Holiday Parade

Today was the annual holiday parade.  We didn’t go last year because it was cold and Anna wasn’t going to remember it anyway.  We all went this year.  Anna, me, my dad, and my mom.

Now you have to understand that my mom doesn’t really do parades.  She likes the marching bands, but that’s about it.  So when I was growing up, my dad was always the one to take my brother and me to the parade* (or most parades for that matter).  And we discussed and debated about her coming.  Since the parade was always a special Daddy thing, we all kind of want it to be a special Anna-and-Gpa(-and-maybe-Mamma) thing, too.  But she still isn’t really going to remember this year, so we all, including my mom (who doesn’t really do parades but kind of wanted to see Anna at her first holiday parade), agreed that we all should go.

And it was cold, but not too cold.  And we found a sunny spot not to far from the beginning of the route.  Anna watched it intently.  She pointed out the snowmen, but other than that, it was hard to tell whether or not she was enjoying herself.  Until it was over.  When she didn’t want to leave.  She would have stayed sitting on the curb watching the cars go by if we’d told her they were part of the parade.

As for me?  It was unexpectedly cathartic.  When the WMU band marched by, playing their fight song, I started to cry.  I don’t know why that was my trigger.  It seemed like the entire city was out.  We were a community together.  Different colors, ages, faiths, all reveling in the same joy.

I cried a little on Wednesday.  Today I wept.

*Those things you learn when you’ve grown up.  When I was a kid, it was the Gilmore’s Holiday Parade.  My dad worked at Gilmore’s, and he worked the parade every year.  He wasn’t in it.  He worked at the staging area.  I don’t remember this.  At all.  I have vague recollections of going to the staging area once, but I think that was after the parade.  But my mom never took us to the parade.  It was something we did with my dad.  So, yeah, while waiting for the parade to start, my mom called my brother to see what he remembered about going to the parade when we were kids.  We think we figured it out.  Daddy and Matt left early and went to staging.  Mommy must have dropped me off a bit later.  But this still means my dad took at least one of us to work every year as part of taking us to the parade.



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First Citizen

The first president I can remember is Ronald Reagan.  But he wasn’t president when I was born.  Jimmy Carter was.  I’m saddened today to think that the first president my daughter will remember is Donald Trump.  But I’m glad that I’ll be able to remind her that the president when she was born was Barack Obama.

The classicist in me can’t help but look back.  We compare ourselves to Rome and Greece.  We are not an Athenian democracy.  Our government is much closer to that of the Roman Republic.  People tend to focus on the fall of the Roman Empire, but we should think about how the Roman Republic fell.  Augustus Caesar did not call himself “emperor”.  He was the First Citizen.  The Roman Republic didn’t fall in glory.  It was chipped away at until the Senate did not have enough power to override the decisions of the First Citizen.  Why was Julius Caesar murdered by members of the Senate?  To protect their power.

Do not read that wrong.  We are better than Ancient Rome.  We can use the lessons of their history.  We can encourage our legislative branch to act as the check on the executive branch our founders designed them to be.

Yes, today I weep.  Today I mourn for the world my daughter is growing up in.  Today I am sad that half of my country voted to return to a glorious past that didn’t exist for the other half of my country.

And tomorrow?  Tomorrow I will stand up and continue to do what I can to make at least my corner of the world a better place.

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The Truth

You may have heard that there’s an election tomorrow.  Unless you’ve been living…  I don’t know where.  I suspect that even people in caves or under rocks are aware that there’s an election tomorrow.  And I say this every time there’s an election.  Go.  Vote.  I don’t care who you’re voting for.  Just do it.  Exercise your right to vote.

But that’s not completely true.

I do care who you’re voting for.  Of course I do.  I want the candidates I’m voting for to win.  (And you can probably guess which candidates those are.)

I’m not saying I want you to tell me.  Unless you really want to tell me.  We have a secret ballot.  Who you choose to vote for isn’t my business.  But of course I care.  I have strong opinions about the purpose of government.  In general, one candidate represents my opinions and the other doesn’t.  So I don’t really want you to vote for the other one.

But even if you’re going to vote for someone else.  Even if I don’t agree with your politics, I still think you should vote.

Even if you don’t want to vote for either of them, I still think you should show up to the polls.  You can leave that part of your ballot blank.  There’s a lot more going on this election that what’s at the top of the ballot.

There’s still time.  This election, I highly recommend Google for finding out about the people on your ballot.  I picked up the League of Women Voters non-partisan guide at the library, but I still had to Google in order to find info about the local library board and school board candidates.

The election is tomorrow.  I hope all of you who are eligible go and vote.  I’ll be at the polls* once I drop Anna off at school.

*Wearing white.  In case you haven’t figured out my politics by now.

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Happy Halloween!

I know I’ve been quiet for a while.  There hasn’t been much to say.  Get up, drop Anna off at school, go to work, pick Anna up from school, go home, go to bed, repeat…  But something happened yesterday that was too sweet not to share.

It’s rather balmy for Halloween this year.  It’s supposed to be in the 50s.  (Yes, balmy is a relative word this time of year.  I remember trick-or-treating in the snow, so 50 is warm!)  I was going to wear my 1920s costume since it’s warm enough that I wouldn’t freeze in it.  Fortunately, I thought to try it on while Anna was taking a nap yesterday.  Madge and Dorcas laughed and said, “Who do you think you are?  Grandma Mary*?”  The only easily accessible costume that fits is the snowman shirt we made when I was pregnant with Anna.  Guess I’ll be a snowman…  So I got the shirt out and hung it on the closet door.

Now, Anna is currently obsessed with snowman.  She’s going to be a chef for Halloween.  Her white chef’s jacket has black buttons.  She’ll tell you it’s a snowman.  She keeps calling all of the scarecrow decorations at our complex snowman.  She loves snowmen.

Yesterday evening, I was reading in the living room and Anna was playing everywhere (like you do when you’re 20 months old).  She suddenly came running down the hallway shouting, “Snowman! Snowman! Snowman!”

“Where did you see a snowman?” I asked, knowing full well.  She took my hand and led me to where my shirt was hanging on the closet door.  She showed me the snowman’s nose and eyes and mouth and we talked about the buttons that would be its shirt.

It gets better.

A bit later, she put her baby in the stroller and took her for a walk.  Down the hall.  To my bedroom.  Right up to my costume.  I lurked in the hallway and watched as she showed baby all about the snowman in Mamma’s room.

Yeah.  I think I’m wearing the right costume this year.

*Contrary to popular culture, the majority of women in the 1920s were not flappers.  My mom’s grandmother, however, actually was one.

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I Think I Might Have Started Something

I picked Anna up from daycare yesterday.  She still spent the night at my parents’ house, but I took her there and stayed until she went to bed.  I’m not sure who was happier, her or me.

So daycare.  I told you about the hoopla in yesterday’s post.  When I got there, Lindsay, the assistant director, came around to give me a hug.  I asked if everything was straightened out, and she said it was.  They’d talked to the Health Department and been assured that all the information I had given them was correct.  And the other parent (or rather his/her mother) had given exactly the same information, too.  So they were good and glad to see me back.

Here’s the rest of the story.  A parent had heard that there were two other parents with viral meningitis and called their pediatrician in a panic.  “There are two parents with meningitis at my daycare!”  And instead of taking a deep breath and asking what type of meningitis, the pediatrician’s office fed the fire.  One of the pregnant teachers had called her OB’s office and the phone nurse was the one who told her that she couldn’t come back to the clinic until she had three notes of clear meningitis tests: one for each child and one for herself.  Again, exactly the opposite of how that HCP should have handled the question.

Anyway, I told Lindsay that I manage all of the CME in town and would be in touch with the appropriate people about adding the topic for OB/GYN Grand Rounds.  I explained that I’m their accredited provider, so I know everyone in charge of CE in the area.  Her eyes lit up.  She turned to Amanda, her assistant.  “She handles all of their credit!”

She looked at me. “Could you get them to cover Hand-Foot-and-Mouth, too?  Remember when we had that outbreak?  We had doctors saying they could come back once the sores scabbed over, doctors saying they needed to be out for a week…”

I smiled.  “I’ll let Pediatrics know.”

I can’t wait to see what other topics get suggested while Anna is still a student there…

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Zeus Births Athena

Hi, guys.  I know those of you who aren’t friends on Facebook are surprised to see me posting in the middle of a weekday.  It’s been a fun interesting few days.  I’m home because I have viral meningitis.

Now, don’t freak out.  I said VIRAL meningitis.  This isn’t the scary thing you hear about on the news that you should get vaccinated for before college.  It’s just like the flu, only in your brain.  Which, frankly, still totally sucks and hurts like hell.  I swear my head went into labor on Sunday.  I just kept waiting for a Greek goddess to pop out.  My head hurt so much that I didn’t even want to read!

The headache started Sunday morning and didn’t get better.  When it was still getting worse at 8 that night, I called my mom and said I couldn’t wait until Monday to see a doctor.  We figured it was a migraine.  But I had other markers for meningitis, and my CRP was elevated, so I agreed to a lumbar puncture (aka spinal tap… this pain chart goes to 11). I mean, it was going to be clear, but better safe than sorry.  When the attending came back with the results… “Sooo… It’s viral meningitis.”

My mom has decided that the PGY-2 who first saw me was doing a happy dance in the hallway because as soon as he saw me he said he was worried about meningitis.  He was right.  But his bedside manner could use a few more lessons with our standardized patients…

Obviously, they were going to admit me.  I mean, I was textbook viral, but it could have been an idiopathic bacterial infection.  The next doctor I saw was one of our IM residents.  (Yes, all of my doctors were colleagues.  That’s what happens when you work at a med school and go to a teaching hospital’s ER.)  At work we regularly joke about the different personalities of the different specialties.  They’re stereotypes, but they’re often so true!  She felt bad because it took so little time to take my history.  I mean, I’m healthy.  Except for the meningitis.  She told me I was the sickest person she’d admitted that night, but she had the shortest history.  Did she forget something?  No. I assured her she hadn’t.  So she asked to see pictures of Anna and showed us pictures of her nephew.

I finally was officially admitted at about 6 am on Monday.  I was beat.  My head hurt.  The lights were too bright.  (Photosensitivity goes along with the meningitis headache.)  My back hurt where they did the lumbar puncture.  (Poor PGY-2.  He had to do it twice because he didn’t get the needle in straight the first time. But I got another shot of lidocaine before he tried again, so the second time didn’t hurt at all.)  My arm hurt because the IV was in my best vein, right inside my elbow.  (Yes, that meant I couldn’t bend my arm far enough to reach my mouth. And, yes, I am right-handed.)  And there’s nothing quite as comfortable as a hospital bed.  (I also have some swampland for sale in Florida if you’re interested.)

So they gave me a IV drip of normal saline, massive doses of antibiotics, and an antiviral that treats herpes simplex in case it was caused by that.  (That’s the only viral meningitis that has a treatment.)  And they told me I was a fall risk, so I couldn’t get out of bed unless someone came to help me.  Seriously.  So not a fall risk.  My head hurt.  Period.  My bathroom trips consisted of someone turning of the bed alarm — that’s right, an alarm would go off if I got out of bed but according to my dry erase board I was allowed to be “up as tolerated”… sure, if they’d turn the bloody alarm off!

I digress.  Someone would come and turn the alarm off, unplug my IV pump from the wall (I still had to take the pole and all its bags to the teeny tiny bathroom with me), and watch me take the pole and practically sprint to the bathroom.  They stopped sticking around to “help” me back to bed after a while.  By midday Tuesday, they decided to just leave the alarm off and let me unplug the IV myself.  I was really glad.  Between the massive doses of antibiotics killing all my gut bacteria (yay…) and the massive quantities of saline being pumped into me, I felt like I had to go to the bathroom All The Time.  It was nice not to have to ask for help I didn’t need and then wait until someone got there.

I was on a floor filled with people getting hips and knees replaced.  I’m sure I was the youngest patient on the floor.  Which, no surprise, made me the healthiest.  And sickest.  Simultaneously.  My attending suggested we change that to the healthiest most infected person because I wasn’t really sick as long as the pain was controlled.

Pain control.  <sigh>  The problem with pain control in the hospital is that, unless on a morphine pump, the person in pain is not in control of the pain control.  This was an issue after my C-section, too.  My pain meds were rarely on time, and it’s hard to maintain control if they’re late.  Honestly, that’s the biggest reason I’m happy to be home. My alarm is set for every four hours.  It goes off, I take whatever it tells me to (ibuprofen or acetaminophen).  I don’t have to wait until the nurse brings me my meds and scans my bracelet.  I know my pain control is handled best when I’m doing it myself.

When they did the day-to-night handoff on Tuesday, the nurse told me that my 24-hour bacterial culture was negative.  When I saw the attending on Wednesday, he said he wasn’t going to wait for the 48-hour culture because the test had been started at 1 am and not read until the afternoon, so it was really a 36-hour culture.  I was liberated from my IV and slated to start on oral analgesics with a discharge on Thursday.

I was soooooooo glad to get rid of the IV.  I still had the hep-lock just in case they needed the line, but I wasn’t hooked up to anything and the machine was turned off.  And it was finally quiet (mostly) in my room.  That pump sounds like a dot matrix printer.  The nurse told me another patient had asked why it sounded like there was a kitten purring in his room, but that’s not what it sounds like.  At first, I was thinking it sounded like a typewriter, but it was definitely a dot matrix printer.  One of the really old ones that had to run across the entire line even if there was nothing to print on it.

So it’s Wednesday, and I’m feeling tons better, and my mom and I are hanging out in my room (since I was still quarantined until infectious disease cleared me), and someone comes in.  She has a gown and gloves but no mask (that being the key item that hospital personnel were to wear in my room) and announces that she’s from patient services.  She had some Medicare paperwork for me to sign.

“I’m not on Medicare.”

“Well, are you on disability right now?  Maybe you have one of those joint plans?”

No…  I’m on PTO right now.

We all had a good laugh.  She thought it was odd that a patient with my birth year was on her list, but maybe it was a disability thing…  She stayed and chatted for quite a while.

Anyway, at about 4, my resident came back to tell me that my viral culture was back and positive for enterovirus.  Since they now knew what had caused the infection and that there was no treatment other than pain control, I was free to go, unless I wanted to spend another night.  And while she was there, the nurse came to announce that ID had cleared me and no one had to wear masks around me anymore.  It was a party in room 254.  I called my mom, and by 5, I was being discharged.  I’ve never had my release processed so quickly.

I would have written while I was still in the hospital, but the IV in my right arm was so awkward that I didn’t feel like trying.  Instead I actually made voice memos on my phone.  I’ve never used them before.  I’ve just never been a voice memo sort of person.  I listened to them to make sure I didn’t miss anything I wanted to mention and they’re totally Radio Diaries.  I was going to delete them, but I’m not sure I want to.

Okay, this next part might get a little, well, ranty.  The TL;DR version is doctors who should know better have freaked out my daycare.

So. <huge sigh>  Remember that party in 254?  While that was going on, I got a call from daycare.  It came up as “No Caller ID”, which usually means daycare, but they knew I was sick and that Anna was with my parents, so why would they be calling me?  I let it go to voicemail.  After everyone left, I checked my message.  Anna’s fine, but we need to talk to you urgently.

You see, I have meningitis.  How do we know Anna doesn’t have it?  (Um, because she clearly doesn’t have it?  It’s not something that you get asymptomatically.)  I mean, is it safe for her to be at school?  Because there’s another parent who has it, too (also enteroviral).  The lead teacher in Anna’s room is pregnant.  There are two other teachers who are pregnant.  Their OBs told them those children needed to have a clear test showing they didn’t have meningitis in order for them to go to their prenatal appointments.  One even went so far as to insist the pregnant patient have a clear meningitis result.

Okay.  I get daycare freaking out. They heard the word “meningitis”.  They didn’t hear “viral”, and even if they did, they don’t know that there is a HUGE difference between viral and bacterial meningitis.  They don’t work in medicine.  I understand them being scared.

But doctors?  Obstetricians go to school for a long time.  You know one of the things that’s covered in med school?  The difference between viral and bacterial meningitis.  You know what else is covered in med school?  That there is only one way to diagnose meningitis and that’s with a lumbar puncture.  And NO ONE is going to perform that test on an otherwise healthy person.  If my CRP had been normal, I probably wouldn’t have had one.

I am beyond pissed that physicians WHO SHOULD KNOW BETTER are telling their patients that they can’t continue to be seen until they have a lumbar puncture even though they have NO SYMPTOMS of meningitis.

What they don’t know is who they are dealing with.  What they don’t know is what I do for a living.  For those of you outside the world of CE, I’m going to give you a little lesson in practice gaps.  A practice gap is the difference between what healthcare providers (HCPs) should be doing and what they actually are doing.  Let me give you an example of a knowledge gap.  All HCPs should know that the only way to diagnose meningitis is through a lumbar puncture.  And here’s an example of a performance gap.  HCPs should not be telling their patients to get a test that is not medically necessary.

Woah.  Wait a minute.  That’s what they just did to my daycare.  And little do they realize that I know who’s in charge of OB/GYN Grand Rounds at both hospitals.  Yeah.  I’ll be talking with them when I back at work on Tuesday.  Clearly they need a reminder about how this whole meningitis thing works.

For the record, Anna is still at school.  She went with a note from the doctor that included a statement that it was completely unfair to say she couldn’t go to school because I got sick.  He and I had a nice mutual grumble about it at my post-discharge follow-up today.  Then he cracked my back.  It was all good.

And I do have to add that daycare was much calmer after I talked to them.  The director actually said she wishes she’d talked to me before she called the other family.  But like I said, I don’t blame them for being scared.  They don’t work in healthcare.  But the people who do should not have given them the advice they were given; they should know better.  And I’ll do my best to make sure that they get a refresher course so that this doesn’t happen to another family in the future.

Okay, rant over.  I’m home.  I’m feeling better, mostly, as long as I keep taking my pain meds. And I’m looking forward to picking Anna up from school.  She’ll spend a couple more nights at my parents’ while I get my keel evened out, but I’ll go for dinner and leave after bedtime.  I definitely needed a break (obviously), but I do miss her.

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New Grief

I’ve been meaning to write.  Life has kept me busy, but not in any interesting ways.  And there are a few things that I’ve been rolling around in my head and just haven’t gotten down on paper… or computer screen.  I didn’t realize it had been quite as long as it has since I last posted.


Those of you in Kalamazoo, from Kalamazoo, friends with anyone who lives here…  You already know what happened Tuesday evening.  About a mile north of my parents’ house, on a stretch of road just south of one of the house one of my best friends lived in, a driver ran into nine cyclists, killing five of them.  (Trigger Warning!  There are photos at the top of that article that may be difficult to look at.)

It’s times like this that remind all of us that Kalamazoo is, in fact, a small town.  Everyone I know knew someone who was injured or killed.  But then there are the people like my dad.  He was friends with three of the five who died.

I avoided Facebook all day on Wednesday, especially after I learned who the victims were.  I used to walk that road to visit Jess.  My mom and I still regularly walk that way to take Anna to the park.  This isn’t going to change that.  But it hurt too much to see the news.

Kalamazoo is a small town.  We all know each other.  And for the second time this year, we’re all grieving together.

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