I have known such great men over the years. Most were patients I have cared for. So many of them I met because their wives pushed them in to the office. When they finally got there, they often shared why they were so reluctant to come. Many thought I was just this kid and I had to win their respect with my skill. Once accomplished, they came in and confided in me.
They appeared to be healthy hard-working husbands and fathers. I, unfortunately, diagnosed quite a few with untreated hypertension, cancer and diabetes. It can be the hardest thing a man does when he admits he has an illness. I found what I though was just a cyst on a patient’s back. It turned out to be metastatic kidney cancer. He was so strong through the ordeal. Most concerned about his wonderful wife. She was my patient. It was not a long illness and he had no long battle. We did not have many treatment options.
My favorite couple was one of my most tragic cases. Mr. C ‘s wife had multiple medical problems. Through it all he was there. She developed a blood clot in her leg and then we finally diagnosed cancer of the kidney. We transferred her to the University Hospital but she died during surgery. He was devastated. Every visit was not about his medical problems but about the loss of his wife, soul mate after more than thirty years of being together. He was comfortable enough after all this time to reveal how lost he felt. He was overwhelmed by the advances from women who wanted to take his wife’s place. He was surprised because many of them were her friends. I tried to be helpful and not offend him. I told him he was such a good husband that they wanted to have the same loving relationship. He was not ready. I found myself giving him tips on how to handle these lovely church ladies many of whom I knew because they were patients or I knew them through my work in the community. He would just say “She was a beautiful woman and no one can replace her.”
One of my colleagues, Dr. S, entrusted the care of his beloved wife to me. It was a compliment but I felt I had failed the first time I admitted her to the hospital. I soon learned that he had been taking IV bags on vacations just in case she had a problem. She had decided he needed support. She was devoted to him. She would tell me stories of the old days when doctors lived in the hospital housing. She was a nurse and that is how they met. She held the family together while he was always in the operating room. They lived on what she earned because residents had meager salaries at that time. He was the beloved surgeon. She had managed his office and his life. When she died, I remember telling him to take care of himself. He had retired. His daughter-in-law hugged him and said that was her responsibility now and she was honored to do it. He had been there for everyone.  He planned to leave no money for his children and they knew that. He made sure that he and his wife had everything and she enjoyed life. They gave to the community and he would never complain if a patient had no insurance. He left his children more than money, it was a legacy of his hard work and total love and devotion to them and his community.
Mr. A cared for his wife who was disabled and in a wheel chair after having a stroke. He was a devoted caregiver and thankfully he had help from his family, friends and a home health aide. His wife had been a dynamic women and quite fashionable. At each visit, she was dressed in one of her many stylish outfits and always her favorite perfume, jewelry and a hat. When his wife died, I was concerned that he would just give up. I think his friends and family felt the same way. They all came to her funeral and made sure he knew that people loved him. He was showered with requests for him to visit friends and relatives all over the country. Those making the request went one-step further and sent plane tickets. The first few months he traveled. They all managed to keep up their active support for a number of years. He thrived with the attention. His faced glowed with gratitude.
We always think the smoker will get lung cancer.  Sometimes, it is the innocent one who spent all those years saying, “Please stop smoking.” Finding out that the lung mass in the non-smoking wife is cancer can be devastating to the family.  When that cancer is one typically associated with second-hand smoke exposure, it is especially hard. She died from her cancer. He had to go on and struggle through her loss and unfortunately, emphysema. His daughters took care of him because he was a loving father and husband.
Fathers Day is a time to honor those men who love and support their families. I remember admitting a dad who had developed pertussis (whooping-cough). The Pediatrician admitted the infant daughter. He was so upset that he had been the one to make his child sick. We explained this can happen. Back then it was a few cases and now there are more.
Loving husbands and fathers make a difference during difficult times. My husband spent many days taking our son to the Pediatrician alone for shots. It was difficult for me to get away from my training and later the office. He did the soccer games, tennis lessons and all the homework. He was the Book Fair volunteer; he and another Dad would make sure the kids made smart book choices. He was the chaperone on the school trips. He made all the visits to the orthodontist for braces, found the Barber for the haircuts and scheduled the music lessons. He cooked all our meals and even did the laundry.

Happy Father’s Day!!!!

My son and several friends developed chicken pox. It was a just before the vaccine was approved for widespread use  and became part of the routine immunization schedule. He developed mesenteric adenitis and for a few hours I held him as he cried in severe pain. A dose of Tylenol finally kicked in. I knew what it was but it was frightening watching him. That year several children died from an invasive streptococcal infection. One of them was a patient. We always feared the complication of Reyes Syndrome but not cellulite or pneumonia due to this invasive bacteria was a surprise.  There were cases from California to New York.

It is not widely known but we are having a resurgence of vaccine preventable diseases in the US. It is happening in many states. There are cases of measles and mumps in California, New Jersey, New York, Ohio and Texas. From January 1 through May 23, 2014 a total of 288 confirmed measles cases have been reported surpassing the highest reported yearly total of measles cases since elimination which was 220 in 2011. We are losing the advantage of herd-immunity because many are choosing not to be vaccinated. The vaccines are not a hundred per cent effective. Many of those immunized do not develop full immunity after vaccination. Thanks to several recently written news articles and television news reports, the alarm is being sounded. We need to be more vigilant. The CDC reports that 280 (97%) of the cases were associated with importation of measles from at least 18 countries.

I found out in medical school I lacked immunity to Mumps. I received a single dose of the vaccine. I remember having both measles and chicken pox along with my sisters and cousins. We were all home from school. Now, I always show immunity when I get blood tests.

My son went to Buenos Aires when he was 11 for a program so he was immunized against Hepatitis A. I remember the Hepatitis A outbreak in my area in the 90’s. I had patients coming in to get blood work. We worked with the local Health Department and they got the Immune globulin. I had my son get the Meningitis vaccine when he was in college even though he was commuting.  I am a believer in immunizations. I am concerned that I should have him tested for immunity to measles, mumps and rubella. There are some patients that do not develop immunity even with adequate vaccination. I may be overly concerned.

I have the responsibility of enforcing the university immunization policy and it is not an easy task. This year I increased the requirements. Many students don’t think it is important. Many doctors also fail to follow the immunization schedules and vaccinate their patients. So I have to take on the role, to insure we have no campus outbreaks. With two cases of chicken pox, I had double work. I had to notify students, get them tested for immunity and those not immune had to be vaccinated. I really do not want a repeat of this.  So, I am hoping my new Electronic Health Record will help me improve compliance.

I have spent many nights not sleeping. The biggest reason was worrying about patients and medical decisions. I would call the ICU at night to make sure patients were stable. The nurses would always reassure me. I would worry about a sick patient from the office and hope my treatment plan was the right choice. It has taken years to be less worried but I still am.

I worried that the new drug I prescribed would treat the condition and not cause a serious side effect. Pharmacology was my best course in medical school. The professor was awesome. We did have to read and know every page of the textbook to pass the exam. I quickly learned that a patient can have the side effect from the list of 10% or 1% most common side effects and that can be a nightmare or a nuisance. So when I am prescribing any medication, I think first is it really necessary. I don’t give out antibiotics for colds. If I give the “Antibiotic to Hold “prescription, my patients don’t fill it, they get better with just time. I love it when they bring back a folded piece of blue paper.

I don’t prescribe sleeping agents or narcotic pain medications to my students. In the past, I reluctantly wrote those prescriptions. I always tried non-narcotic pain medications first and referrals to the appropriate specialist. They came back on narcotics. Also, I tried to get patients to exercise, turn off the TV in the bedroom and meditate to treat insomnia. Those suggestions were met with resistance and the need for an instant cure. So, I prescribed then Halcion and Restoril. They really did not work and caused other problems. In older patients, memory loss, loss of balance and depression. In younger patients, they caused dizziness and palpitations.

The narcotic pain medications were also a problem. My worst case was a nurse that stole my prescription pad and wrote her own prescription for pain medication. She was caught by the pharmacist. I had a very noticeable way of writing prescriptions for controlled substances. She did not notice that and it was her undoing. I learned that technique after a patient changed a quantity of 10 to 100. The pharmacist caught that too. I always gave small quantities. A lesson learned as a resident when one of my drug diverting patients used his prescription to overdose after being confronted by a physician for using multiple doctors to get pain medications. I had to admit him to the hospital because I was the resident physician. With the new electronic data bases, more patients are being caught. I recently had a patient with a 17-page report. The resident I was working with learned the same valuable lesson.

Generics are cheaper and are equivalent to Brand medications but the delivery systems for many drugs are patented. So when a patient complains that their pills are changing colors each month, it is due to generic medications. Brand name drugs have patented colors and company logos. Patients can get pills mixed up and take the wrong one because they can be the same color, shape and size. We all metabolize drugs differently due to genetics based on race and sex. So a patient can be doing well on one form of the drug and have problems with a new prescription due to the rate of absorption of the of the medication.  I learned that the hard way. A patient switched from a brand medication that had the patented slow release delivery system to a generic. She complained that she felt dizzy and faint one hour after taking the new form. She was getting a more rapid release of medication and I had to write “Brand Only, no generic substitution” to get it paid for by her insurance company. I had to fill out a form with a detailed description of the problem.

So, why is this important? It is pharmacology. When I read the side effect profile of most drugs I get nervous. So prescribing them has caused some sleepless nights. So, how do I treat my insomnia? Exercise, yoga and meditation work great. I do not have a TV in my bedroom and I try not to look at any electronic device after 9 pm. I go to bed and practice breath awareness. For pain, I used my chiropractor to treat an injured shoulder and augmented it with yoga therapy. I treated my leg injury with exercise, ice and time. I have learned there is no magic pill.

Narcotic pain medications can be abused. I did Hospice Care for years and I know they can relieve pain and suffering for many patients. However, now they are a problem leading to the FDA approving the Naloxone pen to treat drug overdoses. The pen will be carried by first-responders in the community and on college campuses.

So in my new role, I reiterate, I do not prescribe narcotic pain medications, sleeping agents or medications to treat Attention Deficit Disorder (ADD). The ADD medications are being abused on campuses as “Study Drugs.” In medical school, several classmates crashed due to what we called “Uppers” when they were pulling all-nighters. I always needed sleep and good food before any examination so I could never do an all-nighter. Coffee was not even an option. I did not drink it until Residency and now, I can only have my one cup in the morning. It can cause insomnia due to caffeine.

I am thankful to my Pharmacology professor for forcing me learn all those drug classifications years ago. He also taught me respect for the 10 % and 1%.

March is Women’s History Month and the theme is “Celebrating Women of Character, Courage, and Commitment. “   March 8, was Internal Women’s Day.  The theme was “Inspiring Change.”  Many of my patients would say to me “Thank you taking such good care of me, but I worry about who takes care of you? “ I have thought about that over the years,

The answer to that question is not so easy to elucidate.  I started to reflect and I realized it is the women that I have in my life who care for me and inspire me. Not just one but all of them.  It started with my mother who has always had a sixth sense and always calls at just the right time.  She could look into my eyes and know I was not feeling well. Through high school, college and medical school she was my greatest supporter but also never stop reminding me that she “expected better from me.” That was because I was the oldest child. Not only was my mother there for me but all my aunts.  I had four mothers. The biggest supporter was my grandmother who always made me feel special.  However, she loved all of us the same.  This was evident when she handed out praise or discipline.

My sisters are great.  They have always thought I was the smart one.  However, I think my sister Kathy is the smartest.  She has fixed ripped seams, hemmed and sewn dresses, designed curtains and just been there with her laughter and positive outlook.  She recently finished her degree.  Her goal is to start a program to help students get prepared for college and the workforce. She never has a harsh word or thought for anyone.

In school, I had committed teachers who recognized I was a step ahead.  It started in first grade.  I recently saw my second grade teacher.  She was still so sweet and filled with prasie.  Until 5^th grade, I went to a segregated school.  My sixth grade teacher could have ignored me but she made sure, that I was placed in the honors program for seventh and eighth grade. I was always an avid reader but that program expanded my skills.  Her support was instrumental in my success in high school.

It was my first HS English teacher that pushed me the most. She fearlessly challenged me to write better and read more.  This was despite taking all those math and science courses.  She forced me to put pen to paper and graded my work honestly. I dreaded but learned to rise to the challenge of that “red pen.”  My initial papers were hemorrhaging red ink.  My challenge was to decrease the amount of bleeding.

I had my host of friends in HS. They were there when I lost the race for Student Body President.  One of them became my roommate in college. It broke my heart when she left school to get married.  My next roommate was also wonderful.  When I go home, I still get together with several of my friends from college. We always went to parties together and our rule was “We came together, we leave together.” That kept us all safe.

My best friend from medical school is still my best friend.  She is an OB/GYN.  We have supported each other through many stormy times. She offered to whisk me away on the morning of my first wedding.  She knew what I would later learn; it was not what was right for me at that time. However, there were no hard feelings.

In residency I met my other long-time friend, she is a family physician.  She called me once a week.  For years, we met twice a year at medical conferences to catch-up.  She was an exercise fanatic and I stayed in shape so I could keep up with her.  She is ten years older and still looks great.  When her father died, I was in Maryland.  We could not get up for the funeral. So we all went to see “Having Our Say”, the remarkable play about the Delaney sisters, when I finally could get to see her and her mother.

My late friend who was a Cardiologist adopted me while I lived in Maryland.  We would make shopping trips to the Nordstrom for the Half-Yearly Sale. We would take a Friday off and have a blast.  She taught me about fine cooking and how to write a consultation.  After her help, I received praise from a doctor at Johns Hopkins when I referred a patient.  When he sent me a consultation note, he began by thanking me for the most thorough letter he had received in years.

All these great women were there for me. They are in my yoga class, my female col leagues, former residents and my new friends.  Most important over the past 30 years, it has been my husband who has been there and since we met, has had a positive approval rating from all these women.  He once said “he never worried where I was because he always knew I was in good company.”  He meant all my friends.

I want to thank all the wonderful and courageous women who have been and still are in my life.  They have taught me to be passionate, courageous, and serve others with humility and compassion.