47. Belly Dancer

L. is 42, divorced without children. She presented with abdominal pain. There was no associated gastrointestinal symptoms, no urologic issues, but her current menses, tho light, had been ongoing for 3 weeks. At our first visit, the exam and her membership in a belly-dancing troupe suggested a "soft-tissue" injury, that is, a problem associated with trauma to muscles, tendons or ligaments.

Over the next three weeks, we proceeded through a number of blood and radiology testing, the final an abdominal CT scan; all normal. At our last visit, I decided to start over with a history and exam.

When asked about stress factors, she describe multiple sources:
1. Work difficulties: called to task for being slow when from her perspective, she is just doing her job ("courtesy bagger" at Safeway). She worries that she is being set up to be fired so that she can be replaced by a lower wage (less senior) new employee.
2. Estrangement from family; her father died last year and her sisters didn't even tell her about it.
3. Financial difficulties.
She finally acknowedged that her current pain may be associated with one day when she had push a large number of grocery carts from the parking lot to the front of the store, a sudden stop jamming the cart handles against her abdomen. She has not returned, and has not answered by follow-up calls.

46. Intelligent Design

This morning around 3:30 while I was watching 9lb 6oz Gary trying to figure out an exit strategy with the help of a determined mother and a patient midwife, I decided that anyone who believes in "intelligent design" must never have witnessed a human childbirth, or if she/he has, it's been totally erased from conscious memory. I can understand how the pressures of natural selection could lead to such a strange means of reproduction, but as a thought-out, planned-in-advance design by a superior being? Nope.

45: Resistance Is Futile

From an office email I received last week (I'm not the one being addressed, I just happen to be on the mailing list):

"... good to run into you last night. You discussed with me that you were experiencing some resistance to standard deployment of the tools of [new program X] into your department as well as some concerns from some of your colleagues that movement upstream to primary care may cause problems…

As we discussed our job is to understand that resistance and work with our teams to move through it adjusting our strategy and work as appropriate based on their good thinking."

When I find myself in a room with these people, I don't know what to say, it's like I'm listening to a foreign language I learned in college. Sure, I recognize a lot of words, but I have no idea what is being said.

44:OK, I Believe You

T. presents with pelvic pain. The abdominal exam with its initial gentle palpation that tries to localize the pain and estimate its strength, was, frankly, unimpressive. T. must have sensed this; without warning she grabs my hand, pulling it deep into her abdomen. After a long 30 seconds, she lets go and assumes a semi-fetal position, tears streaming from pain. She explained that she just wanted to demonstrate the pain.

43: Thanks

received an email today:

"Thanks so much Dr. H. Enjoy your Easter Weekend."

Illness can make it hard to see a caregiver as a person, especially when we don't have much to offer (which happens more often than I want to admit), so when someone breaks through and says thanks, well... what can I say but thanks in return.