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http://drdinah.blogspot.com

Almost Christmas

Elise will celebrate her second Christmas. She is such a fun little girl, mostly smiling, but at times whining, and always getting her way. She whined for the lollipop Ryan had in his hand today and so b/c we couldn't stand the whining we made Ryan share it with her. She wouldn't give it back until all that was left was the stick!

She was flower girl for the first time last week; 23 months old to be exact and did a wonderful job of it. Although she would drop the petals and then pick them up again during rehearsal, she walked straight through during the "real thing." She managed to stay on stage for about 20 minutes but got restless. Once it was time for the wedding march out the door, I whisked her back to her seat but she had no shoes!

Ryan performed Away in the Manger with his Kinder class at church. He knew the song and the signs very well and will likely do a repeat performance on Christmas Eve at church and Christmas Day at Anna's. This the first year he has written a wish list for Santa as we haven't fostered the idea too much. The bad thing is he didn't write the list till this week so pretty sure he isn't going to get everything on it, but he gets SOOO many gifts from everyone anyway.



This blog

I wonder if I'm going to keep this blog on this site or change it to the blogspot. It's been on angelfire since 2001 and I have no idea anymore how I even wrote the scripts/code for it. It's now too easy to have a nicer layout but using the templates. Hmmm . . . how to change over?

update of my life

At least 2 times a month--and this per my medical assistant--I say I am going to quit my job. I come into the clinic flustered because 2 hours spent prior to coming to the clinic I have worked on refills or lab review OR I have done the same until 1-2 in the morning and am sleep deprived.

I'm tired!

I get home and I spend time with the kids, try to cook if my mom hasn't done so already, put them to sleep and then at 10pm I'm back to reviewing labs, med refills, or answering some very mundane questions from patients.

I'm tired!

It is Saturday and everything I didn't get to during the week I am trying to do this morning. I'm wondering if life is any better outside of the under-served public health sector. There are many patients I like and many who are grateful. But I'm exhausted--I think they are too needy not just financially, but in everything else like life direction. And I'm tired of being a social worker.

Please, United Way, stop asking me for direct access to my paycheck! I go through all your red tape and give money straight to the people who need it . . .the patients. How many people have needed a $1 for the bus or $20 for their meds. Some have no shame, some don't want to ask, but I feel for them.

One patient comes to me all the time with the same story . . . she has run out of money for her meds. She has medicare but hasn't signed up for medicare part d. I have documented every visit of how I have gone out of my way to get her medicare part d and she takes no active role to pursue it. I have 3 of her bank statements so I know she doesn't make much at all and qualifieds for help but she does NOTHING about it--well, except come to me and the ER. So now I have to do it again. This takes more than the 10 min alotted to see a patient.

And people ask me why I don't want to pick up another extra shift on Saturdays!

The thing that keeps me sane is that I do have a living God who on top of everyone else and this blog that I don't really keep, LISTENS. and family, and friends . . . and uh facebook.

Long time no write

It has been so long since I have written here that I forgot my password! Ryan is 4 yo, Elise 16 mo old. So much has happened. I tend to write a separate journal for both kids which is why I probably have stopped writing here. That and the fact that I discovered facebook!

I got what I asked of Him

I realize that I have become like the very group allowed to escape from Egypt and promised a land of Milk of Honey. They asked for refuge, God granted it to them, but they spent so much time murmuring, they ended up wondering about for 40 years until they died off and missed out!

I wrote my initial personal statement about how I was going to live the cliche of "serving the underserved" in my medical career. I went on several mission trips with that same adage and here I am, doing what I've always said and wanted to do and yet I complain annoyingly like a dripping faucet.

WHY I HATED THE SIXTH GRADE

gym

Sixth grade was the first year I had to "dress out" for gym. In elementary we could wear what we were wearing that day to school--our jeans or shorts under a skirt. At my middle school we were forced to wear burgundy shirts with our Wildcat mascot and grey polyester shorts with a very narrow crotch. That was a big problem since we didn't have spandex during that time and while doing sit-ups, everyone was sure to see what underwear you were wearing that day.

I excelled in long distance running, the flex arm hang, the standing long jump, and tennis but abhored everything else. The worst part about gym however was the dressing room. It smelled of sweat masked with spray on deodorant as I think we all wore the same gym clothes without washing them for about a month.

And finally the worst of it all was the embarrassment of exposing ourselves for the first time. Shower stalls without curtains? Not fun for girls anyway.

update

The baby slept through the night for the first time 2 nights ago. She smiles all the time especially when we change her diaper. She's a gem.

Ryan has been potty trained now for 4 weeks! Life is so much better only changing one set up diapers. We learned that he's extremely allergic to oak pollen though as he's currently sporting two allergic shiners (those blue rings under the eyes).

social work

Fridays are the worst day to be at clinic b/c patients decide to come in at the last minute when we all just want to go home. I worked through lunch and failed to pump so that I wouldn't see my afternoon patients too late. Every patient seemed to need extra leg work done. One needed a CT that day, one hadn't been on meds for months b/c of expenses and now wanted me to find out if MEDICAID would pay for her lap band (likely a big N-O), one needed surgical clearance for an operation on Monday, another few needed every single 15 plus medications rewritten/printed, etc.

My most time consuming patient was a 30 day old child who I didn't mind being consumed with, but the mom made me extremely frustrated. The baby was a newly diagnosed with galactosemia meaning that she lacked the enzyme to breakdown food/formula w/ galactose/lactose. So she needed soy formula. Just getting this mother into the clinic was difficult. When my medical assistant called, she heard the 20 year old mother yell to another , "It's the F----ing doctor . . ."

RUDE

Right before the baby and mom came in I reviewed the electronic chart and found that there had already been numerous attempts to get this mom into the clinic. One note stated that mom said" What do you want?!!" and then hung up on the person calling without getting an appointment.

Anyway, when I saw the mom I found her to be actually nice and I was forgiving. The baby looked great and so I filled out a WIC form so that the mom could get the Soy formula for free. I also ordered labs on the baby which were normal except for the potassium which was a little high.

Later that day, the mother called stating the WIC office closed. My nurse told her to buy some soy formula at the store for the weekend but mom said she had no money and neither did any member in her family. I then called our neighborhood grocer HEB to ask if they'd gladly donate enough soy formula for the weekend and they did. (Thanks H-E-B!)

The other problem though was the potassium. The lab was mostly likely a false positive but I didn't want to chance that. Given that we were closed already I told the mom to bring the child to the nearby hosp ER to get it redrawn and let her know I'd call her over the weekend to follow up.

Saturday 11:30am while I'm at church choir practice I call and the mom tells me she's on her way. I call a few times later and one sister tells me she has no idea where the mom is. Then I call the home number and another sister says she doesn't know where the mom is.

Monday I call the same numbers morning and afternoon. On one afternoon call, one of the sisters tells me "call back" and abruptly hangs up on me. When I call back it would just ring. I also called the hosp ER and found out the baby was never seen. Stressed and frustrated I decided to call Child Protective Services (CPS) on the mom. Turns out she has 2 other children with open cases already!

Today, Tuesday, I talk to the supervisor at CPS who let me know that the sisters also gave her a hard time. She had sent a case worker there and found out that the family had been there the entire day that I was calling. And over the weekend, the mom decided she wanted to go to the lake instead. It wasn't until the caseworker accompanied the mom and child to the hospital that we were able to get the potassium redrawn and confirm that it was indeed NORMAL.

I'm relieved but I'm extremely frustrated. I pray this child will be okay given the parents and family she was born to.

I have tons of patients and it's not like this is the only one with this type of problem called APATHY!

Don't they care? HELP YOURSELVES PEOPLE! Why must the burden be on others all the time? I was happy to help obtaining the soy formula but now I realize this mom and her family are so used to feeding on people's sympathy they don't even TRY TO help themselves. And she's going to teach her children this LAZINESS.

These people need to learn about the immigrant mentality. It's the drive to leave one's country of origin behind to make it in another and do so through hard work. The U.S. is definitely a land of opportunity and while they do "take advantage" of it, they do so in the wrong way.

green giant

even though ryan is 3 1/2 now and yet to be potty trained (but getting better oh so slowly), there is one thing i can't complain about. the boy eats his veggies. during dinner today, we served curry chicken but he sets his eyes on the asparagus first.

the doctor card

because I was in a rush to get to a dental appointment, I volunteered to turn in my patients prescriptions while he got some labs done. I went directly to the window and said "sorry I have to cut in line, but I need these prescriptions filled today." the pharm tech looked at me and said," uh you have to get in line." confidently, i said " no I don't, I'm Dr . . . "

robin would be proud of me today because I played the "i'm the/a doctor" card. I seldom do and he gets on my case because he thinks we'd get better service at clinics, the hospital etc. I also have never made a reservation for myself including my title. i don 't think it would make a difference. At my own clinic, however, I didn't feel that bad saying I was the doctor because I work there-- although I don't know all the pharmacy/lab staff.

NEW BABY

It's been 2 weeks since the new baby girl arrived. I'm sleep deprived but I'm sooooo glad I don't have to be at work. The only bad thing is I only took 4 weeks off (which is the same or slightly more than what I did during residency when I had Ryan 3 years ago). That means I only have 2 weeks left! I have to figure out how I'm going to get enough sleep, breastfeed throughout the night (hopefully only every 4 hours instead of every 2 like I've been doing these last 2 nights), go to work and pump in between patients.

Last time I didn't try as hard as I am now at the breast feeding thing mainly due to the sheer pain of it all. My best friend just had a baby girl 2 months ago and now makes it look so easy. But she did let me know that the first month was difficult.

The baby is beautiful and has a good temperament. I don't know who she looks like, but I figure she'll start looking "like herself" by 2 months. I looked back at Ryan's baby pics those first couple of weeks and he looks very different from how he looked by month 2.

Potty Training

Ryan has yet to be potty trained which is adding stress to an already stressful event of having a new baby. In addition to that, we find ourselves yelling at him more often than usual because in his efforts to interact with the new baby, he actually is rough with her. He has a cough and at times doesn't cover his mouth. He wants to shove the pacifier in her mouth when she is crying. He'll start bouncing around next to me on the couch while I'm breastfeeding which in turn hurts me since the baby is latched to you know what . . . (talk about pain!)

Ah, but I love the boy and feel very guilty when I'm mad at him.

The other thing is he is having terrible 3's rather than terrible twos. He wasn't this bad at 2, but now he is whining, throwing tantrums (even before the baby arrived). We have tried the supernanny techniques but the reflection chair and time out don't always help.

Dealing with two

Just when I could handle one, now that we have two I'm pretty much stuck at home. My mom comes over and is extremely helpful. She is and was Super Mom to me. I think if I was formula feeding the new baby it would be easier, since others could feed her b/c just as I finish breast feeding it's time to feed again. You're supposed to count 2 hours from the BEGINNING of the feeding to the beginning of the next. So if it takes me an hour to feed the baby, in another hour I'm feeding her again. That leaves little time to tend to other things, namely Ryan. especially since a lot of the time the baby doesn't just eat and sleep, but rather eats and then wants to held.

My mother will be taking care of the kids when I'm at work, but my plan is that my father will mainly take care of Ryan.

School shopping

I spent last week school shopping for Ryan. He'll be attending pre-K which people tell me is the Kindergarten of the days of yore. Ryan will not be turning 5 by the September 1st deadline so will not be able to attend the public school that receives our hefty taxes. I could let him wait a year, but that means he'd be wasting a year.

My plan is to put him in private school and then transfer him to public school in 2nd grade where they won't have the age restrictions. We think highly of Ryan of course and think he's the smartest kid around (except for the potty training thing!). He is 3 now and knows the alphabet, numbers, writes his name, knows his address, phone, dob, and can use the computerand mouse and can read a little thanks to the one on one with grandma.

BABYSITTING PATIENTS

That's what I feel I do some more than others, then I let them go, trusting their family members will care, but then I get stuck again.

Patient #1 among millions: History of multiple strokes with uncontrolled diabetes and hypertension. I've typed out her med list. I see her back and her blood pressure and diabetes are sky high. Her daughter is with her and explain everything (she doesn't seem competent). Another son and daughter come in, I explain med list. Pt comes back with med bottles with a lot missing compared to the extensive med list I typed out. I then call the "responsible" son and after weeks, I decide to type out exactly what each pill box should have for am, noon, and pm Finally some success.

Patient #2 among millions: New patient to me a year ago off meds, doesn't know her history too well and never with any family members. Labs show uncontrolled DM and renal failure. I get her controlled after a couple of visits. Had to get some urgent study done and have to drive to her house to make sure she knows about the appt b/c she never answers her phone. Throughout the year her diabetes, chf vacillates among her non-compliance. YESTERDAY: shows up with ONE THOUSAND AND ONE sugar, elevated potassium , renal failure. I finally meet her daughter and granddaughter who are yelling at the patient for lying to them that she was going to her doctor appointments.

There are tons of patients like these who don't want to take responsibility for their own health or can't and have families who don't want to either. Then, they show up in our walk-in clinic where they are squeezed into our already bulging patient panel. The patients in the waiting room complain b/c they're waiting forever to be seen while I'm busting my butt attending to these train wreck walk-ins.

What is worse is that the other day I had a hoarse voice, and gnawing toothache that was hardly ameliorated with tylenol (as I could not take anything stronger w/ the pregnancy).

I need an efficient solution.

WHY I HATED THE 6TH GRADE

Cool By Association

I think the peer pressure thing starts in 6^th grade, just when you’re at the most awkward physical state in your life. Glasses, hair in a headband, brail (zits) on my forehead all amassed into sheer awkwardness on my part.

In the 5^th grade, I had some pretty cool friends. But then, in the 6^th grade, we were divided into a Gifted & Talented sector (GT), Honors, Regular, and the rest (not really sure what that was). Some cool friends were in regular, some in honors, and I was in GT of which we were divided into 2 groups. None of my friends were in my GT class. The only time we were mixed with “the others” was during our elective, which I chose Art.

I sat next to Amy Tyler during art class. She was in the Regular classes, but she was also in the "cool girl" group. She wore the right clothes--which was at that time, Guess Jeans and the Limited tops--and she hung around other “cool” people who didn't happen to be in our art class. So with no one else to talk to, I guess she felt it was okay to talk to me.

I had fun in that class. I wasn't much of artist, but I won 2^nd place one day for taking a leaf from one of my mother’s vines in the back, soaking it in black ink, and imprinting it on a paper. That was art.

One day Amy Tyler asked me, "Dinah, didn't I ever tell you not to wear socks with loafers?" I stared down at my feet. I was wearing my pink striped collard shirt, blue jeans, and my new white loafers from Payless with white socks in which I had folded down the ruffled cuffs I chose that outfit with care the previous night. In my opinion, it was cool, but when she asked me that, I knew that in actuality, it wasn't cool.

I was glad that she took enough interest in me to let me know about my socks with loafers faux paux. That day, I said good bye to the white socks with ruffles of my childhood and to the naivete of peer pressure.

LIFE RIGHT NOW

I've been a big complainer the longer I've been in medicine. Everyday I see more patients, more paper work, & more drug seekers. Just when I thought I had lost all joy, I received a letter from one of my patients. She had sent a letter to Human Resources and sent a copy of it to myself and her surgeon:[an excerpt]

I would like to express my sincere gratitude to Dr. Dinah , Dr [ ], and the CareLink program.

Due to the diligence and professionalism of Dr. Dinah I was diagnosed with lung cancer at the very earliest of stages. I would also like to say that in all of my 62 years she is one of the best doctors I have ever had. She listens . . .she also follows her intuition.

This is a patient that had lost her private insurance and had some reservations in beginning when she had to switch to our "sliding scale" for the uninsured program. Nonetheless, she has received good care.

Anyway, I saw her the other day and thanked her for writing the letter. I won't get anything monetarily for this letter or even an accolade from Human Resources, but it did give me pure joy. I'm going to frame it & hang it on the wall just to remind myself that this is why I work, why I chose this profession, & why I need to persevere. [I'm only 2 years out of residency and I'm feeling the burn of burn out!]

But more importantly, I need to be thankful and and joyful to the Lord for this job. In the sermon today, our pastor mentioned that we can be joyful at church, but sometimes, not very joyful at work. How true that has been for me! I asked for this job, I got it, , and here I am. Thank you Lord!

"A happy heart is good medicine and a cheerful mind works healing, but a broken spirit dries up the bones" Proverbs 17:22 (Amplified)

WHY I HATED THE 6TH GRADE

Minding My Vocabulary


I had Ms Stout for my 6th grade English class. She was a woman who appeared 10 years older than her stated age but dressed 10 years younger. She annoyed me with her loud, tight clothing thrown together with gaudy jewelry. I'm not sure if she annoyed me more before or after she didn't back me up after a certain incident in class.

Again, Corey Christiansen, our gifted and talented groups' class clown was involved. For that day's exercise in English we had to write a sentence, and in it use a good vocabulary word so that is could be dissected grammatically. The previous week I came across this word in the vocabulary section of my Reading class textbook: ejaculate: to exclaim (this was the book's definition, and its ONLY definition).

In keeping with directions, I decided to use my newly learned word in a sentence:
"I ate the whole thing!"ejaculated Andrew.

Once we wrote our sentence, we had to pass it to the student behind us for dissection. I passed my paper to Corey and in seconds he was snickering and laughing to himself.

"What are you laughing at?!!" I asked in my don't mess with me cuz I know I'm smarter than you attitude.

"Do you know what this word means?" He laughed pointing to IT. I explained that of course I did and told him. He laughed even harder and then had the audacity to show Ms Stout. After I vehemently told her what I thought it meant she made me look it up in the dictionary (a real one). I'm not sure I even understood its explanation, but I knew it was something sexual and was extremely embarrassed and mad.

It was me against them now. Was it my fault that this word had a less popular meaning and they were too perverted to only know its infamous one?

(yeah, I know you didn't know it either)

WHY I HATED THE 6TH GRADE

Bad Hair Day

Up until the 6th grade I wore my hair down to my waist usually pulled back in a hair band. I used a wool belt that belonged to one of my sweaters so often that in its dinginess it no longer matched the white sweater to which it belonged.

In the 6th grade I decided to get that infamous "feather-look" sported by those beautiful girls in my 80s teen magazine. I had my hair parted down the middle with the front part cut short so that it could potentially be "feathered." The rest of my hair from my ears back lay straight down below the shoulders. The thing about that do was that it did not work with Filipino hair, in other words, it did not "feather."

When I showed up at school the next day, our class clown Corey Christiansen blurted out,"Whoa I couldn't even recognize you, I though you were the new girl in class!" And then he nudged my then 6th grade crush at the time Patrick Nadol with his elbow saying, "Hey doesn't she look like Elvira (mistress of the night?)!"

A wave of major, intense, 6th grade embarrassment enveloped me, but nonetheless, I kept that hairdo for another 6 months.

WHY I HATED THE 6TH GRADE

The First Day

Beginning around the 6th grade I started wearing jeans on the first day of school. Since the 6th grade was the beginning of middle school for me, I knew I'd be lumped in with the "big kids" and needed to somehow be cool. Wearing jeans was a way to look casual and "safe" just to see what other people are wearing. What I didn't know was that when you're in 6th grade, what ever you do is not cool. You're the lowest of the low.

My first experience of subjugation towards the 7th and 8th graders came around lunch time when I had to open my locker. We never had lockers in the 5th grade, so getting past that combination lock was a big deal. Turn to the right . . .turn to the left . . .pass the original number . . .uggh. I could never get it on the first try! Finally, when I got it open, books fell out along with a dollar bill.

Just as I reached over to get that dollar bill, along came a 7th grader who picked it up for me and then said, "It's mine now!"

And that is why I hated the 6th grade.


LIFE RIGHT NOW

We had some friends over today. Robin showed off his cooking skills. He was the chef and I was his assistant chef. I helped with presentation, virgin cocktails and dessert. But he planned it all and it went very well.

I'm in my second trimester now. I've noticed the baby move earlier than I did during the first pregnany, but I'm also much bigger than I was during the first.

the second time

well we finally live in the house that has been in the making for 2 years and took 13 months to build. the same week we closed, we found out we were pregnant again. we had been in such a rut, stressed, with that feeling of high expectation yet let down over and over again with the house, that the news of the pregnancy was a pleasant surprise but not as joyous as during my first pregnancy.

and that's sad.

during the first pregnancy, we had "to try" for 6 months. this one we didn't . we were stressed, had 3 girls living in our house (our renters), we don't even remember how it happened! but i do praise the lord for another blessing.

the dream home

it has been worth it so far. we've lived here for 2 weeks. we have no blinds, no curtains, no landscaping, didn't have hot water for the first few days, but it was still worth it. we love it.

the smart boy

for a while ryan would beg us to do this and that on the computer. now the 2 1/2 yr old can drag and click with the mouse himself. unbelievable.