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.

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.

I will be celebrating a birthday soon. Who could have predicted that a congenital problem would flare and lead to major surgery? Details another time. The day after surgery I called my mother to give her the details.

I started with “Mom, I am fine, but I had to have surgery yesterday.” Mom. “Oh no, are you alright. Do I need to come?” I reassured her I was fine. To lighten the moment, I reminded her of my problem as a child. You see I was always known to just start vomiting after meals. Sometimes it happened in the car so I was labeled and on each car ride I had to have a large can so I could throw up in it. Thank God for leather seats. I also had to have a large towel in the car.

I vomited at Kindergarten, so I had to carry an extra outfit every day. I was labeled the picky eater, so it was always exciting for everyone when I ate new foods. It is amazing how children can adjust to physical conditions. I think I avoided foods that could have exacerbated the problem. You see, I now know I had a congenital band that was the cause of all those episodes of vomiting.

I told my Mother. I am not sure if she had a slight twinge of guilt, but I reassured her that it would not have been found. Especially back  then. I grew up in Birmingham and let’s face it there was not access to good healthcare for African Americans at that time. Also, the cost structure was different.  Surgery would have been too costly and even dangerous.

“Don’t post it on the Family Reunion page.”

“Of course not.”

“I am going to the reunion meeting and I will tell your cousins and aunts”

“I am going to call your sisters now and then I am going to just fall out on the floor”

“Mom I am fine, don’t do that”

“Yes, I will call your sisters and then fall out on the floor”

I talked to her the next day and she was fine. She updated me on the meeting and the family gossip. She made me laugh so hard, I finally started to feel better. I had had a rough night. We are so resilient. It is based on love and faith. I know I am loved and that just makes me stronger and keeps me going. I love my Mother. She is the rock of our family. My sisters also called that morning and we continued the laughs and love.

“My mother is so full of joy and life. I am her child. And that is better than being the child of anyone else in the world.”

“Wisdom comes only when you stop looking for it and start living the life the Creator intended for you. “

Hopi

“I refuse to accept the view that mankind is so tragically bound to the starless midnight of racism and war that the bright daybreak of peace and brotherhood can never become a reality… I believe that unarmed truth and unconditional love will have the final word.”

Dr. Martin Luther King

My grandparents were often described decent people. The definition: “conforming to generally accepted standards of respectable or moral behavior” is a fitting description of them. They were not perfect but to me they were.  Many times, we would often wish a spanking from my grandmother rather than what my uncles called one of her “sermonettes. Her father, my great-grandfather was a Baptist Minister. She could quote the Bible from memory. When we even mentioned being bored, she handed us the Bible, the dictionary or the Encyclopedia and expected us to read it.. 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 required 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.” My grandfather was just a gentle giant.  Kind, loving and respected by everyone.

I took those lessons to college and to Medical School and it influenced how I cared for my patients. From the first day of my internship, it became apparent that not everyone learned how to be decent.  I had to work hard to do all my notes. One attending critiqued each one to make sure they were grammatically correct and accurate. I went in to admit a patient and she kindly asked me to leave.  I was black and she was obviously 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 early right after our  sign-out.  Well much to my dismay, I was summoned back to the nurse’s station and told to go back in and do the admission. It seems that my attending had told the patient that if she wanted to stay in the hospital she must be admitted by me, Dr. Washington, the Black female intern. The patient looked at me and said” It looks like you and I  are going to have to work together.” I ended up leaving late but I left with a sense of accomplishment.  I was fortunate enough to hear a story marked with pain, suffering and disappointment.  I paid her the respect I was taught to give to all patients and she responded.

It is obvious that more people should have had the benefit of listening to my grandmother and being in the presence of my grandfather. She has been gone from my life for over 10 years but I still carry the imprint of her love and guidance.

Racism, sexism, and fear  are impacting every aspect of our lives. In medicine, it is impacting the diversity of our workforce and increasing health disparities.  As we recognize the life of Dr. Martin Luther King, we see the erosion of the very values he stressed in his sermons and in his life. I often reread some of those sermons to gather inspiration. The January issue of the Society for Teachers of Family Medicine Journal is dedicated to looking at the issue of racism and highlighting departments that are addressing this complex problem.  From the Editor:

“We must create spaces that are more inclusive and recognize our unconscious biases. We need to commit to fighting injustice in health care and ensuring families can live well to the best of their ability. The real work to make this a reality will have to occur in every single medical practice and training program in the nation.”

Bich-May Nguyen, MD, MPH

https://journals.stfm.org/familymedicine/2019/january/

 “There comes a time when one must take a position that is neither safe, nor politic, nor popular, but he must take it because conscience tells him it is right.” 

Dr. Martin Luther King

Hope smiles from the threshold of the year to come, whispering, ‘It will be happier.’Alfred Lord Tennyson

2018 was both exhilarating and unsettling; with happy and sad moments. For me, it started with stress induced hair loss. I noticed it as we were preparing for a major electronic health record implementation. I volunteered to take a lead role in the implementation for our program. I panicked when I finally noticed the patch of thinning. I called my stylist looking for help and she calmly explained to me my options. She explained why crocheting was a better option than braiding, weaving or just having a very low cut natural style. I decided to go with crocheting. It has given me a new carefree look. Thankfully, my hair has grown back but I love this look and plan to keep it for a while.

I have spent 35 years taking care of patients bit you are never prepared  to confront medical problems in you families. After finding the best solution to my problem, I was hit with my mother’s sadness over not only the loss of her sister (the oldest) but also her diagnosis of breast cancer. Her sister had a stroke that would have left her debilitated but my cousins chose hospice care. She went peacefully after her sisters’ visit. My mother sailed through the bilateral mastectomy  We talk almost every day and but she still misses her sister. I could not make it to the funeral and my sisters were there to help her because I was studying for my Family Medicine Recertification Exam. The test was on Friday, April 13.  Not to brag but I passed with a higher score than I did 10 years ago.

In July, we went to the Arrington-Giddens Family Reunion in Chicago. It was so inspiring to see how the Chicago side of our family prospered after my grand aunt fled the racism of Birmingham and along with her brothers who followed built a rich life on the Southside of Chicago. The tour of the area was educational an included the homes Mohammad Ali, Louis Farrakhan, and the Obamas. Shout out to Michelle Obama for the top-selling book of 2019. The book beautifully showed life on the Southside of Chicago and the southern roots of families as they started new lives during the Northern Migration.

In August, we traveled to Birmingham to see my mother. I didn’t have time to visit all my old friends. We did go to church on that Sunday.  I was fortunate enough to wish my second grade teacher farewell because she is over 90 and transitioning from her long life of independence to live with her son in Texas.  I was overcome with both joy and sadness to see someone who once towered over me weakened by age. She was one of the architects of my success along with my mother.

In September, I realized that the love of my life had a terrible shoulder problem. Fortunately with physical therapy, we were able to celebrate his 75^th birthday December 1^st. I am now on the other side of 60. It seems like yesterday we celebrated his 40^th birthday. Now it really is thirty-five years together. So, now it has been thirty-five Christmases and New Year’s spent together.

Politically, this year has been both disappointing and inspiring. The November election led the way for the most diverse group of legislators in our history  and the Mueller investigation were two positives.  The appointment of the most recent SCJ was a disappointment but many rulings by our circuit court judges have protected the rule of law. The fight over the Border Wall, immigration, and the separation of families was not our best moments.

2018 was also my year to embrace my meditation and yoga practice which formed the foundation for my positivity. I am going to rededicate myself to my yoga and meditation practice in 2019.

Here’s to 2019. I am ready to face it head on.  Happy New Year!!!

Your success and happiness lies in you. Resolve to keep happy, and your joy and you shall form an invincible host against difficulties. Helen Keller

I have been fortunate to have experienced the effect  loving fathers  have on the lives of their families, friends and colleagues. My grandfather was the ideal father.  He was always so loving and caring.  He never raised his voice but when he did it was well deserved. He provided for 10 children and scores of grandchildren, great-grandchildren, nieces, nephews, friends and everyone else who found themselves in our extended family.  We called him “Big Daddy.” To others, he was Mr. John, Uncle John and Mr. Waldrop.  I cannot forget my uncles who were my mother’s brothers and her sister’s husbands. They cared for all of us like we were their own children.  My parents were divorced when I was five years-old so they all filled the void.

The others were patients I have cared for over the years.  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. Unfortunately, I 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 thought 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 and his children.  His wife was my patient. It was not a prolonged illness and he did not have a  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 those 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.  I did respect his philosophy; he was going to use all the money he made to enjoy time with his wife.  He planned to leave no money for his children and they knew that.  However, he left them more, the legacy of his hard work and total devotion to them.

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.  I had cared for the wife and my male colleague, her husband. 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 who made sure they all had the best.

Father’s 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

Loving husbands and fathers make a difference. My husband has cared so lovingly for his children. He spent many hours 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 the braces, found the Barber for the haircuts and scheduled the music lessons.  He cooked all our meals and even did the laundry.   He also just made sure I was always safe and loved as I navigated my professional career.  He made some sacrifices that made it possible for me to focus on my career goals.

Happy Father’s Day!!!!