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The Cutest Patient Ever

I was really touched by Signout’s blog post about a charming octogenarian.  It’s patients like these that make you glad to be a doctor… Signout writes:

I have a secret crush on one of my patients, an 85-year old man
who’s recovering from a bad pneumonia. After a weeklong stay in the
intensive care unit, he has recovered at a remarkable pace: the day
after he was extubated, he was out of bed with a physical therapist,
making his way slowly around the ward with a walker and a big smile.

What motivates him to work so hard at recovery, the
nurses say, is his love for his wife. They have been married 60 years.
She comes in to see him every day, wheeled around by their daughter.
The whole time she is there, they say, he holds her hand as if it is
the last time he will see her…

This man is the cutest patient ever… and the dear fellow reminds me of my husband (only a little bit older – the patient is older, not my husband – er, you see what I mean).  One of my single friends asked me how I knew that Steve was the man I wanted to marry, I told them this:

“One day it suddenly occurred to me that if I had a traumatic brain injury or suffered from severe dementia and was totally incapacitated – Steve would faithfully care for me, never leave my side, and devote his entire life to my recovery or best quality of life.  When I realized that he would do this for me without a second thought… I knew I had to marry him.”

Now, I’m not sure that Steve finds that image particularly romantic – but I do.  It’s a doctor thing I guess.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

8 Random Facts Meme

My friend Dr. Rob tagged me with the “8 random facts” meme.  I’m supposed to list 8 little known facts about myself, and then tag 8 other bloggers to go and do likewise.  Although I’ve never participated in chain mail, I’m a sucker for a good blog meme and will bite on this one.

Eight little known things about Dr. Val…

1.  I once worked for a marketing research firm that regularly sent me and a camera crew to the homes of wet vac owners to videotape their home use technique.  That was some entertaining videography, I can tell you.
2.  I have 3 citizenships – US, Canada, and the UK
3.  My dad once unionized a group of pickle factory workers, and was fired the next day.
4.  I worked as a bartender in Manhattan while I was in medical school.
5.  My car was hit by a drunk driver once, so I chased him down, forced him off the road and demanded his license and registration.  Probably a dangerous move, but I was really angry.
6.  As a child I wanted to grow up to be a Hollywood special effects artist.  I still love to watch movies like Lord of the Rings and Alien because of the special effects.
7.  I was a precocious little kid – when I was 6 years old my mother’s friend asked me what I wanted to be when I grew up.  I said, “a philanthropist.”
8.  I worked as a nanny in Quebec for a summer.  The kids called me the “monstre de betteraves” (the “beet monster”) because I ate so many beets from their garden.  They had a pressure cooker – and the fresh beets were so sweet and tasty!  How could I resist?

Ok, well those are my 8 random facts… now I will nominate 8 bloggers to give me the dirt on themselves (if they’re up to the challenge):

Resilient Mom
Sandra Foschi
Dr. Glode
Dr. Silver
Dr. Brown
Dr. Hill
Dr. Herndon
Dr. Poceta

Let’s learn a little about each other, shall we?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Is that your real skin?

I’ve been thinking about skin cancer lately.  A young, fair skinned friend of mine
recently had a small mole removed from her leg.
It turned out to be melanoma!  It
didn’t take me too long to make the connection between her complexion and mine,
and the fact that I’d been avoiding the dermatologist for several years,
worried that I’d come out like a punch biopsy pin cushion since I have quite a
few freckles and moles (and I’ve heard that dermatologists like to err on the
side of caution and biopsy anything remotely suspicious).  But the melanoma story galvanized me into
action.  I made an appointment with a
dermatologist (yes, I had to wait 4 months to get an appointment!) and got a
skin check.  Luckily for me, all was fine.  But I started to reflect on various conversations
I’ve had about my skin recently.  All you
Irish types out there will relate…

Conversation 1

Coworker A: Val, are you ok?
You look kind of sick.

Me: I’m just fine.

Coworker A: But Val, you look a little… bluish…

Me: That’s just my skin color.  My veins show through my skin because it has
no melanin.

Coworker A: (Appearing sympathetic) Oh, well glad you’re
alright.

Conversation 2

Coworker B: (in the middle of a conversation with me, sitting
across from one another on chairs.  I’m wearing a skirt.  Suddenly she lunges forward
and touches my knee and gasps).  Is that
your real skin?

Me: Um… yes.  What
else would it be?

Coworker B: Well, I thought you were wearing white pantyhose.

Me: Nope.  It’s too
hot for pantyhose so I just go bare legged.

Coworker B: (still in shock).  But that’s your skin?  Just like that?

Me: Yeah.  I don’t
tan.

Coworker B: (appearing sympathetic) Oh, wow.

Conversation 3

Dermatologist: Hi, I’m Dr. XXX. (Peering at me, seated on the examining table
in a paper gown.)  Are you Scandinavian?

Me: No, I’m part Welsh – you know, “Jones.”

Dermatologist: Oh, well the Vikings probably invaded Wales
at some point.

Me: (to myself) well thanks for alluding to the raping and pillaging
of my ancestors.

Dermatoligst: You’re high risk for skin cancer.  People like you need to have careful skin
exams every year.

Me: Yes I know.  But
please don’t take any unnecessary biopsies!
I think my moles are all fine.

Dermatologist: Well let’s see…(tearing the paper gown in two).  You definitely need to wear SPF 50…

Me: Sigh.  I know…

Conversation 4:

Husband: (giving me what I thought was a tender look.  He leans in…) Your eye lids are kind of pinkish purple

Me: Yes, that’s the color of the capillaries that show
through my lid skin.  Hard to get a tan
there you know.

Husband: You don’t need a tan – I like your color.  Kind of pastel pink and blue. (He leans in even closer to inspect my eye lids.)

Me: Yeah, not exactly attractive in a bathing suit. (I pull away.  He laughs.)

Husband: Well, yeah.
It’s better not to be out in the sun or on the beach, but you can still
go outside!

Me: Thanks.

Conversation 5:

Asian manicurist: (looking at my hands) Your skin is so white!

Me: Yes, I’m afraid my past efforts to alter that have failed.

Asian manicurist: How did you get your skin so white?

Me: I didn’t do anything.
It’s like that naturally.

Asian manicurist: (looking closer at my hands) I wish I had skin like yours.

Me: Why? (Hoping she’d say something flattering after all).

Asian manicurist: It looks clean.

And so I guess despite all the people I’ve worried with my vaguely cyanotic appearance, there’s one thing for sure: I look clean.  I guess I can live with that.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Alzheimer’s Dementia: A Life Lived in Reverse

My grandmother was a kindly woman.  She grew up in a frontier town in Alaska, the daughter of
a photographer.  She lived simply, and
spent the majority of her waking hours figuring out how to stay warm.  Much to her delight, her mother eventually
moved to San Francisco,
where she was able to thaw out and bloom.

She went on to marry a charismatic business man (one of the
early founders of Technicolor Films) and had 6 children, the first of whom was
autistic.  It was a great challenge
taking care of all those kids, with her husband away on business much of the
time.  And there were no special services
for children with autism then.  So it
came as no surprise when my grandmother seemed a little forgetful and frazzled.  But that forgetfulness was not so innocent as
it turns out.

Memory lapses grew into more advanced confusion, as her
children noticed that she was becoming unreliable.  She would forget to pick them up from school,
couldn’t remember where they were going next, and didn’t recall what they had
told her only moments prior.  My
grandmother had early onset Alzheimer’s disease – and it would take her on a
path of no return.

By the time I was old enough to know my grandmother she was
being cared for by home health aids.  She
was still extremely sweet and gentle, and could have short conversations that
were interesting and engaging, but she had no idea who I was, or why we were
speaking.  Still, her Victorian
upbringing caused her to be extremely well mannered – never letting on that she
secretly wondered why this “nice young girl” (a perfect stranger) was spending
time with her in her house.

But the strangest part of grandma’s journey with Alzheimer’s
was that it took her on a reverse tour of her former life.  She seemed to be reliving each day that had
had the most emotional impact on her – in descending chronological order.  So that some weeks she believed that each day
was her 60th birthday… and then she’d move on to each day being her
58th birthday, and so on… But the most heart-wrenching span of weeks
were when she thought it was the day of her husband’s death.  She wept all day long, reliving the
experience.  We would ask her why she was
crying, and she’d look at us incredulously, “Well, don’t you know that Kay died
today?”  Our lack of appreciating that
obvious fact added to her extreme loneliness… as if she had lost her husband
and no one else cared or noticed.  We
would try to dissuade her of that notion, reminding her of the actual date and
who each of us was.  But alas, the
neurons that housed her emotions seemed to outnumber those that ordered her
memories, and so only time could change her of her perception of reality.

We all watched grandma deteriorate over the years, being
dragged backwards through time by some invisible force, verbalizing her
experiences as she relived them.  It was
a kind of bizarre way to learn about her life – through the eyes of a woman who
told old stories as if they were currently occurring.

But eventually the stories ceased, and she regressed to a
non-verbal state.  Her mind had finished
its story telling long before her body was ready to let go.

Grandma lived until the age of 96, and passed away
peacefully in her sleep.  I can only hope
that she was dreaming of pleasant events in her early childhood when she
slipped into the ether – a baby in a shadow of memory.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

The right balance for good health

I realize that my last post has probably left you wondering what on earth bulldozers and ballerinas have to do with medicine.  Well, let me lead you down my little mental garden path here and explain.

The dancing event took place right next to the National Academy of Sciences, where the Institute of Medicine (IOM) holds its regular meetings.  It was all the more humorous to see these bulldozers (with rose petal-filled buckets) participating in this awkward dance – right in front of the hallowed halls of medicine’s most prestigious scientific body.  As I thought about what the IOM stands for – the pursuit of truth through objective scientific analysis – and what these ballerinas were up to (reveling in the whimsy of life) it struck me that good medicine might actually combine the two.

Clearly, there are aspects of a healthy life that cannot be well defined by science.  Love, peace, and joyfulness are all nourishing to the mind and body – but quantifying them is rather difficult.  The things that grandma taught us – get your beauty rest, be kind to others, get lots of fresh air, marry a loving man (or woman) – are great medicine, and should be the foundation for a life in balance.

However, the science of medicine is also critically important.  The media thrives on exaggeration and controversy.  If there were a mountain of sand in front of us, and we had the choice to move it with a bulldozer or a teaspoon – the media would have us convinced that the spoon was equally effective.  And this is why we are constantly misled about treatments – we hear about efficacy, but we don’t hear about the relative effectiveness compared to other therapies.  So cinnamon, for example, is touted as a great new treatment for diabetes, when in fact it is only a teaspoon compared to the bulldozer of insulin.

And so I guess I would summarize my musings this way: good health is a dance near the IOM, with bulldozers instead of teaspoons.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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