Running, Running…and More Running

Have you noticed that as time marches on we are always running, often literally. We are rushing to work, to an appointment, answering a page, picking up the kids, making dinner, paying bills, planning vacations, reading CME and just trying to keep our heads above the water. No wonder we are stressed and anxious. Did we just replace our ancestors’ worries of finding food with time consuming errands?

Our lives are so filled with little worries that together they take one big toll on our peace of mind. And then you add economic worries, job loss, news of wars and droughts and is becomes overwhelming! When did life become so busy or was it always like this? When I was a kid we did not have money, computers, vacations or the internet. We had TV but when dad came home he took it over and if you were within hollering distance you became the remote control. Oh, how I hated that. Solution…go to your room and turn on the radio, read or go outside to play with your friends.

So, how did I get from there to here? Here I am in the middle of life and truly believe all the information coming at me has caused me to have issues. I want to participate in many things, travel to foreign lands with my kids, see my children participate in sports and music and excel in school, learn Spanish and the guitar (oh if I could only sing!), train for a marathon, write another book, hike and spend more time taking pictures. Seriously, does anyone else have this problem? Is it a personality disorder yet to be discovered?

I really want to simplify life and slow down to smell the roses but my fear is missing out on an amazing experience. Can you imagine going one week without any TV, radio, internet and cell phone? I know I panic when I realize I can’t find my phone or when the internet is down. How about you? Are you addicted to technology and has it affected you or have you seen it affect your patients?

My Grams, Her Battle Was My Battle

There are some wonderful people that will pass through your life and when they leave it is very difficult to go on at times. Holidays, special events, and birthdays become painful reminders of their absence. I wrote this article a few years ago when my Grams was still alive and I read it at her funeral two weeks before I deployed overseas to the Middle East with the Air Force. 2007 was a tough year for my family but my Grams was a beautiful person who blessed my life.

"When my grandmother, Grams, came to live with us in 1997 she was depressed and a shell of person that I had known in my childhood. She came to us because she was leaving a violent marriage of 20 years. The Grams of my youth was vibrant and energetic, spending many summers with my younger sister and I shopping or playing miniature golf. But that cold day in April of 1997 I saw a sad hunched over figure in a wheelchair being wheeled off the airplane. I almost did not recognize her.

Grams settled into our home, spending many hours with my young daughter, Emily, looking at the stars and discussing what to wish for. Over the course of the next 7 months her divorce was finalized and we moved from Ohio to Texas closer to my mother. By this point I was beginning to see shimmers of happiness and energy from Grams, but on occasion she would fall back into the depths of depression. She struggled with being dependent on us for everything and pushed away opportunities of socializing with others outside the family.

By 2001 I had begun my third year of medical school and my grandmother watched the youngest of my 3 children, Gabriel. In October she called to tell me that her mammogram had showed an irregularity and she was told by her doctor that it would need further evaluation. My heart sank as I had a gut feeling that it was going to be bad news. I spoke to many physicians asking which surgeon they would take their mother to and Dr. Ronaghan's name came up more than once. We had her referred and Dr. Ronaghan gave us the grave news. She indeed had what looked like breast cancer and biopsy would be the only positive answer. Grams took the news as if you told her that she had a simple cold. My assumption was either she was in denial, had completely lost her mind, or extremely stoic. I, on the other hand, was falling to pieces inside. The thought of losing my grandmother made me nauseous, but I knew she was counting on me to be there for her. Little did I know that I was going to be leaning more on my grandmother during this process than she on me.
A few days later she had a lumpectomy which revealed lobular carcinoma and would need further surgery. Grams remained enthusiastic and positive about her outcome, she almost seemed happier than I had seen her in 4 years. I didn't know what to make of it, but then again things flew by so fast that I didn't have time to process it.

She went on to have a bilateral mastectomy with positive lymph nodes on the right side. So, we weren't out of the woods yet, she would require chemotherapy and radiation. Chemo would begin in December, 2-3 times per week for several weeks. By the tenth day her hair began to fall out in clumps and we began looking for wigs. One night she asked me to shave her head so she would not have to deal with her hair falling out anymore. I had cut hair many times, even Grams', but this request made me anxious and hesitant, almost to the verge of tears. It made me feel as though the cancer was winning, she was losing herself to the enemy. It was taking her beautiful thick white mane that made her my Grams. Well, we went to the kitchen and I plugged in the electric razor. I stared at her for a long time until she prodded me saying, "Laurie, it will be alright, don't worry. Anyway, I am hoping that it will come back curly!" At that moment I began to realize that the cancer was not going to win, because my Grams was strong and positive in heart and mind. I was looking at the Grams of many years ago, vivacious and alive! Yes, alive...she hadn't died yet. Wake up Laurie and join the fight! I went on to shave her head of course after we entertained the idea of a mohawk.

She continued with the chemotherapy and had good and bad days of vomiting and fatigue but her optimistic attitude never wavered. The children had adjusted to having a Grams without hair, the boys, Jonathan and Gabriel, loved to run around in her wigs. In preschool Jonathan was asked to draw a picture of his family. He drew his mom, dad, brother, sister, and Grams. We all had hair except one figure had no hair and was holding something in her hand. When asked who this was and what were they were holding, Jonathan promptly replied, "That is Grams holding her wig." As the story was relayed to her, Grams eyes twinkled as she replied, "Well, it's too hot to wear a wig all the time."
Grams went on to have six weeks of radiation therapy that resulted in severe burns across her chest. She was in pain most of the time and we did what we could to make her comfortable. She never cried or felt sorry for herself. She always asked me how my day went, always worrying that I wasn't eating right, getting enough sleep, or working too many hours. All the meanwhile she was in the middle of a life and death battle with an ever imposing enemy. She prayed and read her Bible daily, always reassuring the rest of us that she would make it.

Indeed, 5 years later my Grams is still here without any signs of recurrence of the cancer. She taught me the power of positive thinking, humility, love of family and faith in God. I can only hope and pray to be a fraction of the woman that is my Grams. And yes, her hair came back curly."

I hope you enjoyed this and share it with others. Remember each day is a blessing and there is only a finite number of these! Create an impact on someone's life, and it can only improve yours.

Finding Balance

Life has a funny way of reminding you daily that you are not in charge. You walk into work after a full night's sleep, thanks to my ear plugs because hubby snores. (Don't tell him I told you!) My energy is positive and I am ready to conquer the day. Then I proceed to look through the files of the patients on my schedule and then I realize there are a few chronic pain patients, crabby COPD patient with new CHF that refuses to go to a specialist, and on and on it goes. I feel the wind go out of my sails and I lean back in my chair trying to decide how to move my mood to a more positive state. Then I take a little mental mini vacay to a winning lottery ticket. Yep, it works every time.

Then after an exhausting day at work, going home to make dinner, started and folded more laundry, discussed the day with the family as we played "Apples to Apples" (Fun game if you have older kiddos.) I soon realized that I really am very vulnerable to my circumstances. Dealing with difficult patients...frustration and fatigue sets in...fun game with the family...happiness and energy abounds. Geez, this is sad realization my mood is so easily shifted. Maybe it is hormonal or maybe I just don't like not being in control...ahh...that is it.

I am a control freak. Yes, type A personality to the core. See when I go on my mental vacations I am in control and decide my fate. In real life, not so much. Not sure how turned into this over the years. Certainly not genetic as my mom is a peace maker and sweetheart and my biological dad never stuck around to change or be in control of anything.

I guess when I figure out how to solve this little personality disorder I will probably become a wealthy person. Any thoughts?

Patient Negotiation

Over the course of any given day I sometimes find myself either pleading or negotiating with patients to take steps to improve their health. Am I the only one who has found this to be the case? It is becoming increasingly frustrating. Sometimes I just want to say, “Listen, you came to me for help. I am telling you to do ____ it is up to you to do so. Please feel free to come back when you are ready to listen to the advice you paid for."

Sometimes I think parenting has prepared me more for medicine than medical school. Raising teenagers has taught me the skill of listening and then collaborating to reach an agreement without inciting a rebellion. These can be tricky, shark infested waters, one must tread lightly. The last thing I want is a patient stopping his medications or a teenager sneaking around. Unfortunately, I did not raise my patients from infancy. Their previous doctor relationships could have been positive or negative. Their perception of the doctor-patient relationship could be completely skewed from what I would want to instill.

Or maybe this phenomenon is a result of an American culture that encourages instant gratification and looking for the easy solution. Yes, you must give of your liter of soda a day to get your blood sugars under control, and yes, you must exercise to lose weight and feel better and no I don’t have a pill that will fix all of your personal problems. What is a doctor to do? Give up or continue to chip away at a brick wall with a wet noodle? When these patients start to bother you, is this the beginning of burn out?

Don’t get me wrong though. I have many patients that are more than willing to do the work that is needed. They may grumble and tell me I am ruining their fun but they make some changes for the better. I usually thank these patients for doing the right thing and tell them I am going to brag to the other doctors what “good patients” I have. Oh my, I feel like I am bragging to the other mothers in the play group.

The Mother Load

When I was pregnant with my first child I was a sponge for advice. Every mother I met would be inundated with questions about labor, best diapers, breast feeding or formula, best car seat, and on and on. I am sure many of those poor mothers were glad to see me waddle away.

Now on the other end of the spectrum I find myself giving advice to pregnant moms to be about child rearing and discipline. I am discussing with older parents how to teach kids to respect parental authority, deal with teens who are sexually active, kids being bullied, kids on drugs and often how to communicate with their children. It seems many parents these days are either afraid to discipline their children for fear of “not being their friend or hurting their feelings” or are indifferent to their behavior. I find this very concerning. Am I the only one noticing this trend in America?

I recently read some reviews of Amy Chua’s book, “Battle Hymn of the Tiger Mother." It is a memoir written by an American born Chinese mother of two teen girls. Tiger Mother is Amy Chua's own assessment of herself as she was born in the Chinese year of the tiger. She is a strict disciplinarian who micromanages all aspects of her children's lives which may include calling them "garbage", rejecting hand crafted birthday cards or forcing a 7 year-old child to practice at the piano hour upon hour without a bathroom break. She states that this was how she was raised by her Chinese immigrant parents. Her goal is to prepare her children for the harsh world reality. It is tough out there and you need to be prepared.

I certainly do not agree with her harsh and humiliating tactics but she does point out that in our western culture we are raising a generation of weak children who are indulged for the sake of their self esteem. We have lost sight of the fact that children need to learn from failures, solve difficult problems, that there are rules, and that they will be held responsible for their actions. America is back sliding but are we helpless to stop it?

I would hope not. I can only challenge each of us as mothers and physicians who can influence parents and children alike to put forth the energy to change the culture we have developed. Do we want to put our future into hands of adults who expect life to be handed to them on a fluffy pillow to soften their falls? We are doing ourselves, our children and country a disservice if we don’t encourage families to focus on staying together, push parenting with the goal of responsible adults even if it means some discomfort now, and being honest with our children that our country needs strong, creative, hard-working adults to fix the many problems we have created. Will you join me?

I am Tired but Addicted

I started medical school at 28 with 3 little kids who were 5, 3, and 10 months at that time. I had energy to take care of home, husband, kids and study. I made it through residency with a few more gray hairs but was for the most part enjoyable. I had avoided the more strenuous and time consuming residencies because I wanted a family life, which I have truly loved. Then I paid back my time to the US Air Force and life got a little more stressful.

I am not sure if it was the lovely combat boots, the ever changing rules, the fact that I did not have control of my time or travels or the facing a young mother who was about to leave her young infant for a year long deployment. This takes a lot of “brain and heart” energy that I sometimes do not want to expend. I find myself feeling guilty over this but my husband, kids, family and friends need me to be “fully there” also and at times I am just emotionally and mentally spent.

Now as a civilian a typical day may consist of dealing with a depressed cancer patient and their stressed family members, a concerned mother worrying about her obese child, a middle aged woman with vaginal bleeding after menopause, a hypertensive diabetic patient with an oh by the way I have chest pain, or the patient who has lost their job and will soon be homeless and the list goes on and on. Between discussing odd symptoms, rashes, patient comments with colleagues, pouring through online and print resources and cramming the newest medications in my brain…guess what…I am worried about my patients and exhausted at the end of the day.

My weekends take me away to a place without the stresses of patients’ needs but amazingly enough my thoughts always go back to a patient or two. I find myself thinking of a new strategy to combat their hypertension, a positive word I can say to the worried mom, or make a mental note to call a patient on Monday morning to see what the specialist said. So, even though I am tired I cannot pull myself away from the things I love…family, friends and medicine.

I have yet to decide if this line of work is healthy for me but it certainly is addicting and for the most part enjoyable. I certainly pray a lot more these days than I did when I was younger with fewer responsibilities and more energy. I have learned and changed so much from my patients I can’t imagine who I would be otherwise. So as I walk through my day I must remember to take a deep breath, and enjoy these patient doctor moments because I will never be the same.

A Letter From Your Doctor

Dearest patient, this letter is for you.

I hope you read it, all the way through.

There are a few things I want you to know,

First, I am sorry for being so slow.

I can’t seem to break this habit of mine,

of sleeping in until 4:09.

I roll out of bed and onto the floor,

wondering what the day will have in store.

Rounds in the hospital run hour after hour,

The patients’ desire to ask questions is beyond my power.

I make my way through morning traffic and into the clinic,

Go through the labs and many calls in a panic.

By 7:30 I must see the first patient,

The hours in a day are never sufficient.

Sarah is next in line to be seen,

Telling me about her headaches and rebellious teen.

The lobby is getting crowded as the time flies by,

Patients are restless but my mind is on Sarah, I cannot lie.

Mr. Anderson tells me he is mad about the wait,

I apologize and tell to stop smoking or a heart attack will be his fate.

Oh and by the way,

He won’t be able to pay today.

I can only smile and say alright, for you see,

The patient’s well being is really what matters to me.

The next patient is certain he has the Juju Joogled.

I will tell you now, doctors hate being Googled.

The complaints roll in about coughs, pains, vomiting and loud farts.

I finally finish at 5 o’clock and then there are hours of finishing charts.

I rush home to see my family, and as I walk through the door I hear,

“Hey, Mom, my project is due, what do you know about the 1800s and the western frontier?”

Before I know it the day has rushed by to an end.

I fall into bed at a quarter ‘til twelve only to wake up and do it again.

Many familiar faces flash in my dreams,

My patients will never leave me it seems.

So I beg for your forgiveness the next time I am running late,

I can only pray that the care you receive is worth the wait.

*All patients are fictional.

Mom, Are You Blogging About Me Again?

Did you know that more than 133,000,000 blogs have been indexed by Technorati since 2002? That is an amazing number. Now regardless of how many remain active is difficult to assess but it does prove that numerous individuals have found the idea of blogging attractive enough to start one. So, why do we start to blog?

The majority of people want to be heard and known. They want to share their life experience as if the more people know about it, the more meaning it will have. Some want to share their expertise and create a stream of income. Yet others want to blog about family, friends or problems. One of the most popular blogs is a young mother who suffered from post partum depression and her airing of problems resonated with a large audience. She now supports her family with her blog.

I started blogging because I find it fulfilling to write, share my medical and parenting experiences, and I love to interact with people in a variety of modes including the internet. Now, many times I do blog about my family and friends. What do they think about this? Well, to tell you the truth my family doesn’t even read my blog. They wouldn’t have a clue that I wrote about them unless I told them. I really don’t mind because the last thing I want to deal with is the possible criticism. “Why did you say that?” “I would have said this…” Blah, blah, blah!

Blogging is a release from my daily reality for me. It is my time to share a funny story and get feedback from a mostly objective audience. Sometimes I will write about something that has lit a fire under me like watching the movie, “Super Size Me.” Oh my goodness, that got me going about the junk we feed ourselves and family, and personal responsibility that seems to have gone by the wayside in much of America. Everything is always someone else’s fault. See, there I go again! 

So, in summary, I blog for me and for you my audience…if anyone is out there. My family may think I am crazy, wasting my time, etc. But the benefit outweighs the possible criticism, at least for me.

Hello There MiM!

Hello everyone! I am new to MiM and looking forward to learning about everyone here. My name is Laurie Marbas and I am a family doc in rural Colorado. I just finished a stint in the USAF and now my family and I are adjusting to the civilian world. We are loving every minute of it, especially the part of no more deploying!

Just a little bit about my family and I. I am married and when I started medical school (go Texas Tech!) my kiddos were 5, 3, and 10 months. Well, now they are 16, 14, and 12. Needless to say I have a few more wrinkles and not sure about the gray hair because I feel compelled to keep the local beauty parlor in business. During med school my grandmother also lived with us. She suffered through breast cancer my 3rd year and a stroke my 4th so I have learned some tough lessons and am looking forward to sharing these with you all. I also have my own blog at http://laughingdoc.com.

Again, thanks KC for the opportunity to share.
LaughingDoc