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.

Bone weary

I thought the weekend was supposed to be for relaxing, but I think it's just allowed me to feel the weight of all the stuff from the past week (or two), now that there is space for that. And the feeling is necessary, so fine. But I'm warning next week right now: ease up or ... else.

(I'm not very good at actually coming up with threats, but I'm cocking a very pointed eyebrow at Monday and everything after it. It's my teacher look, which actually won a stare-down contest in a teacher-training workshop many years ago. See that, next week? See that eyebrow?)

My thesis is moving forward for real. I have two solid chapters that make sense in succession and are pointing very clearly to a third, which is more exciting than I have the means to describe. But it's been drawing on a lot of mental resources, and when I've come to the end of the day, I've had nothing for anyone else. D and I both go through this -- he'll return after a particularly intense day, having successfully left work at work, but he doesn't quite make it home in his state of mind for several hours after he gets through the door. He floats in some kind of limbo that makes for pretty quiet dinners. I understand -- sometimes the brain doesn't reset for a little while. So I leave him alone until he's ready.

Last week was my turn to be zonked -- not just from all the research interviews and the mental gymnastics of writing, but from the emotional pull of trying to tell a difficult story. (Forgive me if I don't get more specific than that; I did just spend the week up to my ears in the details.)

I'm glad the writing is working. But it's at the expense of other pressing concerns I need to resolve, like the fallout of getting sick while no one was around. D and I didn't come through that situation in the best way, and we've wanted to talk about it, but I've been too frayed to do it without getting upset, which D doesn't deal well with. Our attempts to have a conversation about how we handled things on both our ends have been kind of rocky. And then there's the question about what all these seemingly separate problems -- blood sugar, GI tract, kidneys -- are really indicative of. I've pushed that out of my mind for a while, but Labor Day weekend was a reminder that all is not perfectly well and that we still don't have real answers as to why three different body systems decided to get wonky, all starting in the first half of 2009.

So I want some emotional reserves for this stuff. I know I can't always have enough for all of it, but for next week, I need more.

This

... is how I feel.

Last week's issues are more or less fading away (hooray!) but yesterday was another thesis deadline and I'm now totally brain-drained.

It's a mostly good sort of drained -- I feel like I hit a stride I hadn't achieved in ages, really writing, not just transcribing or starting a scene only to abandon it for a different start. For months, I'd accumulated those starts, 19 pages of them. Yesterday, I turned in a completed chapter with a beginning, middle, and end.

I'm supposed to be writing up a short item for another professor right now, but I think I'm still not quite recharged. Rather, I think I used up my quota of writing brain on an e-mail I had to compose this afternoon. I'd gotten an inquiry from a prospective student, asking about the ins and outs of my program (I'm listed as a student contact for such questions).

Of course, the applicant wanted to know what I thought about the classes, the faculty, etc., etc., and I'm glad to provide my take on my own experience -- which I can only characterize as mixed. But it's not something I share without a lot of consideration about context.

I imagine if you asked each person in my year what he or she thought of the program, none of the responses would be the same. There would be similarities in some areas, but also enormous differences, depending on each individual's personality and expectations. We're all as different as the work we produce. So whenever I reply to someone's inquiry, I have to emphasize the importance of asking other students the same questions he or she has asked me. And I have to word my response so it is absolutely clear that my experience is by no means representative of anyone else's, that in fact there are people I have met who would answer very differently.

For some reason, I don't trust these eager applicants to remember that. I'm sure there are those who will romanticize the "highly intriguing" and "highly illustrious" program I'm a part of (words straight out of today's e-mail), no matter what I say, only to be disappointed when they arrive (if they're admitted). Perhaps I think this because so many people I met in the program eventually found themselves disillusioned with it. The fact is there were (and still are) limited resources, not just in terms of funding but in terms of mentorship, and if you don't fight hard to be your own advocate when you feel like you're not getting what you need, you'll be less satisfied with your experience. I don't want the prospective students who contact me to go into the process of applying -- to this program or any program -- without the understanding that this is part of what will greatly influence how things end up for them.

And then there will be those who'll get turned off before they've gathered enough opinions, taking my comments, no matter how carefully I couch them, as bald-faced denunciations.

It's out of my control, in any case. I can only choose my words so carefully. I just hope I did a good enough job that it'll make the right difference to the right person, if that makes any sense. That's my reason for replying in the first place.

Every kidney has a silver lining, the sequel

Yep, this little nuisance again.

You'd think I'd recognize a kidney stone after the first one, but no, this one presented itself quite differently. Referred pain? You got it (rather, I did).

So a good part of Friday found me waiting here (the hospital's walk-in imaging clinic):


Not exactly my first choice for where to spend all that time. But when the ultrasound didn't reveal anything amiss in my gallbladder (a good thing!), the GI folks had to refer me to somebody else (with a practice in the same medical facility, but an entirely separate registration/appointment process). That doctor, whom I got to see only on the luck of some other patient's cancellation, sent me back to the clinic for an x-ray, which revealed the real cause of all the trouble.

The doctor was very kind and hung around after his office had closed, just so he could interpret the x-ray for me (it was late in the day when he ordered the test, so there was no way the radiologist would have the official report to him in a timely fashion). He could have gone home and told me to wait for the results, to be delivered by phone after the long weekend, with orders to go to the ER if things got worse before then. But he didn't, and I'm thankful. Because of his kindness, I was able to go home with an answer and greater peace of mind. I'm still under orders to go to the ER if anything untoward occurs, but given the size and location of the stone, that's very unlikely.

Who knew I'd be glad to have a kidney stone instead of the alternative?

(Don't get me wrong; it still hurts. But given the choice, while alone, I'd rather deal with a problem I can treat from home as opposed to something that requires hospitalization, no matter how routine. Who would feed the kitty?)

I just hope I'm not in for a repeat of this in the future. Especially since it occurs without warning and in such misleading ways! Worst fear: that it happens while I'm on a plane. If I'd gone with D on Thursday instead of staying behind to work on my thesis, I'd have been somewhere over Texas during the nastier part of that afternoon. I suppose I should thank my writing obligations for preventing that ... ?

Grumbling rights

I'm exercising them. Because the gods of timing just won't leave me alone.

The short version: D left town this morning to throw his brother a bachelor's weekend before said brother's wedding next month. This afternoon, the nagging stitch in my side that started yesterday after lunch turned into an unrelenting pain that still hasn't gone away. A trip to the GI doctor got me some prescription painkillers and orders to return to the hospital in the morning for a thorough ultrasound (the one attempted today wasn't clear enough, so we'll try again when I'm fasting). The hope is that the gallbladder doesn't need to come out.

I'm pretty good at being alone most of the time -- years of living apart from D while we were commuting has trained me well. But this is one of those instances where I really, really wish he were here.