12.12.2013

Hopper and the Trains


photo credit

Lionel Hopper is famous.

According to him anyway.

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When I first entered the exam room, I was greeted by the musty, unmistakable smell of abandoned hygiene. On the exam table sat a new patient named Hopper. He was the doppelganger of Doc on Back to the Future, except Hopper's carefree hair wasn't white, but the color of a faded tangerine and he had thick sideburns flanking a face that looked like it housed a lot of stories.

Hopper got straight to the point. He wanted Dilaudid, a narcotic pain medicine for his back pain of 30 years.

Our conversation went a little something like this:

Me: It is our policy that we do not prescribe narcotics for long-term pain.

Hopper: So what am I supposed to do?

Me: What have you been doing?

Hopper: Drinking beer.

Me: How much beer you drinking?

Hopper: Sometimes 1 or 2 beers a day, or sometimes 20-30 cases of beer a day.

Me: 20 or 30 CASES?? (placing huge emphasis on the word cases)

Hopper: You bet....whatever it takes. I've been all over and can't get a doctor to give me some of that medicine.

Me: You've been all over this city?

Hopper: All over this country. I'm FAMOUS!

Me: Really...what are you famous for?

Hopper: Hoppin' trains. I'm a train hopper!!

He said this with a mix of disgust (that I didn't recognize his fame) and pride (as if train hopping were the equivalent of winning the Nobel Prize).

Hopper: I've been surviving on the streets for 30 years.

Me: I could prescribe you some Naproxen.

Hopper: I can't afford that.

Me: But you can afford Dilaudid?

Hopper: Yep. It's the only thing I can afford.

(Along with 20 cases of beer, I thought....)

Me: Would you like a Toradol shot right now to help with the pain?

Hopper: No way. I'm allergic to needles.

Me: You are allergic to needles? (placing emphasis on needles....)

Hopper: Yep, one time they gave me a TB shot and my arm swelled up to here (spreading his fingers about 5" high from his arm).

Me: That means you were having a reaction to the medicine, which means you could have tuberculosis.

Hopper: Nope. It's those damn needles.

After we finished the visit, the nurse walked by as Hopper was walking down the hallway toward the exit. She heard him muffle under his breath,

"I'm never coming to this clinic again...."

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You win some. You lose some.





12.10.2013

RIPPLES

I love lakes. And the beach--- the smell, endless sky, birds, soft sand. And mostly, I love the hypnotic waves that ripple on and on and on and on.

And yet... here I am living in a desert.

But I realized the other day, that there are waves (of sorts) to appreciate right here in my arid inland life.

My story begins with R, a 50 year female who tripped and landed on her elbow. She didn't show any visible trauma initially, but then large purplish bruises arrived to the party several days late, which caused R to worry and so she came to see me for the first time. With a normal x-ray and exam to back me up, I gave her reassurance that the bruising was a normal response and, "no, you are not crazy to be so worried."

One week later, R  brought in her best friend, I, who had not seen a doctor in several years. The two ladies giggled and carried on in the exam room, like a pair of teenage cheerleaders talking about the football team. I had a boatload of concerns, her health spiraling downward from years of neglect. Over time, we have tackled the problems one by one.

One day, I came in with her husband P, a diabetic who stopped taking his medication several years ago. His diabetes was out of control, bringing with it several other problems along for the ride. Among the first things I did was give him some cream for a bothersome rash. After getting almost immediate relief, he told his daughter to come see me for a rash that she was fighting. The 24 year old daughter, P2, bopped into the office with miserable sores and bobbed out with a prescription for relief.

So..R brought I. And I brought P. And P brought little P up the coconut tree. (Haha...10 points if you can name that book....).

Then there is L. She is an 82 year old firecracker, tough as leather, who was recently diagnosed with breast cancer and underwent a mastectomy. Her two daughters brought her in to see me as a new patient because she was having a reaction to the antibiotic given after surgery.

A week later, I walked into the exam room and saw a familiar face. "Well hello," I said. "Welcome back." One of L's daughters, E, had a few problems of her own she wanted to discuss.. Since then, E has returned several times, and I look forward to her visits.

A couple of weeks ago, as I was taking a history on a new patient named S, she blurted out, "my mother told me to come see you." Turns out, S is just as delightful as her mother and 82 year old grandmother (E and L).

And wouldn't you know it? S has a teenage daughter. And yes, now I have seen her also. Four generations. L+E+S.

Throughout my schooling I heard various providers boast about this sort of thing. "That's what I love about family medicine," they would taunt, "being able to care for the whole family."  Honestly, I didn't understand that appeal.

Until now.

I see they  were right. This privilege brings a certain pleasantness, a kind of soothing rhythm, as I move in and out of their days and observe the ebb and flow of their lives.

Waves.

Oh sure, it isn't a substitute for the beach. But this RIPPLE effect (of seeing friends, families, generations, one bringing another and another) echoes a tiny hint of the ocean and brings a small wave of joy, right here in the desert.

And I don't even have to clean sand from my car.  





11.26.2013

Otis and the EarAche

Otis is a typical 9 year old boy. I realize that is awfully judgy of me, having just known about him for minutes... but I've become pretty good at recognizing key features of patients. For example, I say he's typical because he has two hands and two ears and he wears pants.

He came with his mother to our clinic because one of those darn ears just wouldn't stop hurting. And for good reason. Looking in the ear, my colleague, Vanilla, saw a nasty looking otitis media, an infection of the middle ear. His eardrum looked like a mini cherry tomato.

Open and shut case.

Vanilla prescribed some antibiotics and analgesics and the boy with two ears left.

Three weeks later, Otis came back again, still wearing pants. And still complaining of right ear pain. This time, a peek through the otoscope showed something completely different.

And more worrisome.

His external canal, the hollow tube running from the outside of the ear to the ear drum, was filled with pus. The cherry tomato had popped, spilling pent-up infection into the narrow tunnel. The mother explained that she had not picked up the antibiotic prescription. This didn't surprise Vanilla. It has become a tune we hear all too often these days. So Vanilla cultured the drainage, encouraged the mother to get the medicine (which she agreed to) and the boy with two ears left.

72 hours later, Otis and his mother returned for follow-up. Otis was feeling more miserable, feverish, growing Pseudomonas (learned from the culture result) and still had not taken any antibiotics. Why?

The mother, embarrassed and concerned, confided that she simply couldn't afford the medicine.  Not then. Not now.

Vanilla then came into my office with a dilemma. Here is a minor, hurting, at the mercy of his mother's poverty and lack of resources. We both expressed concern about not only the child's acute suffering, but potential complications of an untreated infection, including hearing loss. This 9 year old typical boy could be on the cusp of turning atypical: with two hands and one ear.

"I want to pay for the boy's antibiotics," she told me. "Should I?"

There are compelling reasons to do it.

And not to do it.

What would YOU do?

11.20.2013

Ukelele and Jesus

Ukelele, as I am going to call her, was strumming along as well as could be expected for a 76 year old widow. Fairly healthy, except for Type II Diabetes, she first came to see me to establish care at our new clinic, which was closer to her home.

A month later, Ukelele thought she was getting Alzheimer's disease, complaining of short term memory loss manifested mostly with forgetting names and misplacing things. I named three objects and asked her to repeat them. Five minutes later, I asked her to repeat those three objects, which she did easily, grinning like a fourth-grade spelling bee winner when she got them right. (I, too, breathed a sigh of relief that I remembered them.)

She passed all of the other components, too, of the mini-mental state examination (MMSE), a screening test used to identify memory and thought impairment. Even more importantly, she drew a clock with clock-like precision, spacing the numbers evenly in circumference. Those with dementia, and forms of hemispatial neglect, typically draw the numbers of the clock bunched on one side. She denied any hint of urinary incontinence.

Whatever she had, it probably wasn't dementia.

Then Ukelele said something which caught my attention.

"When I come to your office or the grocery store, I can remember things perfectly."

Suddenly, I had a clearer understanding of where this conversation and probable diagnosis was heading.

"Tell me about life at home," I queried.

She began to tell her story while I listened, intently, a therapeutic measure in and of itself. She was struggling with financial pressures, missing her husband, and feeling overwhelmed with home repairs and upkeep.

Then, after scoring moderately high on the Geriatric Depression Scale, I presented the idea of depression as a possibility for her memory impairment. We both agreed to try a low dose anti-depressant medication to tackle this.

One month later, she presented for follow-up. Her eyes were wide and bright as she reported,

"I am slowly starting to remember where I put things.... I am sleeping better and not so sad."

Her serotonin-induced improvement incited a dopamine surge for me. I was genuinely happy she was feeling better.

"My knee hurts" she then abruptly changed subjects.

More questions, a knee exam, followed by an x-ray dappled with osteophytes gave me reassurance that she was suffering from the inevitable wear of aging on the joint cartilage: osteoarthritis. Though painful, it is usually not as destructive, nor require toxic medicines as does the pesky cousin: rheumatoid arthritis. This was good news. When I told Ukelele I thought she had arthritis, she clapped her hands in the air, raised her head to the ceiling and squealed,

"Thank you, Jesus!"

She continued, "I have been praying to Jesus that you would say that."

Then she grabbed my hands. "And I have been praying to Jesus, every day, for YOU."

Oh....I thought. What a sweet thing to say, Ukelele. Music to my ears, really.

Because, as God knows, I need it.

We all do.







11.18.2013

To Believe or Not

She came in all spruced up, hair curled, make-up just right. She carried herself well with perfect posture. Except for the curious scars on her left cheek, her complexion was flawless. At first impression, I thought her story was going to be a little more positive than most of the stories I hear day in day out.

My hunch was debunked about 2 sentences into our conversation.

She wanted Alprazolam (Xanax)... a highly addictive drug, which can net sellers upwards of $5 per pill on the streets. It is a medicine I choose not to prescribe, because you know... the rotten few have ruined it for the deserving many.

Before turning Cindy away, I listened, disheartened, as she told me her story. She had been locked away in a tiny room, a prisoner in her own home, with very little food and no sunshine. The jailer was her husband, who had gradually become more abusive, at one point smashing her face and fracturing her left cheekbone. At his breaking point, he threw Cindy in a bedroom, locked the door, and she wouldn't see the light of day for 9 months. He had become her sole source of  food, freedom and fear.

After Cindy's daring escape, she began to have nightmares and anxiety, developing classic symptoms of post-traumatic stress disorder. She was prescribed Xanax to fight her fires, which helped her cope and quenched the flames. She began to help other women with similar stories, and soon became a model of strength, a pillar of support for others. Reaching outwardly helped her heal inwardly. Eventually, she was hired as the director of a local goodwill organization, and she felt strong enough to wean from the Xanax, another captor from which she wanted to escape.

But slowly, her nightmares and flashbacks re-emerged, the embers re-igniting. For the last 6 months, she had embattled the discomforts with stoicism, but finally accepted the need for extrinsic help. She wanted... needed the medicine to cope.

So she sat in my office, crying, hoping for a prescription.

Her story was compelling. It sounded legitimate. Her external scars glaring proof of something gone awry. I told her that I don't prescribe that medicine, but would refer her to our in-house psychiatrist who could give her that, or something more effective. She cringed under the weight of the inevitable wait.

Maybe her store is true, every word. Maybe she is the exact person for whom this medicine is designed for. Maybe she deserves this med, whenever she needs it.

And maybe.....she told me a darn good story, and has developed a Streep-like ability to cry when the moment is right.

I'll never know. She has never returned.

But I have returned again and again to thinking about that experience.

And it haunts me, did I do the right thing?

7.08.2013

Footprints of Southern Utah



Change is rarely easy. Unless you are changing from a standing to {my favorite} lying position. I dig that change every night.


But other types of change, such as leaving a place you love... well... now that can tough -- tough as a cheap steak in an amateur cook's hands.

I've moved 7 times in my life. And each time has been for new and exciting, greener pastures. But this time....my 8th time... feels different. It IS different. I was settled in. Happy. Comfortable. Secure. With my family around, friends found, and job sound.

Then we heard a thunder clap. My husband's company, Viracon, announced out of the clear cold blue, that they were closing their doors. With no job for Possum, a mountain of school debt, and our youngest boys (and only children living at home) leaving on a mission, we decided to make a move. HAHA! Literally.

I am joining the National Health Service Corps and moving to help a place where it is hard to recruit practitioners, with a two-fold benefit. It will help the community (ahhhhhh) and pay off my student loans (yay!!). Our goal is to return to southern Utah in 2-4 years, debt-free, and a little stronger, a little wiser, and a little grayer in the pelo (did I mention I'll be learning Spanish...).

Nice idea. Painful execution.

So I decided to get creative. It's more fun than crying. My solution?

Sole searching.




I started an Instagram / Facebook series entitled Footprints of Southern Utah, documenting my feet / footprints in various undisclosed places that are meaningful to me. I posted daily for three weeks, and followers could guess where I was.

This project was fun and just what I needed to turn my frown upside down.

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Here are the stats:

22 days
38 locations (+ 11 more that didn't make the cut into the project)
26 pairs of shoes (two not pictured)





8 photographers/assistants
4 pedicures
4 colors of nail polish





3 Swig sugar cookies
3 embarrassing moments
1 can of whipping cream
1 pie mis-hap

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Without further adieu, I give to you....

FOOTPRINTS OF SOUTHERN UTAH PICTURE PROJECT

Day One - DIXIE REGIONAL HOSPITAL. This was my last day assisting in the Operating Room, next to my awesome mentor and friend, Dr. Ott. I walked out of the OR, teary and droopy. And the hospital healing gardens took my breath away, and cheered me up. The hospital grounds are soooo lovely! And so are my Keens, I might add.






Day Two - ST. GEORGE TEMPLE - (Does anyone else think the temple builders must have had a wicked sense of humor?)




Day Three - SWIG. I had to eat a few cookies, washed down with a Dirty Dr. Pepper, to get the shot just right. Sometimes I make sacrifices like that. And contrary to what may appear, the health hazards of eating from this footstool is minimal due to the fact that..... not many others have eaten off my footstool.


Or version two....for the more conservative types.





Day Four - OUR POOL, with friends and neighbors and noodles





Day Five - ENTERPRISE RESERVOIR, where my dad and I went fishing, finally. As you can see, we scored.




Day Six -  JUDD'S COUNTRY STORE. How can you not love a store that sells Love Potion #69, DANG Root Beer, Kickapoo Juice, and Bacon flavored soda, plus old-fashioned candy. This is great place for stocking stuffers!





Day Seven - TABERNACLE IN ST. GEORGE.  I love this pic! I look so hip and cute. (And short!) The Tabernacle is a place where I heard my daughter as well as dear friends perform at various times.





Day Eight - KOKOMO SNO. This is a new little sno cone shack... I mean trailer... in Hurricane that is adorbs!!! Complete with changing fluorescent mood lighting. Oh and did I mention delicioso? Try peaches with sweet cream.





Day Nine - COSTCO. True... it isn't fancy {so I paired it with non-fancy shoes} but it isn't available in my new town, and I'm having a little bit of panic attack about it. In other happier news, may I suggest the Hi-Chews?





Day Ten - MY PARENT'S BACKYARD IN ST. GEORGE. Let's get sappy for moment, shall we? I'm sad that this picture doesn't show off my dad's beautiful yard. I'm wearing flowers in my toes to make up for it. Oh I will miss this peaceful, happy place!






Day Eleven - GRAFTON. A favorite place of the hubs and Billy the Kid. A ghost town with charm, history, beauty and mystery.





Day Twelve - CORAL CLIFFS CINEMA. They have such friendly and good-looking ticket takers! (Hey dude... your thumb is butting into my picture).





Day Thirteen - SPRINGDALE AND ZION, one of my favorite places in all the world. PS: Does anyone ever stop and get apple juice from this place?


I'm definitely reflecting on this beauty....





Day Fourteen - DOWNTOWN PUBLIC LIBRARY OF ST. GEORGE. Good study times here with friends. Warning: Do not try this at home. I repeat, do not write on your feet. It tickles.


That's Rhett and Scarlet on the cover by the way. That's why I can handle sitting in the middle of the floor in the middle of the room with stares from all directions. Because tomorrow is another day.





Day Fifteen - What do do in the Summertime? PICKLE BALL COURTS. It is here I love to beat my husband.





Day Fifteen - What to do in the summertime? HURRICANE CITY FINE ARTS BUILDING. Watched + performed many great shows here. The last one, shown here, was Annie, the musical. And no, I'm not putting my feet up on the chairs, kids. That is only an amazing illusion.





Day Fifteen - What to do in the summertime? HURRICANE CITY SWIMMING POOL. The lifeguards are so competent and cute.





Day Fifteen - What to do in the summertime? VIRGIN RIVER. The Laurels and I floated this on my final week as Young Woman's president. I popped a tube. Didn't blow a gasket.





Day Fifteen - What to do in the summertime? ROOFTOP CONCERT IN PROVO. Ok... it's not Southern Utah but such a great event co-founded by my brother. And as a public service, I ought to let you know, it's just as good listening upside down.





Day Fifteen - Oh what to do in the summertime? ST. GEORGE SPLASH PAD. I don't have little kiddos, so why this place you might ask. It was here my friends and I met and made a huge welcome home poster for Bridget's missionary daughter. You might think a wet park is a funny place to make a poster out of paper.  It is.





Day Fifteen - Oh what to do in the summertime? ST. GEORGE DAY SPA. Daisy gave me a spa day with her for Mother's Day. Such a fun gift and day!!





Day Sixteen - WOMEN'S HEALTH SPECIALISTS. This was my office. Dr. Fisher, at your cervix! Loved working here!!





Day Seventeen - HURRICANE HIGH SCHOOL SOCCER FIELD. If you came to the high school soccer games the last few years, you would have heard my voice "Welcome to Tiger Stadium. Where the winds are fierce and so are the Tigers!" I loved announcing the games, and spent many many hours on that field watching my sons beat... play soccer.


See Ms. Fish. See Ms. Fish jumping. See Ms. Fish jumping for joy.





Day Eighteen - Let's go shopping! KITCHEN KORNER. I may or may not have spent a little too much money here. And I may or may not have made a fool of myself taking this picture.





Day Eighteen - Let's go shopping! ACE HARDWARE IN ST GEORGE. Much more than a Hardware store, much to my husband's wallet's dismay.





Day Eighteen - Let's go shopping! CHRISTENSEN'S. Best place for outdoor and dress shoes.





Day Eighteen - Let's go shopping! CLASSIC SPORTS - Best place for athletic supplies. Plus, Jared is the best athletic supporter in town!





Day Eighteen - Let's go shopping! HARMON'S. Best grocery store EVER! Especially their cheese section. Some girls kick up their heel with a juicy kiss. I kick up mine with a juicy selection of cheese.







Day Eighteen - Let's Eat! WHIPTAIL GRILL IN SPRINGDALE BABY!!. One of my all-time favorite places to eat. LOVE their spaghetti squash and goat cheese enchilada, pictured here. I'm hoping to get one in the mail for my birthday.





Day Eighteen - Let's eat! DURANGO'S. A local joint that feeds our family monthly. Ok, weekly.





Day Eighteen - Let's eat! BENJA THAI - Last supper with my bestest friends.





Day Nineteen - DIXIE ROCK, overlooking all of St. George. I'm sporting my new adventure shoes, made by awesome friend Becky Lewis! Oh my sole, those are Dr. Seuss quotes on the bottom.


The shoes are chuck full of quotes and a recipe and signatures and things that I love.






Day Nineteen - SKY MOUNTAIN GOLF COURSE. The place where the colors are really this vibrant. Meaningful because this is where Andy learned to golf and played on the high school team. And where we took family photos and dance pictures.





Day Nineteen - TEN:TWO, an adorable boutique in downtown Hurricane, owned by the darling, creative entrepreneur Shari Leavitt, shown here! She probably won't paint your toes (unless you are doing a Footprints project), but she will sell you some killer polish and cute clothes to match.







Day Twenty - HURRICANE PEACH ORCHARDS, looking towards Molly's nipple, a Hurricane landmark of mammaried fame. I call this Toe Jam: An Ode to the Fruit Orchard.





Day Twenty One - HOME SWEET HOME - MY KITCHEN FLOOR. I love the tile that my husband laid. It looks like aged brown leather. So my aged foot fits right in.






Day Twenty One - HOME SWEET HOME. This pic showcases one of my culinary treats, since I love to cook and bake. This butterscotch pudding with caramel sauce is the last homemade thing I made in my kitchen. Served up on a {foot} bed of lettuce whipping cream.





Day Twenty One - HOME SWEET HOME - MY BACKYARD. This is my favorite of the footprint pictures. It's Wild and carefree and the epitome of summer. Thanks to my honey for taking such good care of our grass. It looks amazing!





Day Twenty One - HOME SWEET HOME. Love at home! Taken on the night before I moved.



So glad my parents came to say good-bye.





Day 22 Moving Day - SAND HOLLOW RESERVOIR. On to new roads, new adventures, and healing of my burned legs.



.

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For those that just can't get enough.... here are the OUTTAKES: the photos and places that didn't make it into the series.


Sean's work / classroom at BYU



Dixie Health and Wellness Center where I was a provider and had a great nurse and office manager



Watching my boys play pickleball



Back for more Kokomo Sno



City pool where Otto teaches swimming lessons and lifeguards



My mom and dad's lush green grass and Daisy's cute feet




I couldn't use this picture because it's false advertising. I don't run.



Which shoe? Chaco or Keen.


A different version of  the pickle ball courts.



We live in a desert.


Croshaw's pies. The pie melted.




Ballard's nursery.


Who doesn't love a good flower foot soak now and then?



Or just a foot soak!


Watch an exciting behind the scenes video of how we took the above photo

video


Desert cracks




The bank


Health and Performance Center Surgical Suite



River Road Operating Room - loved assisting in the OR



Church gym


Me and my dear friend, Amee, at the temple.


Well there you have it.... I shoe'd you a thing or two about my world. It helped heel my heartache about leaving, and was a ball to think about places and people important to our family. Now I'm sure you never want to see another picture of my feet again.



Before you go.... Tell me, do you have a favorite from this footprints series? What do you do to help when making a big change in your life? Have you found a good way to say good-bye? What footprints do you want to leave behind?

I would LOVE you to leave your footprint here and hear from you!

---------------------------
Huge thanks to:

Brent Fisher
Janessa Behunin
Jared Behunin
Stockton Fisher
Sean Fisher
Landon Fisher
Loni Hackworth
Allen Hackworth
Amee Roe
Jennifer Montgomery
Becky Lewis
Shari Leavitt
Lance Gubler
Jared Ellison
Shauna Zundel
Barbara Johnson

xoxo



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