I am just doing my job

This past week as I called my patients to do office visits either by telephone or video, I was so struck by the gratitude they express. One patient thanked me for being concerned about him and calling. They think these visits are special especial in this trying time. I want to say, “I am just doing my job, no need to thank me,” but I don’t. I am frustrated about the technical difficulties that occur when they can’t download the program for a video visit. They apologize, but I want to say, it is not your fault, it is ours. We’ve allowed this technology divide to prevent many from being able to benefit from this technology. We should have moved ahead with these platforms, and when people came to the office, we should make sure they all have smartphones and have our Apps downloaded. We needed the Tech team to meet each patient at the door, but we didn’t, and we failed our seniors. They are the ones we could have helped more. Why do they always have to come to our office? They would benefit from these video visits. Imagine a virtual picture of their home and to make sure they are safe.

I really don’t need a pat on the back for just doing my job. Doing it well was what my grandmother always instilled in us. You must be “ten times better to get 1/10 of the recognition”. We failed our patients when we didn’t help them embrace technology and health. We failed when we didn’t ensure that being healthy meant having a smartphone or a way to connect to their doctors. Also, we allowed many of their grandchildren to be in schools that now can’t provide them with Ipads or laptops at home to do their homework. These wired kids could have passed on their knowledge to their grandparents.

I completed the phone visit with one of my seniors, and she said, “I will be so glad when this is over so I can see you. Please take care of yourself.” I wished I was there to set up her phone so I could see her face.

America should not be lulled into patting someone on the back when all they are doing is the job they are supposed to do. Unfortunately, it was delayed because of politics, failure to listen to experts, and arrogance. Now, hold us responsible for making sure going forward; we are forward-thinking, innovative, and compassionate. We need to make sure that insurance companies do their job and help their patients. We need to make sure all Americans have health insurance, and they have access to health care that is responsive to their needs.

The truth is that our finest moments are most likely to occur when we are feeling deeply uncomfortable, unhappy, or unfulfilled. For it is only in such moments, propelled by our discomfort, that we are likely to step out of our ruts and start searching for different ways or truer answers.  Scott Peck

What a Day!!

Patience was never one of my virtues, as I have stated so many times in past posts. I think I am even more impatient now. Each day feels like it is 100 hours. By the time you finish notes, answer phone calls, and deal with all the emails; you are exhausted. Truthfully, we have just begun this battle with COVID-19. It is touching every person I know. Patients are talking about friends and family members who have lost someone from the complications of this virus. They are young and old. Many of my patients are African American. It is affecting our staff and family members of our colleagues.

I am not sure what the toll of this virus will be on our community, but if you read the experts, it will be extensive. We were dealing with health care disparities and lack of primary care to meet the medical needs of African Americans, Latinx, and Native Americans before COVID-19. Now, it will become more apparent about the lack of primary care for these vulnerable populations. The Emergency Rooms are not the place to go currently. People need to be able to reach out to their primary care doctors to get guidance and help them navigate how to care for themselves at home. That is all I did this morning. I arranged for a patient who is a high risk to get tested. She should not be in an ER but only need to do the drive-in testing. For the drive-in testing, you need an appointment, which would mean having a primary care doctor to get a referral. Some sites do not require a doctor but do require you to schedule an appointment.

My highpoint came during dinner because my husband made my favorite fried oysters. I ate my oysters during a 7 pm Zoom meeting with URM Scholars. We had a very productive meeting. I marvel at their resolve to complete this manuscript for submission while dealing with the reality of being primary care providers during this challenging time. Well, I will rest and get ready for tomorrow.

I find hope in the darkest of days and focus in the brightest. I do not judge the universe.

Dalai Lama

It really is about community

Physicians learn that community is essential. I had my first community with a very close-knit group of cousins. We played together and managed some mischief that was quickly squelched by our grandmother, who was our babysitter. When I entered grade school, I got into trouble because I love to talk. I was a true Scorpio. An introvert who could function as an extrovert. In college, I joined a sorority. In medical school, they assign in you to a team that starts day one in gross anatomy and continues through the clinical years. You must function as a team and study group to be successful. You become a community. You even end up partying together. One classmate gave me rides home to Birmingham from Nashville. He lived in Montgomery. He also picked me up on his way back to Nashville.

I have maintained some of these close friendships over the years. The first was with my best friend from Medical School. We call each other and try to meet up when we can. The second is with my best friend from residency. It started with Sunday night phone calls after graduation in 1990. It included meeting up for major conferences at least once a year.

When I moved back to NJ, my life was a bit more flexible so that I could meet up with friends on a more regular basis. My residency friend and I went to our meetings and met up for lunch dates. My friend from Med school, and I continue to meet up at least once a year.

I loved meeting colleagues at lunch and medical staff meetings. I always take time to talk to staff and find out how they and their families are doing. Now with the COVID pandemic, none of that can happen. The hallway chats and curbside consultations are on hold. All in-person meetings are canceled. The skype calls are rushed. I just want to say, “Let’s Breathe for just one minute together,” We are working from home and doing virtual visits with our patients.

I talked with my best friend from residency over the weekend, and we agreed to return to the Sunday night phone calls to catch up. Like the ’90s, she will call around 9 pm, and we will run down our week.

“Alone, we can do so little; together, we can do so much” – Helen Keller.

Patient status change?

Amid the flurry of emails, meetings, checking residents’ notes, calling patients, and refilling prescriptions, I received a cryptic message in my Epic in-basket “Patient status change.” I clicked on it, and my heart sank. “patient status change: deceased.” I looked twice and then called in our RN. She had not received any notification. I chart checked realized there were no new notes. I finally decided to dial her cellphone, and then that status was confirmed. Her family confirmed she had indeed died at another hospital.

I cried. We violated “social distancing” because it hit us all. My patient was gone. In the past, I would have received a call from the emergency room, but now, they can see my notes because of the electronic health record. They did not have to notify me because they can do it in their chart, and I get the notice.

This process does assume I don’t have a close relationship and would not have an emotional response by the sudden death of a young African American woman who was a beautiful wife, daughter, and especially a mother. I enjoyed seeing her in the office. We had some open discussions about her health and the tragedy that occurred in her life. I loved her relationship with her daughter and enjoyed having them come in together. I will miss those visits.

I have lost many patients over the years. There are so many that have etched their names in my heart. Amid this pandemic, I just realized that I do have to deal with the day-to-day patient care and the unexpected tragedies that will happen. I have been training to perform telehealth visits, and now, I must fast track. We are shifting gears and speeding ahead. As we switch to these virtual visits and limited in-person contact, I realize my status has changed.

“Remember that people are only guests in your story – the same way you are only a guest in theirs – so make the chapters worth reading.” ― Lauren Klarfeld

My home gym

I had been so busy; I never made it to the local YMCA to work out. Several years ago, I designed my home Yoga practice because I had received my 200-hour certification. I had planned to go for the 500-hour, but my work schedule exploded. I then had to design a home meditation practice, so I used several apps- InsightTimer and Deepak and Oprah’s meditation series.  I also went to a HEAL1 series.

For my workouts, I started walking 3-4 miles and then added a workout App called Seven. It helped. It was so important after I had surgery. I used all of this to get back into shape.

Now with the social distancing required to prevent the spread of COVID-19, I am so happy that I designed this program. As a physician, I find that this home gym has helped decrease my stress level and keep me grounded. I need to stay healthy, so I can work and teach my residents. My patients said as they left the office” Stay safe.” This our new reality.

Home GYM

 

2 weeks of COVID-19

It has been a hectic two weeks for me as a physician. I have been staying updated on COVID-19 and trying to see my patients. I had two patients come in for post-hospital visits, and I told them to call and stay out of the office until everything slows down.

I am a constant hand-washer in the office. I have a slight sensitivity to all hand sanitizers, especially our hospital-grade one, so I use soap and water. I use the hand sanitizer on rounds and then race to the sink when it is available. I always wear makeup to prevent myself from touching my face. I have used this precaution as long as I can remember.

We had a virtual meeting yesterday to kick-off our mentoring program and practiced social distancing. I could not talk with my mother for long yesterday, so I called her today.

Me: Hi, mom. How are you?

Mom: Oh, Judy, I am fine. I am not letting this upset me.

Me: Do you have enough groceries?

Mom: Oh, yes, I just have what I need and not the whole shelf.

Me: What?

Mom: Well, I was watching the news, and they interviewed this man outside of the Publix in Hoover. He said people needed to calm down. “Just buy what you need, not the whole shelf. We all need to calm down.”

Me: Are you going to church?

Mom: No, Reverend C closed our church. Your sister sent us the information so we can stream the service from her church. I am not going out. Of course, everyone is thumping on the bible right now. If they just did what it says, we wouldn’t be in this mess. We have had influenza, AIDS, and other plagues, and we didn’t all die. So we all just need to calm down.

Me: Yes, we were talking about the lack of ICU beds and ventilators for those that may need it. I told my friends that you have told me not to put you on a ventilator.

Mom: I never want that. You are right. That is not the way to go.

COVID-19 is a reality, and we have to have real conversations about what is essential in our lives. Buying what we need and thinking of others. Following the rules on handwashing, social distancing, and self-quarantine to keep our family and colleagues healthy. Then, there are crucial questions about end-of-life care we must have with our loved ones. I feel better now. For useful, accurate information:

https://coronavirus.jhu.edu/

 

Where has Decency Gone?

My grandparents were known as decent people. Many people in our community revered them. We were s admonished for our behavior with people saying, “your grandparents would be upset to know that you are misbehaving.” “You know that is not the way a Waldrop acts.” Many times, we would wish a spanking from our grandmother rather than what my uncles called one of her “sermonettes.”

My grandmother was our childcare provider while our parents worked. These sermonettes required us to listen as she called upon us to be decent and caring people. She wanted us to be better than those around us. She expected us to be in church on Sunday mornings and, with one look, put a stop to any misbehaving. The “Golden Rule” was an essential theme in many of those sermonettes.

To paraphrase, “Do to and say about others what you would have done to and said about you.”

I took this quote to heart and it influenced how I cared for my patients and engage with friends, colleagues, and family.

From the first day of my internship, it became apparent that not everyone learned how to be decent. I had to work hard to complete all my notes. One of the attendings critiqued each one to make sure they were grammatically correct and accurate. I learned so much from her. I rewrote every progress note. Initially, I thought she was too harsh, but I soon learned that she cared and knew this was important for my success.

One afternoon during my intern year, I went in to admit a patient, and she kindly asked me to leave. I was “Colored,” and she was a very wealthy white female. Interns did the admitting history and physical on all admissions on the teaching service. I was happy to be sent away. It meant I could leave right after sign-out and get home early for once. Unfortunately, I was summoned back to the nurse’s station and told to go back in and complete the admission. The patient looked at me and said,” You and are going to have to work together.” I ended up leaving late, but I think we both learned a valuable lesson. The attending had told her that she would allow me to admit her or go home, and I learned that he was decent and supported me.

More people should have had the benefit of listening to my grandparents (Big Mama and Big Daddy). I am so thankful for their life and how they demonstrated people who behave decently. Unfortunately, so many events of the past few weeks have been disappointing. I have decided to share only articles from reputable news media sources. I plan not to share any articles from sources I am not familiar with the source. There is an assault on our democracy; it is more evident each day and is very disturbing to watch as our elected officials abdicate their power and influence.

As a physician, I have much at stake in the coming election. Many of my patients may lose healthcare coverage or be deported. The assault on sanctuary cities is a real threat to many of my patients. I know that many of my patients will benefit from the rise of the minimum wage. This is especially true for women of color who have struggled to care for their families with no health insurance and lower wages. For those who say they would instead not vote if their candidate does not win, I want to say as aa black female who grew up in Alabama, I have always had to choose the better of two evils. We have never had the privilege of not voting. You must vote to ensure democracy continues.

I am not ready to say whom I will vote for, but the candidate must be a realist—someone who openly supports reproductive and social justice and supports access to quality health care. The candidate must acknowledge the real consequences of climate change, support diversity, and increase access to quality education. We have a looming debt and a vast wealth gap, so the candidate must have a real plan. I am not naïve enough to believe that we can achieve “Medicare for all” or free education overnight. The Affordable Care Act must be fully implemented. It is a good start. I want free tuition for medical schools to increase and diversify our physician workforce.

Dr. King, “Letter from the Birmingham Jail:”

I am cognizant of the interrelatedness of all communities and states. I cannot sit idly by in Atlanta and not be concerned about what happens in Birmingham. Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly. Never again can we afford to live with the narrow, provincial “outside agitator” idea. Anyone who lives inside the United States can never be considered an outsider anywhere within its bounds.

Being a mentor

“A mentor is someone who allows you to see the hope inside yourself.” — Oprah Winfrey

Reflecting on my journey, I realized that every patient I cared for; every position I held; and every time I dared to change my location provided an opportunity for professional and personal growth. There were painful moments of uncertainty and regret, but they gave me strength and determination. It was the colleagues I worked with that in their small ways lifted me beyond those difficult moments and allowed me to develop my clinical and leadership skills.

When I started in academic Family Medicine in 1996, there were so few African American and Latino educators in Family Medicine. Unfortunately, that is still true but for those of us who are there, we are committed to mentoring the next generation. I still feel like I am early in my career. I feel I have so much more to share. Those pioneers that I met are still paving the way for me and others through their work. I have been fortunate to have those mentors request that I accept a leadership role they held because they knew I could handle the responsibility. I always said, “are you sure?” and they would answer “yes”. They showed support by just saying “please call me if you have any questions.” Believe me I have so many times. I value their experience and wisdom.

I am fortunate enough to be mentoring some wonderful URM women who are so intelligent and full of great ideas to impact our profession. They have a unique prospective because they are first generation medical professionals who come from hard working families. They see like I did the small numbers of underrepresented minorities (URM) in medicine. They are especially concerned about the low number of URM males.

I was fortunate enough to have one of my mentees ask me to do a mock interview with her cousin who was having a big interview at a very prestigious medical school. On the day of our call, we went through some questions. I asked him “why he wanted to go into medicine”. And he gave me the usual answer. I found myself telling him, that we have heard that before. “Tell me who you are and why you should be here?” He then told me about his family and his personal commitment to be in medicine and care for patients. I was almost in tears as he opened up and shared his family’s struggle. I told him “that is the story you tell.”   It is hard to believe that he is almost ready to graduate from medical school . He is a Black male who was provided the opportunity to study and thrive in a supportive environment. I know he will impact medicine by just being a role model for so many other Black males.

Each time I am contacted to talk with someone about how to navigate getting into medical school, I am so angered by the misinformation they have received. This goes back to 1996, when I met a young man who with some direction is now a successful medical professional. I still have the letter that the Dean of his medical school sent informing me they had accepted him. He thanked me for my encouragement and support.

Mentoring is what revives my spirit and renews my hope. Every time I meet with one of my mentees, it is an exchange of ideas and the energy that is palpable. I have had the opportunity to mentor a diverse group of medical students and residents.  I edit articles, give advice on career opportunities or just listen to what is happening in their personal life- the wedding plans, the choice to go into Obstetrics and not family medicine or choose a fellowship. I do have a copy of almost every letter I have written. I enjoy reading each one. They have gone on to successful careers. I have pictures of new babies and see journal articles and presentations they are doing. One student is now a successful Urologist. I remember his interview. If you just looked at the paper, you would have passed him over. He told me his story. At that interview, I saw such potential in him, and he proved me right. I have so many of these stories. They all are such bright stars.

It is so inspiring to see those who I have mentored pay it forward. There is a whole new generation of aspiring URM doctors that despite all the work we have tried to do, have to deal with poor academic advising, lack of mentors and role models, the high cost of just preparing for the MCAT and then applying to medical school. We must get to them early and make sure they know how to navigate through a system that favors those privileged few. The information out there is generic and does not address the challenges of those who are working their way through undergraduate and postbaccalaureate degrees while studying for the MCAT and supporting themselves and their families.

So, let’s all roll up our sleeves because we have work to do. Let’s use our talents to mentor the next generation.

  “A mentor is someone who sees more talent and ability within you, than you see in yourself, and helps bring it out of you.” Bob Proctor

 

 

I am a doctor and thank God I have Health Insurance!!

After having emergency surgery in 11/10/2019, I was hospitalized for 4 days. When I got home, the next day a letter arrived from my insurance company denying my hospital stay. Through the pain, I laughed and thought this is not true. In 2 days, another letter arrived saying that my bill would be covered. That was a relief. I had to apply for short-term disability because I would be out of work for 4 weeks. Thankfully, I had applied for the insurance which would guarantee some income. I would be paid through Cigna and my health insurance is with Aetna. Despite having never taken any of my allowed sick leave, I found out that does not matter.

I now know why it is important to complete all those forms for my patients and advocate for them. The problem is this can be overwhelming because you must not only complete the forms but call your case manager. I was confused because I got so may forms in the mail. I called and found out that my doctor had completed them. The ones I received were only copies.

This time around, I did increase my coverage. The bills are rolling in but thank God I have insurance. The total cost will be low because my employer-based insurance has a low deductible and I stayed in-network with my surgeon and was admitted to the hospital where I work. As we look to the election, we must consider how important health care coverage is. If I had to pay the actual cost of my care, I would have to take out a loan. While we ignore the need for Medicaid expansion and cut taxes to the wealthy, Americans are filing bankruptcy because of inflated health care costs, even the cost of a Tylenol is more that one bottle.

I hope that the political debate can shift to real issues: access to culturally aware health care, healthcare costs, social justice, healthy communities and racism. Health disparities in the US are based not only on income but access to care for minority communities. Also, we will have a shortage of primary care providers who are African-American, Hispanic/Latino, and Native American who will practice in these underserved communities. We will have to address all of these issues.  Thankfully for me, my African-American female physician who also trained with me was there to get me the care I needed.

20000 steps to my Birthday

On Friday, October 11, I had emergency surgery even though right before the procedure, I had a phone meeting with one of the plenary speakers for the 2020 STFM annual meeting.  I reassured him I was fine but just had to move the meeting up by an hour.

My friend and colleague came over to give me a hug and helped me with my gown right before I went My husband was there until I was ready to go the operating room (OR).  After I woke up from anesthesia, I had no memory of the events after I kissed my husband and went to the OR. I do not even remember speaking to my surgeon.  Thankfully, he told my husband the findings and why I had to have an open surgical procedure. Details in the next post.

My first steps were to the bathroom to urinate.  That was a major step.  You see, I had a catheter in my bladder for the surgery.  I also had an endotracheal tube (to help me breathe) and a nasogastric tube (to keep my stomach free of air).  I can tell you that once you start walking, don’t stop.  There is no amount of narcotic pain medication to take away the pain from recovering from abdominal surgery.

The gas pains are horrific.  But for me, the worse was the back spasm.  The hospital got these expensive beds that are like sleeping on a moving rock.  Thankfully, I could walk with my IV pole in the hall.  You would think that we could come up with a more convenient pole but not yet.  It is still the same that you see on all the hospital shows. Also, the gown has not changed. It still needs to be tied the right way so your rear end is not displayed. Also, thanks to one of the nurses who found one of the old recliners for me to sleep in.  When she helped me get comfortably positioned in the recliner, I just remember thinking” Hallelujah, thank you, God.”

You need to pass flatus (pass gas) and have a bowel movement before discharge.  So, initially, I was NPO (nothing by mouth).  That was fine with me as I dealt with the pain.  However, two of my favorite things have always been the chicken broth and the lemon ice on the Liquid diet menu.  The best was the extra strong cup of coffee made by one of the nursing staff and the warm prune juice. The next step was one of the nurses gave me a Pedometer.  It took 20000 steps for me to do the two most important things you need to do after abdominal surgery.  So, I finally passed gas and had a bowel movement.  That pedometer was a symbol for me of success and recovery for me.  I did lose about 12 pounds, but I could not just sit.  You see, narcotics slow the bowel function and can make it more difficult to have that bowel movement which can increase your pain, so it is a double-edged sword.  You must balance the pain and the need to keep moving.  I used the pedometer instead of my phone app because I did not want to be distracted during my walking by phone calls from my family and friends.

My other aid in recovery was meditation.  I used the Insight Timer App.  I typed in surgery and found several healing meditations.  I listened to them when I had pain and they helped relax me and use mantras to keep me positive.  It also drowned out the hospital sounds that are present even with the door closed.

Today is my birthday. Thank you to the wonderful nursing staff at my hospital.  They took such good care of me.  Thank you to my amazing surgical team.  Just to let you know, if I wanted to, I could wear a bikini.  The scar is barely visible.  Also thank you to my family, friends, and colleagues for their good wishes.  I can truly say that I am blessed to be alive to celebrate today.