Travelogue

I understand that when a young adult plans a trip to Europe, everyone tells them to keep a journal. The advice to write it all down is bordering on cliche. The thought, I guess is that you will change so much and have such a fantastic time that you will never want to forget it. So I understand. I've never been to Europe.

I keep wondering why I even bother committing all of this to metaphorical paper. I feel like I'm doing a lot of whining and really, do I even want to remember this time of my life? I tend to write to process and I always had trouble writing about those experiences that were fun, but not terribly thought-provoking. And I always had too many fun things to do on vacations to write a lot. Then, today it hit me. This trip has more life-changing potential than visiting another country, even if you backpack.

Theoretically, I could learn a lot from this experience and become a better doctor. Or I could completely fall apart physically and emotionally and never doctor again. Either way, should be an interesting story to tell. And god knows, I've got enough processing to do.

Wanton Self-pity

I'm feeling bad for feelng sorry for myself.

The socially-conscious part of me keeps saying, "You know, this is an opportunity that people living in poverty all over the world do not have. this surgery isn't even available to everyone in our country, let alone developing countries. Grow up, pull up your big girl pants and answer the fucking door when opportunity knocks."

Then, the spoiled brat hiding not-so-deep within stomps out, slaps that hippy-dippy flake, storms back into her room and resumes crying. She feels like she should get a chance to mourn for the life that she went over $200, 000 into debt to acheive.

I'm sticking with the brat on this one.

Expectations, Readjusted

I'm becoming someone else. It sounds dramatic, but I can't think of another way to say it any better. Let me explain.

I was told as a teenager that my hips wouldn't make it past about 50 years old. When you're young and active, that's easy to dismiss as something that happens when you're old. Now, I'm not so young and activity hurts. So I lose weight, thinking that being heavy is causing the pain. The pain gets worse. So I go to the doctor. And they tell me that X-rays and MRIs look good. Sure, I have hip dysplasia and some femoral deformity, but nothing that looks like it needs to be fixed. Again, it is easy to dismiss the threat of early arthritis.

Then, the surgeon pages me to tell me he thinks that he can fix the pain and delay the hip replacement. But he reiterates that even with this surgery that he is recommending, my left hip particularly won't be my natural, God-given joint by my fiftieth birthday.

I have managed, over the last fifteen or so years to ignore the hip replacement in my future. I have cycled and skiied and hiked and swam. I have never had any plans of stopping these things. I always saw myself growing old as the lady who everyone in the neighborhood shakes their head at affectionately, because she's still riding her bicycle to the grocery store at age 80. Probably wearing a funny hat.

Now, in my post-phone-call-with-the-orthopedist world, I'm not going to be that little old lady. After a hip replacement, there will be no skiing or skating for fear of falling and dislocating the hip. There will no hiking, since that will wear out the joint too fast. I can ride my bike to the store, as long as the road there is completely flat and I don't buy anything when I get there. I will be able to swim, so now I see myself as the little old lady who everyone shakes their head at because she still wears a bathing suit.

The crux of the issue for me is that I have to change what I'm expecting out of life. The whole rest of my life. I chose a career that demands that I stand, walk and run when necessary. After a hip replacement in a young person, failure of that joint is anticipated, since the joint doesn't have as long of a lifespan as the patient. In that case, it may get to the point that I can't perform my job adequately. Does anyone expect themselves to be the person who has to stop working and go on disability? Of course not. I want to retire, because I had a fulfilling career and it is time to focus on other things. I want it to be my choice. It very well may not be.

As I settle into this new future that I should have been (but wasn't) expecting, I find that I can see myself finding peace with it. It's different than what I thought my life would be, but I can start to see how this life might be okay, too.

That being said, I want to ride my bike a few years longer.

Does this thing open in the back or front?

How do you stop being a doctor? When it's time to walk into a medical office by the front door and ask someone else's opinion on a problem with your physical engine, how do you lay aside the whole language and culture to step into the shoes of the guy who sits in the chair that doesn't spin?

I'm currently staring down the barrel of major surgery. An orthopedist, whom I trust, thinks I may need my pelvis broken and realigned to delay hip replacement. But he is trying to be neutral and leave it up to me. He gave me the information (He referred to it as "realigning my expectations.") and asked me to do some research. Another physician, a friend, whom I also trust, in Sports Medicine, thinks that I should get a second opinion.

In fact, every physician I have talked to about this has a opinion. And they aren't shy about sharing them, even with limited information. This is not a common surgery or even a common problem, so it's not like everyone I mention it to understands the intricacies of hip dysplasia in the adult and corrective surgery for it. I guess it's a product of how the medical system has raised us into big, grown-up doctors. We're too used to sharing our opinion, informed or not. And we assume that the person in front of us is interested in what we think.

Add to that the fact that even a family doctor, like me, who avoids to operating room as if it were covered in capsacin can imagine all too well what it might mean to have your pelvis cut apart to the point that the hip socket is free-floating and then may be screwed back into place. We can picture the incision, the osteotomes, the blood loss, the ICU stay, the clot risk, the weight bearing restrictions. And most doctors want to ask about those things. And discuss them, in gross and fine detail. They ask intellectual questions about the interestingly rare problem and procedure in order to learn more. They don't think about the immediacy of the issue for me, the interesting patient.

So who do you talk to? Laypeople often don't understand the magnitude of what I'm talking about. I've gotten a lot of "Yeah, my grandmother had a hip replacement." But it's not a hip replacement. And I'm betting your grandmother wasn't 31. Which is a large part of the problem. It's not that simple.

Part of me- greater than 50%- wishes that for this, I could just return to laymanship. I want to not be able to imagine what is going on after the anesthesia kicks in. I want to not know what questions to ask, so that I can't get the utterly terrifying answers. I want someone to just say to me, "I have the expertise in this area, so let me make the decision." Because as it turns out, I don't have expertise in this area. And I don't know that I can make a decision. I certainly can't make an objective decision. And I feel like every new opinion makes me doubt my previous resolve.

I don't know how to lay aside a lifestyle that encompasses my work, home and social lives. I don't even know if laying it aside is the right thing to do. I just know that sitting on the exam table, when you're used to the rolling stool, is pretty uncomfortable.

Paranoia

I used to spend a good portion of well child checks inwardly rolling my eyes at the parents. I love kids. I think that well child visits are a great way to get the families in to the office to talk about prevention and screen for serious stuff that goes on behind closed doors.

What always killed me was the questions. Mom will have heard from her sister/mother/neighbor/appallingly inaccurate Internet source of an outbreak of listeriosis/autism/influenza/bubonic plague and they are now convinced that little Jimmy (OK, these days it's more likely to be little Jayvon) has contracted said disease. It doesn't matter that Jayvon has never been ill a day in his life/missed a developmental milestone/sneezed twice in a row/been a serf in medieval England. Nothing I can say at this point can trump Aunt Tilly/Mom/Ms. Jones/www.wrongdiagnosis.com (Sweet Jesus, save me from wrongdiagnosis.com!). Which brings up the intriguing, but ultimately irrelevant question of, "If I can't convince you otherwise, why are we even having this conversation?"

Then, the inevitable happened. I popped out one of my own. At various points in the past two years, I have been convinced that my child had measles, pyloric stenosis, Kawasaki disease, and a tail. Granted, that last one was before she was born.

None of this can beat the things that my husband, also a physician, can come up with when pressed. The same man who has repeatedly talked me out of emergent trips to the hospital readily acknowledges that he performs an extensive abdominal exam on our daughter every time he bathes her, just to make sure that no tumors have snuck in under the radar overnight.

When I was twenty weeks pregnant, we both managed to get out of work at the same time for our prenatal ultrasound- a feat that has yet to be repeated. Seriously, I delivered the baby on a weekend that he just happened to not be on call.

We debated beforehand whether or not to tell the technician that we were medical personnel. There are a number of studies that show that if you get treated as a VIP, you are more likely to received sub-standard care in the name of respecting your privacy or honoring your wishes. Our cover was probably already blown by the scrubs covered in mystery fluid that the father of my fetus was wearing. Any residual doubt was eliminated by his first words upon seeing his first-born:

"Oh, good. It has a brain."

Maybe my imagination is sub-standard, but nature has certainly invented fates that are infinitely more terrifying than anything I could have come up with on my own. Having studied embryology, pathophysiology and pediatrics gives those fears the power of realism and crystal clarity. What I underestimated was the extent to which I would worry about this soft, breakable creature with half of my genes.

So, part of me understands why parents are scouring the neighborhood, the Web and my office looking for The Answer, that horrible answer that makes all their kids' symptoms fit into the puzzle and delivers the crushing blow that they really are losing their soft, breakable little creature after all.

And part of me wants to shake those parents. I want to say, "Look. I'm stuck with this knowledge. My kid gets poked and prodded far more than necessary because of this knowledge. Relax. Let me worry for you. That's why I'm here." When I think that way, I start planning my charge on Congress to form a moratorium against all information on the Internet and a gag order for Aunt Tilly.

Here's the thing:

I've never been a feminine woman.I cringe when I think about the extent that I went to in college to fit in with the Southern girls. I spent money on clothes. I lost weight in entirely unsafe ways. I flirted and primped and practiced my walk. I, oh God, joined a sorority. Granted, it was the agriculture sorority and not exactly filled with fashion plates, but still. I wonder now what people must have thought of me. I figure that it was somewhere along the lines of, "Who is that drag queen and where did she buy that awful lipstick?"
And after all that, it didn't stick. As soon as I got into medical school, I got bsy and the backslide began until I find myself here. All I have to show for those years is a cringe-inducing set of memories and a tendency to avoid Wranglers.
In the course of a day, I frequently get mistaken for a nurse, social worker or the girl who brings lunch. Seriously? I'm wearing a white coat, stethoscope and patently not carrying a tray of food. I just asked you intimate details about your bowel movements- which, by the by, you answered. Somehow, these social cues escape most people's attention.
Interestingly, it's usually the women, and not necessarily older women, who assume that I cannot possibly have made it through the requisite schooling to be their physician. The breasts, you know- they prevent your arms from moving far enough toward midline to dissect things or read books.
Not that I disagree. I frequently wonder how I ended up with other people's life or death decisions on my hands. I have trouble getting dressed and making to my car without a near-fatal accident. I almost brained myself on the coffee table this morning because I tripped over the hem of the pants that I just bought on sale and swore that I would shorten before wearing them to work.
It's a never-ending gauntlet to be a woman doctor. Especially one who's hair resolutely refuses to go grey. Not that I want to get old, but it would be nice not to have the following conversation four times a day:
Me: Good morning! I'm Dr. Smith.
Patient: Hi. When did you say the doctor was coming in?
Me: I am your doctor. Dr. Smith. It's on my badge and everything.
Patient: Oh! Sorry. You just look so young. How old are you?
Me: Older than I look.
Patient: They just keep getting younger, don't they Bob?
Bob: Yup. They just keep getting younger. How old did you say you are, sweetheart?
Me: Old enough to be your doctor. How about that rectal bleeding you've been having? That topic sounds significantly less uncomfortable than this conversation.
If there's one thing that I hate more than the joke about asking their grandson to prom, it's being called sweetheart. I don't look like a sweetheart. I don't act like a sweetheart. Calling me sweetheart is only acceptable when used ironically. Unfortunately, in this area of the country, there is apparently a rash of incurable ironopenia.
The truth of the matter is that people don't want to admit that they are sexist and assume without thinking that doctors are big, manly men and nurses are women. I thought, going into this whole thing, that my inability to dress myself and total lack of makeup or hairspray would cancel out that big, fat assumption.
I am proven wrong every day.