fools in my lifetime and I’m sure there are more to come.  The ludicrousness of peoples’ comments can be comical.  Every one of these characters is emblazoned in my memory.  Marionettes in a dark comedy of puppets; the theater of the absurd.  You can’t put a price tag on someone’s value.  My worth can’t be cheapened, no matter what others may have said or done.  The fact of the matter is this; I’m priceless.  


- Posted using BlogPress from my iPhone

Meaningless Chatter

This post is going to be about Shimmer and Shine underwear, balls of yarn, getting booed, grief, hormonal teenaged daughters and skirting the responsibilities of life, but not necessarily in that order.  I've promised this post to myself for a long time but the timing had not seemed right until this morning.  I had to let things percolate in my mind for the past several weeks and now the whistle is blowing and it's time to release the steam.  

A quick refresher; my cousin, Lara, died unexpectedly on August 30th, 2017 at the age of 48 , one day before her 49th birthday.  I've been in this anesthetic bubble ever since, impervious to thoughts or emotions not related to the incomprehensibility that she no longer walks on this planet.  Nothing penetrates my bubble and nothing escapes my bubble.  For the time being it has been safe, warm and dry.  It might not be the best thing for those around me because access is restricted.  No one is allowed inside my bubble.  No one.  When my kids are around, the membrane becomes slightly permeable but otherwise, it is a barrier and a shield.  

As one might expect, it's difficult to remain sheltered and to simultaneously respond to the responsibilities of adult living.  Mostly, I've shut down and I can perform the routine stuff very mechanically because it's been pre-programmed in my brain.  I don't have to think about it.  This grief stuff requires all of your mental capacity so there isn't room for anything other than processing the fact that your person is gone and remembering to brush your teeth.  Ironically, I've cried very little.  I mean, I have cried, but it's so disproportionate to the amount of love and devotion I felt/feel for my cousin.  It makes me wonder if I'm human or a droid.  

I know that it is tiresome to hear about sadness or grief or whatever you want to call it.  I'm kind of bored of it.  I keep thinking that one day I'm going to wake up and feel like I felt on all the days prior to August 30th, 2017.  And some days, mostly some half-days or hours, I temporarily forget that my world no longer contains Lara and I can make dinner or go to work or interact with my children.  If I could choose to completely ignore life's demands, I'd do menial tasks that are repetitive and require no cognitive abilities, like folding clothes or tidying the house.  Or I'd jog.  I started jogging right after Lara died.  My friend and I made a pact and started an 8 week walk to run program.  We never run together and we don't even talk or text or hang out that much, but we made this commitment and we're doing it.  And I feel alive when I am running and immediately afterwards.  She and I are the same.  We both like to hibernate, for different reasons, but we get it and I love her for that.  No expectations. Complete understanding. 

About 2-3 weeks ago I spent an entire week unraveling a mass of yarn that had been living at the bottom of my closet for the past decade.  The yarn had been purchased in 2007 while I was going through breast cancer treatment and I had taken up knitting.  Several lucky souls were recipients of my scarves that year.  I still have about 2 dozen balls of yarn and I will never part from this yarn because I intend to finish those scarves.  

Timeline of ludicrous tasks performed by Michelle since Lara's death

August 30th, 2017 - Lara dies

August 30th - September 5th, 2017 - systematically go through every photo album, box of photos and electronic file of photos.  I recreated our entire 49 years of existence together in a span of 6 days via photo.  During these 6 days I did nothing else.  Obsession requires commitment.  

September 5th - September 8th, 2017 - funeral festivities

September 8th - current - exist

The unraveling of yarn constitutes existing.  Five or six balls of fuzzy yarn had intertwined.  Every night I sat on the sofa and worked on my task.  I don't remember if my kids had started school or not.  Days prior to her death, Houston experienced flooding of biblical proportions and vast swaths of our city lay under water.  Our home was spared, but all around us were friends whose entire lives were in soggy piles of debris in their front yards; photo albums mixed with sheetrock mixed with gramma's Queen Anne chairs mixed with wooden planks from the hard wood floors.  Instead of helping with relief efforts, I picked apart an endless maze of string.  My kids' schools pushed back their start dates by 2 weeks. During that time, I didn't know where they were or what they ate or when they went to sleep because I was either systematically going through hundreds of thousands of photos, at a funeral or pulling apart twine.  One Friday night, after I had freed about 2 balls of yarn, I realized I had no idea  the whereabouts of my 13 year old daughter.  So, I did what every good mother would do, I made her 16 year old brother track her down.  She and a friend were watching a scary movie at a boy's house with his friend.  My son knocked on the door, introduced himself to the parents, retrieved his sister and brought her home.  In the recesses of my mind I knew that it was my job but I didn't care.  I also knew that my 13 year old daughter shouldn't be at the home of some random boy at 10:30 on a Friday night, but it was too much.  I put my money on the fact that she's a good kid and figured I could retro-actively parent at some undisclosed time in the future.  I had made my nieces watch the movie Thirteen when they were 8 and 12 years old to scare them into lives of chastity and my own 13 year old was being parented by her 16 year old brother.  By the way, I finished unraveling that massive, twisted ball of yarn and I never even had to use a pair of scissors.  Once the yarn was unraveled, something unlocked in my brain and I could move forward, but only a few millimeters.  This is a slow and incremental process.  

Teenagers want freedom.  By default, I had been allowing my kid to have boundless freedom and, after the fact, I was questioning her judgement; judgement I should have put boundaries on in the first place.  My same friend who has gotten me off my ass and gotten me running gave me this wise advice: "Talk to her.  Tell her you're sorry.  Tell her you've been in a fog (head's been up my ass).  Tell her you trust her but these are the guidelines."  DAMN!  She is so wise.  It worked.  There has been some resistance and push back but, as it turns out, communicating is helpful.  She doesn't like boundaries any more than I like my husband suggesting I shouldn't eat a whole gallon of ice cream, but we both know it's right.  Her intermittent resentment and the back and forth between us has been a good thing and this morning we bonded over trimming the mini-schnauzer's eyebrows and beard.  He was a reluctant victim of our beauty salon as we roared with laughter.  It's far from over; the bartering and bargaining and strife inherent in raising a teenager, but we've reached a Waterloo.  At least for the time being.  

Last week I took a 2 day course on Advanced Trauma Life Support.  I'm not a surgeon, have never worked in the trauma areas of our ER, never taken the course previously, but now it's a requirement to continue to work in the ER even if I'm only in the triage and urgent care areas.  Generally studying a subject will lend to passing tests of the subject material.  I never opened the book prior to or during the 2 day course and miraculously, I failed the written test.  The test had 40 multiple choice answers and, as I'm a remarkably seasoned and successful test-taker, I figured I could wing it and I'd do just fine.  When your mind has a Bunsen burner motoring it, you're not working at full throttle and you lack the capacity to "wing it".  I failed the f*** out of that test.  As we reviewed the answers I realized that my mind was no where near those questions.  I missed some really stupid and obvious things and I'm not even sure I read the questions half of the time.  In my 35 + years of standardized testing (as a medical professional I've taken more standardized tests than poops) I've NEVER failed a multiple choice test.  I'm probably in the top 10 percent of those in whom bubbling-in answers correctly is part of their skill set.  I was mildly humiliated.  Rather than a warm handshake and look in the eye and hardy, "congratulations, you passed the test", I received a glance of shame, had to stay after class and was scorned for questions answered incorrectly.  "You didn't know the answer to that one?  Come on!  That was easy."  No.  No sir, it was not easy.  It was anything but easy.  A) because I didn't study and B) because my mind has ceased to function since August 30th, 2017.  Back to the drawing board as I read the book, take practice tests and retake the test next week.  Humble pie, self-awareness and forgiving myself.  

Yesterday as my 15 year old middle kid and I walked up to our front door, I noticed a package from Amazon and a gift bag stuffed full of Halloween candy and decorations.  My heart sank.  "Mother-f*cker!  Dammit Jake we've been booed!" Of all the rotten luck I thought to myself.  Getting booed is the dollar store equivalent of getting chain mail.  Pinterest exists for people to either judge others or to be judged.  I'm in the latter category.  "Booing" occurs around Halloween when someone anonymously drops a bag of candy and other crap on your doorstep and then you have to turn around and do it to someone else.  It's cute when your kids are in second grade, not when they are in 8th, 10th and 11th grade. I was PISSED!  How inconsiderate of someone to boo my family when I'm in mourning.  Jake thought my response was hilariously over the top but he did not fail to immediately claim the candy corn as his own.  I picked up the loathsome bag of treats and threw it on the kitchen counter and texted my friends an accusatory text: "Did you boo me?"  Denials from everyone.  I looked at the package and the address was similar to ours, but one number off.  The people at the address on the package had 2 young kids.  Ohhhhhh....the gift bag had been meant for their house.  They were the intended recipients of the booing, not us.  That made more sense.  No one wants to boo us.  I pried the bag of candy corn out of Jake's hands and took the package and the bag of treats down the street.  I'm especially

glad it wasn't for us because someone had taken a lot of time to make the bag look nice and had printed cute stuff to label the bag and I think I was more mad about the expectation that had been placed on me to turn around and have a Pinterest-ready Boo bag than the bag itself.  I couldn't have just put shit in a Walgreen's bag and left it on a door step and that made me mad as hell. 

I realize this whole post has been stream of consciousness.  That's what happens when your mind has been frozen in time.  It starts to thaw out and random thoughts pop up like microwaveable popcorn.  There is no order to it.  This morning I was FaceTiming my friend.  She has 3 small kids and her middle kid just became potty trained.  She gave him the option of underwear with Paw Patrol characters or Shimmer and Shine characters.  He chose the latter.  She questioned whether this was the correct thing to do?  Allow her 2 year old kid to wear Shimmer and Shine underwear.  Initially I thought she shouldn't have given him the choice, but then I realized she was allowing her kid the opportunity to make decisions and demonstrating that she supports his choices.  Shimmer and Shine underwear at age 2 has no impact on your future sexuality or gender identity but your mom letting you make that decision has amazing impact on your confidence.  I'm proud of her.  She's my role model.  She'd 14 years younger than me but oh-so-wise.  

I think I touched on all the topics I had wanted to discuss.  There will be more.  The sadness and grief will wax and wane.  Some days there will be bigger glimpses than other days.  I don't know if I will ever feel the same way I did before August 30th, 2017 but I am open to modifications.  I think I'm less tolerant.  Saying it makes it sound bad.  But maybe I'm less tolerant to requests of my time that I feel are pointless.  I've spent 49 years of my life making sure everyone feels good about the choices I make and now I'm not sure I care.  It sounds like I'm giving up but I'm not.  I'm just becoming choosier.  I'm sure there will be some carnage in my wake but I'm doing my best.  I had to drop a writing class because I couldn't fake it through the class.  Every time someone spoke, all I heard was meaningless chatter and I became more and more irritated.  

That is all for today.