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When I'm not here, you may find me wandering the pages below. (If I'm a regular visitor to your site and I've left your link off or mislinked to you, please let me know! And likewise, if you've blogrolled me, please check that my link is updated: thisroamanticlife.blogspot.com. The extra (a) makes all the difference!)

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Body: in sickness and in health

I won't lie; this body and I have had our issues with each other for many years. Body image -- sure. Physical and mental overextension -- comes with being a Type A kind of girl. I still struggle with these things, so they show up from time to time in my writing.

More recently, illness, pure but not simple, has added itself to the mix in a multi-system sort of way. And the challenges in figuring out exactly what's gone wrong are many. As problems have revealed themselves in the last few years, beginning with reactive hypoglycemia in late 2008, I've documented them here, partly to gain a little clarity on managing complex conditions but mostly to give voice to vulnerabilities I feel but don't normally share with anyone face to face. Better out than in, they say, right? (Oh yes, humor is one way I deal.)

The links below cover the different angles I've examined (and from which I've been examined) within that experience.

Travel: neither here nor there

When the person you're married to lives two time zones away, you log a fair number of frequent flier miles. And if you blog about commuter relationships, you log quite a few posts en route too.

Since we're no longer in separate places, I blog less often from airports. But we do travel -- together now! -- which is much more fun to write about. So in addition to thoughts on our years of commuting, the links below cover the places we've been as a pair and, in some cases, the adventures that have happened on the way.

Writing: the long and short of it

Why do I do it? Good question. Maybe it's not so much that I like to write but that I have to write, even when the words refuse to stick to the page. Believe me, I've tried doing other things like majoring in biochemistry (freshman fall, many semesters ago). Within a year, I'd switched to English with a concentration in creative writing and wasn't looking back.

After graduating, I taught English for a few years and then worked as an editor, which I still do freelance. In 2007, I applied and got into an MFA program at a place I like to call Little U. on the Prairie. I finished my degree in 2011 and have been balancing tutoring and writing on my own ever since.

The following links cover the writing I've done about writing: process, content, obstacles, you name it. It's not always pretty. But some part of me loves it, even when it's hard. And this is the result.

Heart: family and friends

I'd have a hard time explaining who I am without being able to talk about the family I grew up in as well as the people I've met beyond its bounds. But even with such context, it's not easy! In the simplest terms, I'm a first-generation Asian-American who has spent most of this life caught between cultures. That, of course, doesn't even begin to describe what I mean to, but there's my first stab at the heart of it all.

That's what this group of posts is reserved for -- heart. The essential parts of my life whose influences I carry with me, for better or worse. The links below cover what I've written as I've learned how these forces work within me, for me, against me, in spite of me. They anchor me even as they change me, and they keep life interesting.

Recommended reading

What do I do when there's too much on my mind and my words won't stick to the page? I escape into someone else's thoughts. Below is a collection of books and articles that have been sources of information, inspiration, and occasional insight for my own work.

Friday, September 24, 2010

Them's fightin' words

I knew getting a dietitian was the first step toward some important changes, but apparently it's starting a small revolution.

I think I'm firing my endocrinologist.

It's not a straightforward story, but the short version is that on my visit to said endocrinologist's office last week to follow up on that pesky kidney stone, I updated him on the diet adjustments I've been making with the help of my dietitian. And he wasn't happy -- the caloric allowances she'd laid out for me didn't jive with what he thought I should be aiming for (he was advocating a much tighter budget). Not one to sit helpless when given conflicting information, I asked him to speak with the dietitian so that we could determine where the disagreements were in their assessments of my needs. His response: "Tell her that I have a subspecialty degree in metabolic disease" -- or some such field, I can't remember his exact words -- "and if she still has questions after that, she can call me."

Huh. Did he really think she (or I) was going to accept credential-waving as an adequate reason to follow his plan?

Sensing I was getting the brush-off, I e-mailed the dietitian after I got home, explaining the discrepancies between the recommendations, and expressed my concern. She immediately got back to me, promising to contact my doctor so that we could get the diet guideline questions resolved.

Apparently, he wouldn't talk to her.

Instead, he left a message for her with his nurse -- one that wasn't far off from what he'd told me to relay, from what I've gathered. And he's still refusing to take the dietitian's calls.

Is it ego? Insecurity? A control issue? All of the above? I'm done speculating. I need a care team, one in which the various members work together. If someone's refusing to communicate, much less collaborate, there's no way this is going to work out in my best interest. So I'm removing myself from his responsibility.

This has been a long time coming -- over the last few months, this guy has said and done other things that left me feeling unsupported and unheard. It's not worth going into detail, but each incident eroded my trust in him just a little bit more. I'm glad to be able to leave his service, knowing without question that the problems with him aren't "just in my head."

But finding that next person. I can't say I've got a lot of confidence in the current remaining team members (with the exception of the dietitian) -- they communicate minimally, by faxed lab results at best. This endocrinologist was kind of the only person who at least went through the motions of examining the bigger picture (he made the referrals to other specialists, so he got their letters back interpreting the results of their tests). I need someone willing to take the time to look closely, to pursue answers.

I happened to read Big Little Wolf's commentary on the doctor-patient relationship as all this was going on, and that, among other things, has reinforced what I've known for a while: that my search isn't going to be an easy one. But I'm looking because I have to. This mess -- or message service -- masquerading as coordinated care has gone on too long.

And I will totally sic all seven pounds of my attack kitty on the next M.D. who tells me his degree is what makes his plan (or lack thereof) superior to anyone else's.

14 comments:

Kristen @ Motherese said...

I'm really impressed by your decision. Too often I worry about stepping on a doctor's toes - which is a really ridiculous attitude to have when we operate in a medical system that requires us to be our own advocates. I wish you the best in finding a doctor who can act as a reliable and supportive point-person for your care.

Sherlock said...

Good for you! Shopping for docs is frustrating. Perhaps the dietitian knows of some endos she's worked with who would be a better part of the team? Good luck!

Good Enough Woman said...

Way to stand up for yourself and your needs! And I was wondering what Sherlock asked: Does the dietician have any recommendations?

And, Dude. I would not mess with that attack cat. Maybe you should carry a picture of the kitty in your wallet.

C. Troubadour said...

Kristen -- I worry about that too! That's one of the reasons why it took me so long to say enough was enough. I think it's a two-way thing; yes, we go to doctors for their expertise, but when they don't help us feel that we've been heard, how can we feel that their advice is appropriate for what's hurting us?

Sherlock -- I remember you were recently shopping yourself; hope the person you'd found is still working out well. Good suggestion about the dietitian's connections. She's already doing some looking around (she hasn't worked recently with anyone in the field, but she remembers doing so in the past).

GEW -- that is a GREAT idea. I'll just flash the photo whenever I have to open my wallet to get my insurance card out. The office can consider itself duly warned! (In all seriousness, though, this kitty would probably just roll over and ask for a belly rub if presented to a stranger. I caught her mid-yawn in that picture.) As for potential recommendations from the dietitian, see above :)

TKW said...

You have had some high concentrations of assholery going on, there. I am proud of you for walking away from sub-standard care and taking matters into your own hands. The prior endocrinologist sounds like an asshole--so amp-ed up by his degrees that he considered it beneath him to talk to a "nutritionist." Ick.

Look forward to hearing your progress. Thinking of you...

C. Troubadour said...

Thanks, TKW. I have to laugh every time you cry "assholery!" I'm going to remember that as the search for a new person gets going. When in doubt, call the crap for what it really is!

hgg said...

Of course Important Male Endocrinologist cannot be bothered talking to and much less admitting that Female Less-Important Dietitian is right. Male egos must not be hurt!

Good luck finding a new and better one!

C. Troubadour said...

Hi hgg! Perfectly summed up. I'm still floored by his behavior and it's been more than a week since all this went down.

Hope you are well. I'm glad you're still out and about in the blogosphere :)

BigLittleWolf said...

Oh man, CT. Unbelievable. I don't know what it is. I do wonder if this patronizing behavior is directed more often at female patients. I have no data to support this, but it's what I believe. And it's bullshit. No matter who it's directed at, it's bullshit.

"A care team." Now there's a concept. These days, I would just take one decent competent physician.

Keep us posted. And good for standing up for yourself and your right to being treating like an intelligent human being involved in her own health.

C. Troubadour said...

I'm hoping for better from the next doctor, BLW. Yes, just one competent physician makes a world of difference!

I hope you're well. I've been thinking of you through all this and how much you've had to put up with in your experience with the health care system. It takes guts to stand up to all that.

French Fancy... said...

Well done on standing up to this 'specialist', I bet you feel much better and stronger for it. Does your dietician have anybody she can recommend to step into his shoes? It could be she knows just the person to help you.

Sorry I'm so late in coming here - it's been an exhausting time, my friend
x

C. Troubadour said...

Dear FF, how I can imagine your exhaustion! Your new job is a demanding one. The care facility where you're working is lucky to have someone like you; I can't say that enough.

I've done some querying and my interviews have led me to a potential internist who comes with positive reviews. From there, we can determine if an endocrinologist needs to be on board or if she can manage my case on her own. But the first appointment's not till next week, so here we wait ...

SuziCate said...

How frustrating! What ever happened to health "professionals" consulting over patient care? I hope this has all worked out by now...sorry I hadn't been by before now.

C. Troubadour said...

SuziCate, I'm glad you stopped by -- whenever, wherever is fine with me! New doctors this coming week. I'm crossing my fingers.

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Friday, September 24, 2010

Them's fightin' words

I knew getting a dietitian was the first step toward some important changes, but apparently it's starting a small revolution.

I think I'm firing my endocrinologist.

It's not a straightforward story, but the short version is that on my visit to said endocrinologist's office last week to follow up on that pesky kidney stone, I updated him on the diet adjustments I've been making with the help of my dietitian. And he wasn't happy -- the caloric allowances she'd laid out for me didn't jive with what he thought I should be aiming for (he was advocating a much tighter budget). Not one to sit helpless when given conflicting information, I asked him to speak with the dietitian so that we could determine where the disagreements were in their assessments of my needs. His response: "Tell her that I have a subspecialty degree in metabolic disease" -- or some such field, I can't remember his exact words -- "and if she still has questions after that, she can call me."

Huh. Did he really think she (or I) was going to accept credential-waving as an adequate reason to follow his plan?

Sensing I was getting the brush-off, I e-mailed the dietitian after I got home, explaining the discrepancies between the recommendations, and expressed my concern. She immediately got back to me, promising to contact my doctor so that we could get the diet guideline questions resolved.

Apparently, he wouldn't talk to her.

Instead, he left a message for her with his nurse -- one that wasn't far off from what he'd told me to relay, from what I've gathered. And he's still refusing to take the dietitian's calls.

Is it ego? Insecurity? A control issue? All of the above? I'm done speculating. I need a care team, one in which the various members work together. If someone's refusing to communicate, much less collaborate, there's no way this is going to work out in my best interest. So I'm removing myself from his responsibility.

This has been a long time coming -- over the last few months, this guy has said and done other things that left me feeling unsupported and unheard. It's not worth going into detail, but each incident eroded my trust in him just a little bit more. I'm glad to be able to leave his service, knowing without question that the problems with him aren't "just in my head."

But finding that next person. I can't say I've got a lot of confidence in the current remaining team members (with the exception of the dietitian) -- they communicate minimally, by faxed lab results at best. This endocrinologist was kind of the only person who at least went through the motions of examining the bigger picture (he made the referrals to other specialists, so he got their letters back interpreting the results of their tests). I need someone willing to take the time to look closely, to pursue answers.

I happened to read Big Little Wolf's commentary on the doctor-patient relationship as all this was going on, and that, among other things, has reinforced what I've known for a while: that my search isn't going to be an easy one. But I'm looking because I have to. This mess -- or message service -- masquerading as coordinated care has gone on too long.

And I will totally sic all seven pounds of my attack kitty on the next M.D. who tells me his degree is what makes his plan (or lack thereof) superior to anyone else's.

14 comments:

Kristen @ Motherese said...

I'm really impressed by your decision. Too often I worry about stepping on a doctor's toes - which is a really ridiculous attitude to have when we operate in a medical system that requires us to be our own advocates. I wish you the best in finding a doctor who can act as a reliable and supportive point-person for your care.

Sherlock said...

Good for you! Shopping for docs is frustrating. Perhaps the dietitian knows of some endos she's worked with who would be a better part of the team? Good luck!

Good Enough Woman said...

Way to stand up for yourself and your needs! And I was wondering what Sherlock asked: Does the dietician have any recommendations?

And, Dude. I would not mess with that attack cat. Maybe you should carry a picture of the kitty in your wallet.

C. Troubadour said...

Kristen -- I worry about that too! That's one of the reasons why it took me so long to say enough was enough. I think it's a two-way thing; yes, we go to doctors for their expertise, but when they don't help us feel that we've been heard, how can we feel that their advice is appropriate for what's hurting us?

Sherlock -- I remember you were recently shopping yourself; hope the person you'd found is still working out well. Good suggestion about the dietitian's connections. She's already doing some looking around (she hasn't worked recently with anyone in the field, but she remembers doing so in the past).

GEW -- that is a GREAT idea. I'll just flash the photo whenever I have to open my wallet to get my insurance card out. The office can consider itself duly warned! (In all seriousness, though, this kitty would probably just roll over and ask for a belly rub if presented to a stranger. I caught her mid-yawn in that picture.) As for potential recommendations from the dietitian, see above :)

TKW said...

You have had some high concentrations of assholery going on, there. I am proud of you for walking away from sub-standard care and taking matters into your own hands. The prior endocrinologist sounds like an asshole--so amp-ed up by his degrees that he considered it beneath him to talk to a "nutritionist." Ick.

Look forward to hearing your progress. Thinking of you...

C. Troubadour said...

Thanks, TKW. I have to laugh every time you cry "assholery!" I'm going to remember that as the search for a new person gets going. When in doubt, call the crap for what it really is!

hgg said...

Of course Important Male Endocrinologist cannot be bothered talking to and much less admitting that Female Less-Important Dietitian is right. Male egos must not be hurt!

Good luck finding a new and better one!

C. Troubadour said...

Hi hgg! Perfectly summed up. I'm still floored by his behavior and it's been more than a week since all this went down.

Hope you are well. I'm glad you're still out and about in the blogosphere :)

BigLittleWolf said...

Oh man, CT. Unbelievable. I don't know what it is. I do wonder if this patronizing behavior is directed more often at female patients. I have no data to support this, but it's what I believe. And it's bullshit. No matter who it's directed at, it's bullshit.

"A care team." Now there's a concept. These days, I would just take one decent competent physician.

Keep us posted. And good for standing up for yourself and your right to being treating like an intelligent human being involved in her own health.

C. Troubadour said...

I'm hoping for better from the next doctor, BLW. Yes, just one competent physician makes a world of difference!

I hope you're well. I've been thinking of you through all this and how much you've had to put up with in your experience with the health care system. It takes guts to stand up to all that.

French Fancy... said...

Well done on standing up to this 'specialist', I bet you feel much better and stronger for it. Does your dietician have anybody she can recommend to step into his shoes? It could be she knows just the person to help you.

Sorry I'm so late in coming here - it's been an exhausting time, my friend
x

C. Troubadour said...

Dear FF, how I can imagine your exhaustion! Your new job is a demanding one. The care facility where you're working is lucky to have someone like you; I can't say that enough.

I've done some querying and my interviews have led me to a potential internist who comes with positive reviews. From there, we can determine if an endocrinologist needs to be on board or if she can manage my case on her own. But the first appointment's not till next week, so here we wait ...

SuziCate said...

How frustrating! What ever happened to health "professionals" consulting over patient care? I hope this has all worked out by now...sorry I hadn't been by before now.

C. Troubadour said...

SuziCate, I'm glad you stopped by -- whenever, wherever is fine with me! New doctors this coming week. I'm crossing my fingers.