Daily Vignettes: # 1 Meds & Alcohol

I wish I could find the perfect story to illustrate why this job is such a trial. I guess it’s not so much any one, single thing as the accumulation of episodes like the following. I’ll give you three vignettes, each increasing in length, and ending – thank god – with a life lesson. Ha! (Since I’m posting all three at once, I’m also posting backwards so you can more easily read them in order. Hope that doesn’t blow your mind!)

# 1 Meds & Alcohol - Do Not Mix!
Walked into the clinic this morning and the office manager’s office – which patients must walk by on their way into and out of the clinic – is stacked hip-high on two walls with cases of beer and wine. I understand she’s planning the Grand Opening party for the new location tomorrow, yet I’m hesitant to deem this appropriate alcohol storage at a medical clinic.

# 2 Red Tape, or I’m A Rebel Like That

Talking on the phone with a patient who was frustrated because he’s been jumping through insurance-related hoops for the last two weeks, I was empathizing and brain-storming ways I could help him.

Then he says: “I’m just not used to all this red tape.”
Me: “I understand it can be very frustrating.”
Patient: “That’s not it at all. It’s just that I’ve spent my entire career cutting through red tape – I’m a rebel like that! – and it just blows my mind these processes you people have. I could’ve made this happen so much faster, but that’s just me – Mr. Joe Blow – cutting through red tape. You do what you gotta do. I’ll just sit here and wait on you.”

Pet Peeve # 1: “You people.” May I have the grace to never lump people into groups just because I’m frustrated.
Pet Peeve # 2: Implying you could do my job better than me. Take it already. I’ll give it to you. It sucks, believe me, and you’re not helping.
Pet Peeve # 3: Make me feel guilty. “I’ll just sit here and wait.” Yeah, you will.

# 3 The Life Lesson, or Why I Will Not Yell at Old Ladies

Another phone call, same day. I had a 9 am appointment scheduled with a diabetic patient to teach her how to use insulin vials. She’s been using fancy-new-technology insulin pens (easier to administer than vials), but her insurance won’t cover those frills any longer. The patient did not show up for her appointment, and when I called her to reschedule, this was our conversation:

Patient: “I’m not coming in. I’m not switching insulins.”
Me: “But your insurance won’t cover these pens anymore so this could get expensive for you.”
Patient, voice rising: “You tell that doctor that I’m not switching.”
Me: “Ms. Doe, the doctor is the one who asked me to call you and teach you about the new insulin administration method.”
Patient: “I’m. Not. Switching.”
Me: “Would you be willing to come in and just talk? I can show you how it works – it’s really not hard, I promise. We’ll try it together.”
Patient, forcefully: “Why aren’t you telling the doctor what I told you to tell him? You need to go tell the doctor that I won’t switch. I’m not talking to you anymore.”

At this point, I actually lost it. I lost control of the tone of my voice. I said – and I was dripping sarcasm:
“Oh, OK, Ms. Doe, yes ma’am. I will go tell the doctor, right away.”
Patient, barking: “Then you call me right back.”
Me, with a sudden-onset Southern drawl: “You bet I will. Buh-bye.”

And I hung up. That last goodbye was the most sing-song, saccharin farewell I have ever in my life said, and I did not mean her well. I have never lost control like that before. I’m lucky she’s hard-of-hearing and thick-of-accent because I doubt she caught my scathing intent. I’ve always prided myself on being able to meet sour with sweet, kill with kindness, and all that. Lately, I just want to get in a yelling match and be done with it: “OH, YEA, OLD LADY? IF YOU SPENT HALF AS MUCH ENERGY EATING RIGHT AND EXERCISING AS YOU’VE SPENT BEING A BITCH TO ME, YOU WOULDN’T NEED INSULIN!!! Lazy bitch.” Am I a terrible person that I find that rant to be so satisfying?

I do realize that this woman is scared and overwhelmed. She’s poor, she’s isolated, she can’t drive; even something so simple as stopping by the doctor’s office is a daunting task. All these things added together probably mean she feels attacked by this change. She has this one thing that she’s comfortable with, and though it seems small to me – it’s maybe two extra steps to change to this new form of insulin – it’s huge to her. It disrupts her entire sense of order and control. And maybe she’s so exhausted from her life and from her illness that she can’t distinguish between feeling angry at her life situation and feeling angry with me. I’m just the life situation that pushed her over the edge today. I know all this, but in the middle of that phone call, I also felt attacked and overwhelmed, and I reacted just as aggressively as she did. This tells me something that you could’ve probably already told me years ago: I should no longer pride myself on my control over my emotions. Maybe that wasn’t such a great thing to feed my ego on, anyway. Maybe it’s time to admit that I am not a bot, that I have feelings that come in all shapes and sizes, and that they all – good and bad – need an outlet.

I promise I won’t take up yelling at old ladies as my outlet.

Oh, Brave New World That Has Such (Young) People In It

I went to a gym today to find out about membership. I knew, walking in, that I was about to get my socks enthused off - you know how cheery and confident those places are. And it's sort of like buying a car: they hate for you to walk out the door without a purchase. Fortunately, I had the I'm-on-my-lunchbreak excuse, so I kept rushing my enthusiastic salesperson along.

Karyna! (the exclamation point was not on her nametag, but it might as well have been) took all my info ("This is so cool! I'm really glad you're here today!"). Karyna! enthused about my body age - "Because of your great health, your body age is only 3o!!" (Really?? I take such good care of myself that this came as a bit of a disappointment - surely my body is still in its 20's??!) Karyna! walked - or more appropriately, jogged - me through the different fitness plan options.

Best of all, Karyna! was also a high-fiver. As in, "High five! Your BMI rocks!" And also, "High five for getting a great start to the new year!" And finally, when I tried to shake her hand and thank her on my way out, "High five! I don't do handshakes - too formal!"

My body age may be 30, but that experience sure made me feel like a spry granny.

Bitch Confessions

Sometimes I can be - as in I am allowed to be - a bitch.

I work with a very self-centered doctor. Self-centered to the extent that he sees no problem running 1 1/2 or 2 hours late to see patients. Self-centered to the point that he demanded the office manager take down all the clocks in the lobby and in patient rooms so they wouldn't know how late he's running. He is a short man, with disconcertingly small hands, and - appropriately - he throws tantrums on a Napoleanic scale. In his social interactions, he functions at approximately toddler-level: cute and cuddly just up to the point where he doesn't get what he wants, then melting into a screeching, spitting puddle for his nearest caretaker to clean up. Because that's what his staff do - caretake. They pad his world to insulate him from whatever might push him tantrum-ward (it works maybe 50% of the time); they run interference with patients ("Of course, the doctor is here by now."); they agree to take down all the clocks!

Right around the first of December, I decided that I didn't need to pander to this guy any longer. My tail will not wag to please him; my tongue will not loll as I pant my obeisance. I don't like the job anyway. What's the worst that could happen? I might get fired? Oh no.

This non-pandering is not an easy task for two reasons:

• First, I am a people-pleaser, so this is an unnatural response from me. I give everyone the benefit of the doubt; I go out of my way to put others at ease; I never ever have clever, cutting comebacks because that would be mean. (Or, more truthfully, I only think of them after hours of agonizing.)
• Second, for whatever reason, the good doctor does not subject me to his fits of infantility. Daily, I overhear him treating his staff like so much chattel and my jaw clenches, but then he's on his best behavior around me.

Despite the struggle against my true nature, finally, an opportunity: two days before Christmas, he came into my office to tell me what education points to revisit with the next patient. As he's looking out my window, he suddenly says, "I just had a weird vision of myself hanging from one of those trees." "Oh," I sputtered. "Well," I faltered. And the rally: "I guess that's one sort of Christmas decoration." His jaw dropped. He laughed sharply, only once. He walked out of my office.

Sweet, snarky triumph #1.

Adventures in Meditation

I have long flirted with the idea of meditation. The more I read about the brain and about meditation and meditative states, the more I believe that meditation can affect profound change in body and mind. And I love to read about meditating because it’s so much easier than actually doing it! But reading about meditation is often discouraging because authors say things like, “Close your eyes and clear your mind. Visualize breathing in love and compassion…” Screeching tires, smell of burning rubber – you lost me at “clear your mind.”

I had a hesitant conversation about this with my fellow teachers-in-training at a weekend yoga workshop last spring. We were talking about meditation and breathwork, which is a specific form of meditation emphasized in yogic practice. Me: “So when you’re focusing on your breath, how do you clean out some of the clutter?” Them: “You clear your mind.” Me, trying a slightly different angle: “But how do you do that? My mind is so full of words that clearing one thought just makes room for another which reminds me of the first word, and so on.” Them: Silence. Me, one last hurrah: “So when you focus on your breath, your mind stays there?” Them: “Yes.” Either they are blank freaks of nature, very advanced meditation practitioners, or liars. I simply cannot believe that I was the only person in that room dealing with a mind mess. (This is obviously an oversimplification. I’m sure if I had been braver and kept digging at this topic with my classmates, we would have discovered common ground. I do not truly believe they are blank freaks or liars, I promise.)

Over the summer, Chris and I went to an Intro to Meditation session at a center that practices vipassana meditation. Vipassana meditation uses the breath as a way to get past the breath, if that makes any sense. You start off “noticing” the breath, and then you just find that you stop noticing it and voila! you’re meditating! If this description sounds unsatisfactory, believe me, I agree. Here were the instructions from our instructor: “If thoughts arise, label them thoughts and let them go. Think, ‘Thought,’ and release.” (I envisioned a sort of humane, spiritual fishing expedition with thoughts caught like fish and set free.) After 10 minutes, we stopped to check in with each other. Chris reported, “I found myself thinking and labeled it ‘thought.’ Then I wanted to label that act of thinking ‘thought’ as another ‘thought,’ and so I was repeating ‘thought’ ‘thought’ ‘thought.’” He asked, “Is it like a mantra?” Instructor: “Oh. Well. Now, I’m not judging you, but that’s really not how it’s done.” Chris: “OK, but how?” Instructor: Silence.

This overactive mind is referred to in many traditions as “the monkey mind,” a grasping, hooting beast of a brain. Before I learned about monkey mind, I thought of my mind as a puppy – eager and full of energy, but still peeing on the carpet. “Sniff, sniff. That smells great! I wonder what it is? Hey! Who’s that? What are they doing? There’s my dad! I’d better go see – What? That smells great!...” Unfortunately, my first reaction to my puppy mind was training of the choke collar variety: yank and yelp. If my mind wandered once, zing!, “What is wrong with me? Focus on the exhale, dammit, the exhale!” If it wandered twice, ZING!, I was in tears: “I can’t do this. Why even try? What’s the point?” Third time, kick the dog and walk away. It’s no wonder I never progressed further than the yanking and yelping. All I learned was to avoid the stimulus.

What a relief – reading about monkey mind – to find I wasn’t crazy! Ancient yogis and Buddhist monks, far along in their meditation practices (much farther than me or my puzzled yoga classmates), knew exactly what I was going through. But still, after the initial relief of learning I was not alone with my monkey-puppy mind, I had trouble finding a satisfactory answer as to how best to restrain or re-train it. There is a very good reason for this: there is not a satisfactory answer out there, if by satisfactory you mean – as I do – clearly defined. There are no directions to Destination Mind-At-Rest. There is no map to tell you, “Turn right where your sadness dead-ends into depression and then keep going until you see the sun rising over your new thought patterns.” All of this reading and all of this putting-off-meditating-until-I-know-what-I’m-supposed-to-be-doing, and on comes the lightbulb: I have to stop thinking about this and just do it. Nothing can happen until then.

So here is my advice – not as an accomplished meditator or as someone who has lived in a cave and found the meaning of life, but as a novice, clumsy and often discouraged – on one way to begin a meditation practice.

• Find something – anything! – to help you focus your mind. Maybe the catch-and-release model works for you: think “thought” and release. Maybe you can focus on the sensation of breathing in and out. Maybe you can stare at a blank wall or piece of paper. Maybe a mantra would be helpful in replacing some of the mind chatter. Some practices believe you should just sit without using the “props” of mantra or breath to focus on. Again, I’m no expert, but in my brief experience, you’re more likely to stick with it if you’re not maddeningly frustrated the whole time. Ultimately, yes, you want to meditate “prop-free” and experience a quiet space without mantra or external focus, but whatever it takes to get you there is OK, in my oh-so-humble opinion.
• Be comfortable. You don’t have to sit in lotus, or even sit at all, to meditate. Ancient yogic texts advise that you should be comfortable enough that you can (someday!) forget about your body, but not so comfortable that you fall asleep. I sometimes practice lying down if the prospect of sitting up straight seems overwhelming. Or I’ll sit in a chair if I don’t want to creak down to the floor on a stiff day. Whether you’re sitting up or lying down, take care that your spine is straight and your head balanced atop your spine. Sitting, reclining, it doesn’t matter so much how you do it as that you do it.
• Do it, already. Tell yourself that you will sit for x minutes daily, and then sit for x minutes daily. If you miss a day, don’t throw in the towel or label yourself a failure, just come back the next day. Choose a small amount of time for starters. Believe me, 5 minutes seems an eternity when you’re used to always doing. So if it’s 5 minutes a day, great! If it’s 2 minutes, fantastic! Just pick something you know you can stick with for awhile. (21 days to a new habit, as Ashley swears.)
• Keep doing it!! This is the hard part. For the last month, I have committed to 10 minutes of meditation every day. I’ve refused to expect myself to clear my mind or label thoughts “thoughts” or transcend anything. I call this “My 10 Minutes,” as in, “Chris, I’m doing my 10 minutes, so don’t call me for a bit.” And I sit, or I lie down, whatever my body wants. Some days the 10 minutes fly by and I wish I had 10 more. More often, I find myself waiting for the 10 minutes to be over. That’s OK. My mind isn’t used to this rigorous practice of quiet, and it will take awhile to relax into a period of time when nothing is expected. This week I noticed that, even on the days when I’m waiting to be released from my “sit/stay,” I’m a little sad when the alarm goes off. “Good girl!,” I tell myself, "What a good puppy! Let’s do this again tomorrow!”
  

One last word of encouragement from the Bhagavad Gita: “On this path, effort never goes to waste and there is no failure. Even a little effort toward spiritual awareness will protect you from the greatest fear” (Ch.2, v.40). Whatever you have to give, give it. Whatever there is to invest, invest it. There is no failure, here.

Feeding Skelton

Tom Skelton is my favorite character in one of my favorite books, Ray Bradbury’s The Halloween Tree (read it!). Tom Skelton is also our youngest cat, our sweetest boy, our gentlest boy, our ‘fraidy cat. Our Tom Skelton was diagnosed with severe liver disease this summer, and we have been see-sawing with him ever since. His prognosis is “precarious,” according to the Internal Medicine vet. (I never thought I’d be a specialist vet consumer, but when it’s one of your babies, there’s not a second thought.) He will never be completely well; his liver enzymes will always need to be monitored, and he will be on medication – of one sort or another – for the rest of his life, which Dr. Theissen says will probably be shorter than we hope. He turned eight years old this year.

All of this since June. Before June, Skelton was the Easy Cat, the Healthy Cat, the Low-Maintenance Cat; unlike his brother, Gans (aka Hell Cat), who has urinary tract issues and eats a special diet and has never been too shy to assert his desires and dissatisfactions on the world. Gans swaggers down the dividing stripe on the highway of life believing he’s entitled to the most, the best (and he is!), while Skelton tiptoes along the shoulder and sneaks in his love and affection from the periphery (despite his self-effacing nature, he is also entitled to the most! the best!). It’s a personality thing, you know; we adore them both.

One of the struggles of having a cat with liver disease is making sure he continues to eat. Cats – unlike people or dogs – can’t go for long without eating; it damages the liver. And cats with liver disease are often nauseated and have decreased appetites.

I am not a morning person. Used to be, my mornings looked like this: curse the alarm, stumble to the kitchen, dump food in the cat bowls, walk away, wash face, get dressed, etc. But that one small piece of routine – dump food in the cat bowls, walk away – has stretched into a lengthy, sometimes frustrating 30-45 minutes of coaxing-Tom-to-eat. Skelton’s liquid medication – an anti-inflammatory – must be mixed with just the right proportion of his preferred wet food (we serve flavors in weekly rotation), a smidge of dry food, and a small spoonful of tuna juice to make a tasty sludge. Skelton used to be an indiscriminate eater (Gans still is!); this pickiness is new for him, and for us. Usually, after offering Skelton the medicated sludge, I can bustle around the kitchen, making tea and putting my lunch together, paying only half a mind to Tom. But once he finishes the appetizer, I work (and work hard!) to see he eats as much more as he’s willing.

Skelton is an anxious and distractible cat. Rush him and he walks away. Get frustrated with him, start moving too quickly or loudly, and Tom hunkers down in hide-me mode and shuts his eyes – “I can’t see you, you can’t see me!” In order to get him to eat, I once again prepare the perfect concoction of wet-dry-tuna delight sans medication, and I sit on the floor next to him, sometimes petting him, sometimes talking to him. I watch him eat and every bite, I feel nourished somehow, somehow stronger. I feel joy sometimes, watching Tom eat, even when he mouths a bite and spits it back out, even when he crunches over the floor and leaves crumbs. I love his careful, thoughtful process: pick up a piece and hold it on the tongue, spit it out, try another, find the perfect bite to actually chew, swallow, study the bowl, re-approach the bowl from a different angle, begin again. I don’t know why he does this, why he doesn’t just scarf the meal like he used to. I don’t know how much he would eat if I weren’t there – is he eating to please me? Does food taste different than it used to? Why does the food taste better after I’ve touched it and offered it to him between my fingers? Is he not hungry? Is it nausea? I don’t know, but I’m growing to love my early mornings with Tom, sitting by his little (9 lbs and holding) black self, stroking his coat – which is not as luxuriant as it used to be, running my hands along his bony back, and coaching him, “Eat, papa, eat! No one wants a skinny Skelton!” Reminding him how he used to love to sprawl on his back and flaunt his fat belly. I am not a morning person, but mornings with Tom are lovely; every bite a moment to love him longer.