Monday, March 27, 2006

Sick Happens

"I came in right away so I could catch it early. I can't be sick. I don't have time!"

How many times do I hear this each week in my college health practice? Too many. The busy student gets one of the myriad viruses going around. They come rushing in to the clinic, wanting us to fix it immediately so they don't lose any time. Can't afford to be sick. Gotta get well immediately! Give me a magic pill and quick, doc! I've got a paper to write, an exam to study for, homework to do! You have to do something!

Well, guess what, kiddos?
Sick happens. Especially when you stress your poor bod and its defenses by eating your meals at the vending machine or the drive through, sleeping few and erratic hours, and partying hearty on the weekends. Not to mention the "normal" academic and social stressors of student life.

Your body is not a machine. Unlike your computer, it can't just get rebooted and work like a charm. Unlike your car, it can't get a ten-minute lube job and be back on the road, purring smoothly. Your body needs ongoing care. And sometimes, it gets sick. Even if you care for it well, it can catch a virus. When that happens, well, you can't just "get in early and nip it in the bud". And truthfully, we can't help you much anyway.

Viruses are everywhere. The "common cold" is truly common. Modern medicine still has not developed a medicine that can kill any of the usual viruses. But here's where YOU hold the trump card. Your body CAN cure the common cold. That's what your immune system is for. And it works! Miraculously, eventually, you will get well. With or without our help. But you have to give it time. You have to be patient. You have to take a break from the rat race, slow down,
listen to your body and take the rest it needs while it does its amazing cure job.

And maybe your body is telling you something else. Maybe you
need to slow down, to stop and take some time to yourself, take a break from the whirlwind. That paper isn't going anywhere. The sun will still come up tomorrow whether you're in class or in bed. The exam can be rescheduled. Life goes on.

In these days of instant gratification, instant messaging, instant meals and drive-through everything, we forget that our bodies are part of the natural world, which doesn't function in gigabytes and nanoseconds. Nature belies a quick fix. And, when you're flattened by a virus, you learn the primitive truth. Nature will out. Might as well relax and give it up.

Sunday, March 26, 2006

Intention and Action

I'm worn out, so this may not make much sense, but it's fresh in my (tired) mind so here goes. The first two links are informational; the rest are silly pics to illustrate my points and break the monotony.

I've been learning more about Buddhism lately. Reading people like Pema Chodron and also talking with my wonderful Hakomi therapist, who is also a Buddhist . There's a lot in Buddhism about intention. What's important is your intention. If you have benign and loving intentions, you are walking a path of truth, and that's a Good Thing. If someone interprets your action as malignant or hateful, when in fact your intentions were nothing of the kind, well, basically, that's their problem. You might have stuck your foot out simply to tie your shoe, and they happened to trip on it. They might think you were out to hurt them. But you weren't, so your spiritual slate is clean. Something like that. As I said, I'm learning.

I also continue to learn more about soccer. I started playing at age 40, after watching the kids play for several years and finally deciding it looked like fun. Now I play on a women's team in Fall, Spring and Summer, and a co-ed team in the Summer too. I also got the first level of Referee Certification (Grade 9) and have been "running line" as I mentioned in another post.

I had a game today (a 2:1 win - go Sting!) and AR'd (assistant refereed) two games yesterday, which is why I'm about ready to hit the sack now.

In soccer, the referees judge the play on what they see. What's important is the action. If someone kicks another player instead of the ball, the ref will call a foul. It doesn't matter if the kicker was aiming for the ball or if their intention was to kick the ball. They missed. They kicked another person instead, and that's a foul. Often you'll hear them argue with the ref. "I was trying for the ball!" Tough tooties. We don't care. [My ref husband will argue this and there is, in fact, some interpretation allowed, but I'm making it simple for the sake of discussion.}

I don't have anything profound to say about all this. It just struck me as an interesting juxtaposition. What matters, intention or action? If I bake someone a cake with hatred in my heart, will it make them sick? What happens when Buddhists play soccer?

Maybe someone with more clarity and energy can continue this discussion in a comment.

In this moment, my intention is to take this action!

Saturday, March 25, 2006


Being a newcomer to the blogging scene, I'm still learning the ropes. What kinds of blogs are out there, how you can format your blog, sort your responses, link to other sites, etc. Who blogs. Who blogs not. What one does and does not do on a blog ("blogiquette"?).

One thing I read (on a blog, of course, where else?) was that it's common blog practice to post links to other sites, be they blogs too, or news stories, or cool websites one has discovered. This is true. Most of the blogs I visit have tons of cool graphics, pictures, embedded links and so forth. "Everyone's a programmer." Everyone but me.

I understand that I have been remiss in this aspect of blogging to date. In my own defense, I only know one tag of HTML code, and although it is the code that creates a link, my facility with it prohibits frequent use. In other words, I'm no good at it!

However, I get that bloggers must support each other, and there are a few blogs I visit regularly, so I'll make a good faith effort with the HTML and tell you of some of them.

One of my personal favorite blogs is First 50 Words. The blog owner posts writing prompts for reader/writers to use to write just the beginning or a fragment of a piece. It's pressure-free writing practice with lots of variety. Good way to get the muse juices flowing.

I learned all I know about blogging from Marianne Powers whose website has a link to her blog. She's written some good basic blogging lessons that are easy to follow if you're a beginner. She's a published author, so I take her advice seriously as a budding writer.

The way I got into this whole thing was by joining Southwest Writers which is what it sounds like, a group of writers of varying experience. They have workshops here in Albuquerque, writing contests open to anyone anywhere, and a critiquing service. They also have a page of "member links" which you can follow to see what people are writing or blogging.

Southwest Writers was my connection to Sheila Key, a vivacious and very creative writer who is working on a new book entitled 50 Ways to Leave Your 40's. Check out her book and blog at her website. You can contribute your story, and it might make it into print!

Whew! I think 4 links is my limit (I never have more than 4 links a day, doc!). I'll work on my blogging skills so that I can suavely plop links into my text as smoothly as the next gal, but for now, check out some of the other links I have listed over there to the left and down, in the sidebar.



Death Wish

I am not wishing for death, as my post title might imply. Au contraire. But that messenger will come for each of us one day, and we've probably all thought about what will happen to "this earthly vessel" when the spirit leaves it.

My dream, when I die, is to be buried naked directly in the ground, my body curled comfortably, wrapped close in the arms of mother earth. No formaldehyde, no coffin. No slow dessication in a needlessly comfortable box. Nor the crematorium with its blazing efficiency. Not for me. I want to be packed into the ground, covered and comforted by an earthen blanket. My body will mix and meld to become peat, fertilizer, mulch, a meal.

Dust to dust.

Wednesday, March 22, 2006

Dr. Preg, Part 1

I got pregnant during the first month of internship. Why would I do such a durn fool thing? Well, I didn't do it on PURPOSE! It was a mistake! Yes, I know, I know, I was a doctor. Not to mention a grown woman. You'd think I'd have known by then how these things work, right? You'd think I'd know how to prevent this particular predicament, right?

Right. However. Sometimes life throws a curve. You see, I was "regular" as clockwork up until that month. 35 day cycles, on the nose. Years and years of them, without fail. We counted on them. Literally. We counted days and acted accordingly. (Hey, come on, nobody wants to use a condom ALL the time!) And it worked. Well, up until now.

Did you know that stress can mess with your menstrual cycle? No sh*t, Sherlock. I guess I must have had some stress or something. Let's see...finishing medical school, selling our house, moving to a new state, finding a new house, starting internship...gee. Wonder what I had to be stressed about? Go figure.

Once I realized that 36 days had gone by with no period, and then 38, and then 40, I got scared. I slunk into the clinic lab and confessed my sins to Chloe, the lab tech. I begged her to test my urine for me on the QT. The rabbit died. The "x" lit up blue. It was positive. Chloe, shaking her head, agreed not to broadcast the news, and I left in a daze to tell my husband.

He was excited. I was terrified. I was sure they'd kick me out of the program. Who ever heard of a pregnant intern? Who ever wanted a pregnant intern? They'd laugh in my face and send me packing, I was sure of it. Could I hide it? Should I try? Fake my way through in baggy scrubs until there was no denying it, and then at least I'd have a few months of training under my belt before I got the boot?

No. Honesty was best. I'd suck it up, tell all, and take the consequences. Shaking, I called to make an appointment with The Boss.

We showed up at his office early the next morning, my husband and I. Freshly showered, snappily dressed, and nervous as hell.

"So." The Boss smiled at us. "What's up? What's going on?"

Taking heart from his smile, I drew a deep breath and dropped the bomb. "I'm pregnant."

Here it comes, I thought. Walking papers. Pink slip. Sayonara, Spencer. I closed my eyes and waited.

"Well!" The tone of that "Well!" yanked my eyes open. He was beaming! "Congratulations!"

The wave of relief carried me on its crest all the way to D. day.

Tuesday, March 21, 2006

You mean it isn't syphillis?

Sometimes I really love my job. What else can you do that can bring complete happiness to someone in a matter of minutes? Besides selling lottery tickets or HaagenDasz ice cream, I mean.

One of my patients today was a young man with a "rash". So said the nurse's note on the chart in the door box. Rash, okay, fine. I took down the chart, knocked and entered the exam room. The young man was sitting on the exam table, and a young woman was nearby, seated on the edge of the visitor's chair. She was clearly his partner, and both of them looked extremely nervous. Their bodies were stiff, turned slightly away from each other, and both looked seriously and exclusively at me.

I smiled and asked the young man to tell me about his "rash". He described a light patch on his "upper thigh" that he had ignored for a couple of weeks, until it got darker, and itchy, and spread to the other side. I asked to see it, and he obligingly "dropped trau", revealing what was clearly a simple case of "jock itch" or Tinea cruris, a run-of-the-mill fungal infection.

You should have seen their faces when I told them. The lights came on, the teeth came out, the bodies relaxed. "It's not an STD," I reassured them, just to be sure I answered the unasked, and was rewarded with even broader smiles. A little more education, a prescription for cream, and Bye Bye Happy People.

You'd think I had sold them a winning lottery ticket.

Sometimes I really love my job.

Monday, March 20, 2006

A Steaming Pile

There was ice coating the grass this morning when I took the dog to the park. It crunched beneath our feet on this first day of Spring. Neo took awkward high steps for a few minutes, until his feet got used to the sensation. He did his usual tree to tree, sniff and pee thing around to the other side of the park. Then he did his usual squat and poop thing, while I looked delicately away, pretending to admire the mountain view.

Straightening up from his steaming pile, he bounded away with a lolloping romp, a definitive change from his previous desultory trot. Clearly he had divested himself of all burdens and was thoroughly happy. Life was absolutely, wildly wonderful. He cavorted around me as if to say, "Wow! It's morning! Yahoo! We're at the park! I feel great!"

As I picked up said pile to transport it dutifully to the trash can, I thought, "Wouldn't it be nice if we could all do this?" I don't mean
this. I mean, wouldn't it be nice if dumping our burdens were as easy for us as it is for Neo? If we could just let go of all the crap (sic) that we carry around with us, and leave it in a steaming pile on the frosty ground? Then we too could run and leap with happy abandon, free to run the whole breadth and width of the field.

Sunday, March 19, 2006

Giving and Taking Orders

Yesterday I spent the morning "running line" out at the soccer complex. For those that are soccer parents or soccer players, you know what this means. The "linesperson's" official title is "Assistant Referee" or "A.R." As an AR, you assist the Center Referee, who is the big cheese, the bottom line, the boss. The Center makes all the final decisions, sets the tone of the game, and has the power to throw players or parents off the field, even to stop the game if necessary. He or she is the boss. As their assistant, I am "beneath" them, so to speak, and have to bow to their greater authority.

In my job as a doc, I'm not used to taking orders. I'm not that used to giving them, either, to tell the truth. I'm one of those docs that asks for things rather than demands them, that uses "please" and "thank you" and does things for myself if the nurse looks busy. In spite of that, I know that I am in charge in that situation, and that there are people "beneath" me that have to do what I say. I have the greater authority.

It's interesting to move back and forth between those types of roles. I was noticing yesterday, when I wasn't the one in charge, I found it kind of a relief. I could relax, let someone else make the decisions and call the shots. Since I don't do that anywhere else (no, not at home, just ask my husband!) it was kind of a nice change.

That's all for today. No gory story. Just a few random thoughts. (I'm too tired from running up and down the field plus playing my own game today - think I'll hit the hot tub!)

Thursday, March 16, 2006

Even Docs get Dizzy

I love to cut. Just ask any of our nurses. I'm a closet surgeon in a family doc's body. I might have even done a surgery residency, if I could have stomached the idea of spending five years with other surgeons! Just kidding. Sort of. Anway, I didn't. Instead, I satisfy my surgical urges with moles and cysts, happy to have earned the reputation of "lumps and bumps doc" in our clinic.

I don't mind the sight of blood. Gooey pus and fatty globs don't gross me out. I can dig out slimy subcutaneous masses or squeeze oozing bodily fluids without missing a beat. As long as I'm wielding the knife, I'm happy and upright.

But make me watch someone getting cut upon or sewed up, especially if they're in pain, and I'm a goner. I can't take it. I get vaso-vagal (read "dizzy") and have to go put my head between my knees. Or, better yet, take a nap. It's just too much.

The first time this happened, I wasn't even in medical school yet, and it made me doubt my potential for success as a doctor. I was watching my father sew up a drunk. Dad was working on the Navajo reservation at the time. His training was in Internal Medicine, but when you're hundreds of miles from the nearest city, you do it all. In fact, the first delivery I ever watched was done by Dad, but that's another story. At any rate, this time he was being an ER doc. The patient was man who had gotten drunk and been in a fight. He had a full thickness, curving laceration across his cheek just under his left eye. The guy was still drunk in fact, too drunk to think straight or hold still. Dad tried to give him a local anesthetic, but I'm not sure how much made it into the guy's face. What can you do. The idiot was trying to get up off the table and stagger back into the fight, but he really needed that cut sewed up. So Dad went for it.

Hindsight has toughened my memory, but at the time I thought all the moaning and thrashing was due to terrible pain from the cut and the stitches. The poor guy's head was rolling back and forth, blood was flying, his eyes were whites-only. "Unnhhhnhhh! Owww! Nnnnnngggggg!" Dad was chasing the wound back and forth with the suture needle, throwing a stitch in whenever the patient stopped tossing for two seconds. As soon as the needle made contact, "Aauugghhnghh!" he was off again.

I felt the heat rise to my face and the bile to my throat. Oh no. Was I going to faint, for crying out loud? Me, a future physician? Yep, I was definitely going to hit the deck if I didn't get out of there quick. Not wanting to distract my father from his near-impossible task, I slipped into the corridor and out the back door of the hospital. There I squatted against the brick wall in the sun, head between my knees, waiting for the world to upright itself and wondering how I was ever going to make it through med school.

Needless to say, I did make it. So did the drunk. He left the clinic with his face in one piece, thanks to Dad's persistence. I've seen worse since then, and had to leave the room a few more times too, (like during that gall bladder surgery when I was 8 1/2 months pregnant when I almost puked into the wound) but fortunately, along the way, I made the discovery that doing the procedures instead of watching was my ticket to consciousness.

So don't ask me to assist or observe. Just hand me the scalpel and move over.

Monday, March 13, 2006

Shrink Wrap

It's a well-known fact that men don't go to the doctor. They tough it out, they muscle through it, they dismiss it as "no big deal". They'll ignore a 103 degree fever, a broken ankle, a gallbladder attack.

Having established a mode of sexist generalizations, I'll blithely carry on in the same vein.

We all know that while men in general tend to ignore physical maladies, there is one body part that, shall we say, never gets ignored. Au contraire. You know the part I mean. Most men have intimate knowledge of every fold and spot, every seam and squiggle. What it looks like, what it feels like. What size it is. How well and how often it functions. And when there's the minutest change? Zoom! They're in the doctor's office quicker than you can say STD.

This particular young man- we'll call him Peter (oh come on, humor me)- presented with the familiar complaint, "I have bumps on my penis!" (There's always a "!" at the end of that sentence). He was nervous and sweating, and kept moving his hand to his zipper area as if to double check that nothing had fallen off. Yet.

OK, let's have a look. Looks normal to me, Pete. But just in case, we'll do androscopy for HPV.

HPV is the shortened form of Human Papilloma Virus, which is the scientific name for GENITAL WARTS! (this one has to be either screamed or whispered, depending on the context) Androscopy means we look at the, um, affected area with a microscope. (Imagine what THAT does to the male ego). Before we do that, however, we apply a special staining solution called acetic acid, otherwise known as household vinegar. If there is a microscopic wart there, it will shine white when saturated with acid.

The method of applying the vinegar stain is diagrammed in a special handout. The doctor pours the solution (white vinegar is preferred over balsamic or spiced) onto a gauze pad and leaves the room. The patient then unfolds the pad and wraps it, per provided diagram, around The Part, which is then marinated for five minutes. At that point, the doctor returns with the microscope.

So I poured the solution, waved the handout at Pete, and left the room to go have a snack or something while Pete soaked. Five minutes later I knocked on the door.

"Pete? You ready?"

"Well, um, I don't know. I'm, uh, I'm having a problem with....uh...."

"May I come in?" I didn't want him to have to detail whatever his problem was loudly enough for me (and therefore half the clinic) to hear it in the hall.

Inside the room, which now had the unique aroma of a sweaty salad, Pete was standing awkwardly with his pants down to his knees and his hands holding a gauzy bundle at his crotch. He looked mortified. I kept my features neutral and asked him to tell me about the problem. He pointed to the handout and shook his head. "I can't do it right."

The diagram is drawn on an 8 1/2 x11" paper, in landscape orientation. A hand-sketched penis stretches across the long dimension of the paper, ten inches long, three inches wide, with spiral arrows indicating the gauze wrapping technique.

"I don't understand, Pete."

His face was crimson, but he soldiered on. "Well, it looks from the handout like you're supposed to have an erection to do this wrapping right, and I just can't seem to...."

Now THAT was one day I was reeeeeeeeeeally glad I had practiced my poker face.

Thursday, March 09, 2006

Now ICU, Now I Don't

When you're an intern, everything that happens seems momentous. Every patient is unique, every experience is new, every sensation is intense. The learning curve is so steep it feels like it's carving a permanent groove in your brain. You're always in high gear, rarely sleeping, alternating between panic and exhilaration. You know you'll never forget a single moment of this.

Of course, you do forget. I've forgotten. I've forgotten a lot of it.

But there are those experiences, those patients, that are truly unforgettable. Impossible to erase from your memory, even if you wanted to. This was one of them.

The guy seemed a little wacky from the get go. We should have known better.

Oops. I mean, "47 year old married male presented to the emergency room, accompanied by his wife, who expressed concern that her husband might have consumed an excessive amount of aspirin in a state of despondency."

The guy is denying ingesting anything, although he admits that he's been depressed, and refuses to tell his wife or the ER staff where he went that afternoon when he was gone from home a few hours. (This is the time during which his wife suspects he overdosed.) His behavior is strange enough, however, to put up a red flag for the ER doc. They go round and round a while, and finally it's decided that he'll check in for the night for lab tests and observation.

They send him up to the ICU, since there's at least a possibility that he ate a bunch of aspirin, which could throw his body chemistry into deadly disarray. This is where I come in. Those of you in medicine know that the first doctor a patient sees in his hospital room is the intern. Wet behind the ears, eager and sleep-deprived, assigned to do the dreaded "H and P". History and physical. Getting the basic info about the patient. That was me, on my medicine rotation at --we'll call it General Hospital (names have been changed to protect the guilty).

So I trot into the room in my white coat, loaded with pocket-sized reference books and tools of the trade, clipboard and pen at the ready.

The guy is sitting on the bed, fully dressed in his street clothes. I think, "That's odd; usually they come up from the ER in a gown, with their stuff in a bag. Oh well, I heard this guy was a little wacky. Maybe they cut him some slack."

Out loud I say, "Hello, Mr. X, I'm Dr. Spencer. I'm here to do your history and physical."

"Well, I'm leaving." grunts Mr. X.

"Sir, I'm afraid I can't let you do that." The brave little intern, asserting her authority as The Doctor Who Knows Best.

"You gonna stop me?" He stands up, pulling his hand out of his coat pocket to reveal a very small, shiny, grey ---good Lord, it's a gun!

About face. Change in attitude. From brave little intern to backing-out-of-the-room-with-hands-surrendering-in-the-air intern. Hey, you wanna leave? Be my guest. Me, stand in your way? No sir! I'll just skedaddle on outta here. You do whatever you please. I'm no hero. Not stupid, either.

Once out of immediate danger, I hustle over to my chief. "He's got a gun!"

"What? No way! He couldn't get up here with a..." he bit it off and ducked behind the desk as Mr. X emerged from his room, gun in hand, and hit the nearest stair exit, banging through it before anyone could speak or move. "Shit!"

He grabbed up the phone and called security while the nurse called the ER and warned them Mr. X was on his way down and out with a gun. Then we all held our breaths. One word. Then the phone rang. It was the ER. "We haven't seen him. Are you sure he came down?"

Oh no. No. Shit, no!

Yes. He went up. Up, into the hospital. A crazy trapped animal with a gun, loose in the hospital. be continued.............

I'm just teasing you. That, believe it or not, was pretty much the end of the story. After an extremely nerve-wracking half hour, we got word that the police had picked him up across the street from the hospital at a fast food place. He didn't go on a shooting spree in the wards, in fact he never showed his face up there that anyone could recall. How he got out of the hospital, nobody ever saw. The police came back over to interview me and show me the gun for confirmation. Mr. X traded his comfy ICU bed for a jail cell. I never heard what happened to the ER staff that let him out of there without going through the usual routine. I never saw Mr. X again. And I never forgot him.

Wednesday, March 08, 2006

Comments Changed to "Moderated"

Dear friends and readers,

Up to now I've had the comment setting for this blog on "unmoderated". This meant anyone could post here and say whatever they wanted to. Unfortunately, someone posted a comment with a link to a sex toys website. Hence, I have changed the setting to "moderated". This means I need to view and authorize every comment before it appears on the website.

I'm sorry for the inconvenience, but I really don't want trash on this site.



Addendum - March 10 - I disengaged the "moderated" feature and left the word recognition feature. Hopefully, this will be enough to prevent spam and garbage. If not, I'll re-engage "moderated". (Sounds like Captain Picard - "Engage!")

Monday, March 06, 2006

Skin Deep

"I need to listen to your lungs, in the back. May I just reach under your shirt?"

I have never once gotten a "no" to that question, to my continued amazement. We doctors are a trusted lot.

As I lifted up the cotton blouse edge and placed my stethoscope between bra strap and spine, I wondered... How many times have I lifted a T-shirt, a button down, a tank top or jacket? What different skin types have chilled to the touch of my scope? Youthful and taut, old and saggy, fat and pendulous, skinny and bony? Pale white, deep dark brown, copper, dusty, sunburned pink, covered with moles? How often have I felt them, cool and dry, clammy and pale, hot red and feverish?

Reminds me of the old ad jingle: "fat kids, skinny kids, kids who climb on rocks...tall kids, short kids, even kids with chicken pox." But I digress.

I turn my hands over and gaze down at my lined palms. I imagine all the patients I have ever touched rising up out of my skin to stand in miniature on the curving softness. A tiny testimony to the bodies and lives I have been priveleged to know.

Sunday, March 05, 2006

Mary - thoughts from her memorial

One thing that always impressed me about Mary was her posture. She was a tall woman, and stood very straight. When I was a little girl, I looked up, way up, to her. I was a bit intimidated by her stature back then, to be honest. I saw her integrity as distant seriousness.

Over the years, I have come to see that the way she carried her body in the world was a lot like the way she carried her spirit. Many of the words that could be used to describe her physically also fit for her character.

Straight. Strong. Upright. Steady. Straightforward. Tall. Graceful. Open. Alert. Interested.

Reliable. I could always count on Mary, no matter what. She was always there, in my life, somewhere, part of the essential fabric, the basic chords, the foundation.

When I got to where I could look her in the eye, I saw the twinkle there, and came to know the fun loving spirit that lived in her as well. She never lost her straight stature or her graceful posture, but I learned to see the playfulness in her too. She even took to wearing sweatsuits in her later years, although I'd always have to look twice to believe it. I never knew anyone who could wear a sweatsuit and still look so classy.

Mary, thank you for your inspiring posture, and I mean that in every way. I will miss you.

Friday, March 03, 2006

Works in Progress

Items from the "cooker":

"Sick Happens" - a modern day lament about our impatience with illness.

"Skin Deep" - marveling at all the bodies and lives I've been priveleged to touch.

"Clarissa" - a ten year old with viral cardiomyopathy.

"Intern Mommy" - self explanatory, from my own life.

I'll post them as they get closer to the "done" stage. Just wanted to put the ideas out here, in case others are moved by these titles to share their own similar (or different) experiences.


Wednesday, March 01, 2006


by Peggy Spencer, M.D.

“Get the med student to do it.”

The harried intern tossed this instruction to a nurse as he ran into another delivery room. She glanced my way, saw that I’d heard, and beckoned me to follow.

It was my clinical OB rotation at County General, a huge place overwhelmed with over 300 deliveries a month, not enough staff, and no time to teach a med student. The residents were always in the OR with Csections or Gyn surgeries, leaving Labor and Delivery to be run by interns. I had learned on the fly; how to “catch babies”, sew episiotomies, start IV’s, check “Mag” levels, and perform the various and sundry other scut jobs assigned to the “scut dogs” like me. All day I hustled between blood draws and monitor checks, urging laboring women to “push!” and sharing their happy tears when a squirming new life emerged. Every night I fell into bed in a trailer in the hospital parking lot, only to rise 4 or 5 hours later and start all over again, crazily, giddily happy.

Trailing the nurse down the busy hallway, I passed a woman in jail blues with cuffs on her feet and a scowl on her face, waiting her turn for evaluation. The frail and wondrous sound of a newborn’s cry wafted out of a delivery room next door. Down the hall, a woman labored loudly, coached thanklessly by a clumsy female friend. Families wandered the halls, staff came and went. The busy, cheerful bustle was familiar to me by now.

The nurse paused outside #7, the door of which was uncharacteristically closed. Turning to me, she gave me a once-over, and then said without emotion, “It’s a stillborn. Ever do one?”

Stillborn. The word sank into me and settled, lodging somewhere behind my sternum.

“No, never,” I managed. My face stayed impassive, an expression I had practiced until it was internalized. Stay calm. Do not react. Show no shock when a 15- year-old tells you it’s her second child. Show no amusement when a patient mispronounces a medical term. Show no horror when a child comes to the ER bloody and broken by her father. Show no hesitation when asked by a superior to do something. Be the steady, the rational, the nonjudgmental, ever-reliable doctor.

“Hmm.” She looked at me a moment longer, then seemed to come to a decision. “It’s just like a regular delivery. Give the baby to me.”

Just like a regular ----? But how — but who — but what do I — but — it was too late. The door was open and we were inside.

The heavy door swished closed on dimness and muffled silence. In the bed, the only sign of life was the movement of breath. A woman’s chest, gently heaving. A mother’s breast. A mother’s breath. Her child, breathless and still inside her. Her family, tableaued around her in awkward support. Dull faces turned slowly toward me, incomprehension mixed with pain in their eyes. The nurse moved softly, preparing the scene. Sorrow clung like a mist to everything and everyone.

Suddenly, I felt like a marauder. These people had never seen me before in their lives. Here they were, gathered in grief at one of life’s most searing moments, and who is there to “help” them through it? An inexperienced student with an unknown face and unfamiliar hands. I had no business there. They deserved better. She deserved better. Death was laughing in this young mother’s face. She needed a dear and familiar healer to ease this pain, a seasoned guide to smooth this rough passage.

But this was County, and I was all they had.

Inhaling deeply, I lifted my head and stepped forward.

Doctor's Hands

Look at these hands. Just look at 'em. Not a pretty sight, are they? I need to cut my nails again. I know, they're barely two millimeters long, but that's long enough for germs to grow under. Did you read that report about the nurses' fingernails? What they found growing under those things? Yeesh. Frightening. No, I have to keep them short. Yeah, I could put polish on them, I suppose, try to spruce them up a bit, but I doubt it would last more than a day, given how much I wash.

How much? Well, let's see. Twice for every patient. Once before I touch them and once after. Why before? Well, if I wash my hands before I touch them, that reassures them that I'm not going to give them any germs. And washing after reassures me, of course. So. Twice for every patient, once for every time I eat anything, or blow my nose, or go to the bathroom, or brush my teeth, or pick up something off the floor....gosh, I dunno. Seems like a hundred times a day I wash. Can't you tell? Look at 'em. All dry and cracked and chapped. Sometimes I use the backs of my hands to scratch with. That's how rough they are.

See that shiny bit there? At the tip of my thumb? No, that's not leftover polish. That's superglue. Yep. Superglue. Trade secret. When your hands get so dry from washing that the fingers crack, glue the crack shut with superglue. Works wonders.

These here are age spots. Lovely, eh? Why can't they call them "maturity spots" or something? Age spots. Rub it in, why doncha? 47 years old and I have "age" spots.

What else? Oh. Callouses, of course. From writing. No, we don't use dictation or electronic charts in my clinic. One of these days we'll join this century. Meanwhile, we write.

Oh yeah, these things too. What do you call them? "Cuticles" I think. I've heard some people actually trim those things, or oil them and get them pressed or something. Criminey. Who has time for that? I just leave them alone, unless they get torn when I rip off a hangnail with my teeth. Superglue works for hangnail craters too, by the way.

And finally, these ropy blue things. Proof positive that these hands get used. Big ol' veins pumping that used blood. From busy hands to busy heart. Feel 'em if you want. Flatten 'em out and fill 'em back up. Those are some working pipes, my friend.

Yeah, boy. Look at these things. Not much to look at, are they? But I wouldn't trade 'em for the world.

The Authors of "50 Ways" Interview on KCHF TV

50 Ways to Leave Your 40s TV interview with Phoenix' Pat McMahon