Friday, January 27, 2017

The Uncertain Station Between Legal Adulthood and the Real Thing

Image result for when life gives you lemons make lemonade joke






My mom is here tonight. She'll need to fly back tomorrow night, as one of her students has a senior piano recital on Saturday night.

I've trash-talked my mom's reasons for not having been here earlier -- particularly when surgery was happening -- but her reasons for needing to remain on the job were, in truth,  quite valid. I did a senior recital a few years ago -- I did two of them, actually, being the over-achiever that I am -- and I understand the problems I would been put through had either my advisor or even any member of my adjudication panel had found a reason for a no-show. 

Obviously, coverage is arranged in such cases. It's easier to fill in for an adjudication panel member than for an adviser, who has worked with a degree candidate through every step and hurdle, but still, those panels are arranged far in advanced for maximum fairness to degree candidates, who are in competitive situations with one another. A last-minute fill-in inevitably throws off the balance (or facade of balance, anyway) of fairness.  but there's no suitable substitute for having one's department adviser (did you know that both adviser and advisor are acceptable spellings of the word, though adviser is both more common and an older spelling of the word?) in attendance at one's senior recital. Then again, there's really no suitable replacement for having one's next -of-kin in attendance when one is having surgery when the outcome is not predictable, either.

What I had in place of my next-of-kin (who would have been one of my parents, or, at the very least, my twin  brother) was one of my professors armed with a cell phone and the numbers of my next-of-kin, along with a living will/advance healthcare drectives. I was required to fill out one at the ripe old age of 22 years and six weeks because of the absence of my next-of-kin. For the record, I do not wish to be kept alive by artificial means once my brain function has ceased [some would argue that such is already the case], and I do not wish to have any form of nutrition or artificial means to preserve my life, but I do insist upon the comfort measures of IV hydration along with pain medication and sedatives as needed.  It was incredibly kind of my professor to have shown up. For all I know, the department made all of my professors who were on the premises draw straws, and the professor I got was the one who  drew the short straw, though to his credit, he managed not to act as though such was the case.  He was compassionate, and didn't try make incessant small-talk in effect to cover up the awkwardness of the situation. He talked when I wanted to talk, and held my hand when he thought I needed him to do so. It was the best the hospital could do on short notice, and I appreciated the effort on their part to do anything at all. They really didn't have to do so.

My mom has been a good mother, as my father has been a good dad, but there were times in the past when they should have been with me and weren't. i won't go through the list in the event that they happen to read this, as they already know the list all too well, and I don't need to rub salt in their wounds. The difference now is that I'm grown and that their job of raising me an of being there at the times when parents should be present for a kid are technically over. At this point it's strictly a matter of choice.  I feel as though they've made their choices perfectly clear. they don't think it's quite so simple, and that there are times when parents, or anyone doing any job who has other obligations beyond that job, get stuck between the proverbial rock and hard place.  I'm not sure what exactly is the distinction here. I suppose the rock is what  person has to do, while the hard place is what a person doesn't do or the person a parent or someone else doesn't help but is left feeling guilty about not helping. 

That seems to be one of the things I'm very best at --  making people feel guilty for not helping me or for not being there when I need them. I totally get the necessity for work in the lives of most people, parents included. Most of us are not born into families similar to the Rockefellers or Romneys or Trumps, with sufficient wealth that their wealth alone continues to accrue even more wealth without the necessity of their doing much of anything about it on a regular basis other than to check in on things often enough to ensure that the accountants aren't helping themselves to huge chunks of the family fortune. Most of us have family members who may have a bit of flexible work time, but have some non-negotiable aspects to their work. 

If a family member -- a spouse, a kid, or even a grown-up kid -- is in an especially precarious state of health, it is assumed that work will be thrown aside so that the working person will be with the family member who is facing a health crisis.  If the ailing family member has a cold or a sprained ankle, the family member is on his or her own. It's the in-between stuff  -- the judgment calls -- the persistent side ache that turns out to be a ruptured appendix, the "urinary tract infection" that advances very nearly to the point of the affected kidney being removed, the subjective abdominal pain that, when all diagnosing has been said or done, winds up being a two-foot extension of gut that has to be removed and resected, and a  possible intestinal perforation that turn out to be actual intestinal perforation, that cause conflict and hurt feelings on the prt of the grown-up offspring.

Such is often the case all the more when the adult offspring is in many aspects f life, both by parents and by others,  not treated as an adult, it seems, except when it comes to health crises.  I can't decide for myself whether or not to purchase a cello, but I can decide for myself with not parental input how much of my colon can be cut away and resected.  I can't decide without parntal input whom to date on a regular basis, but I can be expected to single-handedly take on incompetent hospital staff members who are not following my doctor's medication orders.

I have many relatives and friends-who-are-like-relatives who have functioned as pseudo-next-of-kin at times in the past, including in medical situations.  For these times and for these relatives and not-quite-relatives, I am most sincerely appreciative of the times they've stepped in. The statute of limitations seems to have expired where these people and this service in concerned, however. They seem to feel that since I'm now an adult, I don't need them anymore when a medical situation that threatens to reach crisis level hits. 

What is the answer to this? Getting married? Spouses seem to have the right to demand that each other be available for health crises.  Perhaps I need a nice, kind, sensitive spouse, complete with an iron-clad prenup if things ultimately fail to work out.

For tonight, my mom is here, though. She's alternating between the bed next to me and the recliner between our two beds. She rubbed my tummy when I was in quite a bit of pain due to trapped gas {TMI i know} against my incision. {Trapped gas in my case is a side-effect of not being able to tolerate the full-liquid diet and having to exist on chocolate pudding and ice cream or sherbet - the only things on the full-liquid diet that I will consider eating. It's one of those things a same-sex parent can do without it quite reaching the "Deliverance" factor, plus she has small enough hands that she can rub the part that hurts without touching anything else that I would prefer not to be touched, though in my case, my midsection consists mostly of flat abdomen; there's a pretty decent margin of error.

There is some peritonitis as a result of the colon perforation as indicated by a temperature of just above 102. If the condition were serious, my temp would be more like 104 or higher. The moderately low fever would indicate that the Levaquin and Keflex (I think that's what I'm being given, but I'm also very confused) are somewhat doing their jobs, but not quite so efficiently as I would like. i would have liked to be back in my condo by now. As it stands, Sunday is the earliest possible discharge date. My mom has to go back for another recital before on Sunday. My dad is supposedly coming back when she leaves.

I get a great deal of ulteriorly motivated attention from male staff members when my mom is here. I'm not allowed to post pictures of her, but I've been told that she looks years younger than her actual age of 49 and is almost movie-star hot. Male staff members find the most superfluous of  reasons to come into my room. In any event, the idea of not getting my medication when I need it or anything else when I want it is laughable as long as my mom is here.

I think I'll switch my scholarly concentration (a supplemental required component of our education, intended to be done independently; I'd already completed considerable work on my original topic, but change and flexibility are both good) to "Patient Experience in Our Facilities." I've been admitted to at least three and have been treated at an additional three.  I may as well make a bit of lemonade out of the lemons life is currently serving up in generous quantities.

Thursday, January 26, 2017

Explanation of Last night, Request for Prayers for Someone Else





sort of what I was seeing last night

Things were neither so dismal nor so nefarious as I thought they were last night and in the wee hours of yesterday morning. I was not being given even close to the correct dosage of pain medication I was prescribed, but it was not, as I feared, due to the staff siphoning meds off patients' allotted dosages in order to make a profit on the street off the purloined meds. It was, instead, a case of a medical staff member, known colloquially as a nurse, who misinterpreted the written and oral (I distinctly heard my doctor articulate the pharmaceutical instructions myself and understood them clearly as crystal despite still being in a state of not-quite-having-emerged-from-the-haze-of-anesthesia (sometimes described as "being in the land of blueberries"). Admittedly, I had a vested interest in the matter: my body, my pain, and my medication were the topics of the conversation, all of which is entirely beside the point. By way of reinforcing the utter  lack of competence involved in misreading or otherwise failing to correctly interpret the given instructions, allow me to explain that my surgeon -- female and roughly thirty-three --  uses penmanship with such textbook -precision that when she writes prescriptions, they're often verified by phone from pharmacists who refuse to believe the prescriptions were written (or signed if the prescriptions themselves were printed by computer form) by anyone qualified legally or otherwise to write prescriptions. Pharmacists assume no doctors, or, for that matter, even nurse practitioners or physicians' assistants -- write the way she does. You know the look of the classic physician's signature  -- appearing as though it could have just easily been scrawled by a twenty-two-month-old child. My gastro-woman's signature and cursive in general (she rarely uses manuscript, though I've seen her write in manuscript, and it's every bit as perfect) looks as though the printing were done not by hand but by a computer cursive font (maybe KG Only Human Regular or something similar) except even less obnoxiously ornate and more perfectly slanted.  Anyone who would have misread what my surgeon wrote would also have misread the font used in the "Dick, Jane, and Sally" basal readers. The language used in the orders was standard as well as clearly penned.  The surgeon wasn't using esoteric vocabulary for the purpose of impressing anyone. A certified nursing assistant should have, and in all likelihood would have understood and correctly followed it. 

Unfortunately for me, it was not a certified nursing assistant charged with dispensing and administering my medication. It was, instead,  beautiful, twenty-four-year-old Nurse Abigail, in her second week on the floor and fifth week on the job. No conspiracy was at work in sending my pain levels to the ceiling (you know the 1-10 scale paients are asked to self-rate their pain) and beyond if such is possible. I said it is possible. The floor charge nurse disagreed with me.

In cases of moderate-to-severe pain, it's imperative for the pain medication to precede the pain. Such is not the case with most conditions which might cause pain, but pain immediately following certain types of surgery is predictably severe enough that it isn't an abuse of painkillers to prescribe it in advance of pain reaching its worst.

I was at the added disadvantage of being small. Medical personnel are apprehensive concerning how any given patient will tolerate medication. Such is all the more the case when the patient is small, as I have been determined to be. it seems that despite how many times a person has undergone surgery and been given the post-surgical painkillers, the same level of caution applies. Hence, my painkillers never get the opportunity to get a jump on my pain.  Then the cute little nurse-in-training (I know she has her full licensure, but she performed very much like a nurse still in training last night) gave me half of what was prescribed and half as frequently as prescribed. The reduction in painkillers only turned me into a raving, technology abusing psychotic. The limit on the antibiotics I had been prescribed for the slight perforation in my colon (courtesy of gastroenterologist #1, who would be facing malpractice charges in a court of law were his patient anyone other than a medical school student at facility affiliated with my medical school) caused my temperature to have to be monitored continually and caused an additional antibiotic to be thrown into my regimen. If anyone was at all concerned about the sometimes constipating effect of opium-based painkillers, he or she can forget all about it. The double-whammy of the mother of all antibiotics combined with the stepmother of all other antibiotics is making constipation sound like heaven.

My surgeon had to show up at 2:45 a.m. last night  to clarify matters to the nursing staff and to write new orders. Matthew says the surgeon had to come in the middle of the night to shut me up, but the new orders to compensate for the failure to adhere to the original orders was why she had to appear. She otherwise could have called in any changes except that she had to examine me again, and if, as Matthew suggested, she had needed to come in to yell at me, she could have done so over the phone as well

The advantage of the double-antibiotic regime is that painkillers can be given to me to any degree that they are not toxic to me. Any constipating properties that did their thing would be a welcome intervention. 

Despite his trash-talking of me, Matthew's appearance here was very much welcomed. (For one reason, there is a fourth-year med student, nicknamed "the c--t," who dislikes me with every fiber of her being. The floor charge nurse was threatening me with summoning "the c--t" if I did not calm down. Before I had to make the choice of cooperating or risking the appearance of "the c--t", my brother fortuitously appeared on the scene.) The lingering effects of pain and of benzos that they gave me to calm me down left me not exactly paranoid, but, just the same, fearing for my life. Matthew and Nurse Abigail conversed congenially throughout the night while ensuring that no one came to smother me with a pillow. (Matthew's "comfort" involved mostly reassuring  me that killing me would be much more easily accomplished by inserting a tube of insulin into my IV. With all the confusion over medication, it could have been easily explained away.)

Tonight my dad is here in the bed next to mine. He is, as am I, an insomniac. He is working on something on his computer, though he will stop what he is doing to talk to me at any time that I want him to do so, which is not very often. I just want someone to check everything that goes in our out of my IV.  I know what happened last night was an honest mistake which was, in theory, corrected, but what is, in reality, in place to keep another rookie nurse from making the same lame mistakes tonight?

There's another new nurse on duty tonight. Her name is Nurse Morgan. She's cute enough, but, if anything, looks even dizzier than did Nurse Abigail. 

As for Nurse Abigail, she has the night off. So does my brother. The two of them are off together on some sort of a soiree. Matthew uses people who crash their cars into me on the freeways of California, or people who mis-administer my medication incorrectly, as a source of date material.  I'm sure Freud would have an explanation for this, but for now, I'm letting it go.

The daughter of a close friend of mine is having shoulder surgery in just a few hours. Please join me in prayers, positive thoughts, or whatever, that everything goes perfectly in her procedure and that she emerges with a shoulder that works just as God originally intended for it to work before injury rendered its function and comfort to levels less than optimal.  Let her parents be calm, and let her surgeon and anesthesiologist both bring their "A" games to the O.R. this morning.

Professor D.: Thanks so much for sitting with me before my surgery and waiting for me through the procedure. i don't know how you knew I needed someone, but I did, and I thank you for being there.

Wednesday, January 25, 2017

Not the Model Patient This Time

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my role model as a patient even if it's fiction



I need more pain meds. They try to give me too little because I am small and they claim they have to ensure that I'm tolerating what I've been given.  Now it is the wee hours of the morning and I'm wide awake with pain even though I i've slept minimally in the day. i'm not trying to be a compete junkie, but i know me rights (because there is a patients' rights chart posted on the inside of every room, not i'm militant and have my rights as connected to drugs committed to memory). if things do not change around here VERY soon i will soon go on the records as being a very difficult patient. there is a man next door who is VERY loud and complaining about anything and everything. maybe they're withholding his med as well.  

i've called my dad, who told me to shut up and go to sleep. i've also called my doctor, who is coming, and Kal Penn, who is on his way as well. if nothing else, I will use devices I have to make my music very loud. i have anne murray of all people blasting at the moment. I'll get their attention, though I will probably get my devices taken away from me. I don't think they'll evict me from the hospital because they are already on shaky ground (I think we just had a small earthquake, BTW; we're doe for The big one any time, but I don't think that one was it) in terms of medical malpractice where I am concerned.

My surgeon says I've been watching too many House, MD reruns.

Merry January 25 to all, and to all except for those who are admitted to this hospital, a good night.

Tuesday, January 24, 2017

A Disaster I Minimized

  Image result for dr. strangeglove







This entire situation has been a disaster. I didn't explain it all, either on a blog or to a friend with whom I exchanged texts. I'm afraid I left my friend thinking I was a major wimp after I had insisted that I wasn't. He was kind enough not to have called me on the inconsistency of my words.

I got a lousy gastroenterologist by the luck of the draw. I managed to pull the alternate prep routine of really well, bau all the alternate prep, authentic prep, or anything else could not make a not-competent practitioner competent.

It's  convoluted story. I will strive to stick to the chase so that this tome isn't 5,000 words long.

I felt while looking at the lesion on the monitor that it would heal with antibiotics and did not require cauterization. I recognize that I was not the board-certified specialist on the case, but still, a conscious patient usually gets an element of a voice in what procedure is used.  He, whom I have nicknamed Dr. Strangeglove, then went on to inexplicably blast the lesion with a flow of air so powerful as to possibly create a small puncture would where the lesion was in the transverse colon wall. The wall of the colon was noticeably thinner in the place where the legion was. There was no reason to power-wash it with air. I screamed. The nurse-anesthetist hit me with a stronger dose of fentanyl without waiting for the doctor to request it, which angered him. 

A catheter containing a scalpel, just in the event that it had been needed, had been inserted into my colon. When Strangeglove removed it, he managed to create a significant cut in my bottom. I screamed when that happened as well. He told me to shut up. The nurse-anesthetist felt that the would should have been sutured. She and Strangeglove argued extensively over whether or not the scalpel had ever left the catheter sleeve to enter the actual colon. This would have increased the chance of the would being infected. The nurse anesthetist, against the doctor's orders, applied a local anesthetic and scrubbed the wound before using the butterfly closure Strangeglove insisted upon. She gave me a tetanus shot even though he said it wasn't necessary.

I had been given enough fentanyl that the pin from the internal wound was manageable at the time. i wasn't given additional painkillers. At about 6:00 p.m. the pain became unmanageable. I called Dr. Strangeglove's answering service. He didn't return my call until almost midnight. He said there was no indication that I needed additional pain medication. 

Meredith had left to return home by then, and my brother as working. I tried driving myself to the hospital once but passed out just walking to the car. I evenntually got myself up and back to my condo. 

I telephoned the paging service of the two OBGYNS with whom I'm working in this rotation, though obviously not at the moment. I asked the operator not to make a special call to wake them but to give them my number and to tell them it was urgent if they received any other calls. On what I found out was the third call received by the two of them, the message was given. The female OBGYN returned my call. She told me to get to the hospital. I dragged myself back to the car, this time without fainting. At one point I had to stop because I was having dry heaves. With my luck, a police officer showed up and thought I was driving under the influence. When I passed out during the field sobriety test, he transported me the rest of the way to the hospital himself after calling the OBGYN's number on my recommendation. I had to talk fast to convince him not to call an ambulance.

The OBGYN hooked me to an IV and gave me Dilaudid, so I'm no longer feeling  though I might die immediately and don't really care if I do.

I had another CT scan, which showed very likely existence of perforation at the lesion. I'm scheduled for immediate sigmoidoscopy (the new gastro-woman says she will ensure the anesthesiologist  gives me whatever is needed to keep the pain manageable to nonexistent. If I'm lucky, they'll fix it with the sigmoidoscopy and tools. If not, we're looking at a laparotomy or laparoscopy, but I don't really care. All I really asked for was a bit of Vicodin. Stupid Dr. Strangeglove. I hate him even if hate is a very strong word.

I don't care whether or not anyone visits me. I'll be in a hospital where the minimum standard of patient care should be OK. As long as they bring me water when I need it and painkillers when I feel as though I'm dying, I will be happy.

My original plan was to be back at work by Wednesday. It my be more like Thursday or Friday before I make it, but I can do paperwork in bed if they bring it to me.

Monday, January 23, 2017

Friends and Procedures, Some of Which Are Invasive (the Procedures, not the Friends)

Image result for snoopy friend comic





I have to have a CT scan, possibly followed by a sigmoidoscopy or colonoscopy in just a couple of hours. It sucks because I had to do the prep for the colonoscopy (though  I used a bit of inside knowledge to cheat ever so slightly; it was absolutely necessary, as there was no way for me to even get half of the Golytely down, much less keep it down) but I may end up just having the sigmoidoscopy. The problem here is that the prep for the colonoscopy  is much more involved, but the sigmoidoscopy hurts  like hell because far less sedation is given than for the colonoscopy. (Some Nazi g-men and women don't give you ANY.) So basically there's a good chance I will have the worst of both even with my modification of the cleanse. (If you ever need the modified cleanse, email me. You can afford to try it if your life isn't on the line if the colonoscopy cannot be done as scheduled and has to be delayed a day.) If you barfed all the Golytely up, you'd have the same issue, so it's not like it's the end of the world. and my sharing this simple trick of the trade that you could probably find by googling it if you tried hard enough is not akin to practicing medicine without a license. Still, I desire not to anger the powers that be any more than is absolutely necessary, so I'm keeping the secret method on the down-low and not publishing it, even though it already HAS been published elsewhere.

And as though things are not grim enough already, my sexy [slutty] scrubs are no longer sexy  [or slutty]. All it takes for me is a mere weekend of being sick and I lose what few curves I had in the first place. This is a sad state of affairs.

At least I have Meredith with me, and when I didn't have her, I had Sophronia and her little sister Celinda, who lets me raid her closet. I even had Cool Guy, Kal Penn, Raoul, and Troy Ming for awhile (as well as Tim, who played his guitar for me even though we're not speaking to one another; it's a weird relationship). Being with friends can make the most horrible things endurable.

Sunday, January 22, 2017

This is not my friend Meredith, but is a reasonable facsimile.




My dear sweet beautiful friend Meredith has stopped by for a visit. I would love to post a picture, but she would prefer that I not do so. Instead, i'll post a picture of her Doppelganger, Duchess Catherine, formerly known as Kate Middleton. Meredith is smaller, but the resemblance is otherwise rather remarkable.

Our lives are our own to live as we see fit. Meredith had been dating a man who is older than either her father or mine is. Furthermore, he wasn't even a particularly attractive 53-year-old, not that looks are of the greatest importance in choosing a significant other. My issue with him was that he seemed to me to be immature, shiftless, not all that nice, and that he didn't appear to treat Meredith as well as she deserved to be treated.

In a move most unlike myself, I kept my mouth shut to Meredith as to how I felt about her new beau. Our other friends did as well. We treated the man cordially but didn't go overboard, as he was less than cordial to us.

In the end, Meredith did the right thing.  I will not give out details that should not be shared, but when the man acted in a way that is contrary to the way any man should treat any woman or even any friend, Meredith cut all ties with him and is not looking back.

I commend Meredith for her wisdom, and I express deep gratitude to her for traveling hundreds of miles to be with me while I'm sick.

Saturday, January 21, 2017

THAT'S WHAT FRIENDS ARE FOR







Last night I was stricken with a somewhat severe attack of iBD -- not so severe that a transfusion was required, but severe enough that a transfusion had to be considered. If you don't know what IBD is, consider yourself fortunate, and we'll leave it at that. 

Matthew was working. There would have been little he could have done to provide comfort to me, but the case was serious enough that I needed someone to be at home with me or I needed to check into the hospital.  As the responsible adult that I now am, I consulted my local gastro man. (I have one in the southern part of the state whom I like better, but it was more practical to consult the one who was within driving distance.) He asked questions and asked about vital signs, which I had taken. He said that I had an hour in which to find a competent adult, ideally one with some medical background. If I was unable to find someone, I would need to be transported to the local hospital.

I telephoned Sopronia, but i knew she had planned to head home about seventy-five minutes away. Even if she came back, she wouldn't be there within an hour. Sophronia made a few quick phone calls, and within fifteen minutes Cool Guy and Kal Penn had both shown up. Sophronia told then she was also on her way, and she and her younger sister did arrive about ninety minutes later.

We have a large condo, and there were plenty of beds for everyone. The maid service had just been there Friday, so linens had all been changed. I was still at the acute stage of needing to visit the bathroom with little notice when they all arrived, so I was moved into my parents' room, as it has the quickest bathroom access. It has an opaque sliding glass door that opens into the main living area. They opened it so that I wouldn't have to be totally isolated. Sophronia made Koolaid, which is best under such circumstances for keeping me hydrated. Cool Guy called the G-man for instructions on when and how much pain killer and other medications I should be given.

Someone turned on mindless TV reruns, which were probably the best possible viewing. I didn't wish to be updated on presidential politics. At midnight Matthew got home. He got his guitar out and called Tim, to whom I'm still not speaking but will allow inside my apartment to play his guitar. He offers the advantage, as well, of being a licensed physician, as opposed to the rest of us flunkie medical students (and one mere high school student).They turned off the TVs and played requests. They all ate, but they were considerate and ate things that weren't so pungent as to make me even more sick just from having to smell their food. 

Celinda, Sophronia's 16-yer-old sister (the one whose closet I raid from time to time) is a high school senior with all credits completed for U.C. admission, so she spends her day at an elementary school campus serving as an assistant. She had wild stories for us. A parent showed up and measured the depth of puddles on the campus, then called the District Office to complain that, with puddles three inches deep, children were at risk of drowning. (This is a K-6 school -- not an infant and toddler program.) Celinda was manning the front desk and was the person who first had contact with the complaining mother. Celinda's response to the mother was that it was a "natural selection" issue -- that any child of at least five years of age who lacked the resourcefulness to rescue himself or herself from the depths of a three-inch puddle was probably looking at a poor prognosis for life in general. She cited something from Darwin's writings on "Natural Selection." At that point the principal walked through and took over. He told Celinda after the fact that while he agreed in principle  with everything she had said to the mother, it probably wasn't the best P.R. move and that our school would fare better without headlines in the Chronicle alluding to natural selection as our school's method for dealing with deep (albeit 3-inch-deep) puddles.  The district sent maintenance people to drain the puddles to a safer lever, which was an act of futility, as rain was falling hard at the time.

A child made it into the office at one point to speak to the principal. How there were not enough checks and balances to keep him out of the office so that a lesser authority but one equally qualified to handle such a problem, wasn't given license to do so, is anyone's guess. My guess would be that the kid used the classroom's bathroom pass to allow himself out of the classroom, then took it upon himself to let himself into the office. The boy said he needed to speak with Mr. X. Mr. X was standing at the counter and asked the kid if the issue was private. The little boy (a first-grader) said it wasn't private, so Mr. X asked what was the concern. The child reported that another boy had said the "W" word to him. Mr. X thought for himself , then whispered to those of us standing nearby, "What's the W word?" Not one of them knew. So Mt. X asked the little boy, "What's the W word?"

" 'What the fuck' " the child answered boldly.

"Oh," the principal replied. "You don't want to say that. I'll talk to him."

"Now?!" the child responded. "Do you want me to go get him from class?"

"No," Mr. X responded. "I'll talk to him later when I get to it. And next time tell your teacher about things like this instead of lying about needing to use the bathroom  so that you can come to the office and tell on someone."

Five minutes later, two mothers came to the office to complain about a single teacher. Mr X's first question was, "Have you spoken to the teacher himself about your concerns?" Neither parent had. The principal said he had a few minutes and would listen briefly to the mothers' concerns, but that he expected them to schedule two separate conferences with the teacher before the concerns were brought again to his attention or to that of anyone in the district office or on the governing board. Then if the teacher was unable to explain the situation and to ease their concerns, he, the principal would be happy to hear them out -- individually, not in tandem.

One mother's concern was that the teacher had supposedly stated that the lady's kid would never make it to college. The principal plucked the cumulative folder from the office next to his and glanced at the writing and math samples the previous year's teacher had placed there. While a great deal can happen between sixth grade and college, he said once the mother had departed that he could certainly understand why a sixth-grade student who consistently misspelled both his own first name  and the word the, and had, at sixth grade, mastery of neither multiplication nor addition facts and, further,  had been offered access to testing in order to rule out any possible learning deficits or disabilities, might not be considered to be on the fast track to college or university. The parent had declined because she insisted the child was doing "just fine" and that he demonstrated mastery of all these skills at home. It was just a "school problem" in the mother's eyes.

Principal X dismissed both mothers after scheduling separate appointments for each of them (they really wanted to take the teacher on together, but the principal refused) with the teacher. Then, out of curiosity, he picked up his telephone and dialed the classroom extension of the accused teacher. "I'm just curious," Principal X expressed. "Did you tell Mrs. Y's son that he would never be admitted to college?"

The teacher paused for only a second. "I can assure you, " he responded, "that not one time this year have I even used the word college and Mrs. Y's son's name in the same sentence."

I have two comments in regard to the stories Celinda shared (which briefly took my mind off how much my stomach hurt: 1) Regarding schools (and especially parents of schoolchildren),  they're caught in a rapid downhill spiral; as the children in school today will be in charge of the medical and assisted living facilities when we're all old, we are all, therefore, screwed; 2) Where was Principal X when I was in school? I would have loved him.

Cool Guy asked if it would help if he rubbed my tummy. Slut that I am, I took him up on the offer, and it did actually help to some degree. (It's one of those things that, in theory, Matthew could have done, but he wouldn't have offered, nor would I have taken him up on the offer even had it been made, due to the creepiness factor. I haven't yet received my DNA results (the saliva was too degraded to be tested in my initial sample) but, to the best of my knowledge, there shouldn't be much if any of that Appalachian or Ozarks indigeneity in there. I do have a question about that which has yet to be answered: Does the test detect consanguinity between parents or grandparents? THAT would be something interesting to know about, though I'm not sure I'd share the knowledge with just anyone) My abdomen hurt just as much before when Cool Guy stopped, but it felt better while he actually was rubbing it. When the action slowed down, he eventually rubbed it enough that I was able to fall asleep for almost two hours.

IBD sucks, but I'm stuck with it. Some day they'll find better ways of treating it, but for now, I watch what I eat and try to manage stress levels (which isn't easy with people such as The Cunt  continually dogging me), and I have transfusions and, as a last resort, cauterization or more invasive surgery. I don't trust any of the medications currently on the market to control the condition, so I manage it in other ways. Sometimes people my age spontaneously grow out of this. If not, a decent medication may ultimately become available.

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Friday, January 20, 2017

Religion in the form of Ecclesiastes and The Golden Rule Combined with blog-Related Housekeeping Chores

It's a hard-knock life around here. Bring your A Game or go back to where you came from.



At least one of my dear friends, and perhaps more, would prefer that I not say some of what I will say here. My presumption is not that my friend and/or anyone else would take issue with the content of what I have to say but, rather, would see what I am conveying here as a response to criticism or as defense of previous writings. I've been advised, with very good reason, not to defend what I have written when criticism or opposition appears. I won't go into the reasons for such, because I think those of your who read here semi-regularly already have a grasp of where I am going with this.

I recently referred to  a fellow student -- one with greater seniority than I but a fellow student nonetheless, as a "cunt." While I'm the first to admit that scooping so low into the lexicon of the English language to find a descriptive noun so fitting for the "peer" in question does not necessarily speak well for my grasp of the English language and does not cause me to feel pride in my level of linguistic skill, I stand by my use of the term in description of the person in question.  At times an unconventional shoe -- perhaps even one that can be purchased at Walmart, of all places --  fits the foot of a particular person, in which case it seems -- to me, anyway --  utterly senseless for me to scour the shoe racks of the most exclusive stores on Rodeo Drive to find another shoe or pair of shoes that might possibly fit almost as well, but almost certainly will not be a better fit if even as good. If future interactions between myself and this person are of sufficiently noteworthy nature to merit inclusion into this blog, the peer in question will likely be referenced by the same crude term. It is my guess that most who read here (I don't advertise this blog to pre-adolescents) can handle the figurative use of the word cunt on occasion. I am speaking for myself right now, but I would not choose to regularly read a blog that was filled with almost nothing but expletives and crudities indicative that the writer's mastery of his or her native language was such that he or she had few options in making his or her points or any other literary references without resorting to gutter language.  In my own case, I feel that the use of this word cunt is the exception rather than the rule in terms of demonstrating my ability to express myself in conventional English terms. If you, as one of my readers,  find my sparing use of the word cunt to be unaccountably coarse to the degree that it causes my blog to be difficult for you to continue to read, please leave either a message here or an email to me at aleximerc@aol.com or a Twitter DM @theAngelAlexis . Perhaps some sort of compromise may be reached.  Let me reassure you, though, that even with the occasional inclusion of cunt as the moniker of choice in referring to or describing a particular one of my colleagues, I have no intention of taking this blog all the way to the depths of the Bowery section of blogs. 

Much verbiage has been created -- by those ranging from authors of religious tomes now having been elevated to the level of scripture, all the way down to those working for the Hallmark corporation and its lesser competitors, who would use sentimentality and greed to guilt all of us into believing that the only way we could ever truly let our loved ones know that we think of them during times of celebrations both major and minor, that we love them, or to convey to those we've wronged  the totality of the depths of sincerity of our admissions of wrongdoing and desire for retrenchment, is by shelling out our hard-earned cash for all the merchandise Hallmark and it competition are manufacturing and hawking. The bottom line here is that many of our religious leaders, along with our modern-day cultural leaders of morality, who would include but not be limited to greeting card manufacturers and crafters who stitch inspirational maxims onto decorative pillows and wall hangings, cling to the concept that love conquers all, that the only way to have a friend is to be a friend, that incivility must always be returned with kindness, and that if a person behaves in an unkind or otherwise unacceptable manner either to you or to me, the only correct way to respond is with kindness and love. It is our responsibility as the recipients of ugly, uncivilized, and abusive  behavior to kill the perpetrator with our own kindness. He or she has not learned to love himself or herself. Only by the attainment of such knowledge of self-worth and self-love will the person be able to recognize his or her own true worth, and thus rejoin the human race on terms that might be compatible with the standards of you or me.

I'm saying here and now that I'm not buying into this particular brand of masochistic pop-psychology.  We've all had hard knocks in life.  No parents are perfect. With such being the case, not one of us received everything we needed from our parents throughout our childhoods and youths. Some of us did better in the parent lottery than did others of us, but not one of us had the advantage of escaping childhood unscarred by errors made by our parents. Likewise, not one of us escaped childhood and youth entirely unscathed where treatment from our peers was concerned. Each and every one of us was, at some point in our earlier lives, a bully to someone else. Similarly, each of us has suffered at the hands of at least one bully, whether it was physical or psychological abuse.  

I don't think I believe the cliche of that which doesn't kill us makes us stronger. In the cases of some lower forms of life, there is something to be said in favor of the immune properties an organism encounters through exposure in formidable  yet ultimately defeatable doses from challengers. That's the theory (which has essentially transcended theory to become law) behind antibiotic-resistant strains of bacteria. The bacteria has been exposed to so many antibiotic substances in just the right  strengths so that it, in effect, becomes invinceable, not unlikely a young prizefighter being provided with an opponent of the perfect strength for each succeeding match until he has developed the strength and skill set to ultimately defeat any opponent who might ever be thrown up against him.   With humans in their natural states, though, I assume it's possible for one to be beaten down, physically and/or mentally, to the point that one continues to exist though not necessarily to thrive. Still, those of us who have made it as far in education as medical school have, for the most part, if not having actually overcome the scars from earlier negative encounters with imperfect upbringings and negative experiences we may have encountered with educational systems and with peers, have dealt and/or made  peace with traumatic experiences from our respective pasts to the degree that it is assumed we can conduct ourselves  professionally. We are expected not necessarily to like each other but to treat each other with professional respect and courtesy, including, to a degree, those who may be somewhat beneath us in the pecking order.

My initial encounters with the cunt were ones of one-sided respect, with the respect coming from my side.  I do not know what it may have been about me that caused her to come at me with, in a verbal manner, all claws bared. I've been told that these sorts of conflicts are, more often than not, female versus female, not that all male-on-male or mixed-gender encounters in our program have been 100% civil and professional. Still, a disproportionate amount of the conflict that has taken place in our program has occurred between women of non-descript physical attributes and average-at-best achievement in the medical program itself versus those who, at the very least, pay close attention to detail in terms of cosmetics, fashion,attire, and accessories, and who excel in most or all components of the medical school program, which is not to say that they're inherently in possession of raw material that would make them better-looking or smarter than others, but it may perhaps seem that way to some of the others. 

I excel in my medical school program despite being considerably younger than the oldest in the program, and am noticeably younger than the youngest in the program other than Matthew. Most material comes easily to me, but I also put in a huge number of study hours. I make a reasonable effort to look presentable whenever I'm on duty, however early than may be. I'm not a mirror addict, nor do I spend a disproportionate amount of money on clothes of make-up. I don't buy an outfit, wear it once, then get rid of it. I've been seen in the same outfits multiple times each quarter.  I do, however, style (or at least thoroughly brush) my hair each day before lecture or work. 

I've had a few breaks which have caused me to gain attention. One was the sexual harassment incident early in the quarter. The other was the flukish hospital parking lot delivery of the baby. I sought out neither of those incidents, yet made myself appear in the best light possible when they happened to me. Sometimes things just happen, and all one can do to mitigate once's circumstances is the best her or she is able to do.

If these things, and I can only guess that it is such things that have gotten under the skin of the cunt and the couple of other students who have behaved less than professionally toward me, have caused sincere distress to the three students in question, and to the cunt in particular, I would encourage A) that they evaluate whether or not medical school is a suitable match for them; an B) that they perhaps seek professional psychological assistance. It is not my job to provide that psychological assistance, not that I am in any way qualified to do so. 

This is not like when I was a substitute teacher in a high school summer school math class,  when some of the girls were a bit jealous that the boys in their classes were looking at me in a way that would have been far more appropriate that the boys look at their female classmates. In that situation, I felt that it was my responsibility to mitigate some of the discrepancies that existed between myself and my temporary students. I made it a point to compliment each girl in the class each day on some aspect of her physical appearance, hoping not only to make the girls feel better about themselves, but to cause the boys, also, to take notice of their female peers. As far as the math was concerned, of course I was better at it than either the boys or the girls. I held a university degree, while they were mere high school students.  In any event, I had a responsibility to these young people - children, really, though soon to be adults. I took very seriously my role both in teaching them and in keeping the girls in the class from being jealous of me.

This situation in which I'm currently involved was nothing like my substitute teaching gig. I have no obligation whatsoever to do anything to help these women who dislike me to feel better about themselves. That's on them, their own advisors, and their own mental health professionals, if they have been wise enough to engage the services of such;  they most certainly are in need of them.

I did not bring this situation on myself. I said or did did nothing to start this supposed feud. I was not the one who called out a peer whose Minnie Mouse Halloween costume featured "the slut look," nor did I suggest that "the slut look" was not a good look for anyone. I would never say something of that nature to anyone else, much less in the presence of peers. It is not my job to say anything to the person who said those things to me to make her feel better about herself because I care about her or for any other reason. If she or either of the other two women who have spoken inappropriately to me this year have serious intent to pursue careers as physicians or surgeons, in addition to brushing up on their studying skills, they need both to grow up and to devote time toward the development of social skills . I am a mere third year medical school student. It is neither my right nor my responsibility to say or to do anything to  accelerate either of these processes in any of these women.





Thursday, January 19, 2017

On Call Nights, Breaches in Protocol, and Cunts

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This is obviously not I, but it is an approximation of how tightly my "shrunk"
scrubs fit me. P.S. I'm a bit less endowed, btw.




Tonight was one of my on-call nights. It wasn't supposed to be, but someone else got sick. It's in my orders that I'm not, until my status changes, to be called to fill in for sick or otherwise unfit-to-work colleagues unless not calling me leaves positions inadequately staffed. Because we're there for our own benefit -- to observe and to learn from the observations, and not to make any staff-to-patient ratios legal -- the position should have been left unmanned rather than my having being called to staff it.

Situations such as these put me in predicaments. If I work through too many consecutive nights and sleep too little, I'm more likely to get sick. No one else usually is walking around with the knowledge in his or her head to speak up for me when vacancies pop up and someone is called upon to fill them. Yet it is clearly coded in the computer system whenever my name is selected from the database that I have limitations, and the person who calls me to fill in is ignoring restrictions that are impossible to miss. 

In the morning, when my preceptor and/or the Director of the Year 3 Clerkship program logs in, it will be apparent that someone ignored codes. Who it was that ignored codes will also be apparent. Will that person blame me? Will my preceptor or the Director blame me? I wouldn't mind having it clarified once and for all as to whether  I'm supposed to speak up when my lower-level superiors screw up and assign me for fill-in slots  despite obviously written orders to the contrary, or whether I'm supposed to do as I am ordered and allow it to be sorted out later. In more clear-cut issues, as in once we've reached the point that we're not mere flunkies and that our presence serves a purpose to preserve patient safety and to protect  hospital liability, obviously I'll do whatever is necessary, then deal with the repercussions after the fact. but when we're little more than mere gawkers, I'm not sure I should go to quite such lengths.  In any event, it will be sorted out in few hours, as I'll be on the hospital floor by 6:00 a.m. at the very latest, which is less than an hour from now.

My skin decided to becoe sensitive to certain fabrics again all of the sudden. The previous time it did that and my dad ordered several pairs of hypoallergenic scrubs for me, the condition lasted just long enough for me to wear each pair of scrubs just once. When I put on a set of them for the second time, it became clear that the washing/sterilizing process had shrunk them ever so slightly, not to the point that the pants were high-waters or that the scrub top was too short, exposing my mid section. It was just that the scrubs fit me "very well," if my intent in dressing myself was to impress others with my slight curves. (I know it's the scrubs and not any recent changes in my body dimensions, as every other garment in my wardrobe fits me in exactly the same way it did before winter break. If anything, my other items of clothing are just a bit looser, as I haven't entirely regained a few pounds that I took off when I was sick.)

Wendell (pronounced wenDELL), a male surgical technician who is very openly gay, spotted me from down the hall wearing my flaming-pink scrubs. "Miss Alexis," he called out, "I don't know if you've been shopping recently or have just gained a few curves in the right places, but I must say I LIKE your new look!"

Just around the corner was, unfortunately, the cunt who took exception to my Minnie Mouse costume that I wore on Halloween. Her curiosity picqued by Wendell's outburst, she took a few steps to look at me from around the corner. 
"Alexis," she said in what I presume was her most officious voice, "I though we had discussed this earlier and that I had made myself perfectly clear. The slut look is unbecoming to you both personally and professionally. I expect you to take note of this and to dress more appropriately from this point forward."

Unbeknownst to the cunt, the Director of Nursing was standing on the other side of the corridor in an alcove. She stepped out to survey the situation. I should add for purposes of clarification that the Director of Nursing does not technically oversee medical students in any way, but that her words concerning our performance in any way when shared with our superiors tend to carry a great deal of weight. 

The Director spoke first to the cunt. "And who might you be?" The cuni gave her name. "And what is your position in thes hospital?" The cunt identified herself as a 4th year medical student. "And who is the person about whose attire you are so concerned that you would use crude and derogatory terminology in describing it?" The cunt pointed at me.

"And what is your name, Miss?" the Director of Nursing asked. I identified myself.
"What is your position?" I identified myself as a third-year medical school student. The director of nurses asked me to turn around slowly. I was hesitant to do this, as it doesn't fall under the job description of the Director of Nursing to critique the attire of medical school students. Still, I sensed I had an ally, so I complied, doing a slow 360-degree turn. 

The Director of Nurses smiled at me. She then turned her attention to the cunt.
"I see nothing in any way inappropriate in this woman's attire. If I did see something of concern, however, my action would be to report it to the young woman's job superior, possibly discreetly snapping a picture of the area that I found to be in violation of uniform code. Were I you, I would not ever loudly call her out on any supposed uniform infraction, especially within the earshot of patients and visitors, particularly using the vulgar language used by you, and especially when you may have seniority in your favor but otherwise have no direct authority over her. Are we clear, Miss (cunt)?" 

"Yes," she replied, red-faced.

"You should be forewarned that I will speak to the Director of Clerkships in regard to this incident," the Director of Nursing forewarned the crab*.

Tacitly the crab nodded.

Numerous personnel had stopped to observe the spectacle. "You can all go back to what you are supposed to be doing now," the Director of Nursing called out to the gawkers.

Wendell fist-bumped me as I passed him in the corridor. As the cunt and I passed, she hissed "slut" at me. I would have liked to have hissed "cunt" back at her, but her cell phone was in her hand and looked as though it might possibly be in "record" mode. I instead admonished, "We should probably avoid vulgar language while on the job."  Not only did I not use the "c"word. but I said just enough that it would be difficult for her to doctor the tape and insert someone else's voice saying what she would have preferred for me to have said. 

Even though I had finished my final of three calls over the night (deliveries of three healthy babies -- 2 vaginal deliveries and one c-section, which is about par for the course these days) sleep was out of the question due to adrenaline flowing freely following conflict. I returned home to shower, dry my hair and dress for today. I don't usually wear scrubs to the office unless I am anticipating an early delivery, but I packed the periwinkle pair of the hypoallergenic scrubs, which have been sterilized and will fit me especially well. If I'm called in to observe and assist in another delivery and happen to run into the cunt, once again she will see me attired in a manner of which she does not approve, not that it is any of her concern. 








Tuesday, January 17, 2017

Butt Doctors and Related Matters

I don't own this photo, but I do love it.



For numerous reasons but due primarily to the luck of the draw, I have somewhat lower-than-average immunity to many of the pathogens that surrounds all of us. My mother did not want me to pursue medicine as a career for that reason. My other primary vocational consideration was law. My dad's response to my mom was that courtrooms, jail conference rooms, and other places attorneys frequently hang out are not the most germ-free places on the planet, either. In the end, the decision was not either of theirs to make, and I chose medicine over law. Now that I'm in the thick of a clerkship rotation [OBGYN] that I am not thoroughly enjoying, I may be having second thoughts and thinking my mother may be smarter than she looks, but it's really too late to turn around now, and, furthermore, this is just one lousy rotation.

Actually, were it just the OB (or "obstetrical") half of the specialty, I might actually like this rotation. Hearing a baby's very first cry is an utterly awe-inspiring experience. Though it's something I've experienced only fifteen times (thirteen times here and twice with the births of my Godchildren), I don't think it would get old if I heard it every day of my working life. It's the GYN (or "gynecological" portion) that I'm not particularly enjoying. Not everyone feels as I do, though. Some doctors find the hours connected to delivering babies to be unmanageable, particularly after too many years in the field. After just over a week into the OBGYN rotation, I can attest to the lunacy of the hours obstetricians work. Babies will begin the labor process when it is convenient for them to do so with no thought whatsoever as to to how their timing is going to impact anyone else. Some doctors will attempt to circumvent babies' self-chosen schedules by inducing labor or by arranging for c-sections for highly dubious causes, including not only a preference for a 9:00 to 6:00 workday but for boat payments that will soon be due or Bentleys that need work. (C-sections result in larger fees.) Some scheduled C-sections are for perfectly sound causes, obviously, and I'm not criticizing the obstetrician who schedules a caesarean delivery for a mother who dilated a full ten centimeters yet couldn't push out her previous six-pound baby, and who is now ready to deliver baby #2, who is over seven pounds. That's a no brainer. Why torture, the mother, the baby, or the doctor? Get the scalpels ready. Additionally, malpractice insurance coverage is especially costly for obstetricians. An OBGYN who cuts his job description in half can still usually find more than enough work, and can do so working more reasonable hours and seeing more of his or her patients' fees deposited into his own account as opposed to the payment going in large amounts to his or her malpractice insurance carrier.

We need doctors to fill all specialties, so I'm not complaining about those who settle on proctology, or urology, or the gynecological half of the obstetrics/gynecology spectrum.  Sometimes I'm really tempted to pull the individuals aside who fulfill these specialties and ask them, "Confidentially, just what was it that led you to choose to look at and or up people's butts all day? You can tell me the truth. Your secret is safe."  Of course I'd never actually ask that, because the people in these specialties are usually highly sensitive about their lines of work. I'd be ratted out, and if I weren't bounced from my program, I'd be severely reprimanded at the very least. I'm not suicidal, professionally or otherwise.

Still, I wonder what calls doctors to these specialties. My guess is that the pay is quite competitive. I've never visited a proctologist (though my gastro man has done a bit of related work for me, and my insurance carrier alone  has forked over a good portion of his first kid's undergrad education fees) but I would guess that he is compensated quite fairly for his work.  I wonder if, in communistic countries, the system allows either those who score highest on exams or who praise the despots in power the most effusively to fill the choicest specialties. "You!" says the med school head-honcho, pointing at the guy sitting in the back row, "Got piss-poor score on exam. You be piss doctor, or what is it they call that in America? Urologist! You be urologist!" . . .   "You!" he says next, pointing at guy with sarcastic expression on his face . . . "You laugh at Kim Jong Il's hair cut  when you seven years old. You be butt doctor." Maybe that's how it goes down in such places. I really don't know. Regardless, I wouldn't place a high premium on the quality of medicine practiced there. For those of you who are world travelers who sometimes venture inside borders of countries ruled by dictators, you would be well-advised to ensure that you have at least one cardiologist and one general surgeon in your traveling party and that they are carrying the equipment and medications they need to get you through a basic procedure until you can be transported to a place that practices at least 19th -century medicine.

I haven't yet decided on a specialty, assuming I'm in a position to have much of a say in the matter. If our system changes much here, I may find that I'm assigned to be a butt doctor for having criticized President-Elect Trump's hairstyle. Just to keep my bases covered, I shall go on record as saying President-Elect Trump has a most stylish haircut (at least as compared to Kim Jong Un or his late father Kim Jong Il). I'm giving compliments freely because I really don't want to be a butt doctor.


in the event that you were wondering how they perfected their technique before trying it out on you



Monday, January 16, 2017

Another day, another . . . nothing, because i don't get paid for this




I've just finished my final call for this on-call series. I'm theoretically on call for the entire long weekend, with today being Martin Luther King Day, but my supervising attending has taken me off remaining calls for the long weekend because we've been hit so hard that I'll be useless this week if I don't get a bit of rest.

My last delivery for this on-call block resulted in a baby boy with Down Syndrome. (Note: it's Down Syndrome, not Down's  or Downs Syndrome. Even parents of children with the condition often get this wrong.) Some lab work needs to come back to confirm the diagnosis officially, but it's a done deal where this baby is concerned. The baby's father is an RN (we've worked together), and he recognized it before anyone said anything. No one did actually say anything about it.

Down Syndrome occurs with abnormal chromosomal division. A human cell typically has twenty-three pairs of chromosomes, with one set coming from each parent. When a baby has Down Syndrome, a third chromosome # 21 is present. Most often this third chromosome comes from the mother. This form of Down Syndrome is known as Trisomy 21, and is responsible for roughly 95% of all cases of Down Syndrome. There are variations of Down syndrome. One rare  type, known as translocation, happens when a part of the extra chromosome breaks off and attaches itself to another chromosome (usually 13, 15, or 22, if it matters to anyone.) The outcome of the translocation form of down syndrome in terms of the child's prognosis is typically the same as the basic Trisomy 21 form. Its difference is really significant only in that one parent is usually an asymptomatic carrier of the trait. This might significantly influence a couple's decision as to whether or not to have more biological children. A third form of Down Syndrome, known as mosaicism, occurs when, for some reason, not all cells in the child's body contain duplicates of chromosome #21. When such is the case, the degree to which the child is impacted by the resulting disability varies widely.

Down Syndrome is usually diagnosed at birth because of physical manifestations, though the diagnosis must be confirmed through lab work, as some children or even adults possess physical traits consistent with the syndrome without actually having it.

The baby whose delivery I participated in today had a smallish head. I believe that was what first set of the father's radar. He then reached for one of the baby's hands, and traced the crease across the palm. Without even really thinking about it, I reached for the little guy' foot and felt between his first and second toes, where there was a noticeable crease. The father made eye contact with me. I'm not certain exactly what was meant by the look we exchanged, but I assume he was confirming what we both knew, and maybe he was silently imploring for me not to say anything aloud. The mother may not yet have been ready to hear it. Regardless, it's not the place of a third-year medical student to announce the diagnosis, whatever the diagnosis may be.

The Apgar measures were low for muscle tone, and the baby's cry was weak. He was stable, though. We cleaned and wrapped him and handed him to his mommy. the father whispered a question to the OBGYN and pediatrician about lab testing. the pediatrician said they would get a blood sample right away.

The baby and his parents were moved to a more comfortable room. As we left them, the father squeezed my hand and told me thanks in a whispered voice. I just nodded. I'm not sure why he was thanking me, unless it was for not blurting anything out. I just nodded.

The prototypical Down Syndrome baby has a mother  thirty-five years of age or older at birth. This little guy's mom is twenty-six. At this point, no actions on the part of either parent are known to contribute to the likelihood of producing a baby with Down Syndrome. A mom can drink like a fish throughout her whole pregnancy and use every banned substance known to man. That will cause a host of other conditions for the baby, but it does nothing to increase the baby's chances  of Down syndrome.

The way the age factor works, as best we understand it, is that the older a mother is, the more negative exposure her eggs have had. while we don't know what specifically would cause Chromosome #21 to split, we do know that older eggs are more likely to be damaged. The odds are still slight in favor of Down syndrome, but  the chances of the condition occurring increase with maternal age.

Amniocentesis is recommended for mothers 35 and up because 35 is the initial age at which the chance of Down Syndrome is greater than the chance of miscarriage due to amniocentesis (or chorionic villi sampling -- a similar prenatal test in which cord blood is s; there's still an abdominal injection required, but the risks of miscarriage due to the procedure are slightly lower). Not everyone who opts for either amniocentesis or chorionic villi sampling automatically plans to terminate the pregnancy if the results of the testing indicate that the child has Down Syndrome. Some parents just want to be prepared in advanced for whatever it is that they are facing. Regardless of their choice or of the reason they made the choice, i'm not there to judge them. I just feel for them. as one pediatrician told me early in my thrid year, with everything than can possibly go wring between a child's conception and birth, it's a mircale that any baby escapes the process unscathed.

I desperately need the day off tomorrow. I'm so exhausted that I'm typing gibberish and having to go back to make sense of it. I typed something last night about Fiji to a friend. I haven't a clue as to what I was typing about. Why Fiji, of all places?

Tomorrow I shall mostly sleep, eat, and play my instruments. I will probably make a quick trip to the hospital to check on the new little family whose baby I just helped deliver. By now the mom should have been told. I hope they're OK.




Sunday, January 15, 2017

Music Lessons, the People Who Teach Them, and Those Who Pay for Them

This is not I. We don't have an early picture of me playing the piano.



I've taken a lot of piano lessons in my day, and I've given a few as well. The vast majority of the lessons I've both taken and given have taken place without money changing hands. My mother taught me until I was twelve. She was skilled enough, and our relationship as piano student and teacher was pretty much free of rancor,  that I didn't really need to upgrade to a new teacher.  It was just that, from her experience, at a certain point a student learns most of what he or she will ever learn from a given teacher, and there comes a time for change. We were, fortunately, living in a university town. The university had a sufficiently high-quality music department that a decent piano teacher was easy enough to procure. I wouldn't say that the new guy was any better than my mom (he had essentially identical credentials for the job, which would have been a PhD in piano performance. It was a lateral move for me. The new guy didn't hold me back, nor did he necessarily accelerate my progress. It was, if anything, probably good to hear someone else saying the same things my mom had said, thus reaffirming basic principles.  It was also a break for my mom. We didn't have conflicts during my piano lesson, but passing the burden of  my lessons off to someone else might have freed us up from the necessity of being civil to one another for thirty consecutive minutes out of every week, which might have been more of a strain than either of us could have borne.

Incidentally, it's been strongly recommended by several of the gurus of education that there are three things a parent should not attempt to teach his or her own child: reading, swimming, and playing the piano. I learned to read independently, but my mom taught Matthew to read. My dad taught both Matthew and me to swim. My mom taught me to pay the piano, which I, in turn,  taught Matthew. This leads to one of two conclusions: A) the educational gurus do not know what the hell about which they are talking; B) we are one fucked-up family, and our failure to follows these basic directives as given by leading experts in the field of education only served to make us even more fucked up than we otherwise would have been. I'll leave it to each of my thirteen or so readers to form his or her own conclusion.

I taught Matthew to play the piano. At somewhere around the time we were five, after I had already been playing for a few years and could play simple Mozart compositions, Bach Two-Part Inventions, and anything that didn't required large hands, my mom decided that it was time for Matthew to learn to play the piano. She was patient at first, but it soon drove her to distraction that Matthew did not master the basic concepts of piano as easily as I did. At some point after a month or two of lessons, she concluded that she couldn't teach him any longer. I don't know if she considered hiring another teacher for him, considering that the parent-child relationship might be interfering with her ability to teach him, but she didn't rush out to find another teacher for him. Then, before long, she noticed that he was playing the simple tunes and scales she had tried to teach him. "Where did you learn to play that?" she asked him after hearing him play a two-octave B-flat scale with both hands.

"Baby Lexus showed me," he answered her. She was shocked but decided to leave well enough alone. Matthew's level of piano skill never quite approached mine, but he played better than most of our peers who studied piano at the time. He ultimately moved on to guitar as his primary instrument, but still plays simple classics proficiently. 

My other experience in teaching piano came when I was receiving in-patient treatment for post-traumatic stress disorder. A requirement for high school graduation at my local high school was to devote 100 hours throughout the final two years of high school to community service. Prior to my senior year, i had completed over forty of those hours. Once I was in the facility, my options for service were limited. I suppose I could have scrubbed floors or emptied trash cans, but assisting others with their academic studies and teaching piano to those who were interested seemed  great deal more appealing.  Because the nature of the service was "volunteer," again, no payment was involved.

A friend of mine is now attempting to complete her master's degree in vocal music performance. She has a few grants and is receiving a bit of help from her parents as well, but she would prefer to teach music on the side as opposed to taking on shifts at Starbucks or flipping burgers at In & Out or wherever else burgers are flipped. She is qualified to teach voice lessons to an undergraduate college student or lower. She is also qualified to teach flute lessons to from high school level down, and is qualified to teach basic piano lessons, as in to anyone who has mastered less than five solid years worth of piano curriculum.  She has printed flyers and business cards, and she had posted at actual venues and on-line sites where her prospective clientele might be found.

My friend has had numerous inquiries, but  the point at which she loses clients seems to be over the cost for lessons.  She is requesting a flat rate of  $25 dollars per half-hour lesson. I've told her I would consider it to be a reasonable rate, and it's what everyone I know pays for starting level music lessons.  For some reason -- maybe because of Internet tutorials or other things available elsewhere -- people do not seem to want to pay the going rate for piano lessons. Some people get around paying the going rate by just a bit in signing up for (in my opinion) slightly funky group lesson formats. Again, just in my opinion, kids spend a lot of time standing around in lines waiting for their turns to play, and instructors spend as much time disciplining as teaching. I see this as neither an efficient way nor a cost-efficient way for a child to be taught music.  If others are having success with this manner of piano instruction, more power to them, but I'd love to see this model taught in a way that it actually works.

I have a friend who is a recently retired California public school teacher. Her pension and savings are such that she isn't in any grave need of supplementing her income. She is a virtuoso pianists and has been asked for many years about giving piano lessons.  She has always said that she would consider taking on a few piano students when she retired, but that the money she earned had to be worth tying up an afternoon ir two  in her week in order for her to consider teaching.piano. She, too, has announced the $25.00 rate, with a family rate of $20.00 per lesson for two or more children in the same family provided that the lessons are on the same day and are consecutive. She will teach the lessons at the client's home for an additional five dollars (the five dollars is applied only one time for families with multiple students on the same day).  This friend of mine is highly qualified. She has the right, and she has utilized that right, to use the university's logo in her lesson flyers and on her business cards.

 She has had many inquiries but few (as in zero)  takers once the fee schedule is announced. She even offers to give the child's or family's lessons for free  for the first month as sort of a trial run. Still, that $25-dollar-per-lesson fee scares people away.

My friend, the retired one, said that much earlier in her life, she gave lessons free of charge to children in families where to money might have been a hardship. What she found was that families took the attitude that what they got was what they paid for. Because the lessons weren't costing them anything, they were far less likely to see to it that their children practice. children, to, valued the lessons less because their parents did. She saw next no no progress in those students who received free lessons.

(On an only mildly related note, my mom considers the same principle to be at work in private education versus public schooling. When parents are shelling out their own hard-earned bucks for their kids' education, they A) think it's a superior product because they are paying for it. They hold their children accountable both for meeting academic standards and for meeting behavior standards; and B) they believe that because they are paying for it, it must somehow inherently be superior to that which is provided gratis by the public schools around them, and they, again, insist that their children apply themselves to their work and take advantage of what is offered by those private schools.)


When I took cello lessons briefly, I paid $35.00 dollars for each 1/2-hour lesson. I am in an area where the cost-of-living is higher than it is where my friends are proposing to teach, which could account for the accelerated cost of the lessons. Still, I thought nothing of paying the $35-per-hour fee. Music lessons - except for the group lessons public schools provide -- are not free. If a person wants his or her child to achieve at a high level in musicianship, private instruction is essential. A person may labor under the illusion that his or her child is a modern-day Mozart whose skills will turn into glorious music without outside intervention, but that person is, for all intents and purposes, a fool. Furthermore, even Mozart received instruction in basic music skills. The concepts may have come more easily to him than to most, and the instruction may not have continued for as long as it was continued with most musicians of his calibre, but suffice it to say that  Wolfgang Amadeus Mozart was not entirely a self-taught musician. 

Furthermore, if one intends to take music to a higher level, fees for various services are going to pop up on a regular basis. Methods books, even in public school music programs, must usually be purchased by students' parents. Instruments may need to be rented or purchased. (The easiest way around this is to join choir, as no one can charge a person rent for his or her own voice; not quite, but almost equally automatically free, are the use of a school's baritones and tubas. Hardly anyone wants to play baritone or tuba, so many schools have a few baritones or tubas lying around, available for student use free of charge. The methods books will still need to be purchased, but those are minor charges in comparison with actual instrument rental fees. If your child plays clarinet, saxophone, oboe, or bassoon, reeds will need to be purchased, The reeds seem to split on a regular basis, usually at the worst possible times, so extras need to be kept on hand. My friend Megan admits to having had a fascination with her older brother's saxophone reeds when she was about four years old, and single-handedly shredded dozens of the things with her bare hands before anyone figured out that it was she who was doing it and told her to cut it the hell out or else . . . Strings of violins, violas, and cellos are similarly lacking in sturdiness, and seem to snap regularly in the hands of inexperienced players attempting to tune the instruments.

As the skills of a musician build, likewise do the opportunities for him or her to spend money in honing his or her craft. Master's classes, in which an individual musician appears with two to ten other student musicians to be briefly instructed by the expert or "master," but also benefits from the pointers the master gives to his or her peers, happen multiple times each year and  may be a required part of a musician's tutelage. Solo performance festivals, at which musicians play in the presence of a panel of experts and are critiqued and given pointers, but sometimes given honors as well, are also a regular part of a young person's musical education. Perhaps a musician plays an instrument for which accompaniment is needed. Do not delude yourself into thinking that those accompanists crawl out of the woodwork and beg for the honor of accompanying your young musician just for the pure pleasure of the experience and for the bragging rights of having done so. The accompaniment for a senior recital to fulfill that portion of a bachelor's degree typically costs $400, payable (usually in cash) either on the night of the rehearsal, or, at the very latest, on the day or night of the rehearsal, prior to performance. Accompanists are not expected to resort to small claims court to recover their fees, which is why they payment typically precedes the performance. And accompaniment fees are  one of many fees related to the senior recital. The hall must be rented. If the hall is not in pristine condition following the recital, a fee covers cleaning the cleaning. The programs must be printed, adjudicators in many instances must be paid. Even ushers and an M.C. in many instances have to be compensated. A fee covers the estimated cost of the utilities used for the building during the evening. The accompanist fee for a master's recital is even more, though if the musician for whose musical education you are footing the bill has reached this level, by now you're well aware of the costs, both overt and hidden, connected to a high-calibre music education. you know even about the post-recital reception that the music student and/or his cash cows are expected to cough up the money to cover. The reception need not be  elaborate, but your music student does wish to be the one everyone talks about each time there's another recital, as in, "Remember the girl who served generic Oreos and Kool-Aid after her recital?"  Beef Wellington isn't required, but it's best to stay at least a cut above popcorn and powdered lemonade, with paper towels purloined from the staff restroom serving as party napkins.

Music instruction fees start out small, though $25 dollars apparently doesn't seem all that small to some, and grow commensurately  as a musician's skills grow.   Thus the need need for an instructor of greater skill increases, and with that greater level of skill in an instructor, the size of the fee will logically increase. Ultimately these fees are paid as part of university tuition. Still, university students who pay thousands of dollars per semester for private music instruction would laugh at parents who grumble at having to shell out a mere $25 per half-hour lesson.

The piano teacher who is asking for a mere $25 per lesson had to shell out a cast-of living-adjusted version of that $25 fee himself or herself doe several years a long time ago, along with countless hours of practice. The piano fairy obviously didn't just visit his or her room and sprinkle magic dust on him or her one night,  declaring,  "You shall be a great pianist and have all that goes along with it, including the necessary method books and sheet music, an adequate instrument on which to play, and free music lessons."  The piano teacher obviously had to pay for all of those things himself  or herself, usually with the help of others - namely, parents.  Now, not only is he or she, the music teacher, asking in that $25 piano lesson rate, for a return on all the costs he or she incurred through the years, but for the opportunity to put bread on his or her own table, and perhaps  even for the opportunity to give his or her own child opportunities to study in fields the piano teacher is not qualified to teach. Perhaps the piano teacher's child would like to study gymnastics.  Is the gymnastics instructor willing to give the piano teacher's child a cut in  tuition rate because many parents think $25 dollars is too much to pay for a piano lesson?  I haven't asked any gymnastics teachers about their policies lately, but my guess is no, they're not willing to be flexible.

Perhaps your child has no interest in piano lessons. If such is the case, great. The world probably already has too many people who were forced to take piano lessons as kids who had no interest in learning. If your child expresses an interest in learning to play the piano, however, and purchasing a new or used piano is within your means, do considering picking up a piano and making arrangements for lessons. Also require a minimum commitment from your child, which may be three months, four months, or a year, depending upon your family's finances and other logistical considerations. Please, however, do not let the $25 or $35 lesson fee be the deciding factor against you child's having lessons.  Allowing the piano teacher's  fee, which usually amounts to far less than what your family pays for cable television, for manicures and pedicures, or for pizza in a given month, would seem to me to be an imbalance in a family's priorities. I'll discuss this on another day, but even if a child never approaches mastery the piano, just by virtue of having a piano in a child's home and by his or her been given a few months of lessons, both his or her verbal and performance IQs will have been raised by roughly 5%. That number rises dramatically if the child  actually achieves some degree of musicality, but even if the piano remains essentially decorative furniture -- played by a child a couple times a month when he or she has tired of video games, it is serving a constructive purpose.

Moreover, while not every child will grow to be the next Vladimer Horowitz (quite frankly, hardly if any of them at  all will be), your refusal to adjust your family's budget  in order to pay a piano teacher a measly $25 per week  (or, God forbid $30 or $35 if that's the going rate in your neck of the woods), will, in the end, cost you more than whatever it was that the  piano teacher  requested for his or her services. 


                                         I do not own this video.