What would YOU do?

Religion is always a touchy subject.

I was brought up without the routine of church every Sunday. I remember my 5th grade art teacher being appalled when I told her we had too much to do, we simply did not have time to sit in church. Yet, I turned out OK. (Then again, I have never been much of a sitter--more of a doer--I even have a hard time watching TV or a movie. I feel that there is so much more that I could fill that time with... such a waste.)

Let me say, before I lose the small audience that I do have, that I am a very spiritual person. I definitely believe in a higher power, but I am more inclined to believe in nature (Mother Nature) than in an overseeing man. hmmm, so, in effect, is it the sex of the force with which I take issue? I do not think so. Taoism somehow feels right to me, but I really have to study more. I also am very interested in Buddhism. So much to see and learn.

The reason I am bringing up this subject? What do I do, when a patient asks, "Are you Christian, doctor. Will you pray with me?" It has happened on more than one occasion, and in the past, I have prayed with them in my own way... but I always feel somewhat of a phony. This is especially true since prayer is not so much used in Taoism and Buddhism--more of a meditation or conjuring, for lack of a better term. Considering my field, I expect to be asked to pray many times in the future.

So, what do you do? What do you think is appropriate?

little rant

I find it quite irksome when people who should know better "verb" adverbs or nouns. I just read an article that said, "... you can up your intake..." UP IS NOT A VERB, people!! Neither is lunch ("let's lunch"), Kohl's ("the more you know, the more you Kohl's"), and many more...

I remember in college, when I saw this on a t-shirt for one of the campus fraternities: "we've upped our standards, so up yours." It was funny then. And, they were fraternity brothers... they had an excuse. But this?!

I have seen this kind of grammatical suicide in news articles, magazines, on professional blogs... even have heard this on radio news. (I do not watch TV, so for all I know, it is happening there, too.) Is it laziness? simple lack of knowledge?! Are we allowing too much informality in our lives?

Guatemalan experiments

I came across this in the news today, and was plainly shocked.

In today's society and times, human subjects are very closely guarded. Any time a researcher wants to do as much as reviewing charts, one has to get permission from the institute's IRB (Institutional Review Board), after taking a tutorial and test about human subjects.

The fact that a power such as the United States took advantage of the poor and minorities is incomprehensible to me. Between 1946 and 1948, Dr. John C. Cutler was involved in a study in Guatemala. He infected 696 people with syphilis (+/- gonorrhea) by sending infected prostitutes to call on prisoners and enlisted men alike... anyone resistant was inoculated directly. The records are fuzzy as to whether the men were then treated with penicillin, or what the dose was--never mind the prostitutes. Dr. Cutler was apparently also involved in the Tuskegee Study in Alabama. At the Tuskegee Institute between 1932 and 1972, 600 black men who had syphilis were followed (all in the name of science and medicine, certainly) without being offered treatment. In both of these cases, the people involved did not know that they were being used as human test tubes... experimental subjects.

The Eugenics movement started around the same time--in the early 1940s--with the introduction of Planned Parenthood. Eugenics is the belief that certain people are unfit to breed and pass on their genes--and so they should not. We all joke that there should be a permit to procreate--to have children--these people were not joking. For people like Margaret Sanger, population control was the name of the game. Honestly, I had no idea that this was the impetus behind Planned Parenthood!!

calling names

I just ran across a blog written by a family practice resident, pontificating "What's in a name?" I find this to be an interesting topic, as I have struggled with it myself in the past.

This, I feel, is very generational, as well as regional. ie: I am much more comfortable calling my colleagues by their first name when they are close to my age (by which I mean within 20 years). However, my soon to be partner is 73, and although I call him by his first name in private conversation with my guy (always preceded by a pause and followed by a giggle), you can bet I call him Dr when speaking to him. (He, by the way, calls me everything from "gorgeous" to "sweets..." although generally, he calls me by my first name. In case you wonder, I don't mind--his demeanor is such that it completely does not sound crass or degrading.) I also have a neurologist friend who is about 3 years shy of being my parents' age. When he asked me to call him by his first name, it took a while (and several slip ups) to get used to.

As for regional: I did my med school clinicals all over the states, followed by residency/ fellowship in the East. I can tell you that in the midwest, it is much more common for Drs to introduce themselves by their first name to other healthcare professionals. It is understood that they, in turn, will be introduced as "Dr" to patients. As soon as I came to the East Coast, it was Drs all around. This makes me often feel pretentious, so I will frequently introduce myself by my first and last name, followed by my specialty. I let them decide what to call me. And, for the most part, I will eventually correct them to call me by my first name in private.

As for patients, I am not too interested in being buddies, so I introduce myself as Dr. Older patients appreciate the formality, for the most part. Although, I have had elderly patients insisting on knowing my first name--and then calling me by that name--which made me feel a little like I was talking to my grandparents. Also, being young and attractive, I have been hit on by patients (of all ages), and I believe that introducing myself as "Dr" nips that possibility in the bud--sometimes. On the other hand, introducing myself as my first name invites that kind of discussion.

Of course, things will be a little different very soon. I think that at my new position, I may introduce myself to patients as first and last name, and let them choose... or maybe the first name will suffice. Cancer is a place where it's nice to have a buddy.

geniuses... and seriously smart people

I had to share this story with you, so you could laugh, shake your head, or both. Apparently, some real savant was testing the wit of his local men in blues. Probably not a good idea to play with their toys... especially right under their noses!

And then there are the Romanian fortune tellers, who as far as I am concerned, are truly visionary. Again, they won the fight to avoid tax payment... and with solid reasons. nice.

no one left behind

Just in case you thought that Whole Foods qualifies as a "local, small farm." It does not, and certainly the Whole Foods chain is not immune to its own FDA recall.

Granted, this is a preemptive recall of sorts--no one has reported getting ill, yet. But, during "routine sampling," the cheese in question was found to be contaminated with Listeria monocytogenes and Staphylococcus aureus.

buy local, know your food, support small farms

watch out, furry ones

While the rest of the world blogs about docs stuck in chimneys (seriously?! what a dumb-ass) and fancy new google tools (well, not entirely new), I'd like to turn your attention to this: ANOTHER FREAKIN' CAT FOOD RECALL!!

I don't know why this aggravates me so... oh, yeah, because their livelihood is in our hands--completely. And, wouldn't you know it? Salmonella is the culprit, yet again!

As for the huge egg recall, I'll just say, "I told you so." Yes, I have been touting the benefits of buying from local, small farms for a long time. Yes, it may be a little more expensive, but what price is your health? I speak from experience--I have had Salmonella poisoning before. Once on vacation: bad Chinese, and once more recently: the tomato recall. Granted the vacation bug was so, so much worse than the tomatoes, but, then again, I ate only one of the tainted fruits.

As for the Iams? Again? Iams cat food was recalled previously, and not that long ago--in fact, just a month ago. grrrrr

campaigning

Here's an unusual, but very realistic, way to get some money together.

With breast augmentation the second most popular elective plastic surgery procedure in the world (second only to liposculpture), this is not so far-fetched. In a country like Venezuela that needs a dramatic government overhaul, this sounds like a great idea to me!!

the way of our words

Linguistics is just a cool field all-around.

This site is very interesting, especially to those of us from other countries, or who grew up with accents surrounding our day-to-day. You can browse the sound of the English accent in different cities and countries. I think it would be even more poignant if they had a male and female version of each, but maybe that's just me...

What they do provide is information on each speaker, including: age, years speaking English, how they learned the language (naturally or academically), and whether they ever lived in an English-speaking country. Hell of a project, really.

corn--quintessential summer (kind of)

So, yes, corn IS the quintessential summer veggie, but the recipe I am about to throw at you is not, AT ALL, quintessentially summery... in fact, it is, quite frankly, late autumn-wintery. That being said, we do not have the luxury of an outdoor grill. And, well, oven-cooking is slightly less heat-inducing than stove-top cooking. So, there you have it...

"Oven-Roasted Corn"... or maybe "Oven-Braised Corn" would be a better title

you need:

6 ears of corn; peeled of leaves and silk, washed and split in half (dry lightly)
4-6 garlic cloves--minced
1/4C olive oil
1/4C vegetable broth*
couple of pinches of salt and pepper
few sprinkles of marjoram
(any other herbs/ spices to your liking)

you do:

-preheat oven to 350F
-place ears of corn in large enough baking dish that they are not overlapping, but cozy
-sprinkle corn with salt, pepper, marjoram, and any other herbs or spices you wish to use
-sprinkle with garlic
-mix olive oil and vegetable broth and pour over corn
-cover tightly with aluminum foil and place in oven for 30 minutes
-turn corn (add a little more broth or water if dish is dry)**
-cover again with foil, and back in the oven for another 30 minutes
-turn the oven up to 400F and take off foil (again, add broth or water as needed)**
-allow to bake an additional 15-20 minutes

enjoy!

*of course, home-made broth beats out any store-bought. in a pinch, I find Trader Joe's (!-yes, Trader Joe's) to work well
**remember that steam will be hot when you take off the foil--do this carefully, and away from your face!!

obviously

OK, so for crazy people like myself, this is reason enough to have a baby!!

It is such a cool contraption--it does EVERYTHING!! And they have funky, chic little freezer trays for left overs. I have always thought that if I had a child, I would definitely cook my own baby food. This little guy makes it effortless. I am considering buying one now... joking! (OK, only partially joking)

Obviously, I would have to buy every one of the accessories. OK, no buying... this is THE ONLY thing that needs to go on the baby shower list, as far as I am concerned. (That and a remote-controlled helicopter for my guy, of course.)

babies... and recalls...

Another day of recalling. This time on NeoProfen, which is an injectable ibuprofen.

This is a form of non-steroidal anti-inflammatory which is used in neonates with patent ductus arteriosus. In this congenital malformation, there is aberrant blood flow between the aorta and pulmonary artery. This type of blood flow is actually normal in fetal anatomy, but the connection normally closes soon after birth. The abnormality is relatively common in the United States, occurring in 8 per 1000 births.

The injectable medication in question has a specific patient profile, including gestational age and weight. In this case, the medication did not meet a quality standard, and this recall will result in a shortage, since the lots that are being recalled are the only lots available.

People that need to know: parents of patients, pediatricians, neonatal cardiologists, pediatric surgeons, and anesthesiologists.

Boring...

One of my favorite patients, who has become a friend, just reminded me of something terribly important.

When we are medical students, interns, residents... we LOVE the adrenaline rushes. We love the interesting patients.. the "once in a lifetime"s... We want to see and experience all of the 'wows.' We trade stories, often elaborating and honing our emphasis on this or that, to make it sound that much more dramatic, we accentuate, we underline, we really lay it on--suddenly, there is blood everywhere, guts are flying, the nurses are frantic, and then we come in and save the day. Don't get me wrong. Sadly, it really is like that, sometimes. But as attendings, it's just our day-to-day... and not the pleasant part of day-to-day.

As an intern in Michigan, we didn't have the 80 hour work week. We worked often in 36 hour shifts, to go home and sleep (hell, who am I kidding, we didn't, actually, sleep--we partied and danced), to come back and do it all over again. We RAN to codes, to see interesting patients. We stayed much past those 36 hours often, to see a rare, or "cool" case, or even just to hang around, in case one came in.

For my surgical residency, I chose to come to New York, but not some posh little hospital. Nope, I went for the hell-hole, in the middle of a crime-ridden area, which farmed us out to other crime-ridden areas in every borough (save Staten Island) and Jersey. During my 3rd year (I think) the 80 hour work week came into effect. We were threatened by our superiors to lie on the forms, as NONE of us worked fewer than 100 hours/ week... although usually more, we lost track... and most of us (yours truly at the top of the list) didn't mind lying. How else would we see all of those funky, excellent cases?!

Hand fellowship--no different. But by this point, my philosophy changed a little. I did this in the South Bronx at a city hospital. Scary place, scary patients... a lot of unethical people (hospital personnel included)--exactly what I wanted--because I knew I would train here and see the worst of the worst so that I could handle anything... Even though I hoped I would never see it again.

When we come to our own as attendings, we really love boring. We don't want to see those one in a million cases. Don't get me wrong, we can handle it, because we are wired to do so--especially as surgeons, I think we are such adrenaline junkies that we LOVE those cases as much as we HATE them. We still boast to our colleagues, all the while praying to whoever our Gods are that we never have to face that again... and going to the hospital at all hours to check up on that patient. just in case.

My breast fellowship, I approached differently. Of course, this was after a few years "out in the field." I knew exactly what I wanted out of it, and I made sure that I got it. Yes, I did see some interesting cases, and yes, I made some mistakes. In the end, the attitude was "well, now I know how to handle it, and I really hope I never see it again." (By the way, in regards to my earlier post, I met a very successful plastic surgeon, who said that he had no less than 10--TEN!!--such cases in his first year. The candidacy and straighforwardness were almost more alarming than the fact.)

So now, when I hear that my patient... my friend... had an uneventful chemo day--after too many events, too much excitement (and not the pleasant kind) on this road of breast cancer diagnosis and treatment--I am no less than thrilled.

Renaissance Fantasies

I am seriously jonesing... (OK, given the context, that's pretty funny: my computer, not recognizing 'jonesing' offered to replace with 'jousting.')

At any rate, I am having Ren Fest withdrawl. Have you been? I adore Renaissance Festivals. Everything from the wardrobes to the mysticism, to the "English" accents (let's face it... they often sound Irish in truth... or sometimes even Russian--Master Card and Lady Visa is just cooky enough to make me smile every time), to the food... the jewelry (ah! the jewelry), and the shows--the bawdy comedy is probably my favorite.

I have attended Renaissance Festivals in Kansas City, Michigan, and now in my new home--New York. Each has been attended by yours truly multiply. Yes, I even dress up--usually as a gypsy, which is easy for me (what does that say?) and not crazy weird (just weird enough). My favorite faire is likely Kansas City. I think because it was my first, and I have many wonderful memories of that particular one.

They are all big, and full of adventure. You are likely to see a wedding, or two. Lots of kids dressed up on some adventure... or playing a game. Belly dancers, people eating huge turkey legs (not terribly appetizing to see, if you ask me, but it's all part of the fun), hawks and vultures, strong man contests, jousting, even, if you are so inclined (I, somehow, never have been, but...)

So, wanna come to the Renaissance Faire?

Never get complacent

It is not everyday that you look down, and your "routine" breast case has turned into a chest case. THANK goodness that it is not everyday!!

Young woman--35--diagnosed with breast cancer 3 years ago. At that time, she had her (unilateral) mastectomy and tissue expander placement. Then, skin necrosis and excision, followed by failed tissue expander--they were unable to expand...

So, she went through her chemo, never had radiation, and we come to this year and her care with me. Back in February, I exchanged her tissue expander for a new one (in fact, there was a hole identified in the old one--presumably from a needle stick). I expanded her over the next 3 months. She is finally happy with size, so we schedule an implant swap--gel (silicone) in place of saline tissue expander--and to augment the other side to match. Enter yesterday...

Cancer side: trying to release capsule, I made a plane inside the pectoralis. I caught it right away, but still... not the way things are supposed to go. "Prophylactic side:" Tooling along, releasing the pec and suddenly I am looking at lung. It was not my day.

Cancer side: oversewed muscle plane and started over again... finished capsulorrhaphy and placed implant--success.
Prophylactic side: oversewed intercostal muscles over a red rubber catheter, oversewed with pec... got a post-op chest xray: tiny apical PTX

Kept her overnight, got serial chest xrays. She is fine, felt greal this morning, pneumo is resolving, and she went home. She feels like a queen, and couldn't stop thanking me. I feel like crap. I consider myself a safe, conscientious surgeon--not a cowboy or careless. How could this happen?! I have heard from a few people that the only way to become an expert is to make and overcome the mistakes.

So, maybe I don't want to be an expert!!

Oh, boy...

I just read this fantastic entry at The Blog That Ate Manhattan, and I am having doubts about my choices... not that any choices have been made, per se, but the potential and the direction of my choices. Let me explain.

I moved to New York--THE City--10 years ago, to start residency, then fellowship, and then to work. Because my residency farmed us out all over the area--including Jersey and Long Island, Queens, Brooklyn, etc.--living in Manhattan was actually most central. It was wonderful!! I adored living in the city, everything from convenience, to the people, to being able to run in the street at night completely feeling safe (because of all of the people and the light), to the restaurants... oh, I could go on and on. It was incredible. For me, it was peaceful; it felt like home. (This is very hard to explain to non-Manhattanites, but it is so true.) And, as for TBTAM, September 11th, that most awful of all days, made me feel even more tied to the city. as hard as it was.

Then, about a year after I started working, I moved out to Queens. I suffered from SEVERE withdrawl. It is just not that easy to get into the city, although it should be, when you have a life outside of the city. My beloved did not understand--although he, too, lived in Queens, his office was in the city. This meant that he was in the city on a daily basis, and for completely different reasons than I had been. He thought of the city as a crazy, busy, dirty place... quite the opposite of my belief.

Now, in fellowship again, we moved even further away--1 hour north, to be exact. It is a nice place, but WOW! I miss Manhattan so much. But, we have had a taste of peace, tranquility... and still with a healthy dose of convenience (although I still do not feel safe running here at night--too dark, too deserted).

As I look forward to practice again, we have geared our search to warmer climes--this past year was not a kind one to the Northeast--or places in the Midwest, to be closer to family. So, it is in these areas that we are considering larger cities. My love has told me time and time again that The City is just too expensive, and if we stay, he would prefer Queens (most likely), or one of the other Boroughs. Whereas for my tastes, I would prefer to live IN Manhattan, or not at all.

My heart breaks at the thought of truly leaving... there had better be something spectacular out there for me! But I also cannot imagine again living in New York, and not in The City.

Has it really been almost a year?!

WOW! It has been a long, long time... anyone still checking in from time to time?

I have had a bit of a career change--I am currently in a fabulous Breast Oncoplastic Fellowship. This means that I am training to do everything from breast oncologic procedures (and those for benign disease) to the reconstructive aspects of breast... as well as aesthetic breast surgeries. So, everything breast, in a nutshell. I am very much enjoying this, but I have been quite busy.

In addition, I am trying to figure out what is next--in other words, do I want to start a private (solo) practice, or be hired by a hospital... or something in between? and where to? yet another question. We have decided that we either want to be close to family, or in a warm place. and yet... it has not been easy to find something. I have tried recruiters, but the majority want me to either do general surgery with some breast, or they need someone in New York. As for the first, I have not done general surgery in more than 5 (five!!) years, and although I was very good at it at one point, it has been a looooong time. I really am not wanting to experiment on patients... As for the second, New York is terribly saturated with both breast surgeons and plastic surgeons... and it is cold... and I have really had enough... it is time to move on (figuratively and literally).

So, there you have it--the main headers to my brain's thoughts of late. There is much more, but this is enough for now.

So, any ideas or thoughts from the peanut gallery? ;) Are any of you hospital administrators looking for an assertive, passionate breast surgeon? Or maybe you are in need of a partner, tired of doing breast? I can wish...

Never, not once. until yesteday

I am not proud. I am, in fact, rather ashamed. But the other emotions I feel are anger, distaste, and, quite frankly, dread.

I took the gentleman from this post to the OR last week... last Monday, to be exact. He was a mess. I have never seen anything like it. A grown man, mid-40s, strong (as far as looks--very muscular, fit), handsome, even... quivering uncontrollably at the sight of an IV needle. No joke. It took 5 of us to hold him down, after a lot of begging and bargaining, that is, to sssslide that little 20 into one of the hoses on his arm.

The surgery itself? I was so happy. I took off the distal phalanx routinely, looked at the middle phalanx--SOLID. No signs of infection. Surrounding skin? Healthy. Beautiful. The closure? I gotta tell you, I was so conscious of this man wanting to get back to work, I did not even allow a little dog ear. The whole surgery (minus starting the IV) went so smoothly, I was thrilled that he was coming for his first post op visit yesterday.

By the way, he called the day after surgery about some papers he needed to get filled out for work, but that was it. Smooth sailing. No calls about pain, nothing.

I explicitly ask all of my patients to leave their surgical dressing on until they see me at the first post-op visit. I tell them, reinforce it with their loved ones and write it in capital letters on the discharge papers. It is really, really rare that these orders are not followed. Seriously, my patients know I mean business.

So, I was almost confused when my friend came in with no dressing. Not even something he threw on at home, which some people try to fool me with. (Trust me, a surgeon ALWAYS knows their own dressing.) When I asked him what happened and when? He answered that the night of the surgery (!!!) the finger was itching him, so he took off the dressing so he could bite it (!). Then, over the past week, he remained with no dressing, going about his business (although he assured me he stayed in the house) changing his baby's diapers and the such, but NEVER ONCE WASHING HIS HAND!!!!

He complained (now, in my office, as he waved the swollen digit around) that the pain was tremendous. I asked him why he never called. I was calm, at first, when I reminded him that he called about his papers, but never mentioned any of this. My eyes were met with a blank stare.

I asked him to wash his hands now, in the office, with soap and water. As soon as he finished, he turned to me, "Why is there pus coming out?"

I looked in disbelief, at the same time realizing that it was the only explanation: he had a wound infection, which explained the tremendous pain and swelling. When he washed his hands, he dislodged some dirt and blood that was covering the wound, and now the pus was pouring out.

I told him that I would need to take out at least a few sutures and open the wound to let the pus drain. It was the only way to get rid of the pus and the pain. He started moaning and crying (crying, with tears streaming down his face). This is when the fiasco started. I called my medical assistant into the room. We are both small women. He is a tall, muscular, fit man. After wrestling with him for about 20 minutes, I asked my MA to call our administrator in. A man, pretty much the peace keeper, but not much larger than us. The amazing thing is that the whole problem was that this patient was truly, magnificently AFRAID. He was not aggressive to me or anyone else; he just would not allow me to do what I needed to. The whole procedure, on a cooperative patient, would take less than 1 minute. Really. Start to finish.

With this man, it took an hour and a half. Every five seconds, he was ready, and then he would freak out again. Taking out 3 sutures took 45 minutes. (I left the rest for another day.) He had on 5 layers of shirts, which he started taking off one by one. (I really kept thinking that he was going to be sitting in front of me nude.) He had on two hats (I am not joking). Once he finally let me do what I needed to do, it really did take exactly 2 seconds (scissors into wound, spread, done).

The thing that I find worst of all is my reaction. After the first 30 minutes of begging and cajoling, trying to mesmerize him into cooperating... I lost it. I really did. I was screaming at him. I have never done that. I feel awful. I was cursing, too. Not pretty, not professional. Really, really awful. I cannot stop thinking about it, replaying it in my brain. I cannot justify it. All I can say is that I really just wanted to do right for this man, and he would not let me. On top of that, I had patients piling up outside, so I felt pressured to get a move on. I even told him (and this I truly meant with all my heart) that if I had known that this was how things would go, I would have come in on my day off so I could spend as much time as necessary with him--even the whole day, if I had to. Unfortunately, that was not the case here.

The only good thing, well 2 good things: 1. When all was said and done and the dust settled, he thanked me. I mean, the man knows I really was trying to do good for him, NOT to hurt him. He understands he brought this on himself. 2. We called him today, and he said he is feeling much better with less pain. He is doing the wound care that I instructed him on.

No matter, I am seeing him again on Friday. He is one of the patients that I would move in with, if I could.

Silence...

I don't really know where to start. Is anyone still out there? Any of the five of you? I have been silent for so long. I thought that, by now, I would be up and running in my little 'enterprise.' ;) FAAAAAR from it.

Opening a private practice must be one of the most frustrating things in the world. Especially in this economic climate.

In order to get a business loan, you must be in business for at least two years. What if you need money to start that business? What if, like me, you are not independently wealthy? You can try lines of credit or business credit cards. Even those, with most banks, you have to already be in business to get. You can try "angel investors." However, most of these guys are currently interested in web-based, tech-y stuff. (Angel investors, by the way, got their name from the early 1900s, when wealthy businessmen would invest in Broadway shows. Now, most angels are far from multi-millionaires. They just find a company that they believe in and want to help. These people are very business-savvy and more often than not want to be on the board of directors or a partner of the company they support.) There are also physician funding companies on the internet. I will have more to say about these in the next few weeks, as I delve more deeply into them.

The whole setting up a corporation thing is another story entirely. Word to the wise: make sure the person that does this for you knows what they are doing!! The first guy I talked to was a business lawyer, who had never heard of a D.O. And he touted himself as a 'specialist' in professional corporations. "So, we don't have to set you up as a doctor, we could just do a regular corporation." This was after my explanation of, "I am a surgeon, a physician..." Which was then followed by, "OK, doooctooor." (very long, drawn out, not nice.) The next one is a family friend of a very close friend. Not good. This is the one that is actually working on my papers, but extremely slowly (molasses slow), and often with mistakes that I have to clean up. I have already paid him, and he is (finally) about two-thirds done, but it has been painful... and I have no idea when the other third will get finished.

These are major hold-ups. Hence, my silence.

And, I am in the meantime, keeping my "day job." Very busy. That was a joy, by the way, telling Mr. Big-Shot President of the company that I am opening a private practice. There I was, excited, like a little puppy, as what I do in my spare time does not affect Mr. BS Pres in any way, shape, or form. But, to be nice, I thought it only right that I put my plans "out there, in the open," so nothing has to be a secret. (Also, so if--rather when--insurance companies make mistakes and send checks to the wrong place, it won't be as big of an ordeal to retrieve the money.) The meeting ended in the most uncomfortable way: Mr. BS just repeating over and over again that I could not steal the group's patients, and me reassuring him that that was not my intention. He was so bothered, in fact, that he came to my office the next day to interrupt my patient hours and again reitterate that I was not to steal patients. This went on for another fifteen minutes.

Joyful.

Just a Few Words

Just explaining my silence here. I am in the midst of (ack!) starting a private practice (while keeping my "day job" with the group--it would be a little wacky to give up a steady income for something that is only a dream at this point). And I am overwhelmed. Hence, it leaves little time for posting anything here. Albeit, I do wish I had the time and energy, because, believe you me, I have the stories... just not the juice in my batteries. Soon, soon, I hope... thank you for being patient and understanding. I am assuming both of those. :)