Here is what I have learned since starting my new Geriatrics rotation:
If you are a woman, do not under any circumstances even set foot in West Virginia. If you live in Maryland and need to drive to Ohio, pee in a bottle until you get there.
Do not stop in West Virginia!
There is something about the men here...they hate women.
I told you all about my last absurd preceptor who hates white people and women. Well, he's gone. I then had a lovely Peds rotation with a great doctor.
And now I have returned to Hell.
Let's call him Dr. Holy. We will call him this because I think he believes himself to be so. If you can get past the Christian soft-rock CD being played OVER AND OVER in his office, and the giant "Jesus Saves" posters at every single turn, it turns out he's really a total weirdo.
My first day- I wore black dress pans, black heels, and a blue v-neck shirt. I've worn this shirt on every other rotation I've had and never had any problems. 8am, I meet Dr. Holy in the hospital. Every time he speaks to me, he speaks to my chest. Weird. By 10am he says (and I quote) "Going forward, can you please wear something that doesn't show your cleavage. It's very distracting." WHO THE FUCK TALKS LIKE THAT? first of all, nobody else I've worn this shirt around has a problem with it. More importantly, you can't see any boob unless you're looking down my shirt from my angle!
Today, I wore a shirt with a scoop neck. What does he do? Spends the whole day talking to my chest again. What the hell is wrong with this man?
I'll tell ya what's wrong with him. Dr. Crazy was just, at his core, a self absorbed asshole. Dr. Holy, on the other hand...well...you spend so many years on the God Squad and some things start to get repressed. He doesn't have anything that couldn't be cured with his wife giving him a good blow job.
In the mean time, he has a boob obsession.
It goes beyond just my boobs.
He is the doc for the nursery at the hospital. So when a baby is born, he sometimes is the doc who examines the baby and talks to the mom, etc etc. Today he berated a mom for not breastfeeding. He stopped just short of telling her that she's a bad mother, but he did say that, "A really good mom who loves her baby would breastfeed her."
DUDE!!!!
He seems like the type of man who thinks women are just a tad beneath him. That women belong home with the children and their boobs and if you don't do that then there's something wrong with you.
Why does this shit keep happening to me?
I need to get home to NJ where people are less backwards!
On a happier note....
Roger is wonderful. Working hard, but that's what makes him wonderful.
I am blissfully in love.
I told my mom the other night that this is truly the first time I have wanted a marriage, and not just a wedding.
Tuesday, October 23, 2007
Wednesday, October 03, 2007
October 3, 2007 6:05pm
Day over. I had dinner. Now I am ready to calmly recap my afternoon learning.
I don't have kids of my own, so I always feel just a little bit guilty giving parents advice about their kids. Some things I am confident about like when immunizations are recommended, medication dosing, at what age to start baby food, when to switch to 2% milk, etc. Things that are fairly set guidelines that I just need to parrot back.
Then there's the grey areas on child behavior, discipline, going back to work, and other very personal decisions.
For example, a first time mom brought her 2 year old into the office this afternoon. Chief complaint of decreased appetite and decreased bowel movements, also tantrums. So I go in the room and find a very distressed mom who tells me that the little one has been very picky with his eating, and he is throwing 3-4 fits each day.
I was a little frustrated because she had been squeezed in on a very busy day and she was all upset over what is, essentially, the terrible two's and two year molars coming in. I checked him over thoroughly and assured her he wasn't ill, but the molars are probably bothering him so he doesn't much feel like eating. Not to worry, he won't starve. Less eating means less pooping. The fits are, well, normal, though annoying.
Then she asked me how to stop the fits. This is where I started to feel like I didn't have a right to tell her what to do because I don't have kids myself.
My advice, essentially, consisted of "Isolate and Ignore". He throws the fit to get attention. If you give in every time then he will know he can manipulate you. If you just let him have his fit and ignore it by leaving the room or just not feeding into it, then you can welcome him back when he's ready to calm down. She also needs to be consistent. Whatever is not okay to do today also can't be okay to do tomorrow. She can't just let him do something over and over and then one day not let him do it anymore. The rules have to be the same if he's at home or at grandma's house (luckily, grandma was also in the room so we could all be in agreement). Most of all, if she says she's going to punish him by taking x toy away...then follow through and really do if. If he learns that all of her threats are empty threats, he won't take her very seriously. He can start learning that there are certain "rules". Wherever he goes for the rest of his life, there will always be rules he needs to follow.
The doc agreed with my assessment that it was a healthy kid with a 2 year old 'tude. Mom even shook my hand as she was leaving, so maybe she appreciated what I said to her. We gave her the phone number of a local parenting class.
So, on the one hand I was glad to help. On the other, I felt guilty....like I had no right to tell her how to raise her kid. Then again, she asked for my advice. I didn't run up to her in the grocery store out of nowhere and start telling her what to do.
Now, the other thing that I wanted to write about....
I still don't have any children of my own (in case you thought I popped a few out in the past few paragraphs). Therefore, I can't actually relate to what it's like to look forward to bringing this perfect person into the world, only to one day find out that they have a problem of some sort. I'm sure it is devastating and requires some adjustment time.
However....
I am getting really frustrated over the past few weeks( and also in family practice, and also in my mom's pedi neurology office) with seeing parents who are unwilling to accept that their child has a problem and then get them the proper help.
Two examples:
An otherwise healthy 7 year old boy starts 1st grade and becomes a total emotional basket case. He worries about everything. Going to school every day is a battle. He cries and cries all morning. Then he goes into school and is okay for the day there, but as soon as he gets home he just sits in his room and doesn't want to play or talk or do anything. Some days he doesn't even go to school because he is such an emotional wreck that mom keeps him home. Mom brings him to the doc's office. Doc recommends looking into some counseling at the school and prescribes an antidepressant that also helps with anxiety in kids really well. Three weeks later, they come in for a follow-up visit. The first week was rough, but the last two weeks have been better. He gradually cried less and less. He is now just a little upset in the morning, but has made it to school every day for the past two weeks. He comes home in the afternoon and plays (ironically) school with his stuffed animals, and talks with mom and dad about his day when they have dinner. These are all good things, right?
So mom says she wants to immediately take him off the medication. Can't find out from him if he feels better now with the medication, because mom told him it was for his allergies (which he doesn't have). Mom keeps saying she's uncomfortable with him being on a medication. Okay, I get that. Other than the occasional antibiotic, it's tough to put your kid on something to take every day. But if he had asthma, or diabetes, wouldn't you want him to have the medication he needs to make his life better? We tried this to see if it helps, and he is obviously thriving on the medication. Taking him off of it might mean that he will go back to where he was 3 weeks ago, and then if she wants him back on it he will have to take it for a few weeks before it works well again. Mom seems to have a hang-up about even thinking that her kid could have a problem with depression, so she wants him off the medicine ASAP. Well, isn't that just hurting the kid? Aren't you making him suffer because you can't accept that he needs some help right now? He's okay with it. In fact, he's doing better than ever. Isn't this really about him and not you?
Of course, we can't say that to mom. So we agree to take him off it for a trial and see how he does. The counseling went nowhere. She had one visit with the school counselor and then declined any more visits and didn't want the counselor to contact him during the school day (she thought he would be embarrassed. In my opinion, kids are thrilled to get out of class to go somewhere "special". It's the mom who is embarrassed.)
Example 2. A 4 year old boy who weighs 80 lbs. Yes, 80 lbs. He has a vocabulary of less than 4 words. He expresses himself by grunting. He eats until he vomits, and then continues eating. He throws huge, violent tantrums whenever there is even a slight change in his routine. At the age of 3, when he wasn't speaking, doc referred the family to something called Birth to Three. It's supposed to help kids with developmental delays. Well, dad never let the people evaluate the kid. They hired a speech therapist and got his vocabulary up from 0 words to 10 words and some grunts. It was a nightmare trying to examine this kid because he thrashed around, punched, kicked, and screamed. Dad swore his behavior is "fine". Dad says "oh, he talks a lot at home." right. According to Dad, there is "nothing wrong with my son. He's just going at his own pace."
Coincidentally, I saw the mom later in the day with one of their older children. Just before she left she said, "Now, please don't tell me I'm crazy. Everyone says I am. But, I think there's something wrong with my son." Halleluah! Yes! We do too! It didn't take much convincing to get her to agree to an appointment with a neurologist (which isn't until December, unfortunately). She has done some of her own research on the internet and suspects something in the autism spectrum or Prader-Willy Syndrome. All are things we in the office had discussed as possible causes for his language delay and inability to deviate from routine. My fear is that mom will go home and dad will immediately control the situation again. Even if they go to the neurologist, who knows if dad will ever accept that his son has a problem that needs to be dealt with? Mom is already on that road, I think. I just hope she's strong enough to know when she needs to do what's best for her son and ignore the pig-headed dad.
Argh!!!!
Okay, all of that is off my chest now. I feel better. Whew!
I don't have kids of my own, so I always feel just a little bit guilty giving parents advice about their kids. Some things I am confident about like when immunizations are recommended, medication dosing, at what age to start baby food, when to switch to 2% milk, etc. Things that are fairly set guidelines that I just need to parrot back.
Then there's the grey areas on child behavior, discipline, going back to work, and other very personal decisions.
For example, a first time mom brought her 2 year old into the office this afternoon. Chief complaint of decreased appetite and decreased bowel movements, also tantrums. So I go in the room and find a very distressed mom who tells me that the little one has been very picky with his eating, and he is throwing 3-4 fits each day.
I was a little frustrated because she had been squeezed in on a very busy day and she was all upset over what is, essentially, the terrible two's and two year molars coming in. I checked him over thoroughly and assured her he wasn't ill, but the molars are probably bothering him so he doesn't much feel like eating. Not to worry, he won't starve. Less eating means less pooping. The fits are, well, normal, though annoying.
Then she asked me how to stop the fits. This is where I started to feel like I didn't have a right to tell her what to do because I don't have kids myself.
My advice, essentially, consisted of "Isolate and Ignore". He throws the fit to get attention. If you give in every time then he will know he can manipulate you. If you just let him have his fit and ignore it by leaving the room or just not feeding into it, then you can welcome him back when he's ready to calm down. She also needs to be consistent. Whatever is not okay to do today also can't be okay to do tomorrow. She can't just let him do something over and over and then one day not let him do it anymore. The rules have to be the same if he's at home or at grandma's house (luckily, grandma was also in the room so we could all be in agreement). Most of all, if she says she's going to punish him by taking x toy away...then follow through and really do if. If he learns that all of her threats are empty threats, he won't take her very seriously. He can start learning that there are certain "rules". Wherever he goes for the rest of his life, there will always be rules he needs to follow.
The doc agreed with my assessment that it was a healthy kid with a 2 year old 'tude. Mom even shook my hand as she was leaving, so maybe she appreciated what I said to her. We gave her the phone number of a local parenting class.
So, on the one hand I was glad to help. On the other, I felt guilty....like I had no right to tell her how to raise her kid. Then again, she asked for my advice. I didn't run up to her in the grocery store out of nowhere and start telling her what to do.
Now, the other thing that I wanted to write about....
I still don't have any children of my own (in case you thought I popped a few out in the past few paragraphs). Therefore, I can't actually relate to what it's like to look forward to bringing this perfect person into the world, only to one day find out that they have a problem of some sort. I'm sure it is devastating and requires some adjustment time.
However....
I am getting really frustrated over the past few weeks( and also in family practice, and also in my mom's pedi neurology office) with seeing parents who are unwilling to accept that their child has a problem and then get them the proper help.
Two examples:
An otherwise healthy 7 year old boy starts 1st grade and becomes a total emotional basket case. He worries about everything. Going to school every day is a battle. He cries and cries all morning. Then he goes into school and is okay for the day there, but as soon as he gets home he just sits in his room and doesn't want to play or talk or do anything. Some days he doesn't even go to school because he is such an emotional wreck that mom keeps him home. Mom brings him to the doc's office. Doc recommends looking into some counseling at the school and prescribes an antidepressant that also helps with anxiety in kids really well. Three weeks later, they come in for a follow-up visit. The first week was rough, but the last two weeks have been better. He gradually cried less and less. He is now just a little upset in the morning, but has made it to school every day for the past two weeks. He comes home in the afternoon and plays (ironically) school with his stuffed animals, and talks with mom and dad about his day when they have dinner. These are all good things, right?
So mom says she wants to immediately take him off the medication. Can't find out from him if he feels better now with the medication, because mom told him it was for his allergies (which he doesn't have). Mom keeps saying she's uncomfortable with him being on a medication. Okay, I get that. Other than the occasional antibiotic, it's tough to put your kid on something to take every day. But if he had asthma, or diabetes, wouldn't you want him to have the medication he needs to make his life better? We tried this to see if it helps, and he is obviously thriving on the medication. Taking him off of it might mean that he will go back to where he was 3 weeks ago, and then if she wants him back on it he will have to take it for a few weeks before it works well again. Mom seems to have a hang-up about even thinking that her kid could have a problem with depression, so she wants him off the medicine ASAP. Well, isn't that just hurting the kid? Aren't you making him suffer because you can't accept that he needs some help right now? He's okay with it. In fact, he's doing better than ever. Isn't this really about him and not you?
Of course, we can't say that to mom. So we agree to take him off it for a trial and see how he does. The counseling went nowhere. She had one visit with the school counselor and then declined any more visits and didn't want the counselor to contact him during the school day (she thought he would be embarrassed. In my opinion, kids are thrilled to get out of class to go somewhere "special". It's the mom who is embarrassed.)
Example 2. A 4 year old boy who weighs 80 lbs. Yes, 80 lbs. He has a vocabulary of less than 4 words. He expresses himself by grunting. He eats until he vomits, and then continues eating. He throws huge, violent tantrums whenever there is even a slight change in his routine. At the age of 3, when he wasn't speaking, doc referred the family to something called Birth to Three. It's supposed to help kids with developmental delays. Well, dad never let the people evaluate the kid. They hired a speech therapist and got his vocabulary up from 0 words to 10 words and some grunts. It was a nightmare trying to examine this kid because he thrashed around, punched, kicked, and screamed. Dad swore his behavior is "fine". Dad says "oh, he talks a lot at home." right. According to Dad, there is "nothing wrong with my son. He's just going at his own pace."
Coincidentally, I saw the mom later in the day with one of their older children. Just before she left she said, "Now, please don't tell me I'm crazy. Everyone says I am. But, I think there's something wrong with my son." Halleluah! Yes! We do too! It didn't take much convincing to get her to agree to an appointment with a neurologist (which isn't until December, unfortunately). She has done some of her own research on the internet and suspects something in the autism spectrum or Prader-Willy Syndrome. All are things we in the office had discussed as possible causes for his language delay and inability to deviate from routine. My fear is that mom will go home and dad will immediately control the situation again. Even if they go to the neurologist, who knows if dad will ever accept that his son has a problem that needs to be dealt with? Mom is already on that road, I think. I just hope she's strong enough to know when she needs to do what's best for her son and ignore the pig-headed dad.
Argh!!!!
Okay, all of that is off my chest now. I feel better. Whew!
October 3, 2007 12:22pm
Since I'm on my peds rotation right now, I'm feeling the urge to bitch about some kiddie related things. I'm only on a lunch break at the moment, so I will have to continue when I get home later.
The doctor I'm working with wants to write a book called "How to Raise a Brat". A How-To on raising a child to be the most needy, annoying, misbehaved adult possible. He's only half joking about this. It almost seems as if some parents are actually striving to achieve this with their children.
Remember when you were a kid and got it into your head that everyone hated you because you weren't allowed to use the china to serve mud pies (assuming you had parents who were smart enough to not let you serve mud pies on the china and have limits on what is toy vs. not toy), and you'd tie some of your toys up in a blanket, attach it to a broom handle, and head off into the world on your own? I was about 6 the first time I got it into my head to run away. I made it to the end of the driveway. Nobody went chasing after me (though probably someone watched me from the window). If I told my mom I hated her and she was the worst mommy in the world, she didn't go running after me, begging for me to forgive her and telling me that she loves me oh so much.
I walked to the end of the driveway and sat. I sat until my butt got cold and then I came back inside. Then, I had to apologize to my mom for talking to her that way.
There is a bit of parenting advice here. Maybe a kid just needs some alone time. Just a bit of space to have a fit. Most importantly....the kid does not rule the show.
I see so many parents in the office who seem to just let their kids run the house. Then, the mom is "so overwhelmed!". Well, gee, I wonder why. You're letting a 4 year old boss you around.
I know some kinds have real behavior problems (more on that after lunch), but some kids just need some discipline in their home! Good grief! I know spanking is a hot topic for some people. But for pete's sake, nobody will fault you for yelling at your kid when they misbehave. There's a kid in the office who is tugging at my stethoscope around my neck and ripping the BP cuff off the wall, and mom is saying in a sweet voice, "Now, Billy, don't do that. Billy. Don't do that. Billy, mommy is asking nicely. Can you please not do that?"
Billy isn't paying a bit of attention. How about the "Mom Eye" and a big loud, "Billy! YOU QUIT DOING THAT RIGHT NOW. SIT DOWN IN THAT CHAIR AND BE QUIET WHILE THE DR EXAMINES YOUR SISTER."
The tone of one's voice is far more important than the words used. Though, in this case, billy is 8 years old and is old enough to understand the message of "Sit down and be quiet". The speaking softly to one's children deal just doesn't seem to be working for little Billy! Does mom think that Billy will just crumble to pieces and be doomed to a shrink's couch if she gives him a stern look and a yell?
And then I think some of these kids get labeled as "bad kids", or people think they have an attention problem....when it's really just that nobody has ever made them even try to sit still and behave. Kids aren't just born knowing how to behave. Well, sure, some are. Some are the perfect children from birth. But most need some rules and limits so they can learn how to behave.
If we have to go to war 20 years from now, I think we're doomed. There's going to be a whole generation of wimps who never had to deal with disappointment or consequences. They get a trophy for just showing up to the game and are so used to people cheering them on that as adults they don't get why nobody is cheering for them.
This is not an exaggeration. There was an article in the Wall Street Journal recently about companies having problems with new, young employees. They expect to be rewarded for everything they do. One young man came to work every day on time for a year. He wanted to know why he wasn't given some special recognition for that.
Oy!
Okay, back to my social research.....
The doctor I'm working with wants to write a book called "How to Raise a Brat". A How-To on raising a child to be the most needy, annoying, misbehaved adult possible. He's only half joking about this. It almost seems as if some parents are actually striving to achieve this with their children.
Remember when you were a kid and got it into your head that everyone hated you because you weren't allowed to use the china to serve mud pies (assuming you had parents who were smart enough to not let you serve mud pies on the china and have limits on what is toy vs. not toy), and you'd tie some of your toys up in a blanket, attach it to a broom handle, and head off into the world on your own? I was about 6 the first time I got it into my head to run away. I made it to the end of the driveway. Nobody went chasing after me (though probably someone watched me from the window). If I told my mom I hated her and she was the worst mommy in the world, she didn't go running after me, begging for me to forgive her and telling me that she loves me oh so much.
I walked to the end of the driveway and sat. I sat until my butt got cold and then I came back inside. Then, I had to apologize to my mom for talking to her that way.
There is a bit of parenting advice here. Maybe a kid just needs some alone time. Just a bit of space to have a fit. Most importantly....the kid does not rule the show.
I see so many parents in the office who seem to just let their kids run the house. Then, the mom is "so overwhelmed!". Well, gee, I wonder why. You're letting a 4 year old boss you around.
I know some kinds have real behavior problems (more on that after lunch), but some kids just need some discipline in their home! Good grief! I know spanking is a hot topic for some people. But for pete's sake, nobody will fault you for yelling at your kid when they misbehave. There's a kid in the office who is tugging at my stethoscope around my neck and ripping the BP cuff off the wall, and mom is saying in a sweet voice, "Now, Billy, don't do that. Billy. Don't do that. Billy, mommy is asking nicely. Can you please not do that?"
Billy isn't paying a bit of attention. How about the "Mom Eye" and a big loud, "Billy! YOU QUIT DOING THAT RIGHT NOW. SIT DOWN IN THAT CHAIR AND BE QUIET WHILE THE DR EXAMINES YOUR SISTER."
The tone of one's voice is far more important than the words used. Though, in this case, billy is 8 years old and is old enough to understand the message of "Sit down and be quiet". The speaking softly to one's children deal just doesn't seem to be working for little Billy! Does mom think that Billy will just crumble to pieces and be doomed to a shrink's couch if she gives him a stern look and a yell?
And then I think some of these kids get labeled as "bad kids", or people think they have an attention problem....when it's really just that nobody has ever made them even try to sit still and behave. Kids aren't just born knowing how to behave. Well, sure, some are. Some are the perfect children from birth. But most need some rules and limits so they can learn how to behave.
If we have to go to war 20 years from now, I think we're doomed. There's going to be a whole generation of wimps who never had to deal with disappointment or consequences. They get a trophy for just showing up to the game and are so used to people cheering them on that as adults they don't get why nobody is cheering for them.
This is not an exaggeration. There was an article in the Wall Street Journal recently about companies having problems with new, young employees. They expect to be rewarded for everything they do. One young man came to work every day on time for a year. He wanted to know why he wasn't given some special recognition for that.
Oy!
Okay, back to my social research.....
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