I was playing a pretend game with my 3.5 year old grandson. The game involved me, as a policeman, him, as a "bad guy", and an imaginary Santa character. At one point he asked me where "Santa" lived and I replied, of course, "the North Pole."
"Not THAT Santa, Grandma, the pretend Santa!"
Playing a pretend game with a pretend character who represents a pretend character. My mind boggles.
I've become reluctantly familiar with the medical establishment. For years, I was, as one of my primary care doctors once joked, "as healthy as a horse." Not anymore.
Over the last several years there has been a shift in medical record keeping, due partly to the increased use of electronic records and partly to patient demands for access to their own personal medical records. With the advent of the Patient Portal test results, visit notes, and after visit summaries are readily available to read, often within hours of the encounter.
One of the terms I've had to adjust to is "patient denies." Every visit requires an assessment, a list of questions about my current status--pain, falls, safety, mood, etc. In the after visit summaries my responses are recorded as "patient denies pain," "patient denies recent falls," and so on. It always makes me feel like the nurse doesn't quite believe me. Sure, she denies pain, but is she really in pain? Why can't they say "patient reports no pain"? Or even better, "patient has no pain." There is an implication in "denies" that seems to say, "there could be pain, but she won't admit it."
Then, as if that isn't disturbing enough to read every month, there are the myriad modifiers available. Extensive, widespread, severe, multiple, innumerable. In one type of scan I receive there is interest in the extent to which various structures have uptake of the contrast agent. Those that do exhibit "markedly avid uptake." Avid, there are avid sports fans, or avid birders, or avid readers. As the dictionary defines it: characterized by enthusiasm and vigorous pursuit : very eager and enthusiastic. Gotta love those eager little tumors!
The one I like, though, is "unremarkable." For the record, I have an "unremarkable gallbladder." And, my kidneys have "no significant abnormality noted." So, there is some abnormality, but it's not significant??? But, I really like "stable." Or, even better, "significantly decreased."
I've debated the value of being able to read test results before meeting with the physician. On the one hand, getting the results sooner can be reassuring and relieve the anxiety of waiting. But, on the other hand, without proper interpretation the reports can be terrifying. About every third word is a medical term I need to google--mesentery, hyperattenuating, hypoattenuating, hepatomegaly, hypodensity, granuloma, atelectasis! I should have a medical degree by now!!
Over the last several years I've taken a few storytelling and memoir writing classes (okay, maybe more than a few) and have become very interested in the role of narrative in shaping our thoughts and feelings. Therapists often talk about rewriting a script or re-framing an event, for instance. Basically they are asking you to change the plot line of the story, imagine different motivations for the characters.
I never took a real literature class in my formal studies, so the idea of the "hero's journey" was something new for me as I started exploring narratives. (Which also may tell you something about the flaws in my educational journey. How could such a basic concept be missed?) There are different ways to think about it or describe it, but the simplest is there is a departure, a challenge, and a return. It can have many other layers and there is a wide body of scholarship on the difference between the male hero and the female, the nature of the challenge, and the type of transformation. You can add mentors along the way, there can be refusal of the journey at first, supernatural forces or intervention, etc. Think about Star Wars, Lord of the Rings, most fairy tales, and Harry Potter.
In storytelling this is often discussed as a good story should have a beginning, a middle, and an end. A key element stressed is that a personal story should show change or growth. "First I was this way, then something happened, now I'm different." I can think of many stories in my own life that fit this model.
But, what about stories that don't work that way. What if a person faces a challenge in relationships, health, career, or some other aspect of life and DOESN'T CHANGE! Was there no journey? Is there no hero? Is it a meaningless blip in life? Is the lack of change itself the transformation? How do we explain or describe that journey?
I had trouble sleeping last night and for some reason my mind went back to a scene from about 30 years ago. At the time, I thought, "This would be a great opening line for a novel." The problem was, not being a writer, I could never form the perfect sentence. Let me describe the scene.
It was dusk and I was standing at the kitchen sink after dinner. Looking out the window I could see three other houses, and though I couldn't see inside them, from each of them I could see a single light from the kitchen window. In that moment I thought about the inter-connectedness of our lives, how many women were standing at kitchen sinks at that moment? How many had stood at those sinks in all the years past or future? It wasn't a gendered feeling, a sense that women were toiling in the kitchen. It was more comforting than that, a sense of timelessness and continuity. But, even then, there was a hint of something else. Loneliness is too strong of a word, but certainly a feeling that I was alone, or solitary.
So, now someone can take those opposing ideas--connection and solitariness and write a novel! I've given you a great start.
Not able to sleep, and still struggling with how I could write the perfect opening scene of my never to be written novel, I wondered out into my 17th floor city view living room. Looking out the windows, seeing all the other lights and activity, but also the dark and quiet buildings, I was reminded of how we go through life surrounded by people, connected to and loved by many, but still alone.
Sounds way more depressing than it felt! Which is why I'm not a writer.
I live in Chicago and make frequent trips to Northwest Indiana. The trip is pretty straightforward, expressway nearly all the way. I have two options--use the Illinois Skyway and Indiana toll road, or use the Dan Ryan and Bishop Ford expressways (note that now that I live in Chicago I no longer use highway numbers, like 94 or 90 or 80, that's just not how we do it here!) On a good day, the trip on either route can take as little as 42 minutes. On a bad day, it can easily be 90 minutes or more. Generally, the toll route is faster, but costs about $8 one way. Before leaving either Chicago or Indiana I use my map app to get an estimate of the time for each route. If the non-toll option is less than 8 minutes longer, I will take it. If the difference is more than 10 minutes, I take the toll route.
What to do in the range of 8-10 minutes? Clearly, my time is worth somewhere between $1.00 and $1.25 a minute and , but exactly where? I've found that in that range I begin to consider the time of day, the amount of daylight, the weather, and how likely I am to run into an unexpected delay once I start on my route. Occasionally, I have even taken the longer, non-toll route if I'm not in a hurry, it's a sunny day, and I feel adventurous. But, even there a limit exists. I can think of no situation where I would take the non-toll option if the time difference was 20 minutes or more.
Similarly, I work out a few times a week at a gym located about a 20 minute drive from my apartment. Within 2 blocks of the gym there is free on-street parking. Right in front of the gym is metered parking which costs about $3.00 for an hour. Generally, I park on the free parking street, but if the weather is bad, I'm late or tired, or just cranky, I pay to park.
The moral of this story, everyday we make minute economic decisions which make very little economic sense.
I've been thinking lately about what is meant by the term"normal."
It first occurred to me when I was looking at a set of lab results from a blood test. For every thing tested there was a "normal range." Noticing that a few of my readings were outside of that range I queried my doctor about whether I should be concerned. "Oh no," he replied, "We don't worry until the number reaches X." In this case X was a number waaay higher than the top of the normal range. So, normal is all relative. There is "normal" and there is "higher than normal" and there is "concerningly higher than normal."
I've been spending a lot of time in medical offices over the past year. I think hospitals, clinics, and doctor's offices could use a good systems engineer.
At one office I go to a treatment center and then have a follow up visit with a nurse practitioner. When I check in at the clinic they affix a label to an index card that I am to pass on to the NP check in desk. Why? Who knows.
At the oral surgeons, I check in and they give me a tiny piece of paper that I am to give to the dental assistant who calls my name. Why? Who knows.
At radiology, they no longer call for you by name after checking in, but give you a little ticket just like the ones you get at the supermarket deli counter. The assistant comes out and calls for "605!." However, if nobody answers, they follow that up with "Smith?" I suppose they could look like raffle tickets. Which is better, "I'd like a pound of sliced liver," or "Hurray! I won a CT scan today!"? At least they don't have that little digital display you anxiously watch count up to your number, "Now scanning number 237."
Of course at each of these offices they ask for my name and birth date at check in. Given the need to speak loudly due to masks and the open seating, I can tell you the age of every other person sitting in the room. So much for privacy there!
It is amazing that in the day of high tech, the patient is still carrying around these little slips of paper. When my father was staying at a rehab institution, all medical records were conveyed by fax. Are medical offices the sole remaining users of fax machines?
