Tongue Depressors

Ever since my partners and I decided to go it on our own and start our own practice I have had this image of stocking drawers in exam rooms with tongue depressors. In reality it is one of a million things that needs to happen before a medical practice is open and is frankly on the bottom of any sort of order of importance. But tongue depressors are one of those omnipresent images that a medical exam room brings to mind. Have you ever been in an office that didn't have a neat glass container of the wooden sticks or a drawer dedicated to holding them? They are, in a way a symbolic and universal tool of all physicians.

This morning, after months of preparation, I finally got to fill drawers with tongue depressors. It wasn't anything ceremonial. It wasn't what I set out to do this morning. It just happened. After stocking exam rooms with diapers, wipes, wheeled stools and sharps boxes, speculums and alcohol swabs, barf buckets and reflex hammers I came to the bottom box in the pile and pulled out the little wooden sticks.

It made me stop and think about everything that went into those little sticks and everything that had to happen before they ended up in those drawers.

For instance: First we had to dream up our practice and decide to take the plunge, the leap of faith that it takes to go out on our own. We had to decide that those tongue depressors would exist in the first place.

Then we needed to write a business plan and get a business loan to pay for tongue depressors as well as pay the nurse and medical assistants to make sure that they are in the drawer when I need them. Pay the receptionist to talk to the patient and arrange that they will be sitting in this room when I decide I need a tongue depressor. Then we had to advertise for, interview and hire all those people.

We had to find a building, pick out the cabinets, choose the walls to put them on not to mention the carpet, electrical outlets, flooring and ceiling, even where to put the walls in the first place. Then we hired a contractor to install all of it so that I would have a place to put the tongue depressors.

Much time and energy went into choosing, contracting and installing the computers, printers and electronic medical records so that when I used a tongue depressor I could document what I found and what I decided to do about it.

We bought a refrigerator and installed temperature controls as well as an alarm system for those controls. We bought coolers so that if the controls failed we could save the contents of the refrigerators. We stocked the fridge with thousands of dollars worth of vaccines and stocked the nurses station with syringes, needles, alcohol swabs and band aides, (not to mention the nurses themselves). Then we brought in the health department to inspect our fridge, vaccines, coolers, needles and sharps containers and nurses. All this so that our patients would stay healthy and I wouldn't need as many tongue depressors.

Then we installed an alarm system so that nobody would steal our tongue depressors (or the computers, phones, cash or the giant TV that we use to distract kids while they are waiting for their date with my tongue depressor).

We put ads in the paper, built a website, a facebook page, wrote letters and printed fliers and business cards so that more people would come see us. Because if people came to see us I would get a chance to use and therefore pay for the tongue depressors.

We filled out pages and pages of paperwork for dozens of insurance companies, government agencies and community programs so that our patients can afford a visit to the room with the tongue depressors.

We obtained our own insurance so that if I do a lousy job with the tongue depressor I don't put my partners out of business. More insurance so that if a nurse gets a sliver from a tongue depressor or a patient crams one into his ear and sues us we can still afford to practice medicine with the remaining wooden throat inspectors.

We hired someone to make us a sign, wash our windows, clean our carpet, install blinds, configure our computers, organize our phones, keep track of our numbers, review our contracts, mow our grass, seal our driveway, bill various insurance companies, plow our driveway, call our patients and remind them about their appointments and many more I can't remember off hand. We bought exam tables and diapers, waiting room chairs and automatic paper towel dispensers, pens and ipads. All so that we can do what we do.... well you get it.

There have been a lot of hours, a lot of thought, planning and effort that has gone into starting our practice. It has been stressful and I have felt like I was neglecting my family on multiple occasions. But it is indeed a dream come true. It is a goal I never thought I would obtain so early in life, starting my own practice and stocking drawers with tongue depressors.

The Passage

I mentioned a while ago that I was saving Justin Cronin's The Passage for my maternity leave. I did this because the book is frickin huge. 750+ pages huge. Makes me wanna buy a Kindle huge. Chicago area phonebook huge. It sat on my bed stand teasing me during my 3am nursing sessions with Eliott, waiting for me to make good on my word. I finally picked it up with about 3 weeks left in my maternity leave, took off the dust jacket and put it back down again without starting it. Instead went and lifted some weights to train for reading it and devoured the Hunger Games by S. Collins instead.

The Hunger Games was wonderful and took me all of three days to read. In fact about 4 chapters in I went onto Amazon and ordered the other two books in the series. But I digress.

I finally started The Passage with about 1 week left and my leave and just finished it this weekend. It was a great book. Epic, riveting, thought provoking and suspenseful right up until the end.

Then Justin Cronin did something that I loath. In the last paragraph I lost all hope for the characters. With a handful of keystrokes he ruined it for me. For them, the people I had spent so much time following, cheering for, worrying about when I wasn't reading. I know that becoming attached to fictional characters is a novelist's job but cheese and rice Cronin, did you have to go and do that? I was mad. I wanted to chuck the book against a wall. I probably would have done just that had I kept up on my weight lifting but I didn't so instead I just threw it onto the ottoman and swore. Joel looked up from his book, The Game of Thrones, another behemoth, and asked "What?"

"Great book. Lousy ending. Don't read it." I complained.

But now, because the book has been bothering me all weekend, haunting me, I looked it up on line. It turns out the book is the first in a series of three and that the next installment, The Twelve, is due to be released next year.

OK Mr. Cronin, you got me. I'll start lifting weights now.

The Things We Do

Oh the things we do for family, for love and for the future...

I've been back at work now for two weeks and Joel and I have been really feeling the pressure of having two young children and two young businesses. I have been busy with the practice I am starting with three other wonderful docs. And Joel has been wrangling hops and hop growers all spring. In between it all our wonderful children grow and thrive, and learn patience.

Last weekend is all a blur and I can't recall if the events I'm about to share happened on Saturday or Sunday. Not that it matters. Not that you care.

You see, the Michigan Hop Alliance, Joel's fledgling company, has leased several acres of 3rd year hops on Old Mission peninsula. Each of the guys in the group is putting in time on these fields in hopes of a decent profit in the fall. But it is hard for all of them, or even two of them to get to the land at the same time. So last weekend I offered to help Joel out and drive our beat up Blazer down the rows of hops at one mile an hour so that Joel can hang the strings that these happy little plants grow on.

I reasoned that Adeline and Eliott could sit in the truck with me as I drove. If I managed that, then Joel could stand on the platform of the 20 ft tall scaffolding of doom he had constructed to fit on top of an old hay trailer. And it may have worked out swimmingly...but it didn't.

You see, our Blazer, though a trustworthy and stalwart vehicle, lacks certain amenities like heat and air conditioning and rear view mirrors. It smells like beaver dung and fluvial sediments of lives past. It sounds like a 747 readying for take-off though that might just be in comparison to my silent hybrid. And it if filled with junk mail, preschool art projects and empty snack packages not to mention power tools, half a dozen coffee mugs and a wasps nest or two. It also has a thermometer which tipped into the 90s as we careened up center road with the trailer rocking back and forth on the reese hitch behind us.

The peninsula is beautiful this time of year by the way, the cherries are beef red on their trees, the vineyards cast geometric shadows across rolling hills and the lake shines back at you, at times from every direction. Never the less it was F-n hot.

We reached the farm and Joel set up the scaffold. A chore that takes about a half an hour which by shear coincidence is the maximum attention span of our three year old. Lest I fail to mention it, she is in the wonderful "why" stage. (Why does this farm only have 3 chickens, why is the barn brown, why is daddy's drill going again, why is Eliott crying?)

I load Adeline back into the truck, letting her sit in the front seat next to me for the tediously slow trip down the rows of hops. (Why is this seat big? Why is that button there? Why can't I sit on the floor?) All the while Joel is on the scaffold giving instructions (A little closer, Stop, OK go)
About 10 minutes into it a new voice is added to the chorus. (WHHHAAAAAAAA, SOB, SOB, WWWHHHAAAAAAAA) Eliott is awake, and hungry. It has been, after all, 3 hours since he ate last.

I pause, throw the truck in park, (why are you getting out mommy?) and try to calm him down. But Eliott is dripping with sweat (the thermometer reads 92 now) and screaming at the top of his lungs.

So I did what any good pediatrician, mother would do. I brought him back to the drivers seat with me, threw the truck into 1st, (OK you can go now, keep it slow) pulled up my sweat drenched tank top and fed him. (Why is Eliott hungry mommy? Why is that bird there?) Then "mommy I'm hot." And I realize for the first time that Adeline is sitting in the sunny side of the truck, windows down. Her little face is flushed bright red and streaked with dirt that I hope came from the garden behind the barn and not the chicken coop. (STOP! Go slower.) Now Eliott's foot is caught in the steering wheel and he grunts.

Sweat and milk drip down my belly as we make the turn for the next row.

Adeline is quiet for a moment, glancing over I see she has found the empty clam shell packaging of Olsen's sugar cookies and is licking the frosting remnants directly from the plastic. (OK you can go faster.)

We eventually move Adeline to the back of the truck where she can riddle Joel with whys from the shade of the open rear hatch. Eliott finishes his meal and is content to soak his diaper and his car seat and I figure out just the right speed to match Joel's knot tying abilities.

On our way home I can't help but think that this would be one of those days that a great future is built on. One of those stories that you tell your children when they are old enough to be appalled that I drove and breastfed at the same time or that cars didn't always have AC.

But most of all I'm thinking that I'm glad I didn't bring the dog.

Shortest Leave Ever

I'm sorry that I've neglected to post in the last few weeks. Of course I apologize mainly to myself. That I have lost so many thoughts into an oblivion of caring for a newborn. But I would not trade a moment that I spent with Eliott. So I'll give you the short recap...
Eliott was born at 5:44pm on his due date, May 15th. I managed to plant 48 potato plants that morning and spent only 5 hours in labor. With his sister before him it was a long 26 hour labor with every complication one would expect a pediatrician's child would have including a nuchal cord x 2, needing an amnioinfusion, she was sunny side up and stayed that way through delivery resulting in some wild tearing, not to mention the meconium needing tracheal suction twice, the forceps and the vacuum. Bless Eliott's soul I only had some ("nasty" to quote the OB "This is a very strange tear") tearing.
He took to nursing within minutes and latched like the good little 8lb 11oz baby boy he was. He is growing great and is in the 90th percentile for all his measurements. He sleeps 4 hours in a row overnight and doesn't mind being set down much at all. This is good because Adeline is, on occasion, a handful. As an infant she required constant rocking and walking. She was very colicky at this age and was definitely a trial. Eliott came with much less drama.
Speaking of Adeline, she did some regressing at first. She had a few accidents and threw some nasty tantrums but now she is growing into her big sister role wonderfully. She loves to help wash and fold diapers. She helps cook and pick up. She ADORES her little brother.
This summer and my maternity leave have been complicated by the fact that I am starting a new practice. We're opening August 8th and there has been a lot to do that didn't stop for a maternity leave. So unfortunately for Eliott and I, we spent a lot of time in meetings. I would be signing on for a 6 figure loan in a meeting with several people wearing expensive suites and impressive titles on their name tags and Eliott would be sitting beneath my chair as I rocked him back and forth in his car seat. I would be walking around our new building with IT people, contractors and my new partners, Eliott strapped tightly to my chest in his Moby wrap. I nursed as I designed magazine ads and worked out office work flow documents as I changed diapers or lay awake nursing at 3am. I feel that so much of my maternity leave was gobbled up worrying about and working for this new practice that surely Eliott must have been jipped. But I know in the long run it is all for him and his sister. It's just unfortunate timing for him. It all had to be this way. I can't imagine any other child in my arms at any other time. I can't imagine doing this new business any differently. And now that I head back to work tomorrow to care for other's children all I can think about is next spring, next summer, things will be quieter. Next year I will be able to give more time to my children.

Maybe.

Why me and my unborn son would be better off in Croatia.

Every year around mother's day the Save The Children Foundation releases it's "State of the World's Mothers" complete with rankings as to where mothers and children are better off. Every year I skim the list and shake my head that the United States ranks so low among developed countries. I even find myself making excuses like "Our infant mortality is so high because we save so many premies." and "Our maternity leave numbers are so skewed because we have so many more women that work." But this year I really looked at where the numbers came from and what actually went into the rankings.
I was shocked!

I'll compare us to Croatia for an example.
The US ranked 31st. Croatia ranked27th.
I'm not even going to compare us to the top ten countries because it's just not pretty. It makes a strong case for government run health systems.... but I'm not going there today.

I am 38+ weeks pregnant.

• Here in the United States I have a 1:2,100 chance of dying when I give birth in the next few weeks. In Croatia I would have a 1:5,200 chance. Holy %^&* that makes me more than twice as likely to leave my husband a widower with two kids. Can I still get a plane ticket???



• If I were Croatian I would have been on maternity leave for 30 days already instead of slogging though half days of back pain and swollen feet. And I would be expected to take a full year off after I delivered to care for my child. YES PAID!!!



• And how could I complain that maybe it's because more of the US work force is made p of women than in Croatia when 24% of their government seats are held by women when here it's 17%. Oh and a woman in Croatia makes 67% of what a man in the same job does. Which sounds absolutely shitty until you compare it to the US where I make 62% of what a male with my job makes. On that note I have to stick my middle finger up to the world when I see that even Norway which ranked #1 that number is only 77%.



• But whatever, as long as I have a healthy baby right? Well the infant mortality rate in Croatia is 5:1000 live born births. Here in the US it's 8:1000.



• On the flip side if my baby were a girl her life expectancy here in the US would be 82 as opposed to 80 in Croatia. And she would expect 17 years of formal schooling here and 14 in Croatia. Though she would be just as likely to enroll in secondary school here as there (94%)

Don't get me wrong, there are a lot harder places in the world to raise children. I've seen several of them up close and I would never have the strength to walk in those women's shoes (or lack there of). But if Malawi can cut it's child mortality IN HALF in ten years, think of what we could do if we put our minds too it!

Bottom line is that we have a lot of work to do as a nation but the first thing we have to do is pull our heads out of our asses and realize that things can be better for both women and children so that maybe by the time Adeline is ready to have children she is better off than the women in Norway, Australia, Iceland, Sweden, Denmark, New Zealand, Finland, Belgium, Netherlands, France, Germany, Spain, United Kingdom, Switzerland, Portugal, Ireland, Slovenia, Estonia, Greece, Canada, Italy, Hungary, Lithuania, Czech Republic, Latvia, Austria, Croatia, Japan, Poland and Slovakia. ALL of which out ranked us this year.

But don't take it from me, read it yourself....

http://www.savethechildren.org/

38 week pain in the back

Is there any way I can get one of these on wheels and at counter height? If I could I would be way more productive and comfortable at work. Oh and maybe I wouldn't constantly feel as if my left kidney was about to explode....

Open Letter to my Treadmill

Dear Sole,

Yeah. I mean you in the corner with the clear plastic sheet draped over your dusty, rubber tread. I've got my eye on you. Don't think for a minute that just because I'm lying here on the floor with 7 pillows propped underneath me in a mad attempt to contort the sciatic pain out of my body that I've forgotten about you. And no, that rolled up yoga mat doesn't hide you from my ire at all.
Oh no.
No way.
I remember.
You and I have a date with my Sauconys, you lazy $!^@*. Now I know it's been nearly a month since we've tangoed. You see all that snow outside. You know full well that these are the kinds of days I love to drip sweat onto your console. Now I know you're laughing at me underneath all that drywall dust laden plastic, I realize that you are chuckling at my sore back and heavy belly. Is that a Mai tai in your water bottle holder??
Even with all your tricks I can still stomp you into the floor. Trust me I'll be back.
Maybe not today, maybe not tomorrow but soon.
So be ready. It won't be long now.

Sarah

PS. Sorry I called you a $!^@*. I miss you too.