I'm tired of being vague about things

This weekend we cleaned the house, which shouldn’t have been as big a deal as it was, but it was and so I’m feeling very accomplished and proud of my kids. We swept, swiffered, vacuumed, dusted, de-cluttered and cleaned bathrooms. We also rearranged the living room, at the request of my son, into an arrangement that solves the problem of flow into the sitting area and has the happy coincidence of being easier for us to play fetch with the dog!

My physical therapy is making progress, which is good but it is also not complete which is making me impatient. Being well enough to actually do the cleaning that was necessary was progress, but I did have to watch the amount of stair-climbing I did and was sore for a couple of days afterward anyway. I’m still swimming a couple of times a week and am more limited by my availability & boredom than by my pain now. I’m getting another steroid injection in my worse knee and that will help a lot. Soon I might even be able to do weight bearing exercises!

***************

I’ve now passed the 2 year mark since I left my marriage, though the divorce was finalized months later. As happens with the passage of time, the edges of the pain are softening and life is looking, in many ways, better than it ever has. I’m exploring my own sense of self, wants and needs with patience in the safe space of independence. I’m enjoying dating and connecting with people on all sorts of levels, though I still miss many of my far flung friends. One of my co-workers told me months ago about her dating adventures and how she went on many dates after a big break up. I remember the story making me sad and overwhelmed, now I believe that it was actually as fun as she said it was.

***************

I’m trying to stay engaged in Ob/Gyn medicine while I’m on this hiatus from residency so I’m not completely rusty when I go back. I’m finding as many excuses as I can to read practice bulletins and even reading the main academic journal we have (the one we get paper copies of as residents). I have issues and issues stacked up, unexplored. I decided to start with 2019 and read some of them. I’m also continuing to think about surgery, imagining the steps and the sensations of the common procedures I do - cesareans, hysterectomies, etc. I want to spend some time with the laparoscopic trainer in the sim lab but it is going to have to wait until my duties at home are a little less time consuming. I’m hoping that after spring break I’ll be able to work a regular in-office schedule instead of having to work from home sometimes. Everyone needs to get used to me having obligations outside of parenting so we can ease back into residency.

***************

I have this chronic health condition that I have alluded to here but not spelled out. I have something called endolymph hydrops in my left ear. The medical eponym is Meniere’s disease, which is a term I hate. In part because it is more of a syndrome than a disease and in part because I hate eponyms.

I started having symptoms in the 2nd year of med school, whether it was just onset of the hydrops or if I had an infection in the ear after which the consequence was hydrops, we’ll never know. I believe it was the latter. The most limiting symptom of this condition is episodes of debilitating vertigo. Fortunately I have had very few of these and not for nearly three years. However, it does also have symptoms of progressive but waxing & waning hearing loss and tinnitus. Also the process of losing hearing is not painless, at least for me. It is accompanied by pain and fullness in my inner ear that causes headaches and fatigue.

I’ve got some triggers that I avoid or manage to reduce symptoms and I’ve recently learned that I clench my jaw a lot and have TMJ pain as well that is causing some of my symptoms and is not related to the hydrops. A bite guard helps so I’m splurging for a custom one so I can sleep a little easier. The cheap one I have now is already helping. I take a low dose diuretic that has absolutely no data to support it (Never seen such an empty review from the Cochrane database!). Some doctors tell me it will help the fullness, others say it is really only for the vertigo. So I may not need to take it but I think it helps so I am going to keep taking it. I’m limited in dose by my very low blood pressure so this is as much effect as I’m going to get.

There are also times that the tinnitus & hearing just get worse and I don’t know why. Right now is one of those times. It may get better again, but it is pretty bad right now. I have profound hearing loss in low frequencies and mild hearing loss in higher (conversational) frequencies. I have a REALLY hard time localizing sound right now (recently thought my kids were in the bathroom together, which they would never do!) My new ear doctor says that I definitely qualify for a hearing aid at this point. Whether or not I can tolerate one will be another question. Hearing loss sometimes causes paradoxical noise sensitivity and I’ve got that. Also insurance doesn’t cover hearing aids or accompanying visits at all.

Right now I have this low steady tinnitus that is constant, but better than it has been the last few days (bite guard!). There have been moments this week where the tinnitus is so distracting, I have trouble thinking, I talk loudly, or I just have to go to my room and put glycerine drops in my ear and lay down (the drops put pressure against my eardrum and into my cochlea, they are soothing). Interestingly, I have another tone of tinnitus that comes when certain muscles in my back & neck are tensed. In a quiet room, I can tell when that tone is present and if I relax the muscles, it goes right away. I’m regularly wowed by this little experiment on my 8th cranial nerve.

The changes to my reality with this syndrome now include that I don’t drink alcohol (I already didn’t drink caffeine but that would have been another change to make), I endeavor to eat a low sodium diet (I fail miserably often), I have an earplug that I can use if I want to be social someplace loud (any bar, restaurant or public gathering place, even movies sometimes), and sometimes I can’t bear to be in any of those places at all. I can’t go see live music without days of repercussions so it has to be good to make it worth it. Even during this leave of absence when I’m able to think about my food more and get enough sleep (obviously fatigue is also a trigger), I’m still very tense and stressed (I want to go back to work, but the timing of that is very much out of my control, not something I cope well with). Couple all that with a rising pollen count (nothing like living in Oregon at least), and I’ve been pretty symptomatic recently.

This too shall pass.

Medical middle man syndrome

My mom and I were talking about dinner table conversation and I mentioned that I had the idea to get some conversation starters for us to use because frankly I run out of energy & inspiration trying to engage my teenagers. So she found a list of nearly 100 questions (we took out the Jesus ones), we printed them out and she cut them into strips and we put them in a vase to use as conversation starters at dinner tonight. They were a big hit! Each kid picked several, prompted me and Grandma to pick and we talked and joked about our answers. And we got to tell some family stories and talk about relatives and that was very heartwarming.

When the kids were little there was a parenting strategy to get them to complete tasks quickly that involved setting a timer and letting the timer be the “bad guy” instead of the parent. It sounded ridiculous to me, that a kid would not be able to connect the person to the timer. But it mostly worked! I think this new dinner table conversation approach is very similar. There’s something empowering in them picking out their own question instead of me asking/interrogating them. All in all it made for a very pleasant meal.

***************

I started my new job about 2 weeks ago. Shortly after which, the woman who is training me announced that she is leaving. So the person who was filling in on the QI duties is going to be gone at the end of March and the job has been vacant for some time. In steps this now well-rested resident, experienced in program management and interested in quality improvement, to help out. Serendipity. I honestly do not believe that the Universe navigates itself to provide these sorts of opportunities for people. The Universe is chaotic and random, and sometimes things just work out. Whether this opportunity is provided by the cold randomness of existence or because of The Secret & the “law of attraction” (insert eyeroll emoji here), I am grateful and engaged in doing the very best for the organization that I can while I’m here.

One of my recent tasks was looking over phone triage protocols for a new service we are starting that adds a layer of evaluation & support over the phone before patients get sent to the resident pager. In order for the nurses at the triage service to take the calls, we need to approve, add and amend protocols that they will use to address some simple concerns. I was able to review this with the clinical manager so that instead of asking a very busy attending to create it, she was able to take a proposal to them and ask for revisions/approval.

I’m also going to be running an every other week 90 minute meeting about quality improvement initiatives at our practice. I’ll write more later about why these QI measures are important to clinical care anc clinic operations. I just wanted to get started blogging about the new job and now it is time to get some sleep.

***************

Children are like a gas - they will fill up any space you allow them to occupy. This is not a good or bad thing, it just is. My children have very quickly gotten used to having me around more. They are taking up more space; there are requests for things that they can very easily accomplish on their own (Can I have some milk? Will you go get my __?). Sometimes I oblige them, sometimes I make them do it themselves. Usually the former is met with appreciation, the latter with resignation. Also, they have lost the ability to get themselves up and out the door in the mornings. There is oversleeping, forgetting to set alarms (okay, I’m guilty of that one too), some unfortunate cases where the bus comes much earlier than expected. After a whole school year of up and at ‘em, they are now decidedly slacking. I’ve decided that is okay for now. I will wean them back to the harsh reality of getting their acts together when we are all ready for me to go back to work.

***************

Some of the scariest moments of my life have been filled with worry about my children. Fortunately these days, mostly I’m feeling moments of joy, peace and an unclenching of my heart as my kids demonstrate resiliency and emotional fluency they are mastering in the process of recovering from the first real moments where their lives went sideways. Not that there haven’t been hardships in their lives, but the divorce and relocation were the first big “oh shit” moments they’ve experienced, where their lives unfolded in drastically unexpected ways. They’re both learning to deal with disappointment and not to let a bad moment ruin their entire day. They are better able to communicate their needs and are more open and loving people than the angry (albeit justifiably) and resentful people they were at the beginning of this big change. Bittersweet indeed that just as they develop these nuanced personalities, they are nearly done being my full-time responsibility. I swear, they were toddlers & preschoolers like 20 minutes ago, where has the time gone?!?

***************

One of the dizzying things about this temporary job I’ve got is that it is squarely in the “other half” of the health care system from where I have been situated as a resident. Instead of seeing patients and learning clinical decision making, I’m dealing with a lot of administration, billing, health information management, insurance (private & public) and practice management issues. These are real and important issues and it is amazing how divorced they are from the day to day work of taking care of patients. We have a whole office of billing & HIM people who retrieve & send out records and submit and manage reimbursements. This is a very necessary part of the current structure of our delivery of health care. Granted, I think Medicare for all is the way to go, but DAMN there is going to be some serious unemployment that we will have to deal with if that ever were to become the way things work. There are so many middle men in medicine, I can’t even accurately convey the scope of it.