My seventh-grade science teacher proposed a great debate juxtaposing evolution and creation. Being the biblical literalist that I was then, I argued with all my might for creationism. My friend Vicki, the eventual valedictorian of our class, defended the theory of evolution. I’m not sure who won that debate, but I do know that I’ve been pondering the questions we raised ever since.
The current version of legislation just passed by the House to replace the Affordable Care Act relegates those with pre-existing conditions to high-risk pools. This means that when you become sick or injured you will no longer be guaranteed medical insurance. Your state (specifically, whoever is in control of your state at any given time) will determine your fate—which and how much of your medical expenses to cover and how much to charge you for the insurance that may or may not cover your no-fault-of-your-own illness or injury.
This week I completed and defended a thesis to obtain my master’s degree in theology. The thesis was about salvation—a Latin-derived term that implies health, wholeness, and safety. I reread the Bible from its beginning to end to glean everything it had to say regarding salvation.
Today is the fourth of July. The weather is beautiful—perfect for our local parade that starts soon. My broken shoulder is healing nicely so I am able to golf in a tournament this weekend. I can’t wait! We are fortunate to live in a country with freedom and opportunity. I pray that we all continue to work so that this gift is shared equally among us.
I slipped on the ice and shattered my left shoulder this past winter. It’s been 13 weeks since the injury and I now have new empathy for those who have broken bones. Fortunately, I did not require surgery, and my Orthopedist, Dr. Peter Cha, of Beacon Orthopedics, continues to be encouraged each time he sees me. Likewise, my physical therapist, Allyson, at Reconstructive Orthopedics, remains totally optimistic that I will have a complete recovery. As a doctor, I share their optimism. As a patient, however, I am not so patient.
Well it’s been almost six months since I’ve posted anything. I just couldn’t. But it is January 1 and the beginning of a new year so I’m getting back on the horse. My parents wouldn’t have wanted it any other way. I agree. So with mom and dad always in my heart and mind, I’ll begin again.
I guess politics is as good a place to start as anywhere. Controversial, yes, but generally not boring. So here we go.
Still counting the days, and now weeks, since mom died. It’s been 8 weeks and one day. I passed the board recertification exam that I took the day after mom’s first hospital admission. She would have been very proud of me. She always was. I had my first birthday without her…no words for that feeling. Back to golfing, working regular hours, participating on church committees, etc. Going on vacation in July. Settling the estate. Using electronic health records at work now (or at least, making progress in that direction). Living life. Going on. Staying busy, functional, active.
It’s been 4 1/2 weeks since mom died. It feels like four and a half days, or hours. I can hardly believe it, actually, except that she isn’t here. And that is so profoundly real. This daily realization makes mornings especially painful.
Mom talked alot about joy during her final days. I know she would want that for me and I’m sure she is experiencing joy now. But her absence is still so overwhelming. I can’t yet feel joy. I am resuming normal activities during the day, though, even if robotically.
It’s been two-and-one-half weeks now since my mother died. I spend a lot of time reflecting on her final days. She basked in the physical touch and expressions of love that our family was given the gift of giving her. I treasure the moments of stroking her forehead, holding her hand, and telling her I love her…and receiving the same from her. She breathed gently into death as seven of us held her, silently watching and waiting…
Two weeks ago today, I went to my mom’s house to meet a caretaker and an oxygen supply person to arrange increased in-home support for her. Mom had declined since I had last seen her, two days before, and didn’t look good, so I stayed with her that night. She was worse the next morning so we went to the hospital. She didn’t come home again, but I know she is home. I am muddling through my days right now but am functional, if only at half speed. I miss her deeply.
In my last post, I talked about the upcoming board recertification exam that I took on April 11. It seemed very important at the time, and I guess it was. I took it, it was hard, and now I await the results that usually take about three months to receive. Since then, however, my life has changed.
My mom died last week.
I sit here this Sunday morning, six days now without her here, finding it difficult to breathe or move.
Five weeks from now, April 11, I will travel to Kings Island in Mason, Ohio to take my 2nd rheumatology recertification exam—rheumatologists must recertify every ten years.
Prior to taking the exam, physicians complete multiple open-book tests and complete a tedious exercise referred to as a “practice improvement module.” So I have been spending the past several months studying at home every evening. All of this is quite labor intensive but, I must admit, it’s helpful.
I read the most intriguing chapter this morning from a book written by Emmet Fox in 1932, that ultimately inspired the formation of 12 Step programs, such as Alcoholics Anonymous.
I look forward to seeing my patients in 2012, as I have come to place extreme value on the relationships that I have established with patients over the past 25 years. I look forward to facing the challenges of meeting electronic health record requirements because it keeps me and my staff on our toes and not bored with old systems. And I look forward to learning more and more rheumatology as medical research progresses and offers hope to those who suffer with arthritis, autoimmune and inflammatory diseases.
Playing golf well is not easy. Neither is living with arthritis. I know firsthand about the challenges of golf— I want to shoot under 80, but I don’t…yet.
I know a little bit about arthritis from a personal perspective (I have some osteoarthritis in my back), but mostly I know how difficult it is to live with arthritis from the experiences my patients share with me. Each day people who live with rheumatoid arthritis, osteoarthritis, psoriatic arthritis, and gout must determine to get up, exercise, work, play, have relationships, and enjoy life. And just as the game of golf has its ups and downs, its moments of success and times of disappointment, life with arthritis can certainly be unpredictable.
But we push on, we keep trying new approaches and working hard. Because it’s worth it. Golf is only a game, whereas living with arthritis is serious business. But both can be fun, full, and rewarding, if we keep trying. Or, we can give in, settle for bogeys rather than pars, focus on our disease rather than our health, and miss the joy of the journey.
Yesterday I rode my bicycle, and I planned my ride so it included a visit to the polls (it was election day). I didn’t want to ride my bicycle, and I didn’t want to vote. For some reason, yesterday I just didn’t care, and I didn’t want to do two things I know are good for me. I could have put the bike ride off, but I couldn’t comfortably live with myself if I didn’t vote, so I decided to kill two birds I didn’t want with one stone: a bicycle ride to the polls.
As usual, I felt much better after a couple of pedal strokes, and I felt awesome voting in my bicycle helmet and gloves. I turned heads. I like to turn heads. And, let me tell you, I voted as you might expect a person who rides a bicycle in this community to vote…I voted differently than my neighbors. But that’s not my point.
I took a different route home, and I spotted one of my neighbors out raking his leaves. Most of our neighbors have lawn services, so he goes a little against the grain, too. Lately he’s been alluding to the fact that his health isn’t so good, so I stopped to learn from him what’s going on. He lives alone and has no family in town, and if his health is failing, he’ll need some support.
I learned that the kidney disease my neighbor has lived with for many years is rapidly shifting; he’ll probably soon begin dialysis and go on a transplant waiting list. (I asked him what he needed. He said, “A donor.” Uh oh. I’ll save the conversation that occured between my higher and lower natures upon hearing that response for another post.)
Here’s my point today: I have Type 1 Diabetes. My neighbor has kidney disease. Neither of us knew of the others’ disease even though we’ve lived with these companions for a long time. I was riding my bicycle. He was raking his leaves. We were not sitting inside watching TV and complaining. We talked a little bit about being healthy people who happen to have diseases. Then we got all worked up talking about politics (we lean the same way).
Yes, disease may take us. It may change what we do and how we do it. So there you go. Disease does not get to make us unhealthy or unhappy.
Evelyn V. Hess, MDWhen I completed my rheumatology fellowship at the University of Cincinnati, I told my mentor, Dr. Evelyn Hess, that I was elated and relieved to have finally completed my medical education; now I could rest.
Dr. Hess quickly shot back (with an expression similar to the expression she wears in the image I’ve posted of her here) that I had only just begun my educational process and that I would be studying and learning for the rest of my life. I looked at her strangely, though I somehow knew she was right. The next day, I began my vacation in Hawaii.
After one month of rest, I hung out my shingle…I opened my private practice…and yes, my true education really began then. Not only did I have to start independently putting into practice the knowledge I had acquired over the years, as I was now seeing patients completely without supervision for the first time (an intimidating realization for any new doctor), but I was also learning the nuances of running a business and earning a living.
Twenty four years later, I continue to see patients and manage a private practice. The field of rheumatology has grown exponentially since I completed my formal education. But by staying connected to research and excellent rheumatologists at UC (where I have worked in the outpatient clinic since my fellowship), by reading journals, and by attending annual ACR meetings, I have expanded my knowledge base in synchrony with the growth in my field. All this education is actually delightful—it’s as if each new thought and new discovery adds granules of sand atop an ever-expanding base…I picture it in my mind’s eye as a giant sand pyramid. At this point in my career and in my education, because I’ve constructed a solid, wide base of knowledge in which to anchor new information, I can sit back at meetings and absorb the gestalt of a lecture rather than fervishly writing notes and facts as many of us do when we’re learning something new.
The greater challenge to me these days is keeping abreast of the swiftly changing administrative aspect of running a medical practice—electronic health records, revised coding and documentation requirements, etc, are radically changing how physicians practice medicine and earn a living. Once again, a part of my education is only beginning. It keeps me sharp. I didn’t realize, back then, how right Dr. Hess really was.
Three days to go until my mom and I board the Cincinnati Megabus heading for Chicago. Mom turned 80 yesterday, so this trip will be part of her birthday festivities.
I try to attend the American College of Rheumatology’s annual meeting to keep up with new medical research and developments, and with changes in the ever-expanding regulations and requirements for running a medical practice.
This year I’ll go a day early to take a board-recertification course (rheumatologists have to recertify every 10 years), so there’s a good chance I’ll get burnt out before the conference ends a week later. Which means…Mom and I may end of doing some shopping on the Magnificent Mile, and I’m sure we’ll try out a little deep dish pizza.
Stay tuned for updates from the conference.
You may already know, Reader, that Dr. Fritz’s office has a back door. That glass door leads directly from the office to a field of grass, and almost 20 years ago, it was one of the deciding factors in Dr. Fritz’s decision to lease this particular office space. When the architect was called to build the space out, that back door received a lot of attention…frankly, most of the way the office works hinges (a pun!) on the back door. It lets the light in. It lets the doctor out.
In good weather, you will probably find the back door propped open and Dr. Fritz sitting (or lying) in the grass in the sun. That’s where she often dictates her patient notes. It’s where she reads patient charts and where she rests. It’s where she daydreams. It’s one reason her patients see her as so relaxed and happy (and tan).
I guess everyone needs a back door.
Navigating the maze of managing and maintaining a medical practice today is increasingly difficult. Often, I wish that on any given day I could see my patients, collect a reasonable amount of money for my service, pay my staff and myself, and go home. But practicing medicine has become much more complex than that. Between insurance hassles, demands for medical offices to become “paperless,” decreasing reimbursement rates, and multitudes of forms to fill out for essentially everything, the challenge to stay focused on patient care escalates.
I love taking care of patients. And I actually love the business end of practicing medicine. That is why I continue to have a solo, subspecialty practice after 25 years. But I must admit that I didn’t anticipate so much change in how I practice medicine at this point in my career. So now I look forward to tackling the new hurdles of being a self-employed doctor as I continue to connect with and hopefully help the person who sits in front of me—even if a computer sits between us.
Renoir, Aline, and Coco, 1912At the time of Dr. Fritz’s first visit with her patients, she explores their social histories. Taking a comprehensive social history is a critical part of being a good physician. Why? Because social histories—family relationships, social relationships, work, hobbies, pets, activities, exercise, habits, etc—tell physicians a lot about their patients; social histories are a window into patients’ presenting problems and offer a glimpse into the structures that will support the suggested treatments.
That’s what I think about when I gaze upon this image of the French impressionist Auguste Renoir and his friends. I mean, look how frail he is as a result of the limited treatments available for Rheumatoid Arthritis in the early 1900s—Renior is slumped back in his chair, his feet are bound in braces in an attempt to slow their deforming, his hands are gnarled.
And yet he has these very nice people with him.
I like to explore the body language in this image…first of all, I like it that they’re all outside in the fresh air together. Both the child and the woman lean in toward the artist…it’s not, however, as if they’re propping him up. I get the feeling they simply gravitate to him. They gaze in his direction, and they’re both smiling at Renior rather than at the camera. Nice. And the child wears a hat exactly like Renoir’s hat! Seriously, that’s love, isn’t it? And the ample woman in the polka-dotted dress covers Renoir’s knotted hand with her own wide one.
What a fortunate man Renior was—all the while he lived with Rheumatoid Arthritis, he continued to do work he loved while sitting outside in the company of young people and a wide woman who love him.
After 25 years of diagnosing and treating patients with fibromyalgia, I am struck by a perception of imbalance consistently present in the lives of patients with this syndrome. I too often observe individuals who are working too hard, not playing hard enough, and hardly resting at all. And more often than not, there seems to be a lack of time for stillness, reflection, and spiritual refreshment. It has long been my contention that reestablishing harmony among the different aspects of our selves—physical, intellectual, emotional and spiritual—would go a long way in restoring good-quality sleep, reducing pain and fatigue, and diminishing the central nervous system amplification associated with fibromyalgia.
Reader, welcome to this blog’s first post. I hope you find the blog informative, insightful, interesting, (and other things that don’t necessarily begin with the prefix “in”). We’ll cover a lot of territory here.
So, we begin with Pierre-Auguste Renoir, the famous 19th-century French impressionist who worked for over 60 years and created beauty (some claim he painted about 6000 pictures) all the while living with Rheumatoid Arthrtitis.
Fortunately, 21st-century artists who live with RA have unbelievably more treatments available to them than Renoir; but it’s not the thought of Rheumatoid Arthritis I want to leave with you. Rather, it’s the thought of Renoir’s “can-do” spirit that impresses me. We can hardly expect to live our lives without disease—and we have little control over that. Perhaps all we can control is how we structure healthy, productive days while living with the diseases that will accompany us.
I encourage all of those living with disease, and you, too, Reader, to seek fresh air, to work in the shade of a wide umbrella, to feel the comfort of a blanket draped across the shoulders, and to wear fashionable hats. And to do beautiful work.
Notice how Renoir holds his brush cupped between his twisted hands. Remain inventive.