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How doctors think

Today I had my regular follow up appointment with my cardiologist. I’ve been feeling great, so I expected a quick visit. The problem was that I went there on crutches. Last night I was weeding the flower beds and I must have done too much because this morning I woke up and my knee was very painful and swollen. The whole thing reminded me of what happened to me a few month ago—hemarthosis in my left knee, when it filled up with blood.

After I explained what had happened to me back in February, while it was not his area of expertise, he wanted to look at it. With no prompting from me, he offered to call the orthopedic practice that I use. So he did. I waited a while till the ortho guy called back. Then I carefully eavesdropped on their conversation from across the hall.

I was amazed as my cardio guy described my history and present condition precisely as I had relayed it to him. I thought, wow, this guy really listens. He stripped out the bits of my story that were not fact based (i.e. my feeling that the ER doctor should have admitted me earlier) but still conveyed the urgency of the situation and the problems I had had earlier.

Long story longer, I go to the ER tomorrow (Saturday morning) to meet the ortho guy for his assessment. He will drain it if he feels it’s necessary.

How cool is that? What service.

Interestingly enough, I just finished “How Doctors Think” by Jerome Groopman. Groopman describes different decision making procedures that doctors might use. There are what he calls algorithms that some physicians follow: If this is true, then go here; if the answer is no, go here—and on and on, following a decision tree till they arrive at a diagnosis.

This is not a bad thing necessarily, but sometimes you need out of the box thinking, especially with patients who have been suffering for years and having doctors tell them there’s nothing wrong with them.

Other times, the affection that doctors have for their patients may cause them to forego a painful test that would help a patient. They may dislike a person and that could color their judgment.

Acknowledging uncertainly is OK, too, though scary for everyone.

He ended the book talking about “patient as partner”—a nifty concept that I like. I am still learning how to do that. Every time something happens to me, I learn more. This is a heck of way to do it, but we learn from experience. For instance, I am now an expert of sorts on hemarthrosis, mitral valve replacement, pacemakers and open heart surgery—as they apply to me. There are so many things that can go wrong with your heart, I no longer pretend to know what your problem is like, because you are not me.

So, let’s see what happens tomorrow.

A wedding

Our youngest son Patrick blew into town on Thursday this past week since he was in the wedding party for yet another friend’s nuptials. The groom was Tommy and the bride was named Shannon. She had a little trouble breaking into the group of friends that has been hanging out together since high school, but Patrick reports that she has gained more acceptance now. He said the friends were originally skeptical since Tommy and Shannon met on line on a site called match.com. They bought a house together a while ago, and now they have made everything official.

It was a nice wedding ceremony, especially since Patrick shaved his Taliban beard for the occasion. Kathy and I went to the church and later to the reception. The party was held in the same hall that we had had our parish’s 75th anniversary dinner, so I already knew the food would be terrible. That was OK, though, since we had a good table of people including one of Patrick’s friends and his mother, and the parents of yet another one of Patrick’s friends. It took them three hours to get to the bride and groom’s first dance, so we didn’t linger for much longer after that.

A lá my father, I took some photos at the 2:00 p.m. ceremony, came home and downloaded them to my computer, digitally enhanced the ones that needed some adjustment, printed off copies for Patrick’s friends, and delivered them to the photo subjects at the 6:00 p.m. reception. Everyone was duly impressed and grateful. To be fair, though, dad used to develop his own black and white photos, so he didn’t have the turnaround time I do.

Patrick brought another birthday present for Max—a Transformer. We thought that was kind of fun because Transformers were the big thing when our boys were growing up, and they have made comeback lately. Today we were talking about where to go for lunch, since Patrick has to fly back this afternoon. Max piped up with “I know a great vegetarian place!” So that was where we went. There was a twenty minute wait, though, so we left to go a different restaurant, a place known for its burger—and yes, they did have a veggie variety.

D-I-V-O-R-C-E

That was the name of the 1967 song by Tammy Wynette. In the song, the little boy is four. Our little Max is four today, five tomorrow. His parents’ divorce papers just arrived. Our son is quite cheerful about it, pleased to see the words “dissolution”. He seems to think his marriage is over, that he won’t have to deal with his wife anymore, that he is somehow free.

I wonder. Does it ever really end? He is bound to her forever through their little boy. Even after Max turns 18, that doesn’t mean things will change substantially. Your kids are your kids no matter how old they are. We are always doing things for them, helping them out, watching out for them, worrying about them, and our kids are 35,33 and 29.

Surprisingly, our son let us read the settlement papers. Usually he is not that forthcoming about his private business, which is fine. The packet ran about 25 pages, half of it dealing with Max and how the custody arrangement would work, with alternate weekends, Mothers Day, Fathers Day, Christmas, Christmas Eve, visitation, schoolwork, transportation, emergencies, and on and on. Funny how an intact family just rolls with this stuff, working out arrangements to keep everyone happy. Not that everyone is really happy all the time with the way things go, but we are reasonably mollified with whatever set up we agree to follow.

Now it’s codified. Pick him at a certain time, drop him off at a specific time. All that stuff. The papers also say that neither parent may disparage the other in hearing of the child. I wonder if that is really something you can order people to do. Even two parent families have adults who tear each other up in front of the kids. This is one thing I worry about: how Max’s parents will handle all this over the coming years. While I am not a big fan, even Dr. Phil points out that if you try to use the child to gain leverage over the other parent, the kid will wind up hating both of you.

Max has had over a year of alternate weekends, so it won’t be an entirely new concept to him. He looked forward to “sleepovers” at our house. Now he will be at his father’s apartment, wherever that turns out to be.

That’s another thing I worry about, selfishly—how often will we see our grandson now? That’s likely to change.

Fortunately, this is all happening right in our own town and not hundreds of miles away.
Unfortunately, this is all happening in our own town and not hundreds of miles away..

Fortunately, we know what’s going on.
Unfortunately, well, you get the picture.

Is there an end? Do things work out OK for our little, cute, trusting, huggable Max? Will he be sad, bitter, angry, confused, hurt, or happy, well adjusted, loving, and well integrated?
I haven’t forgotten our own son in all this, but right now I worry about little guy. Tomorrow is his fifth birthday. Both his mother’s family and ours will be there, on neutral ground.

So here we go, into a whole different world than we ever conceived of. Say a prayer for us?

Confession

As some of you know, our daughter Ann lives in Ireland. Her father in law died this past week, so she and her husband traveled to Dublin for the funeral. Tom, her father in law, had been ill for a long time with cancer, so it was not unexpected. His wife is in the beginning throes of Alzheimer’s, so things are not good over there right now.

We called Ann today, like we do most Saturday mornings to see how she was doing. She was on an outing with her husband Peter and his sister’s family when we reached her in their car. She wanted to call us back rather than talk in the car, and so we talked to her again once they had arrived at their destination.

She said she wanted us both on the phone because she had something to tell us. “I’m not pregnant or anything, so don’t get excited” she cautioned us.

.She went on to say that we had her wedding anniversary date wrong.

Some background information: Her husband is from Ireland, and for a long time they lived in the United States, in a house in Chicago. Two years ago at the end of May, we all flew over to Ireland for their wedding. It was a magical time and we thoroughly enjoyed our trip, as we got to see Dublin and Galway and the countryside in between. So her remark was a little confusing. Is it May 29 instead of May 30? What was she talking about.

“Our anniversary is actually October 15, 1996.”

This was days before they left for Chicago, to “live in sin”, as Kathy said. Turns out they were married in Cleveland in a courtroom. They forgot they needed witnesses, so they scanned the room looking for likely candidates. They discounted the prostitutes and drug dealers awaiting trial, and chose two college girls who were there as part of a class assignment.

Her friends and her two brothers knew the secret, but they kept it for all these years. Beth and Peter did not want his parents to know because the parents were upset about the kids moving to the US. If his parents knew they were already married, the kids thought that would drive them nuts, since they would have wanted a wedding in the church.

Now that Peter’s father is gone, and his mother is not all that aware of her surroundings, they thought it was safe to tell us the truth. They knew we would think it was kind of funny. You see, it must be in the genes. Kathy’s parents were secretly married. Both her sisters had secret justice of the peace ceremonies, and one of our sons eloped. What is it with this family?

We are glad they told us, though. Now we can celebrate two anniversaries if we like. I am glad they let us enjoy the moment in their church wedding—that was very special to me. Now, though, we have to go around and explain to our friends that they weren’t living in sin for all those years after all.

Everybody talks about it

How come the weather person on TV is there every day? She gives us the seven day forecast—why come back the next day? We have the seven day forecast. We know what’s going to happen. Come back in a week and give us the weather for the next seven days.

It doesn’t work that way, though.

Oh—another thing. Why do they tell us what happened today? We lived through it. We already know that. We want to know about tomorrow.

I barely remember this, but apparently when the networks decided to have news at all, they allotted fifteen minutes for it each night. Now you can watch it 24/7 if you care to. Maybe we should go back to fifteen minutes. They could probably cover all the important stuff in that time without commercials.

Honest to goodness, now the local stations cover lost dogs returned to their owners. Maybe that’s human interest. At least for any dogs within earshot of the TV.

My dog has it too good to get himself lost. Each Saturday he gets a greenie. That’s a good thing. He loves them, and they’re supposed to help clean his teeth. It’s to the point now that he expects his treat to be delivered early in the day. When it’s not forthcoming, he gets a little peevish. Last weekend it was late in the afternoon and he still hadn’t gotten his greenie. He came over to me expectantly, and I asked him if he wanted a treat. He looked at me and tossed head and snorted like a horse!

He got his treat.

We had our own treat today. Air conditioning. I tried to turn it on the other day and nothing happened. We had the guy scheduled to come out today anyway, so we just sweltered (do people “swelter” or it that just “days”?) a little longer. Turned out just to be a blown fuse. It was 81 degrees in the house and it took about twelve hours to bring it down to 70.

Kathy found me out on the deck reading and said, “You ought to cut the grass because it’s going to rain.” She had been watching the weather forecast apparently. So I dutifully resisted the idea and finally gave in to her superior logic.

The western sky was indeed darkening by the minute, so I was quite pleased with myself and Kathy was quite pleased with herself when I finished.

Then the sun came out. The storm clouds drifted north and missed us entirely.

Sure enough. I checked the seven day from three days ago. It said it might rain. Or it might not.