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My sister called me this morning from Italy. She had to leave the country to deliver a paper at a medical meeting in Genoa. The doctor who did the valve replacement this morning on mom, called her as soon as he was done and she in turn first called Joan, our younger sister who was in the waiting room of the cath unit just a couple of 100 feet from Mom, to give her the news and then she called me.

I've just gotten to work and opened my phone to see a picture of mom from Joan, awake in the CCU and smiling.

My tears are flowing freely now. Everything is going to be OK.

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I'll be on a red eye to Baltimore Wednesday night. Mom's aortic valve is shot and badly in need of replacement. She's to undergo a TAVR (trans aorta valve replacement) procedure this coming Friday. My anxiety level is up around me ears.

Mom has had a progressively worsening situation with this valve for the past couple of years that has gotten progressively tighter and more stenotic until the past 3 weeks where she is now essentially house bound due to the shortness of breath it's causing. She needs this done and she needs it done now. Originally this procedure had been scheduled for the end of June, but her deterioration makes it imperative to get it over with ASAP.

I'm both relieved to have this done, but nervous, particularly as I am aware of most of the potential complications. It didn't help that I had b'fast Friday with a cardiology colleague who was very positive about the procedure, and then went on to recount all the potential horrific complications. I didn't have the appetite to finish my meal, not that I wasn't already aware of them.
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I have been on pins and needles for days.

Mom is in the ICU after surgery this afternoon. I won't go into details here just yet, but the prognosis post-operatively is better than I had allowed myself to hope for. My sister is on faculty at the university where her surgery was, and the surgeon was the same on who did her initial surgery when she was diagnosed 14 years ago. My sister just called an hour ago, with the news and I'm finally feeling like I can breath again. It will be another 10 days before we get the final word from pathology, but things look much better than they have for the past month.

I've been on the phone with a dozen different relatives from all over the country in the past hour, from my mother-in-law in Florida, to my nephew and his wife in Cleveland, to my cousin in the Bay Area, to my aunt on Long Island.

Tonight I think I'll actually be able to sleep. Which is more than I can say for last night. Or the night before. Or the night before that......
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All gratitude to Anne Herbert for this thought.

Last Thursday was my husband's birthday. We partnered 32 years ago, when I was 26 and he, 29. I'll let y'all do the math.

After wracking my head for weeks what to get him, it hit me mid morning. He is happiest when he's building things. Tools are easy. Knowing which tools to get, not so much. In an event, it was off to the local pawn shop, who carry used tools of good quality, at less than I could acquire them elsewhere on short notice. I pulled into the public parking lot around the corner from my destination, and had just started towards the kiosk to pay for parking. In the past 2 years, most of the downtown parking meters have disappeared, and now, you walk to an automated kiosk, and pay to get a paper receipt, which you then leave on your dashboard. I wasn't 3 feet from my car, when the door to the vehicle next mine, a car that was already running and had just been pulling out, opened and a woman called out to me. "Wait!"

I turned. She scurried over to me, pushed a small scrap of paper into my hand and said, "here. Use this." She smiled, then departed. She had just handed me a parking receipt with half an hour on it. I looked up to see her already backing out of her spot, and with a slightly dumbstruck look on my face, smiled at her and waved, mouthing, "thanks," not that she could hear me over the traffic noise, with her windows rolled up. Twenty minutes later, I exited the shop, a laser level and a finish sander (with dust collector bag) in hand. With that, it was back to the office.

The following night, we went out to dinner with Jan, the dear friend who was Best Woman when we got married, to celebrate his birthday. All three of us ordered the chowder, followed by the calamari, both dishes they do exceptionally well. Mom had mentioned to me, she had sent him a card for his birthday, and I asked if it had come. He had picked up the mail on the way to the restaurant and indeed there was a card from her, but he had not had time to open it. When we got home, we fell into bed, intent on marital time before sleep overtook us, but alas the long day and the good food got the better of both of us. Despite our ardor, fatigue won out and too soon we were out cold.

In the morning, he opened the mail and there was a card from Mom, the face of which read, "To my Son-in-law".

This is huge. (and yes, there was a check inside, identical to the ones I know she sends to my sisters' husbands on their birthdays, but for the first time, she has called LJ her son-in-law!) Somebody, pinch me. I need to be certain I'm not dreaming.
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My sisters and I gave Mom an iPad for her birthday. When my husband & I were back for Thanksgiving, I loaded Words with Friends onto her device in hopes she would use it.

She loves it.

I grew up doing the NY Times crossword with Mom, and she's always loved Scabble, so I'm not surprised. If you've played me, you'll find Mom a fairly strong player. (The acorn did not fall far from the tree.)

Mom has 11 boards open with me, at the moment.

Anyone game to take on a very sharp old lady at Words?
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Mom turned 80 on 2 November.

My sisters (actually I suspect this is more the doing of the younger of my sisters) decided that taking mom to Vegas would be an appropriate way to celebrate. So, we will meet in Las Vegas on December 3. I have booked a flight for the two of us directly out of Santa Rosa to Las Vegas that Friday to return late afternoon the following Monday.

The pricing of all this crap on the airlines is just pissing me off. If I had wanted to fly the day before the price would have been half, but that would mean not seeing patients that day since the only flight leaves at noon. Fortunately, I did have 23,000 frequent flyer miles on Alaska Airlines; by redeeming 20,000 I was able to get $200 knocked off the price of the tickets. By the way, by booking the flight myself on the net rather than have an agent do it over the phone I was able to save another 30 bucks in fees. Oh, nothing more than carry on at that price; checked bags would be another 20 bucks apiece.

However, even more annoying was the special that they have on Virgin America. If we could have flown out of San Francisco at 7 AM on Thursday morning, and back the same time the following Tuesday, the flight would have been all of $39, each way. That however would have required canceling patients all day Thursday, and half of Tuesday, neither of which I can afford, plus it would require $70 round-trip bus fare to the airport and back for each of us or a drive to SFO with long-term parking at 14 bucks a day.

Now I just have to talk to Jan. With flex will be able to drop us off on Friday at the airport and pick us up again on Monday.
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What a bloody way to end an afternoon!

A few minutes past five, I left to go pick up my car at the repair shop. Took me 20 minutes to negotiate rush hour, then I walked in to the place to deal with the receptionist who'd been left with instructions on how much to collect from me, and what papers she needed me to sign or initial. The poor estimator has had a hell of a time with her personal life; in the three weeks since the shop has had my vehicle, her husband has been hospitalized as many times, most recently in the wee hours of this morning, when she brought him to the ER in congestive heart failure. The poor woman is being run ragged.

I paid them my deductible, as well as for the dings they removed (not from the accident), and then got to see my car. The repairs they did looked great. The paintless dent removal lived up to its reputation and at $195, was $5 less than the estimate, and well worth the money. Their repairs to the front end damage looked wonderful as well. We then drove, me in my car and the receptionist in the rental, over to their rental area so I could finish that end of the transaction. Driving the Mercedes felt a bit strange, thought I'm not sure if its because the car just has a different feel from the Prius I've been in for the past 3 weeks, or because they weren't able to completely align it, due to the bushings that are torn in the rear. I was beginning to feel a bit uneasy.

However, it was as I was taking my things out of the trunk of the rental, to put them in my own, that I spotted the damage to my rear passenger door. It was covered with gouges, not scratches, but gouges, some of them right down to the primer, and none of them had been there when I left them the car. The receptionist was half way across the parking lot when I called her back.

Showing her the damage I said, "I'm not taking the car back like this. This was not there when I left you my car." She asked what I wanted her to do. I told her I was leaving them the car and not returning the rental to them until this was taken care of. She said she understood, but she wasn't authorized to have this fixed. She is after all, just the receptionist, not the estimator in charge. It was already after 6pm and a Friday to boot. I'll have to take this up with the estimator Monday morning. Bloody wonderful.

As the Prius needed to have its oil changed, as well as a car wash thanks to an avian bombing, the rental agent, who just happens to be one of my patients, swapped it with another Prius, keeping it on the same contract, since as of today I've exhausted the rental coverage in my own insurance policy, and part of the shop's agreement with me was they're going to cover anything above what my insurance would cover.

This was however when my mood went from annoyance mixed with resignation, to angst tinged with guilt and despair. My mother called.

My mother and I have a difficult relationship. I'm an adult, a relatively accomplished middle-aged man, and yet somehow, nearly every conversation we have leaves me feeling both like damaged goods and a failure. I'm not above using a modicum of Jewish guilt on a patient not doing what I think they should, but I try to apply it judiciously. I learned how to use it at the feet of the master, my mother, who unfortunately uses it, not as a surgeon wielding a scalpel, but rather as a workman with a sledge.

Behind the cut - Mom's a Jewish mother, and even after 52 years, it still makes me crazy! )
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It's been a stressful October. Much has been trying my wits and my nerves.

1) The car accident- the 28th of last month I was hit. I will not go into major detail as I've posted several times about this. However, this morning the estimator at the repair place called to say that once they had torn down the bumper assembly there was more damage than previously seen, and it will add on another week to the repair as well as another $750. I called today once again to see if the police report is done and almost 3 weeks after the fact, it still is not. I still do not have either the name of the man who hit me, nor his insurance information, if any was in force at the time of the crash. I did at least find out from the police today, that he was not killed and the preliminary report faults him for the accident, but unless I want to go down to Rohnert Park during my work day to get the face sheet to the report (they're open 9-5, M-F only), they will not give me any more details. They need to see my ID in order to release anything to me. I still will have to come up with the $500 deductible when I get my car, which now will not be till next Friday, rather than tomorrow as originally promised. I will at some point see that money again, once my insurance company collects from his, or once my uninsured motorist coverage kicks in.

2) My trip to LA sucked. I went to see Mom and as usual, it was 36 hours of mental chess. Emotionally and mentally tiring. I love and adore her, but comments like, "I don't understand why you divorced your family," are wounding. That combined with the drive south thru a monsoon, and the drive back detouring around the I-5 closure on the LA side of the Grapevine made it a very long weekend.

3) My %$#@ing neck has been throbbing for the past three days. Woke up on Monday with it aching and it's just not letting up.

4) I'm behind in my own paper work. I've been taking two days a week to work on it, and letting my PA see patients, but somehow every last person in my office MUST ask me questions while I'm trying to get the paperwork done and hence it's like plodding through quicksand.

5) Exacerbating it all, is that even though I'm really working hard, there is so much stuff not getting in front of me in a timely manner that its jacking my frustration level up around my ears. Patients coming in for follow up and either lab results or ER notes or consultation notes aren't back, and I have to get a staff person to scramble to call for them, taking them away from the work they were doing. Chart notes that I'm certain I dictated are not on the chart, either due to my transcriptionist being way behind, or my staff person here in the office not having had time to put the notes into the chart. Letters to colleagues I dictated on the first of the month, finally arrived here today to be mailed, so they won't be seen until the beginning of next week, three weeks after they were dictated.

6) I wind up doing things that have to be done for people's benefit, that I will never get compensated for. Yesterday, while I was trying to get my paperwork done, I had a call from a doc from the endocrine clinic down at the University about a mutual patient. It seems that patient's mother called him all concerned about a serious long-standing medical problem and as the man's primary provider, the specialist called me. I wound up spending 25 minutes on the phone over 3 separate phone calls with the specialist, 15 minutes over 2 calls to the man's mother (he was at work and not reachable) and another 20 minutes over two calls to the pharmacy where he gets his drugs, or more importantly, where he has NOT been getting his drugs on a regular basis. This gentleman has a hormone disorder, which could, if not adequately treated, kill him in short order. By checking up on him with the pharmacy where his mother picks up his meds for him, it turns out he's been missing more than half of what he's supposed to be taking, for at least the past 6 months. AND he wonders why he hasn't been feeling well.....

It was the right thing for me to do, to sort out this problem and hopefully, with his mom riding heard on him, the appropriate meds will be taken. However, as I did not physically see this man, despite the fact that I spent a good hour either on the phone or going over his papers from both his chart and his med refills from the pharmacy, I CANNOT BILL for this care. There is something very wrong with this scenario.

It's 8:30pm - I need to go home.


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