Sunday, December 14, 2014


Spontaneity or life out of balance?
So, in case you haven't noticed, I've been TBTB (Too Busy To Blog) lately. Those are definitely four words I never thought I'd hear myself say, especially that cringe-inducing B word: busy. Unlike the majority of the rest of the world, I don't harbor mad love for the chronically busy. Personally, I find them transparent, boring, and predictable. When every aspect of your day's been planned down to the last detail, it really doesn't leave much room for spontaneity. And that's not very appealing to a free spirit like me.

My three year blogaversary has just passed. When I started blogging, my life was seriously koyaanisqatsi. Despite the fact that I'm a physician, I've never been one of those who lives to work. Work doesn't define me, and though it didn't back then, I'd allowed it to consume nearly every moment of my time because I felt I had no choice in the matter. Working to live didn't seem like an option. The gravid incongruity of my free spirit vs chronically busy situation finally got my attention, and fortunately, spontaneity won out.

Initially, blogging provided a much-needed outlet, a serious means of catharsis. It gradually evolved into what it is today, a fun way to connect with other people all over the world. For the first few months, I blogged every day. When Spartacus and I moved back to Atlanta from Rome, GA, it dropped down to every other day, then once a week. After I started working again, this time only three days a week, I found that once a month sufficed.

Working to live, not living to work
The last couple of months have been a blur. I'm transitioning into my new job by covering interventional pain clinic several days a month, so I've pretty much been back to working full-time. Shifting from anesthesia to pain medicine is accompanied by a significant learning curve, necessitating a fair amount of independent study. It's a bit like being in residency again. My current job finishes at the end of December, and in January, I'll be working four days a week instead of three. Can't argue with that. So, these major changes in my professional life, as well as the long-awaited closing on my house last month, have occupied a big chunk of my time. And I am breathing a huge sigh of relief. 2014 has been a tough year for lots of reasons I won't go into, which is why I'm glad I'm an optimist. Optimism is just as legitimate a reality as pessimism is. It's a matter of distinguishing what you do and don't have control over and rolling with it. Being adaptable and flexible, instead of schedule-driven. That's the beauty of spontaneity. There's always a workaround.

The stuff that matters...
Similarly to how my blogposts have naturally occurred a little less frequently over time, I too have been attenuating. And I'm not referring to the fact that Spartacus and I now have only one mortgage, instead of three. I'm talking about my attitude, how I deal with stress. I've learned not to take things personally. I've quit taking myself and others so seriously. I introspect less and do what I want more. I'm pretty good at living in the moment and following my heart without worry, regret, or expectation. Most importantly, I've realized that my happiness is my decision. Making a few small adjustments in perspective has allowed me to dial down my emotional responses, appreciate just how noncatastrophic most problems really are, and conserve my energy for the stuff that really matters. Three years ago, I would have thought being TBTB was a sure sign of failure. It's actually just a sign that I'm AALL (alive and loving life).

Tuesday, November 4, 2014

It's About Time

The early bird gets the worm, er, blueberry pie.
It's 4:30 a.m. in early November on my day off, and I'm asking myself "WTF am I doing awake right now???" This ridiculously antiquated daylight savings thingy has messed with my circadian rhythms so much so that for the past few days, I've been hitting the hay at 8:30 pm and rolling out of bed eight hours later. The crazy thing about changing time is that we don't even understand what time itself is. We've developed super-precise atomic clocks that are accurate to 0.0000000000000001 second, but scientists can only offer theories about time because guess why? Time isn't a natural phenomenon. It's a human invention that's morphed into a tool of social control. Sort of puts a new spin on hurrying and procrastination, doesn't it?

It's only been a little over a month since I published my last blog post. It's not that I haven't had anything to write about. I haven't had the time, and that's sort of shaken my world a bit. For the past 2 1/2 years, I've had a pretty light schedule, giving anesthesia three days a week and having the rest of my time to do with as I pleased. Having a schedule like this isn't normal in my line of work.

Being a physician is such hard work!
 "Lazy" and "physician" typically aren't words you'd use together in a sentence, but the compromise I worked out with my burned out self so I wouldn't quit medicine altogether did indeed involve me becoming just that: a lazy physician. Laziness has definitely had its perks. I no longer work in a hospital. I don't take call. I don't work on weekends or holidays. I sleep in my own bed at night, instead of a call room. I have days off during the week where I can sleep late and do whatever I want. It's really been a best-of-both worlds situation. The only thing that's really been challenging has been learning to survive on half of my previous income, especially since I've been paying two mortgages this entire time.

Six months ago, I decided I'd had enough of being a landlord, so I put my rental house back on the market. The loss of rental income has been incredibly painful. Living paycheck to paycheck has sucked, and it's a position I never thought I'd see myself in when I first became a practicing physician.

No explanation needed.
Since I wrote about my rental house ordeal pretty extensively in my last blogpost, I won't bore you with those details again. I do have some awesome news, though. My house went under contract on October 7, and is set to close in nine days. Free at last! Aside from one minor hiccup with the inspection (which cost me $900), everything's been moving along nicely. The final mortgage payment's been made, and I'm like a little kid at Christmas, counting the days before Santa's arrival.
The only bugaboo here is that I have to bring money to the closing table. Because I don't want to borrow against a credit card, I've had to shift gears from being lazy to modestly busy.

My light morning reading. Coffee is mandatory.
I won't lie. The past couple of weeks have been pretty intense. Not only have I started orienting in clinic for my upcoming new gig in interventional pain management, I've been working more at my regular job. I'm temporarily back to working five days a week, but surprisingly, it really hasn't been too terrible. I've been able to accumulate the funds I need for closing without having to go into debt. Acclimating to my new job has necessitated some case study and textbook reading, so I'm back on the learning curve. Thank goodness I didn't get rid of my old iPad. Instead of purchasing unwieldy hard copy textbooks, I downloaded cloud-based Kindle versions from, so I can access them via my laptop, iPhone, or iPad. It's made reading, a task that I truly don't enjoy, much more convenient and even somewhat pleasurable.

I'm feeling excited about the work-related changes going on in my life, despite the stressful and time-consuming logistics of securing malpractice insurance. My current job contract specifies that I must secure tail insurance coverage upon leaving the practice. With tail insurance running around $28,000, I've been engaged in negotiations with my new employer to cover my tail on their policy so I won't have to pay the premium.

Chester, rescuing his fallen lens from a giant burrito.
Yesterday, I received confirmation that I was approved for prior acts coverage, obviating the need for separate tail insurance. Hallelujah!! Now I can finally sign my contract. I'll finish my current job in mid-December, and then, I'll drop back down to four days a week in my new position. That means I'll still have plenty of time for hanging out with my favorite people during the week.

After months of upheaval and barely scraping by, I feel like I can exhale again. The weight of my domicile and malpractice albatrosses have been lifted. I've successfully avoided foreclosure, which at one point was a serious consideration. I'm entering a new phase in my career, one that will eventually lead to board-certification in pain medicine. My professional tail is covered. Even though I'll be working one extra day a week at my new job, my income is going up considerably, so I'll be able to splurge on a few of the little luxuries I've been missing, like pedicures and massages. My feet resemble those of a yeti. My shoulders and back are constantly knotted up from weight-lifting. My 52nd birthday's coming up on Friday, so I'll be giving myself a spa day this weekend for sure. Woot! Like the autumn leaves falling from the trees right now, everything's relaxing into place. It's about time.

Tuesday, September 30, 2014

Lost In Tune

Spartacus looking about as concerned as he was in my driverless dream.
I just woke up from the most bizarre dream. In it, Spartacus and I were retrieving our car from a valet parking service. I was sitting in the passenger seat, fiddling around with my phone, trying to find some music to channel through the car stereo. Spartacus appeared to be rooting around in the trunk for something, and as I turned my head to see what he was up to, I noticed a giant pair of speakers perched in the back seat of the car. Some really awesome music suddenly started blasting out of them. I can't recall what it was, but it definitely needed to be cranked up. Lost in tune, I didn't notice the car was moving or realize that Spartacus was sitting in the trunk until we hit top speed out on the freeway. I could only see his head and part of his face, and he didn't seem concerned at all about what was going on. He had this placid look, like he was enjoying the breeze blowing his hair back or something. Meanwhile, I'm panicking and yelling at him in complete disbelief about what I was seeing in the rear view mirror, frantically undoing my seatbelt, scooting my ass over to take control of the wheel, completely astonished that we hadn't collided with anyone yet.

That driverless car dream is a perfect metaphor for how life's been feeling recently: kinda crazy and a little out of control. Where to begin?

My house, my albatross. But, hey, the yard looks great!
Back in May, Spartacus and I decided to put our rental houses on the market. We never wanted to be landlords in the first place...Wall Street, the mortgage financiers, the investment bankers and whoever else was involved in orchestrating the crash of 2008 decided our fate for us. Thanks a pantload, assholes! I'm still trying to get my head around how the banks all got bailed out, while our house values are simultaneously plummeting without a corresponding reduction in mortgage balance. After trying without success to sell my house between 2010 and 2012, I had no choice but to rent it out. Sure, having renters provides income. But, that income gets taxed, and the way things have worked out over the last couple of years, being a landlord has been more of a tax liability than an asset. Just like the poor bastard in the Rime of the Ancient Mariner, that house has become my albatross. God knows, I've fantasized about burning the damn thing down. (Oops, should I have said that out loud? Wouldn't surprise me at all if the insurance adjusters were monitoring my computer along with the NSA).

Chester & I helped rescue this bird yesterday. I need such luck!
Fortunately, Spartacus's house sold almost overnight. I still can't believe his house sold before mine. After having mine listed for a couple of months with the same realtor who managed the property while my tenants lived there, I decided to switch agents. My listing wasn't getting any action. I was constantly having to pull teeth with the guy regarding showings. He really didn't seem to care about getting the place sold. I'd admired how aggressive and responsive Spartacus's agent was while his house was on the market, so I listed the house with her. Definitely a wise decision. We determined that the house would show better a) if it was staged and b) if the yard was shored up, so I employed the services of an interior decorator and Spartacus and I worked on the landscaping ourselves. So far, we've had decent traffic, but no offers. Last week, we reduced the price considerably, and I learned last night that there's a buyer who's very interested in the house. Maybe this'll be my lucky break. One less albatross.

Lunch with Naureen turned out to be more than just soup and nuts.
Two weeks ago, I resigned from my job, so there's that. I really hadn't been looking to change jobs. Back in July, I was having lunch with my girlfriend, Naureen. She completed her anesthesiology pain fellowship several years ago and is currently in practice with a mutual friend of ours from residency. I was reminiscing about how much I'd enjoyed my time on Emory's Acute Pain Service when I was on faculty there. She was like, "You should come work for us!" A couple of weeks later, I got a call from her practice's COO, went in for an interview, and was pretty much offered a position on the spot. It's somewhat of a departure from my current work as an anesthesiologist. Right now, I'm either giving anesthesia myself or supervising anesthetists. In this new job, I'll divide my time equally between evaluating pain clinic patients for interventional procedures and giving sedation for those procedures. I'm looking forward to being back in the pain management arena. Chronic pain patients are an especially challenging lot, so I've got my work cut out for me. What's really great about this job is that it will afford me an opportunity to board-certify in pain medicine without having to go the fellowship route. Once I get settled in, I'm going to enroll in that acupuncture for physicians course I had hoped to have completed by this stage in my career. Who knows, maybe one day, I'll be my own boss?

Everyone's much happier when I'm minding my own business.
Back to my dream. The most difficult aspect of my day to day reality is the fact that my sons have cystic fibrosis (CF) and there's nothing I can do to fix it for them. I try not to let it nag me, but it's always in the back of my mind, an albatross of a different feather. The news from their latest clinic visits hasn't exactly been cheery. Rory recently had to undergo a "tune up" because his lung functions were down. When he texted me from the clinic to let me know he was going on IV antibiotics, I sort of lost it, expressing my frustration over being so helpless with regard to his disease. He responded back, "Your sense of helplessness smothers me at times." Wow. Clearly, he needed to get that off his chest and I guess I needed to hear it. I spent the rest of that morning in tears, feeling like an ass, feeling sorry for myself, but mostly just feeling overwhelmed. I'm his mom. And, moms are supposed to fix everything, right? Not to mention the fact that I'm also a physician who's responsible for fixing people's health problems. It's exceedingly hard to acknowledge my limitations. I wish it were me that had CF instead of my sons. But, Rory is an adult. He wants to navigate the waters of chronic disease management for himself, without my well-intended parental interference. Stepping back from this interaction with him, I realized just how insidious and intrusive worrying about things over which I have no control can be for everyone involved. I'm glad Rory was able to be so brutally honest with me.

Nick & Rory, in their element.
Like the driverless car in my dream, I'm not sure where I'm going with this post. What's felt like veering off course over the last few months may very well be unrecognized plasticity, righting myself by relinquishing the wheel. The time and effort I put into fretting over houses and jobs and health is better spent lost in tune, enjoying the ride, and trusting in life's mystery. I know my house will eventually sell. Since the overgrown ivy in the backyard is the only real reservation the most recent interested buyer expressed about purchasing my house, I've got a yard guy lined up to clear it away. Hopefully, that will appease her. I'm filling out mountains of credentialing paperwork for my new job, which I should be starting in the next few weeks. In the meantime, I've been reacquainting myself with the focused physical exam for evaluating chronic pain, reviewing the neurochemistry and pathophysiology of different pain syndromes, and refreshing my working knowledge of various diagnostic and therapeutic nerve blocks and interventions. No matter how much I prepare, negotiating the learning curve that lies ahead is still going to be a matter of getting my feet wet on the job. Rory is feeling better after his IV antibiotics, although his lung functions didn't improve that much. His doc is going to keep him on the antibiotics for another week. Maybe it'll make a difference. What's important is that he and Nick are living life on their own terms, making amazing music together and independently managing their health issues. They're so lucky to be musicians. I think music's probably been more therapeutic for their bodies and spirits than any other available treatment. Can't argue with that.

I'll leave you with their latest song, "Asklepieion Hiss." This is the first time Rory's composed music around lyrics. The lyrics are actually a poem that my ex-husband--Nick and Rory's father--wrote. In the poem, he's imploring Asklepius, the ancient Greek god of medicine, to heal his sons' cystic fibrosis. It's absolutely beautiful. I hope you'll have a listen, and maybe even find yourself lost in tune.

Prayer to the Solar Storm
by Jim Landt

Awake, awake my golden snake
Coiled tight, deep sleeping in my Soul
Let in thy light, with healing bite
To airtight pathways clogged with coal
Awake and kiss, asklepieion hiss
Thy strike breeds fear in submerged swarms
Connect above, Apollo's love
Streaming down to cleanse my forms
Speak truth to right my Earthqueen's blight.
Bring order to my chaos deep.
Thy photon spray and cosmic ray
Yield healing dreams in each night's sleep.

Friday, August 29, 2014

Beyond These Walls

Bridesmaiding at my sister's 1986 wedding.

As a newly engaged 24 year old, you'd have thunk I'd be immersing myself in typical bride-to-be behavior: selecting a venue, shopping for a dress, poring over china patterns and crystal stemware, and most importantly, deciding what flavor of wedding cake I wanted. I'll be honest, cake is really the only reason I go to weddings. God, how I love wedding cake! Or really just cake of any kind, especially yellow cake with chocolate fudge frosting, or salted caramel with true buttercream, the kind that's made with eggs and butter, not powdered sugar and Crisco. Wait, what was I just talking about?

Oh yes, back to being 24. Welp, that was waaaaaay back in 1986, the year Oprah Winfrey got her talk show on national TV. I was living on Briarcliff Road in the roach-infested basement of this crazy middle-aged Spandex-wearing divorcée's house. She augmented the fortune she made in alimony from her ex-husband by giving high colonic irrigations right inside her freakin' domicile. How gross is that?? I knew this because as soon as I signed the lease, she supplied me with brochures and booklets extolling the virtues of colonic irrigation while in the same breath admonishing me that I was to have no overnight guests. Yeah, right! 

Hardly working while wearing my fiancé's shirt.
I liked living alone, without a roommate. At the time, I was working as a mental health assistant in a private psychiatric hospital, a job which paid $5.85 per hour and provided me with full health care and profit sharing benefits as well as 2 weeks of vacation. I'd never felt so independent. Although I'd started college at Auburn in 1980--studying visual art--I dropped out three years later with a GPA of 1.2, mostly because of partying, but also because of raging insecurities, a complete lack of self-confidence, and lots of inner turmoil and self-loathing. Basically, I didn't trust myself or my abilities. I was too worried about what everyone else thought of me. 

That job at the psych hospital may not have sounded like much, but it was just what I needed to restore my confidence and get back into school. So, while I was working full-time, I was also attending community college as a full-time student. And boy, did I enjoy being a student. I wasn't worried about deciding on a major...I just took classes that appealed to me: music appreciation, French, German, biology, psychology. I ended up getting an associate's degree that was inconsequential. But, the experience of plunging headfirst back into school, doing it strictly for myself and raising my GPA to 3.9ish, was exhilarating. I felt like I could do anything I wanted to.

Sorry girls, I'm a man magnet, even for men made of bronze.

One afternoon, I was hanging around my apartment, daydreaming about life with my future husband whilst watching Oprah Winfrey. I'd just finished washing and drying my clothes at the laundromat, and was about to commence folding them when the craziest thing happened. Oprah was interviewing people who found out later in life that they were gay. 

Immediately, I was struck with panic. "What if I'm gay and don't know it?" I became so obsessed with this completely irrational thought that it nearly destroyed every shred of happiness and pleasure I'd permitted myself up till then. I couldn't get this thought out of my mind. It felt foreign, like it was originating from a source outside myself. I mean, I'd never been attracted to women before. Why would I all of a sudden turn gay, especially when I adored men so much? Wait, do people turn gay or are they born that way? It was pretty clear that I was tormenting myself, pulling the rug out from beneath my own feet. Cognitively, I knew this was insane, but I didn't know how to stop. It was as if I had a built in radar detector of self-defeat, ready to crush my happiness into smithereens.

Feigning happiness while wearing itchy tights

Overwhelmed by the unsettling fear that I didn't really know myself, which quickly segued into a disturbing sense of helplessness and lack of control, I went into therapy. I can't say that therapy did much for me. After months of rehashing old issues about my sexuality (yeah, I'd been around the block only about a zillion times by the time I was 20), which only served to stir up feelings of frustration and anger toward my parents, I called it quits. The thoughts were still there and showed no sign of budging. Everything felt mechanical. What was supposed to be the happiest time in my life was painful. Ruined. Why was I so different from everyone else? Why couldn't I just be happy

Well, the problem turned out to be that I didn't feel deserving of happiness in the first place. Somehow, I'd gotten this idea that happiness was something you had to earn, that if you worked hard enough and struggled long enough, eventually you'd be rewarded with everlasting happiness. In other words, I didn't perceive myself as the source from which my own personal happiness could spring. Not surprising when you consider that we're ingrained from an early age to believe that something or someone outside of us is responsible for our attitudes and actions. "Look what you made me do!" and "Johnny hurt my feelings!" are two perfect examples of this blame-gaming. By the same token, taking credit for our success is viewed as pretentious. We owe it all to someone else, right? Whereas Gallant might say, "My bones are growing," Goofus would declare, "I'm growing my bones." It's a matter of perspective, really. If we're not the ones controlling ourselves, then who is? 

Babies...all action, no talk. No talk, no thoughts. We sure had it easy!

Long story short, by ignoring those troublesome thoughts and feelings, I quit thinking about them. Pretty cool, huh? Instead of thinking my thoughts were being thunk, I determined that since I was the one thinking them in the first place, I could just as easily not think them. I'd been making myself miserable for no reason. Actions do speak louder than words. Thoughts are the mind's words, so they can only get the best of us if we let them. If you want to change your attitude, your feelings, or your thoughts, then change what you're doing. 

Hmmm, is Mom the victim of my full diaper here?

We are not helpless victims of circumstance, genetics, or biochemistry, regardless of what the medical establishment, the pharmaceutical industry, the justice system, and society would have us believe. I'm well aware that this contradicts popular opinion, but human emotion and behavior are not diseases, except perhaps in the metaphorical sense. Attributing worry and unhappiness to genetics or biochemistry is basically just an updated version of "the devil made me do it." The good news is that just as helplessness is learned, it can be unlearned. Why give power to self-defeating thoughts and feelings? Seriously, it's about as necessary as drinking one's own urine (Is It Necessary For Me To Drink My Own Urine?), a matter of choice. (If you're offended by this, that's your choice as well). It is we who are responsible for our attitudes and our actions, not anything or anyone else. 

Chester & me, exercising our free will & self-determination in public

Because of my opinions on the subject of mental illness, especially with regard to biopsychiatry, I've been accused of being unempathetic and uncompassionate, of having never suffered through major depression myself, of being narrow-minded, and a host of other criticisms, none of which I take personally. Oh, the stories I could tell. People are free to think whatever they want to think, and what other people think of me is none of my business. The irony here is that people can and do think themselves into unhappiness, despair, and disability, as if they're not capable of thinking freely for themselves in the first place. Maybe it's a matter of whether or not a person believes he or she has free will. Self-determination, which is the essence of free will, means just that: making choices, solving problems, and taking control of and responsibility for one's own life, as well as accepting the consequences of one's attitudes and actions. As for compassion, this quote says it all for me: "Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime." Helping people help themselves to become independent is the highest form of compassion, IMO. 

Being silly is just one of  my special skills.

Without going into detail, it's taken me quite a few years and a lot of life experience to find my happy place. And, by no means does that mean I'm always ha-ha happy. Anyone who knows me knows I have a few things I could choose to be very sad about. Like sad-all-the-time-majorly-depressed-life-is-so-unfair about. At 24, I fixated on a single irrational and devastating thought that today, I wouldn't have given a second thought. It would have slid right on by. Being happy is an attitude, an approach to life that comes from a deep enthusiasm for life itself as well as the ability to keep moving on. It's impossible to be self-absorbed, imprisoned by your thoughts and fears, when you're immersed in the sensual wonders of each moment. My favorite Lao-tzu quote is "Stop thinking, and end your problems." The less I've thought about my problems, the more I've acted to change either the problem itself or my attitude about it. This aphorism by my friend, Marty Rubin, is also apropos: "We are the mountains we must cross." No doubt about it, we're our own worst enemies. Being at odds with ourselves--even on a frenemy level--is sad and wholly unnecessary, seeing as how we're stuck with ourselves for an entire lifetime.  Kind of pointless, really, when we can just as easily befriend ourselves. It's not rocket science. It's simply a matter of action.

We don't think about ice cream, we scream for it!

On a lighter note, the best part about not spending all my time thinking about my problems means I have lots more time for things I enjoy, like running. Lately, it's been so hot and humid that I've been running inside on the treadmill. Although I've watched all sorts of interesting documentaries and programs about cute puppies and kittens, I'll be glad when it cools off enough for me to get back to running outside. So much to see and experience beyond these walls. I do have one small problem, though, and it's the reason I've got to keep running. The problem is the ice cream shop that recently opened up down the street. Now I'm being confronted with the deep contemplation that invariably accompanies 24 flavors of soft serve and a dozen kinds of Philadelphia style water ice. The place has only been open 10 days, and already, I've been there four times! Less thinking means more running, and more running means more ice cream. Yeah! 

Saturday, July 26, 2014

Our Biggest Issue

Boris, in his comfy chair
Last weekend, amidst all the turmoil in this world, Boris--our beloved little 18 year old cat--died. We woke up early last Saturday morning, fully expecting to be greeted by Boris's usual "where's my breakfast?" meows, followed by him ignoring our dogs while boldly drinking from their water bowl, and then sauntering over to his comfy brown chair for a nap. Instead, we awoke to find him lethargic, confused, and very weak. Thinking Boris might have suffered a stroke, we immediately took him to the vet. The news wasn't reassuring. Although Boris hadn't had a stroke, he was severely dehydrated; his labwork revealed that he was in renal failure. The vet recommended a trial of intravenous hydration. Feeling this was a reasonable course of action, and knowing that either Boris would respond or he wouldn't, we left Little Buddy in the doctor's capable hands.

Ria's peach pancakes=pure comfort
Funked out and in dire need of some comforting familiarity, Spartacus and I hit Ria's, our usual Saturday morning breakfast spot. In between talking about Boris and guzzling strong coffee, we discussed a conversation I was involved in on Blog Catalog (BC). BC is a worldwide blogging community with an active discussion forum. I've befriended people from all over the world there, several of whom are kindred spirits that I'd love to meet in person someday. I've shared some of the most intimate details of my life on BC, things that most people don't know about me. The topics of discussion are endless. We talk about our blogs, personal lives, culture, nature, religion, politics, philosophy, history, technology, art, poetry, music, pets, travel, name it. Occasionally, the discussions get heated or trolls stop by to visit, but fortunately, the forum moderates itself pretty well. In my three years of involvement on BC, I've learned a tremendous amount about communication, how to talk open-mindedly with other people about complex or emotionally charged issues and perhaps most importantly, how not to take things too personally or myself too seriously.  

Anyhow, back to the discussion. It was centered on the observation that no one on the forum was talking about the current turmoil in the world, namely the bombing of that Malaysian Air passenger plane over the Ukraine or the Israeli-Palestine conflict in Gaza, the question being whether this lack of interest was an isolated phenomenon or reflective of society at large. In other words, were the world's big issues somehow less significant than our personal lives? Shouldn't we be more focused on things bigger than ourselves?

Visiting with Boris
Later that afternoon, we visited Boris at the vet. A tech brought him into the visitation room, swaddled in a wooly green blanket. He didn't seem seem bothered by the IV line above his paw. He meowed in recognition when he saw us, and we took that as a sign he was responding favorably to the hydration. He surprised us by wriggling out of his blanket to explore the room. I took lots of pictures of him and Spartacus. It was a very good 45 minutes. Feeling somewhat reassured, we went out for dinner, both of us thinking Boris would be coming home the next day.

At 7 o'clock the next morning, the vet called. Boris's condition had deteriorated overnight and he was now minimally responsive. He wasn't going to make it. We jumped out of bed and headed over there, hoping that Boris could hang on long enough for us to cuddle him one last time before saying goodbye. 

Anguish and letting go
They brought him out, wrapped in the same green blanket, but this time he looked terrible. Ragged. Worn out. Breathing hard with his mouth wide open. It was awful. Spartacus and I both wept inconsolably. Even though Boris was very old and we knew this day would eventually come, we still weren't prepared for it. What a profound experience it was to cradle this majestic, fiercely independent living creature who'd brought so much joy into our lives as he breathed his last few breaths. Boris lived a good life and died a gentle death. I'm grateful that he didn't suffer through a prolonged, painful illness and that we were able to comfort him in his final moments. 

I'll be honest. The only big issues in my life concern the people (and pets) I know and love. I am much more interested in sharing experiences and connecting with other people than worrying about what's going on in the world. That doesn't mean I deem war and suffering as insignificant or that I lack compassion. It means I understand that the only control I have is over myself and my own actions in life. Kind of like that old TV commercial which went something like, "We don't want to change the world, we just want to change your oil." Being an agent of change isn't about changing other people anyway. We're all constantly changing the world through our own spheres of interaction and influence, just by being here and living life. Nearly all of the problems in the world result from fear generated by people minding other people's business instead of tending to their own. Human behavior hasn't really changed much throughout the millennia. There has always been war, hatred, famine, torture, and poverty. It's just that now there's no escaping the nosy neighbor media. 24/7, it's there in your face, like Gladys Kravitz on steroids. As long as people concern themselves with what everyone else should be doing, instead of focusing on doing what good they can in their own lives, there will be fear and judgment and conflict and injustice.

L-->R: Me, Nick, Jim, & Rory
Monday, the day after Boris died, was my sons' 24th birthday. Back in May, Nick bagged his first wild turkey on a hunting trip with his dad, Jim. This was the first time Nick had hunted since high school, and his birthday wish was for us to have Thanksgiving in July with roast wild turkey and all the trimmings. By us, I mean his twin brother, Rory, Jim and his girlfriend, Glenda, his friends, Chad and Tiberius Funk, Spartacus, and me. Quite a crowd, huh? Coincidentally, Nick's been struggling with a lung infection that hasn't responded to oral antibiotics, pretty typical for someone with cystic fibrosis. So, on Monday, while I was baking birthday cake and roasting his gorgeous 15 pound bird, Nick was at Emory, getting a special catheter placed in his arm for a couple weeks' worth of home intravenous antibiotic therapy. Such is life. That evening, amidst all the turmoil in the world, Nick and Rory celebrated their birthday, surrounded by family and friends whose only goal was to thoroughly enjoy ourselves and each other, our biggest issue being whether or not to have a tiny sliver or a bigass slice of German chocolate cake. 

Sunday, June 22, 2014

Good Hands, Better Feet

Don't even think about going outside, y'all!
It's sweltering here in Hotlanta, one of those oppressively humid late June days where the air, sticky and thick as cooked pudding, bitch-slaps you back inside your nice cool house just for thinking about attempting a daylight 4 mile run. I can't imagine what it was like a hundred years ago, living down here without air conditioning. Alas, air conditioning's become somewhat of a sore subject for Spartacus and me. Sounds like one of those #firstworldproblems, right? Damn straight it is. The woeful story of our air-conditioning albatross began in July of 2011. Back then, we were living in Rome, Georgia, which is another story for another time. Anyhow, our Atlanta house was on the market, and every few weeks, we'd drive down to check on it. Since July 4th was on a Monday that year, and I happened to have the day off, we road-tripped to Atlanta to make sure the house was OK before heading over to Chambodia for some Ethiopian grub.

Feel free to sue me. I've got my MD and an umbrella!
The house looked fine, but it was hot as hell inside. I set the thermostat to 72 degrees to cool it down, figuring that one of the agents who'd recently shown the place must've screwed around with the settings. The system cycled on, but only warm air issued forth from the ducts. Hmmm. Low freon? A busted compressor? I was standing in the master bathroom, gazing out the window into the backyard and wondering "WTF?", when I discovered exactly what the problem was. Some asshole had stolen the AC unit right off its slab! Motherfuckers probably got $50 for the copper tubing inside. So I did what any reasonable person would do. After reporting the theft to the police, I called my insurance company. I mean, that's what insurance is for, isn't it? For six years, I'd had my home and three automobiles insured through Metlife, plus umbrella coverage since I'm one of those "rich" doctors that everyone loves to sue. Clearly, I was a loyal customer. Metlife cut me a check, and within a couple of days, I had a brand new AC unit, clad in an iron cage to prevent it from being stolen again. 

Look, it's the Good Hand of Insurance!
Fast forward two years. New city, new house, same crappy luck. On the same day last August, lightning struck one of our AC units and I lost one of the diamonds from a pair of earrings, both of which were insured with Metlife. Spartacus and I roughed it for a few days, sleeping in the guest bedroom which was cooled by the other equally ancient AC unit. Lightning strikes are considered acts of God and Metlife cheerfully agreed to cover the cost of the damaged AC unit. However, they informed me that my diamond earrings were no longer insured. That's where things got ugly. A little detective work into my plethora of policies revealed that when we moved from Rome back to Atlanta, Metlife dropped the coverage on the earrings without my knowledge or consent. After several weeks of battling it out with the underwriters, Metlife acknowledged they'd made a mistake in dropping that coverage and forwarded me a check for the missing diamond. Everything was good, or so I thought.

Fuck you, Metlife, Nationwide is on our side!
Even though Metlife had come through for me on the air conditioners and the diamond earrings, I couldn't help but feel annoyed that my monthly premiums had skyrocketed so drastically upon moving back to Atlanta. An increase of $200 per month isn't exactly chump change. Aside from the price-gouging, Metlife's customer service totally sucked because they'd outsourced it to somewhere in Asia. Nothing adds to the frustration of dealing with insurance bullshit than trying to converse with someone speaking unintelligible English who can't possibly begin to relate to your situation because they probably don't even have insurance where they live. Unacceptable! Spartacus had his rental property and car insured with Nationwide, so I called them back in April to see what kind of quote they'd give me. For comparable coverage, they were way cheaper than Metlife, plus their customer service was based in the good old US of A. We added my rental property and three autos, along with that all important umbrella coverage, to his existing policy. Nationwide advised me that because of the air-conditioning and lost diamond claims, I'd be better off continuing to insure our primary residence, which happens to be a condo, with Metlife until July 4th. That's when the 2011 AC theft claim would magically disappear. Apparently, if you have more than two claims as a homeowner, you get flagged as a liability, and each claim stays on your record for three years. Given that Nationwide's quote for said property was considerably higher than what I was already paying with Metlife, waiting until July seemed reasonable. I sent Metlife a letter, canceling all my policies except for our condo.  

Would Snoopy approve of this??
Long story short, Metlife was pissed about me canceling those policies. About a month after I'd switched over to Nationwide, they decided to cancel our condo policy, citing the theft, lightning, and mysterious disappearance claims as their reasons for nonrenewal. Since I'd gotten that condo policy quote from Nationwide back in April, I figured we'd suck it up and pay them the higher premium until the theft claim expired in July. We had no clue as to the shitstorm that awaited us. When we tried to add the condo onto our joint policy, Nationwide's underwriters refused because, aside from the three claims I'd previously filed with Metlife--one of which was about to expire--Spartacus had made a telephone inquiry last summer when his rental property was broken into and the refrigerator was stolen. Mind you, he never even filed a claim. But, in the world of insurance, being naïve enough to make a simple inquiry can and will be held against you. Four strikes and we were out. To make matters worse, Wells Fargo, our mortgage company, began hounding us about the impending cancellation, threatening to secure hazard insurance for us at our expense. When I called Wells Fargo to let them know that our property was deemed uninsurable, they gave us their list of insurers. Awesome! At least now we had some options. We breathed sighs of relief, thinking our ordeal was coming to an end.

In other news, Boris finally got his driver's license! 
Welp, no such luck. None of the insurers on their list issued condo policies. Wells Fargo then referred us to the State of Georgia's Underwriting Association to inquire about the FAIR (Fair Access to Insurance Requirements) plan. The lady who answered the phone suggested that we call a few more insurance companies, as the FAIR plan didn't insure condos, either. Metlife's letter was indeed prophetic: we were pretty much fucked. Spartacus and I both got on the horn and started calling every insurance company we could think of. Finally, GEICO agreed to insure our condo through Travelers. Problem solved. Yet the nightmare continued. Now, Nationwide was going to cancel the insurance on my rental property because the address on the umbrella policy didn't match up with our homeowner's policy. "But, we don't have a homeowner's policy with you," I tried to explain, "we only have the two rental properties." At this point, the slop thickened considerably. Nationwide had mistakenly listed Spartacus's rental property as our primary residence, even though he'd been very clear that it was a rental when the policy was intially secured. That's why the addresses weren't matching up with the newer umbrella policy. We also learned that Nationwide won't cover rental properties or give you an umbrella unless they're also insuring your primary residence. Basically, we're being punished for being honest with our insurance company. The umbrella policy's a wash. Guess I'll have to call GEICO for that, since they're the ones insuring our condo. We're still awaiting a decision from Nationwide's underwriters about whether the rental properties can be retained. Sigh. We'd probably have better luck getting our cat, Boris, insured as a driver on one of our cars. LOL. 

Good hands, better feet
This isn't the first post I've written about the scam known as insurance, nor will it be my last. The problem is that the very idea of insurance doesn't jive with the way I live my life: insurance concerns itself with what might-but-probably-won't happen, while I'm all about what IS happening right now. Think about it for a moment. The insurance industry capitalizes on our fears and insecurities, conditioning us to into leading sheltered existences where every move we make is calculated and risk-stratified. Spontaneity simply isn't tolerated. Why, at any time, I could walk out my front door and get hit by a bus! Actually, it's more likely that my car would be stolen, my house broken into, or I'd be held up at gun point as my mailbox was being robbed of its contents. It's summertime in here in the 'hood, and Thug University's in full session. For weeks now, the Kirkwood Neighbors' FB site has been bursting its seams with alarming reports of such shenanigans and tomfoolery, so much so that Spartacus purchased a stun gun for me to take on my evening runs. It's basically a giant 7.5 million volt-powered dildo, a little too obtrusive for a jaunt around the 'hood, plus there's no way it'll fit inside my running belt. In the spirit of compromise, I've started carrying a miniature toy handgun instead. Now, heat stroke's the only thing Spartacus worries about when I'm out running. These Code Pudding days of summer, along with the neighborhood's unruly hooligans, have motivated me to run faster than ever, a pace of 9:17 per mile to be exact. At that speed, I'm confident I could probably outrun an out-of-shape elderly mugger. Knowing that I'm running back to the cool air-conditioned comfort of my house is also a great motivator. And ironically, so is knowing that our older AC unit's probably gonna blow any day now. Tomorrow, we're getting an energy-efficient, white solar-reflective cool roof installed. It should cut down on our summertime energy bills by about 30 percent. Best of all, our HOA has agreed to pay for part of it. Hell, we may not even need our AC anymore! Now that's a risk I'm willing to take.

Related posts:
A Matter of Principle
What Would Hippocrates Do?
The World Seemed Right Again
A Taste of Immortality
The Appointment (a four part short story)
  Part I: The Appointment
  Part II: Amplitude
  Part III: Redemption
  Part IV: Insurance
Nowsurance (My Summer of Living Dangerously)
Fail-Safe (a four part short story)
  Part I: Fail-Safe
  Part II: Detour
  Part III: Marvelously Fresh, Decidedly Vague
  Part IV: From Cupcake Epiphany to the Future Now
About A Boob

Monday, May 19, 2014

Welcome To The Club

So, my Club of the Chronically Busy application got denied.
It's been a minute since I've blogged, hasn't it? Although I'm not a member of the Club of the Chronically Busy--you know, those who spend vast portions of the miniscule amount of free time they want us to think they have, regaling us with incessant updates on their importantly spent time and concurrent unavailability because spontaneity and laziness frighten them so--I actually have been kind of busy. In fact, I've been so busy that I've neglected to pay the annual dues for my highly coveted state and national society of anesthesiologists memberships. Shame on me! Why, with the American Society of Anesthesiologists being bargain-priced at only $665/year, and the Georgia Society of Anesthesiologists a mere $375 annually, how on earth could I pass up such a deal? I've been so enriched by these organizational memberships over the years (not!), how could I have been so careless?

More bitter pills of rejection. Boo hoo. 
Last week, I received this not-so-gently worded reminder from the GSA, admonishing me that since I didn't remit the required dues payment by April 20, 2014, "the delinquent member's membership shall automatically terminate and the Secretary shall notify the ASA of the same." Bunch of tattletales. Whatever. To add insult to injury, the last two lines of the letter read: "Together, the GSA and ASA are successful in representing the professional interests of anesthesiologists. Your support for the GSA is, therefore, appropriate and deserved." Talk about a guilt trip! The real reasons I didn't pay my dues are because a) I'm paying two mortgages and don't happen to have $1k in spare change lying around to pay these exorbitant fees, and 2) I'm aggravated that the ASA now mandates membership in one's state society for annual renewal. In other words, we no longer get to decide whether we want to join at the state level; Big Brother's making that decision for us. Pfffft. Sounds like a racket to me.

Wish I could dip my bruised toe into this cool snowball tree!
So, what exactly has been keeping me so busy lately? Well, for one thing, I've started running. The spring of 2014 here in Georgia has been absolutely amazing, with milder than normal temps and relatively low humidity. I've gotten to where I crave being outdoors as much as possible. I can't think of a better way to accomplish that than taking Simon and Lilly on daily three mile walks, followed by a solo run. With all this walking and running, there are bound to be a few injuries. I've only been running for a couple of weeks, but I'm already up to 4 miles, which I run at a pace of 10 minutes per mile. Even though I bought new running shoes, sized up a half-size to prevent toe-strike trauma, I ended up with a bruised big toenail last night. It doesn't hurt, and it's not bad enough to quit running, but I won't be getting a pedicure anytime soon.

Nobody puts Lilly in a corner, not even Horner's!
Coincidentally with the onset of these super long dog walks, Lilly developed a weird eye condition where her third eyelids suddenly popped up. The vet initially thought it was some sort of parasite-borne inflammatory process. She drew some labwork, but since Lilly wouldn't pee for her, Spartacus and I had to collect a urine sample later that day. A urine sample? From a dog???? I wasn't even sure exactly where her urethra was, much less how we'd obtain a sample. After visually inspecting her hindquarters, we devised a plan in which we'd shove a small shallow container under her junk as soon as she popped a squat. Worked like a charm. When two weeks of topical and oral steroids yielded no improvement, we were referred to a veterinary ophthalmologist. I had no idea that canine subspecialties even existed. After running a few tests, the diagnosis came back as Horner's syndrome. Horner's syndrome occurs when there's damage to the sympathetic nerves supplying the eye and eyelids, causing the eyeball to sink back slightly, reddening of the conjunctival sac, constriction of the pupil, droopiness of the upper eyelid, and in dogs, elevation of the third eyelids. It's usually benign, but can be associated with trauma, cancer, or other systemic disease. She explained that weird stuff like Horner's just happens in dogs sometimes and since Lilly's bloodwork and neurological exams were negative, we'd wait a few weeks to see if the problem resolved. What didn't make sense to me was that Lilly's Horner's was bilateral (occuring on both sides). There had to be an explanation.

Training collar snafu :-(
As soon as I googled canine Horner's syndrome, I figured it out. When I take the dogs on walks, I clip the leashes to their training collars which have rounded prongs situated on either side of the trachea. Lilly's collar is a little too small and fits pretty snugly. Since the sympathetic nerve chains run on either side of the neck, exactly where those prongs would be applying pressure during a walk, I surmised that it was the probably the collar that caused her bilateral Horner's syndrome. Needless to say, we're not using the collars anymore. The only reason I use them is because I'm walking two very large, strong dogs by myself in a dog-centric neighborhood, and other people's dogs aren't as well behaved as Simon and Lilly. They're basically just there to nip potential canine altercations in the bud. Ugh. It could take weeks for her eyes to go back to normal, but I'm confident that they will. Fortunately for me and Lilly, our injuries haven't slowed us down a bit.

English country gardening is punishable by law in Atlanta
Even though I walk and run the same routes every day, the routes themselves are never the same. Here in the KWD (Kirkwood, our historic East Atlanta neighborhood), there are always people and other animals doing interesting things outside, from squirrels making booty calls to movies being filmed right across the street to the lady dressed like Santa's helper, who walks around with a clipboard inspecting telephone poles and preaching expletive-laden sermons to an audience of no one. Not long ago, there was a full-sized goat living inside a house just a few doors down from us. How agrarian is that?! More recently, one of my neighbors became a local celebrity when the City of Atlanta charged him with code violations regarding his yard. Ray McGrath has lived in Kirkwood for 32 years. He teaches botany at a local college and maintains his yard in the style of an English country garden. His colorful, unmanicured garden attracts all manner of birds, butterflies, and bees; it's a natural habitat. Ray's egregious offense prompted the city to fine him $1000, citing him for a "premises covered with high weeds and overgrowth." Ray went to his court hearing and actually pled guilty to having an English country garden, LOL. Luckily, the Kirkwood community got wind of Ray's hearing and bombarded the city solicitor with e-mails on his behalf. When he showed up in court a few weeks later, the judge quickly dismissed his case, and he's been back out tinkering around in his yard ever since.

Yep, that's real blood on that there iron
Last, but not least, I've been busy being a rock and roll mom. My sons' band, BearKnuckle, just released its second EP, "Blood on the Iron". You may be wondering, how did they come up with such a provocative title? Welp, let's just say there was a testosterone-fueled altercation at a party involving lots of booze, two jealous men, an iron, and leave it at that. BearKnuckle's EP release party was last Thursday night, kicking off their tour of the southeast. Boy, am I glad I requested Friday off! I didn't get home from that show till nearly 3 a.m., and though I was hung over from my lack of sleep, I spent the day uploading live videos from the show and grooving on BearKnuckle's awesome performance. I don't know how I managed to do the three mile dog walk and a four mile run that night, but I did it. As Spartacus and I were chilling out that evening, watching a rerun of "Dexter," it occurred to me that I'd promised to make Nick and Rory some homemade Clif energy bars to take on their tour, a tour which they were leaving for in two days. We'd talked about this a month ago, when the boys told me how difficult it is to eat healthy on the road. When they're on tour, Nick always brings trail mix, granola, and dried fruit that he ends up sharing with everyone. On the road, nutritious food is scarce and expensive. Having balanced healthy snacks to munch on in the car is a big help, but trail mix, granola, and dried fruit become a total yawnfest after a few hundred miles. During our conversation, Rory mentioned that he loves Clif bars. We were all like, "Yeah! Clif bars! That's the ticket!" Clif bars are expensive, so I told the boys I'd make some homemade ones. Clif bars are exciting, too. So many flavors! The downside is that they aren't exactly healthy...they're loaded with carbs and processed ingredients. As far as homemade Clif bars go, I got as far as researching recipes before Lilly's crazy eyes distracted me. Upon finding a recipe I liked, I ordered a big bag of puffed quinoa to substitute for the puffed rice cereal it called for, knowing that since quinoa's packed with protein, fiber, iron, and magnesium, it would result in a much better nutrition profile than rice. To sum it up, I was pretty confident I could make better Clif bars myself.

Post-slingin' Spring flinging in Bessie Branham Park
Saturday morning, before Spartacus and I walked across the street to enjoy the sights, sounds, and smells of the annual Kirkwood Spring Fling, I grabbed that big ol' bag of puffed quinoa and started slinging away in the kitchen. The basic recipe called for simple ingredients: rolled oats, puffed rice or quinoa, raw honey, flax seed, dried fruit, nut butter, chopped nuts &/or seeds, vanilla, and cinnamon. Fortunately, I had everything I needed on hand. As usual, I improvised a lot. (I'm one of those people who can never follow a on my own terms, y'all!) The original recipe was similar to a no-bake cookie, meaning that the bars needed refrigeration to hold their shape. According to the recipe's author, baking them had resulted in crunchy bricks, not the moist chewy texture of a Clif bar. Since the boys wouldn't have access to a refrigerator on tour, I decided to dehydrate the bars instead, adding chia seeds as an egg substitute to help bind the mixture as well as supplying protein, fiber, omega-3 and -6 fatty acids, and minerals. The first batch I made was chocolate chip. I added bittersweet chocolate chips to the original recipe, used dried raisins and apples for the fruit, and sprouted pumpkin and sunflower seeds for the nuts. For the chocolate brownie version, I got really creative. I had a jar of organic Nutella (cocoa-hazelnut spread), so I used that along with some almond butter, cacao powder, cacao nibs, dried Montmorency cherries, and ground cardamom to produce a satisfyingly deep dark chocolate confection. Since I had lots of dried apple bits left over, I decided to try an apple pie version. I wasn't too pleased with that one until I added some unsweetened organic applesauce and lots of pie spice; the peanut butter was overpowering. Think I'll tweak it next time and use macadamia nut butter instead. It's rich and buttery, but much more neutral than peanut or almond butter. It'll really let the apples shine through.

BearKnuckle Bars!!!
I went all out, packaging the dehydrated bars individually in cellophane with laser-printed labels. As the labels were printing, it dawned on me that I couldn't call them Clif bars because that name's been trademarked. I thought about calling them Kris Bars, but then, it came to me. These were BearKnuckle Bars! Believe it or not, they're so darn good, I'm thinking about marketing them to some of the small businesses in the area. Wish me luck. On Friday, I'll be flying up to Columbus, Ohio for BearKnuckle's Saturday night show on the OSU campus. My younger sister lives there with her husband, and BearKnuckle will be performing in the same show as their son's band, Love Alive. Needless to say, I am super-stoked.

Why I refuse to feed the machine
Last week, I came across this Walt Whitman quote: "Do anything, but let it produce joy." I'd just scribbled it on the chalkboard backplash above my stove when I got that stupid downer of a letter from the GSA. Womp womp womp woooomp *sad trombone*. Sorry, but no, paying $1040 in annual dues to a couple of professional organizations whose services I don't utilize doesn't exactly produce much joy for me. Fuck that shit. I refuse to feed the bureaucracy machine any more than I have to. It's really kind of a no-brainer, especially after getting ass-raped by Uncle Sam....AGAIN! What little extra money I do have nowadays is better spent enjoying lattes on a sunny afternoon at Taproom Coffee, the hip new coffee and craft brew joint down the street, or buying comfy running shoes or helping fund a cool project, like "Just Breathe" by Ian Pettigrew, a Canadian artist afflicted with cystic fibrosis (CF) whose dream it is to photograph adults living with CF. My beautiful sons are on his list of subjects.

Welcome to the club, Kris Landt!!!
I saw some graffiti when I ran past the Big Nerd Ranch last night, the same run during which I injured my big toe. It served to reinforce this joy-producing theme of liberation from imposed obligation I've been grooving on lately. "Do what makes you happy," it read. It's ironic how members of The Club of the Chronically Busy tend to be the unhappiest and least-fulfilled people I know. Makes me wonder who and what they're doing it all for, and glad I'm not one of them. As for the ASA and GSA, they're basically political machines. I've never been interested in politics, and apparently, my unwillingness to shell out large amounts of dough to invest in bureaucracy makes me a delinquent, unappreciative loser in their book. They may represent my profession on a legislative and economic level, but they don't represent me personally as a practicing physician anesthesiologist. Here's the thing. Like Groucho Marx, who famously said he'd "refuse to join any club that would have me as a member," I don't want or need to belong to a club. I'm happiest doing my own thing. If there's a club for that, then sign me up.

BearKnuckle, "Blood on the Iron" EP
Ian Pettigrew, "Just Breathe" project

BearKnuckle, "Soma" from "Blood on the Iron"

Sunday, April 6, 2014

About A Boob

#clownmakeupselfie #selfbreastexam
Forgive me for sounding cynical, but I am SO not getting this whole no-makeup selfie for breast cancer awareness trend on Facebook. In case you're not familiar with it, it's where women post bare-faced (and in some cases looking downright haggard) photos of themselves with the hashtags "cancerawareness" and "nomakeupselfie" as a means of drawing attention to a subject which already receives a sizable amount of public awareness. I mean, seriously, it is a nice gesture, I suppose. But, if the ubiquitous pink ribbons aren't getting women to self-examine their breasts, why on earth would anyone expect a barrage of frightening au naturale mug shots to accomplish what symbolic imagery has failed to do?

People are scared of clowns for a reason. Wearing THAT much makeup is definitely unnatural, concealing what really lies beneath. Unfortunately, these no-makeup selfies come across as clownish and self-congratulatory. Hell, even the breast cancer survivors are pissed! As if masquerading publicly for a minute without makeup could ever pretend to demonstrate real empathy. I mean, if the point of this exercise is raising breast cancer awareness, why not just post a self-breast exam selfie or video instead? Oh, jeez, I forgot, we're not allowed to show our tits in public! LOLZ. (Please note that I am by no means judging the individuals who got sucked into this campaign, only the mass hysteria and collective call to conformity that fueled it).

Mom, breastfeeding me 
My mom was diagnosed with breast cancer twenty years ago at age 60. It was the first time in my life I'd ever seen Mom so sick. For weeks, she was incapacitated. She went through lumpectomy surgery, radiation, and chemo, lost all her hair, and was hospitalized once or twice for a dangerously low white blood cell count which predisposed her to a life-threatening array of normally harmless infections. Several years ago, new tumors were found in both breasts, at which point she decided to undergo bilateral mastectomies instead of more chemo or radiation. Poof! The breasts that nursed me, my sister, and my two little brothers were gone.

Spartacus, his mom, & brother Brian (1964)
Spartacus's mother died from an aggressive, untreatable form of breast cancer when he was only six. Three summers ago, his beloved stepmom died from complications following LVAD (left ventricular assist device...a heart pump) placement for end-stage congestive heart failure she'd incurred as a result of having her mitral valve severely damaged from breast cancer treatment in 2001 with the chemotherapeutic agent, herceptin. And then, there's my cousin who was diagnosed with breast cancer in her twenties. She underwent radiation, bilateral mastectomies, breast reconstruction, and chemo. Both Mom and my cousin are doing great. Clearly, I'm well acquainted with the grim reality of breast cancer.

Strategically placed tomatoes=instant boob lift!
Recently, the value of mammography has come under scrutiny, especially for women younger than 50. For a screening test to be of value, it has to be both sensitive and specific. Sensitivity identifies true positives and specificity identifies true negatives. In the case of mammography, true positives are being diagnosed along with what seems to be an unacceptably high rate of false positives. In other words, breast cancer is being overdiagnosed. Women who really don't have breast cancer risk being treated for it, as do women whose indolent breast cancers wouldn't have harmed them if left untreated. My poor younger sister, who has dense fibrocystic breasts like me, tells me she's had at least 25-30 mammograms since turning 30, along with ultrasounds, a biopsy, and titanium clip placement. Because our breasts are difficult to image, we've both been called back for further imaging after a routine mammographic exam, only to be told it's nothing again and again. Do the benefits really outweigh the risks?

I'm a less-is-more kind of gal. Coming from a 51 year old physician, especially one whose own mother had breast cancer, that may sound odd. It really isn't odd at all. Doctors make pretty lousy patients. The nature of our profession dictates that we're not allowed to be sick...ever. Who'll take care of our patients? When it comes to our own deaths, physicians tend to be minimalists. We know enough about the limitations of modern medicine to know with certainty that we don't want to die the slow, horrible, painful deaths in the ICU so many of our patients unwittingly opt for. I may not know how I'm going to die, but I sure do know how I don't want to live.

The mammography suite: "No Country For Ripe Tomatoes."
But, I digress. Back to the less-is-more thing. Until about a month ago, almost two years had elapsed since my last mammogram. In the meantime, all the media and research hullaballoo surrounding mammography's predictive value gave me pause. It's not a benign procedure and has to be approached with cautious consideration. Because my mom's breast cancer was post-menopausal, my risk for developing it isn't significantly increased. I've never smoked, have always maintained a healthy weight and been physically active, had my children when I was young and breastfed them, blah, blah blah. The idea of being exposed to any amount of radiation isn't very appealing. I'm sure I've already accumulated quite enough after years of working in the operating room with all those X-rays and fluoroscopy. Thank goodness for lead aprons and thyroid shields! And then, there's the simple fact that having my boobs squished between two pieces of hard, cold plastic totally sucks. Theoretically speaking, compressing breast tissue like that could lead to derangements in cellular integrity. So many anxiety-producing what ifs. Too many. And that's not even taking into consideration the stress of having to wait in limbo for a week to ten days to get the results.

Autonomy, self-determination, & mischief
I know my body better than anyone else. I also know what types of intervention I will and won't accept. I'm a believer in the autonomy and self-determination of each individual, as well as in self-advocacy. I don't share the same blind faith in science that many of my colleagues do; in fact, I think the acceptance of scientific facts actually requires more in the way of faith than believing in God does. As Sherlock Holmes astutely observed, "Facts are always convincing; it's the conclusions drawn from facts that are often in error." I guess I'm a bit of a skeptic, especially when it comes to being voluntarily incapacitated or disfigured. Treatment options for cancer are a highly personal thing. I don't view a person who abstains from aggressive treatment as being any less courageous than someone who chooses chemo, radiation, and radical surgery. Everyone has their limits, and I know what mine are. Were I to develop breast cancer, I'd agree to non-disfiguring surgery, but not to chemotherapy or radiation. The thought of having my boobs cut off is just too much. So is the thought of chemo drugs and X-rays indiscriminately rearranging my cellular architecture and DNA. Again, I'm not judging you, so don't judge me.

My anxiety-inducing mammogram report
Back to my most recent mammogram, I'm not sure why I scheduled it in the first place. Based on my self-breast exams, I didn't think it was indicated. My doctor certainly didn't pressure me into it. Whatever. It happened. After the boob squishing, the radiology tech assured me my results I'd received my results in three days. A week passed, and still no results. I assumed no news was good news. If something was abnormal, they would have called me, right? Ten days later, I went to have my new IUD placed. My gyn doc hadn't received the results, either, so she called over to the mammography suite to inquire about them. Here's what the report said: "There is an 8 mm mass with an indistinct margin in the left breast at 5 o'clock middle depth. Impression: Incomplete. Needs additional imaging evaluation." Well, la dee fucking da, let the goddamn needless anxiety sweatfest begin!

Me and Spartacus, deeply engaged in needless worry.
Over the ten days I had to wait to have this additional imaging, I gained about 5 pounds from a stress-eating binge that consisted of Dekalb Farmers Market candy (coconut curry cashews, dark chocolate covered almonds, and macha tea and salted chocolate caramels. Mmm-mm, good!) washed down with plenty of red wine. I felt so fat, disgusting, and horrible that I resorted to wearing scrub pants EVERYWHERE. I decided not to discuss this with anyone but Spartacus, my younger sister, and my closest friends. Until it's an issue, it's a non-issue, right? Not so much. Poor Spartacus. He barely got to know his mom before she died from breast cancer, and now, his crazy wife's personified her left breast into a creature that requests--no demands--headrubs, backscratches, and another $6.99 bottle of Protocolo tempranillo from the Candler Park Market.

Shaman chameleons we are.
I debated about whether or not to tell my children. I didn't want to worry them unnecessarily. Because my son, Nick, is studying ayurveda and happens to be a manager at a natural foods store, I decided to talk to him about what was going on. We talked about adjusting my diet. I already drink a boatload of alkaline organic green juice, laden with wheat grass, celery, dandelion, cilantro, fennel, turmeric, ginger, and lime. But, I drink way too much coffee, which is known to aggravate conditions in the fibrocystic breast. Cutting back on alcohol is easy, but caffeine...whoa! I purchased some tulsi (holy basil) tea and started my caffeine detox. I've been pleasantly surprised at how easy it's been to reduce my caffeine intake to one cup of coffee per day. The tea tastes good and it's also relaxing. My confidence was restored...or so I thought.

Hurry, let's get outta here!!!
Two days ago, I had my long-awaited additional imaging. I went to work as usual, came home early, let the dogs out, grabbed some lunch, and headed over to Piedmont Hospital. The anxiety I felt was almost unbearable. So much ado about a boob. Having been told in advance that this ordeal would take anywhere from 1-3 hours, I wanted to be prepared. I stopped at Arden's Garden and got myself a blueberry-sesame Love Bar and a bottle of pH Solution in case I got hungry or thirsty. This next part's a little embarrassing. As any woman who undergoes mammography knows, you're not supposed to wear deodorant or antiperspirant on the day of your test because it can affect the results, i.e. the aluminum in those products mimics calcifications in breast tissue. Needless to say, by the time I hiked my left arm up to position my naked, defenseless boob onto the X-ray plate, I had a raging case of B.O. At first, I thought it was the technician's breath, but no, it was me! Ugh. As soon as I was released from the spot compression imaging, I went and scrubbed my armpits. The tech informed me that, depending on those results, the radiologist might order an ultrasound. Fifteen minutes later, I was called back for an ultrasound. Being familiar with ultrasonography, I watched as the tech located and measured a radiolucent oval. I recognized it immediately as a fluid-filled cyst. Sure enough, that's all it was. Spartacus had driven through horrible traffic to get to the waiting room, and was visibly relieved when I flashed him the thumbs up. We couldn't get out of there fast enough. His feelings might change when we're billed for the $2000.00 deductible, though. Not only is reassurance anxiety-provoking, it's expensive, too.

One of my father's busty bronzes.
It'll be a looooooong time before I consider having another mammogram. For a minimalist like me, I'm not sure screening tests make a lot of sense. The information they yield isn't the problem, it's what I'd do (or not do) with it. I pretty much live life right here in the moment, and I don't go looking for problems or worries. If it ain't broke, don't fix it. Live and let live. In this day and age of prophylactic double mastectomies that are based solely on genetic testing and probability, despite the fact that with early detection the 5 year survival rate for Stage 0-I breast cancers is 100% while stage II is 93%, it seems that perhaps we've entered into a realm of breast cancer hyperawareness. I don't view my tits as unnecessary or expendable. In fact, I'm quite attached to them. Spartacus enjoys them, too. Bottom line is, I'm not sure I'd want to live without them. Once again, making such decisions is highly personal, whether it's undergoing genetic testing and prophylactic mastectomy because of a strong family history of breast or ovarian cancer, deciding whether or not to have chemo, radiation, or surgery if cancer is found, or submitting to routine mammographic screening in the first place. It's a matter of quality versus quantity of life, and quality is something that defies analysis or explanation. It's strictly a perceptual experience. And being held captive by screening tests and all their what ifs doesn't feel like quality to me. I think I'll just stick with my own intuitive version of health and breast awareness. It hasn't failed me yet.