Hemorrhaging is not fun.  Unfortunately, this was my big lesson over spring break.  Amazing what a very small lesion in a highly vascular region can do, especially if you have been taking a baby aspirin daily — supposedly for your health.

At least I had the opportunity to further study NMB, shorthand for the “Not Me Barrier” which I propose is a primary plague in medical care today.  Not all — but too many — doctors draw an impenetrable line between the ill and those caring for them.  The ill are “not me” and so a wall forms.   The unwell are treated markedly differently than the well.

I had wrongly thought NMB was a side effect of the oncology ward.  I see NMB in the painful lack of eye contact in the oncology waiting room and clinic.  NMB exudes from the floor’s muted voices and shortage of small talk.  Previously I had blamed the unique fear cancer evokes as the etiology for NMB.

However, NMB is alive and well in the ER and on the floor, too.  I received excellent care which is of course what matters most.  I am well enough to worry about details, thanks to that care.  However, I note that no doctor addressed me as an individual.  I was a hematocrit or hemoglobin or blood pressure.  No physician acknowledged that it was too gorgeous of a spring day to be stuck in the ER.  No one noted the tedium as I lay hours on end awaiting serial hematocrits.  No one discussed my presumedly NPO status.  I didn’t mind.  Nurses and techs were plenty chatty, and of course good conversation is not the goal.

However, I wondered about the physicians’ interaction style — why did it exist and what was its impact?  As I lay there and contemplated and overheard residents giving the classical medical presentations of patients in nearby beds, I began to appreciate a contributing factor in NMB — entrenched tradition.  Those in my field, psychiatry, used to similarly feed high barriers with tradition.  The grand Freudian tradition meant purposefully little affect or intimacy was shared by psychiatrists.  However, over time research evidenced that warmth, empathy and carefully sharing a little of ourselves generally results in better outcomes.  Subsequently, the field has thawed.

I wonder if medicine has moved more tepidly in this direction due to the unique pain of caring for the mortally ill?  Certainly, the traditional patient presentations pointedly omit any inkling of a person’s humanity.  This probably once held a necessary purpose.   A doc in a small town might require more of a protective barrier, as he sees those he knows so well fall ill or die.  I doubt if this remains ideal as often now patients are less well known.  Distance is inevitable in many current medical systems.  We have short appointments. Call systems don’t allow patients to reach their own doctors in emergencies.   And, with frequent job and health insurance changes, patients change providers often.

And, I suggest that the traditions of medical communication can further increase distance in the doctor patient relationship, a distance that has grown too great.  Medical presentations rarely include a word referencing a patient’s individual personhood.

What would it be like if we changed this?  If, instead of “a 43 year old with breast cancer 4 years post chemo on baby aspirin with new onset hemorrhaging,” we presented “a 43 year old child psychiatrist and mother of three breast cancer survivor on aspirin who is hemorrhaging while reading “Hunger Games”?  I had mentioned this information as I met the residents.

What would happen if we simply required routine inclusion of one humanizing word or phrase in medical presentations and paperwork?  One detail?  How would that change the subsequent interactions and treatment course?  I hypothesize that the attending would then enter the room with more warmth and more interest in a routine case.  And, don’t we do a better job when interested?  Don’t more mistakes occur when bored?

I received excellent care despite these ruminations.  I am perfectly healthy again.  However, I wonder if anyone noticed that I was sent home with a last recorded blood pressure of 93/54 from hours prior and was still losing blood?  I felt vastly better and was begging to go home, so I did not disagree.   However,  if a physician had been a trifle more aware of me as a person,  I wonder if one last blood pressure would have been checked?

Interestingly,  only one almost doctor that I met lacked NMB.  A future family practice fourth year medical student went about her tasks expertly, not differently than the physicians.  She took no more time.  However, before leaving the room she paused and offered, “I’m sorry this happened to you.”  Such a simple sentence made all the difference.

I hope she holds on to that.  I am betting on her.  Of course, so many wonderful doctors like her  – including many of my friends and colleagues —  indeed do continue to treat patients not only medically superbly but also as people.  However,  I worry that the traditions of medicine work against my medical student.  If she hears enough cold, objectified presentations or reads enough dehumanizing paperwork, will the patients become less three dimensional in her mind?  It is time to modernize this tradition.

This is a friendly reminder to give yourself the same good preventative care that you give to everyone else. Here’s the Center for Disease Control’s suggested screening test list .I know this sounds obvious, but come on, really, how many of you follow through with your own care?

After all, how can someone juggling a zillion patients and parenting responsibilities possibly make time for a doctor’s appointment?  And, of course, doctors well know the myriad of discomforts and indignation of a colonoscopy or mammogram.  However, so often these are just excuses — actually our ambivalence simply is prevailing.

And, we have a powerful reason for ambivalence.  There is no romanticizing of illness once you have been in the trenches.   The nitty-gritty ugliness of disease is a reality  –  so we have more reason to fear finding something.  We know what finding illness really means —  not only to ourselves but also to our kids.

As someone who likely could have avoided some awfulness if I’d had timely preventative care, I’m writing this post to encourage you to challenge ambivalence.   Take care of yourself.  Good luck with it.

Despite all of the wonderful good the foundation has accomplished, I have a concern with Komen beyond the current brouhaha.    Consider Wikipedia’s summary:

“Since its inception in 1982, Komen has invested nearly $2 billion for breast cancer research, education, advocacy, health services and social support programs in the U.S., and through partnerships in more than 50 countries…Susan Goodman Komen, was born in 1943 in Peoria, IL.  She was diagnosed with breast cancer at the age of 33.  She died of the disease at age 36 in 1980.  Komen’s younger sister, Nancy Goodman Brinker … founded the Susan G. Komen Breast Cancer Foundation in Komen’s memory.

…Komen paid founder and CEO Nancy Brinker [Komen's sister]

$417, 712 in 2011 … “

If this information is correct, the dead woman’s sister has become rich off of her sister’s tragedy and off of our donations.  This seems unseemly and wrong.

Thank goodness for “Charity Navigator” and similar resources which clarify and consolidate such information.  For example, there you can see that the president of the highly rated Breast Cancer Coalition Fund takes home half Brinker’s salary.   Of course, that means more money for its cause.

Today Susan Niebur died from inflammatory breast cancer.  An astrophysicist and mother of a 4 and 6 year old, Niebur posted a link to  Mothers with Cancer Help Page in a final post on her blog “Toddler Planet.” Blogs offer such an oddly intimate, novel way for those in medical fields to peek into what the  experience  of illness really is.   We see such a limited piece in  clinics and on hospital floors.  Here, in a final post, Niebur shows how to rise above terminal illness — as her blog evidences she did right along.  She helped others even as her own situation was dire.

Just a couple of weeks ago Niebur improved her resource information for mothers with cancer, as she describes:

I’ve updated a resource page at Mothers With Cancer accordingly — check there if you’re helping a cancer patient and looking for resources for cleaning, cooking, hats and scarves, lymphedema sleeves, wigs, makeup, and how to organize to help a friend with cancer…

I hope her loved ones find comfort knowing that so many others find use and comfort in her words,  words that were spread so widely.  Please continue to spread them widely — pass the links along.

Parents have answers. Especially doctor moms. We have been studying for so many years.  We just need to impose our hard won answers on our kids.  We tell. Kids listen and do.  I use the term “Answer Parenting” to refer to such parenting via administering answers and agendas.

Such “Answer Parenting” can be tempting but has short-comings. First, the approach generally peeves the child. Who likes to be told what to do? And, who likes to deal with a peeved child? Second, the approach doesn’t allow the child to practice figuring out an answer or to practice using their own growing little seats of wisdom and morals as they search for answers.

So, at home I increasingly turn to “Question Parenting.” I flood my kids with endless inquiries. Of course, this is not novel. Therapists of multiple theoretical ilks long have been helping children develop decision making skills via asking endless questions. And, innumerable parenting approaches (such as my favorite “Collaborative Problem Solving” by Ross Greene), lean heavily on eliciting the child’s input. However, I’m increasingly including interminable questioning into every day routine parenting exchanges — with good results.

Yesterday evening during dinner offers an example:

My six year old J: “Can I please be excused?”

Me: ”What do you think?”

J: ”I know. I have to eat my vegetables. How much do I have to eat?”

Me: ”Hmmmm. I wonder.”

J: ”How about if I just eat the carrots all up?”

Me: ”Is that the best you can do?”

J: ”How about one leaf of spinach too?”

Me: ”What do you think?”

J: “One more leaf. I think that’s enough.”

Me: ”Sounds perfect.”

The method, to my amazement, even seems routinely to work on the older kids. When they act up, I ask questions:

“How am I going to get to spoil you if you do that?”

Or, “Don’t you want to fix that?”

Or, “How could you fix that?”

And, oddly enough, the kids tend to offer incredibly reasonable responses and remedy the situation.

Today just as I grew annoyed picking up the endless pile of juice boxes that seem to multiply in my car’s depths, it dawned on me.  No more sippy cups.  I have long ago out-grown the days of sippy cups.

I hated them.  Why could I never find the correct sippy cup valve anyway?  And, how many long lost sippy cups did I find over the years with a potently smelling mixture inside?  No matter how much I scrubbed those cups I could not get out the smell.    I am glad to be done with them.  But where did sippy cup days go?

And, as I reflected further — I realized more items have quietly slipped away.  The days of diapers are long gone.  I celebrated as each child left them behind.   Especially swim diapers.  And, the days of car seats are gone. Now one lone booster sits in the back seat.  And, my youngest just asked today about getting rid of it.

As I leaned down to fish out an ever elusive juice-box straw wrapper, it dawned on me.  The age of juice boxes also is passing.  Then the magna-tiles will go.  Then the legos.  And the mad-libs. And maybe even construction paper.

Nope.  This post has nothing to do with medicine.  Blame the upcoming end of summer which has always made me nostalgic.  But today, I just offer a reminder that the days of mothering kids are short.

Good luck with the mothering juggle.  Enjoy your juice boxes.

After thinking a recent case had gone fairly swimmingly, at the end it became clear I had misinterpreted data and made less than stellar medication choices with less than ideal outcomes.  Nobody was injured.  Everyone is fine.  But mistakes really upset me.  Beyond being annoying, errors highlight the likelihood of future mistakes and thus my omnipresent fear.  What if my mistake someday causes someone irreparable harm?

Hopefully, professionally my worries make me more cautious and a better doctor.  However, I suspect the wariness impacts my mothering more negatively.  The fear tempts me to be a helicopter mom.  Alright.  I admit it.  The fear definitely has succeeded in making me  a complete and utter helicopter Mom.   I always worry about my choices.  What if I do something wrong, and my child is hurt?   What if I let my child climb the wrong tree, and he breaks something?  What if I don’t let him climb enough trees, and he becomes timid?  The what ifs are unending.

There are days it is simply hard to remember that at home all is well.   The kids are tucked into bed.  The dog is curled at my feet.   Sure, I made mistakes today.

Nonetheless all is OK.

As high achieving moms, many mom docs are prone to push their kids hard.  Daily I struggle to hold myself back from falling victim to this tendency.   Every time I schedule the kids’ tennis lessons, I wonder if they shouldn’t have just one more lesson?  Should they have a tutor to get ahead in math or Spanish or Something?  An extra class?  Singing lessons? How hard to push?  How much to schedule?

David Brooks’ NYTimes opinion piece reminds me to slow down and to let the poor tortured kids slow down too.  Brooks points out that college grads need to be able to explore and to find their own paths.  And, children need free time to practice exploration.  Brooks also underlines the importance of kids growing up without a constant focus on their own little beings.  Looking outside of the self is so key to building a meaningful life.  Take a look.  It is worth a read.

My six year old’s newest obsession is FlightAware.com.   The website provides a little picture of the chosen specific airplane (you just plug in airlines & flight number) with its exact location shown on a map plus planned flight path plus flight time countdown.  What an amazing way for a child to feel a little more connected to you, even when you are in the sky and unreachable.  Plus, it can’t hurt the geography education.

My little one is utterly charmed by this one.  Enjoy.

This you tube spot to raise awareness for melanoma is fantastic.   Please re-post wherever you can.    I wonder if everyone who sees the video posts it, how many lives can be saved.   Admittedly, I feel strongly about this one.  My beautiful little girl when just 4 years old had two surgeries on her face for a lesion that many considered melanoma.  She is fine years later now, but the word melanoma still makes it hard to catch my breath.  Take a look.  Take care.