Is It Cancer?

You notice a pain in your left elbow. Now that you think about it, the pain has actually been there for a few days. Maybe even weeks. You don’t remember hitting your elbow, or doing anything to injure it. What could be going on?

You Google “pain in left elbow” during your lunch break. The selection of websites that flash on your computer screen are overwhelming. You had no idea the subject of elbow pain was so important. You click on a link, one that has the word “medicine” in its web address. According to this website, your elbow pain could be due to anything from bumping your elbow, to arthritis, to cancer.

Cancer? Your fingers freeze, suspended over the keyboard. You are absolutely certain you did not bump your elbow. In fact, now that you think about it, you’re very careful with your elbows: tucking them in when you walk through doorways, never resting your hands on your hips so your elbows aren’t protruding like wings. And arthritis? Bah! Just yesterday you carried a laundry basket overflowing with dirty clothes up the stairs and never broke a sweat. You’re in your prime.

It must be cancer. You can’t recall anyone in your family history battling elbow cancer, but isn’t everyone getting cancer these days? Because of the food we’re eating … or not eating. And doesn’t cancer spread? You sit back in your chair. Maybe your elbow cancer has spread to your shoulder and now you have shoulder cancer. All at once your left shoulder seems achy.

You need to have this elbow (and now shoulder) examined immediately. You call your doctor to schedule an appointment. After listening to the options in the prerecorded message, you accidentally hit the wrong option and get the medical records department instead of the scheduling department. The medical records person transfers you, only you’re disconnected and need to call back and start all over again.

After choosing the correct option you are put on hold, though a friendly recorded voice reassures you that your call is very important to them. (So important that you are made to wait several minutes.) Finally, your call is answered. You inform the receptionist that you need to see your doctor as soon as possible for serious elbow pain. She tells you that your doctor’s schedule is booked. You feel that making an appointment with your doctor is some sort of race and you have lost.

The receptionist manages to “squeeze” you into your doctor’s busy schedule, making it sound as if it’s a favor and you should be grateful. You are, because since you’ve been on hold your elbow pain has grown worse.

The two weeks until you see your doctor seem endless. Mentally, you have decided who will inherit your most valuable assest. You wonder if you should make amends with the cranky neighbor you haven’t spoken to for three years. Or better yet, wait until he reads your obituary. How you died from elbow cancer. Won’t he feel bad then!

When you finally see your doctor, he seems rushed.  You remind yourself that you were inconveniently fit into his schedule, after all.

“Does it hurt when I do this?” he asks, bending your arm at a ninety degree angle.

“No,” you say sheepishly.

But it had hurt when you did this same movement five hundred times the past two weeks to verify if the pain was still there.

“How about when I do this?” he asks, moving your arm in a different direction.

“That’s okay too.”

“Everything seems alright to me. I don’t see anything to be concerned with. Maybe you just whacked it.”

“I’m certain I didn’t hit it,” you say.

But he’s not listening. He has written in your chart and left the room to see a patient who was not squeezed into his schedule.

That night you tell your friend about your elbow pain, and how you fear it is cancer that has now spread to your brain. She commiserates, and recommends you see her doctor. But her doctor is a holistic doctor, not a medical doctor.

Your friend’s holistic doctor answers the phone on the first ring. Not only are there no phone trees or being put on hold, the holistic doctor will see you first thing in the morning. When you arrive at her office, there is music playing. She smells of patchouli oil. The holistic doctor takes your elbow pain very, very seriously. She explains that discomfort in any part of the body indicates inner pain … as well as a deficiency of vitamins and minerals.

When you leave her office, you have spent two hundred dollars on a monthly supply of vitamins and minerals. You have also bought a manual that will guide you towards inner peace, and a packet of tea bags whose name you can’t pronounce. The holistic doctor promises that, in time, these will heal your elbow and shoulder pain.

As you drive to work, you think about your elbow and how it used to not hurt. Then suddenly you realize it is no longer hurting, as you remember hitting it on the banister while you were carrying that load of dirty laundry up the stairs, without breaking a sweat.

 

Hand Wash? Hogwash!

Picture this: you are invited to someone’s home for dinner. After greeting you warmly at the door, the hostess excuses herself to use the bathroom. You hear the toilet flush and within seconds the bathroom door immediately opens and she exits. Your hostess proceeds to prepare food for dinner – without washing her hands. Would you want to eat her food? Call me picky or unreasonable, but I would suddenly develop food allergies to everything she had touched as an excuse not to put that food in my mouth.

Hand washing seems pretty intuitive. It’s hardly a complicated matter. Our hands get dirty. We wash them. The end. In addition, the Centers for Disease Control (CDC) bombards us with facts on why we need to wash our hands, and how we should wash our hands. We all know hand washing stops the spread of viruses and nasty infections. We see commercials on TV, advertisements in magazines, and there are even signs in public restrooms reminding employees to soap up before returning to work.

Surprisingly, the basic concept of hand washing is a relatively new tidbit of disease prevention knowledge. While this controversial subject (yes – it was very controversial) took root in 1847, I tend to believe there were people in previous centuries who discovered that washing one’s hands was a good thing. There had to have an English lass in the Middle Ages who found that when she washed her hands after cleaning the family outhouse, that mysterious stomach virus stopped plaguing her household. But since we don’t know the name of that wise maiden, we give credit to the person who first publicly proclaimed the benefits of using soap and water on our hands.

That person was a Hungarian obstetrician named Ignaz Semmelweis. Iggie was working in a Vienna hospital when he noticed something rather peculiar. Women who had their babies delivered by medical students often developed fatal infections after giving birth. Prior to Iggie entering the scene, these deaths were blamed on “an imbalance of humours in the body”. Humours were considered the four chief fluids of the body: blood, phlegm, yellow bile, and black bile. Basically, humours were regarded as the present day ying and yang of human bodily fluids.

While the rest of the obstetrical staff wrote the deaths off to those pesky humours (remember – this was before the existence of personal injury lawyers), Iggie was less convinced.

“Humours schmumours!” Iggie announced. (Actually, he didn’t. Or maybe he did.)

Iggie knew something more was going on than just the four chief body fluids getting out of whack. He decided to investigate.

Lo and behold, Iggie discovered that prior to delivering babies, the medical students were dissecting cadavers. Now, when I gave birth, my doctor practically put on a hazmat suit. But in 1847, medical students performed autopsies on dead bodies before moseying their way upstairs to the birthing room where they proceeded to deliver babies without washing their hands. Let’s simplify this: medical students had their hands deep inside the open cavities of a dead person before putting their unwashed, (and of course ungloved – they weren’t invented yet) hands deep inside “ladies’ cavities”.

Feeling a bit squirmy, ladies? Me too.

Iggie denounced this practice and mandated that all medical students wash their hands in a chloride lime solution after autopsies and prior to delivering babies. The maternal death rate plummeted.

Problem solved, right? Nope. Because nothing is ever simple (and people have a tendency to be stubborn jerks), the medical staff at the Vienna hospital derided Iggie.

“Have you heard what that Dr. Ignaz Semmelweis is proposing?” a Dr. Dorfmeister said while dining over Weiner Schnitzel.

“It’s outrageous!” Dr. Herrmann said, “Pass me a piece of that Gugelhupf, will you? Washing hands after performing autopsies! What’s next? Washing our hands after using the bathroom and coughing?”

“Hahaha. Oh, Dr. Herrmann. You’re such a card!”

The medical staff ridiculed and mocked poor Iggie. Soon he was dismissed from the Vienna hospital. Upon leaving (and the subsequent cessation of hand washing practices) maternal death rates skyrocketed again. But the medical staff continued to blame those darn humours for the women’s deaths, and not the remnants of dead body particles on the hands of medical students.

Iggie was unable to find work in the Vienna community. No one wanted to hire a handwasher. He moved to Budapest, where he continued to tout his hand washing practices. Similar to Vienna, Budapest doctors were not keen on the idea of washing hands in between delivering babies either. They thought it took too much time, and frankly, they would have to admit that all of those deaths were their fault.

Sadly, the continuous rejection of Iggie’s revolutionary discovery took its toll, and eventually he was admitted to a mental hospital where he died shortly thereafter. The benefits of hand washing weren’t accepted until decades after Iggie’s death.

Today, Dr. Ignaz Semmelweis is heralded as the pioneer of infection control. Let’s all think of him when we wash our hands later.

I’m Sorry … And I Mean It!

Last week my husband was on a flight to Boston when the stewardess spilled a can of V8 all over the man sitting next to him. The man was drenched – V8 juice soaked into his lap, suit jacket, and white shirt. Some even got in his hair.

“I’d like to apologize,” the stewardess said, “But it wasn’t my fault. The can exploded. I can’t apologize for something that wasn’t my fault.”

Outrageously, the V8 can never apologized to the passenger. Perhaps because it was lacking lips and a brain.

A similar incident occurred several years ago. A teenage driver was speeding on our street while texting and lost control of her car. She deftly landed in our yard, though she had to crash through our picket fence to get there. When the girl’s mother arrived at the scene, she studied her daughter’s car and our fence before saying, “This isn’t so bad.” She then proceeded to ask us to not report it to our homeowners insurance.

Of course we were going to. This resulted in an exchange of some heated words.

Woman: My daughter is a good kid. She was in church all day.

My husband: I was in church today too, but you don’t see me crashing through people’s fences. What if my daughter had been in the yard when this happened?!

Woman (looking around): I don’t see any kids.

A simple “I’m sorry” would have made all the difference. Had the woman apologized, perhaps we would have calmed down and not contacted our insurance. We may have taken the woman’s offer to give us money to repair the fence and left insurance out of the equation. But nothing in her attitude gave us the impression she would follow through with that offer. Responsibility was not taken. A much needed apology never given.

If the stewardess on my husband’s flight had apologized for dumping a can of tomato juice on a passenger, other passengers might have felt bad for her. They may have left the flight talking about how well the stewardess handled the situation. Instead they spoke of how rude she was, and encouraged the V8 drenched man to file a complaint with the airline. When she shifted the blame to the self-imploding can, it made her look callous and immature.

Research has shown that patients are less likely to sue a doctor over a medical error if the physician simply says, “I’m sorry” in a kind way.* Whether it is pride or fear of a lawsuit, many doctors don’t take the time to apologize, which only makes the patient more angry and wanting retaliation – usually in the form of suing the doctor who made the mistake. But if the doctor apologizes, anger is quelled and a lawsuit is less likely to happen.

In most circumstances, it seems that two little words can change the course of events in a very big way.

* sources: Apologies and Medical Errors and Physician Apologies

My Disease

I have a disease. Although it’s not recognized by the American Medical Association, it is actually quite common among women. It is referred to as the Melting Flesh Disease.

The symptoms of Melting Flesh Disease occur quite suddenly – in fact, moments after giving birth. The skin on one’s abdomen suddenly sags as though it has lost all hope. Victims of Melting Flesh Disease can go to the gym as much as their hearts content, but this only causes psychological trauma because no matter how many crunches they do or abdominal machines they use, there is no hope for Melting Flesh Disease. The damage has been done. The skin will continue to wrinkle and sag like a deflated balloon. Once round and taught, belly buttons resemble a puckered face.

Some women victoriously avoid Melting Flesh Disease. These women are either 6 feet tall and/or had babies weighing no more than five pounds. For those of us who had hearty-sized babies and are of average height, we paid severely.

It is easy to blame the media for our angst. Every magazine cover, underwear sale flyer, and commercial show women sporting flat abdomens with suspiciously perky breasts. Yet, we can’t fault the media entirely. While at the grocery store recently, a woman in a halter top was sashaying through the aisles. She was not a model, but she had a stomach that did not have Melting Flesh Disease and she clearly enjoyed flaunting it. My reaction? I stood up taller and sucked in my breath until my stretched-out belly muscles ached.

“What can be done?” I asked my physician, “Is there hope?”

“Not really. Multiple pregnancies stretch out abdominal muscles and skin until their elasticity is lost. The only thing that can be done is surgery.”

Upon returning home I did an Internet search. The cost of curing Melting Flesh Disease would be around $10,000 and it’s considered major surgery. There is hope, I suppose, if I had nothing else to use $10,000 on and had a full-time nanny to help me while I recuperate.

Thus, the only option is to make Melting Flesh Disease attractive. Like a war wound that someone is proud of displaying (“See this scar? I got that in ‘Nam”), Melting Flesh Disease must be embraced. When our loose skin peeks out from under our shirts, people would nudge one another and whisper, “See her? She carried another life in her body for 9 months. She then went through intense pain to deliver the baby. Her body and heart were forever changed. She is so brave.”

When society looks at models prancing around in string bikinis they would scoff, “She doesn’t have a mommy tummy. She’s got a long way to go.”  Tummy tucks would be dismissed – a sign of hiding the ultimate sacrifice. Melting Flesh Disease would be renamed. Instead it would be called Warrior Stomach.

Losing It On The Job

“Would you care for some more lemonade?” the waiter asked.

“No thank you,” I said, studying my glass, “I think I’m good. But thanks anyways.”

The waiter stepped back – as though slapped – and held his hands up, palms facing outwards. After the waiter walked away from our table, my husband and I exchanged looks.

“Was it something I said?” I asked him.

“I don’t think so … but he did seem a bit offended.”

“Good grief! It was only lemonade!” I looked after the waiter before continuing, “Maybe he’s starting to snap and my declining another glass of lemonade is the tip of the iceberg.”

While we’ve all experienced bad days at work, most of us have managed to hold it together during those times. Granted, we may have been a tad snippy, but we didn’t tell our boss exactly what we thought of her, or lashed out at the difficult customer.

What would society look like if suddenly all social mores were tossed to the curb?

Here’s a glimpse:

The barista: What was that sir? You wanted a quad venti soy white mocha latte? Well, la-te-dah! Aren’t you all fancy and sophisticated. Here. Here’s a large coffee with good old fashioned milk. It tastes better than that fru fru stuff you call coffee. NEXT!

The gynecologist:  Hmmm … so it burns when you pee? I should have gone into psychiatry. Hell, I’m going to need a psychiatrist after doing this for a living.

The guest service desk at a hotel: Your room service hasn’t arrived yet?  Who do you think we have working in the kitchen? Superman? Guess what: You are one of hundreds of guests here and you’re no more important that the other ones. If you’re that hungry go find food on your own. Or better yet: go stay at another hotel. Have a nice day.

The historic tour guide: Hey listen, if your kid touches that vase one more time I’m gonna break it over his head. Seriously. And you! Over there! Didn’t I say no flash photography? What part of NO FLASH PHOTOGRAPHY do you not understand?

The waiter: This isn’t what you ordered? As my kindergarten teacher used to say, “You get what you get and you don’t get upset.”

The fitness instructor: Who are we kidding? We both know you’re not going to stick with this diet and exercise regime. Don’t give me that look! This is the third time you’ve been to this gym and you joined two years ago. And spare me the, “but I rarely eat” song and dance.

The psychotherapist: Lemme guess: It’s not your fault and your parents were terrible. Newsflash: life isn’t fair and it never will be.

The classroom teacher: Why am I crawling out the window? Because I can’t take one more second of your incessant chatter. The 24 of you sound like mosquitoes buzzing in my ears. You’re going to tell your parents? Go ahead! I’m a member of a teacher’s union. Good luck!

WTR! (What the Reflux!)

My daughter entered this world the traditional way: with a nice strong epidural and lots of yelling at my husband. I will never forget the moment she was born. She let out a high pitched scream and didn’t stop. My obstetrician paused, looked over at my daughter and said, “Well! There’s nothing wrong with her lungs.” He then pulled off his gloves, tossed them in the garbage, and left to go deliver another baby.

My husband and I looked at one another with raised eyebrows. Even though this was our first baby, we both had a suspicion that if an obstetrician comments on how loud an infant is crying, it can’t possibly be a good sign. We were right. She did not stop screaming. Even the newborn nursery – where I tried to put her so I could sleep – brought her back.

“She can’t stay,” the nurse said cheerfully as she wheeled my crying daughter into my hospital room, “She’s keeping all the other babies awake.”

As I watched the pink-smocked nurse leave, I burst into tears. I didn’t get it. Weren’t babies supposed to sleep? How was I going to sleep with this red faced, screaming little person in my arms? Welcome to parenthood.

The hospital made us take her home. She cried the entire way there. She cried the rest of the day. Then all night. She cried, and cried, and cried. For weeks. And months.

She also vomited excessively. No sooner had I fed her then everything she had taken in would come right back up. Our pediatrician, an angel in the form of a stocky Italian man, was concerned about the weight she was losing. He also wasn’t pleased with her incessant screaming. He diagnosed her with reflux and so our journey began.

My daughter is almost ten now, so most of us are familiar with the term “reflux” being associated with infants. But back in 2003, it was a relatively new concept, and this concept generally did not go over well with the majority of people.

“Reflux? Whoever heard of a baby having reflux? That’s for adults”, “In my day it was called colic”, “How can you medicate a six-week old infant? Aren’t you worried what that will do to her?” “Are you sure you’re not overreacting?”, “Who is your pediatrician?” These were only a few of the comments I heard when I tried to make excuses for why my daughter was so fussy…and didn’t sleep…and why I looked like something out of Night of the Living Dead.

People tried to commiserate with me. “It will get better once she turns three months old.” (It didn’t.) “I know exactly what you’re going through. My son was so colicky when he was born! He didn’t sleep through the night until he was five weeks old!” (Excuse me while I sob.) “Have you tried burping her more?” (Thanks Einstein. Never thought of that.) I found I wanted to kick these people even though they were trying to help.

The word “reflux” became equated with a naughty four letter word in our household. A pacifier was the only thing that would occasionally soothe her, and yet when a well meaning acquaintance told me that her children never used pacifiers (since a good mom should know how to soothe her baby without the use of a pacifier – her words, not mine) I threw it away; Only to drive out to the grocery store late at night to replace it.

I felt inadequate and not up to the task of caring for this puking, crying, squirmy, rashy, insomniac baby. Was I accidentally assigned the wrong daughter? Wasn’t she really supposed to go to a great mom who could handle everything? A mom who makes her own bread and soap and doesn’t own a TV and drives a Prius?

Shortly before her 4th birthday, the doctors discovered that my daughter had a malfunctioning lower esophageal sphincter. In other words, the muscle that was supposed to tighten around her esophagus to keep her esophagus closed and stomach acids in her stomach was not working at all. The doctors suspected that even though she was on reflux medicines, they would never provide adequate relief. At this point, the only option was surgery.

If the idea of my four year old daughter undergoing major surgery hadn’t freaked me out, I may have felt vindicated. Her reflux had been really bad. I hadn’t been overreacting or wrong to use medicine. She wasn’t sleeping because she was in pain, not because I put her to bed too early or too late, or because she didn’t nap. I had done everything I could, and what I had done had not been wrong.

Six years ago on July 12th my little treasure had a Nissen Fundoplication to correct her reflux. The surgery was four hours long and it seems like just yesterday we were sitting in the OR waiting room of the children’s hospital, watching parents leave because their kid’s surgery was over but my daughter’s was not. When they finally wheeled her out of the OR, she looked so tiny on that big gurney. As I approached her the anesthesiologist put his arm around my shoulders and said, “She did great and you’re doing great.” They were the kindest words I could have heard at that moment.

My daughter opened her eyes and looked around with heavy eyelids. “Mommy,” she mumbled groggily, “Get me out of this thing.”

The nurses placed her in my arms and I rocked her back and forth, knowing that the worst was over. Knowing that when we left the hospital the pain she had always known would finally be gone.

You’re Not So Different From Your Car

Unlike an aged cheddar or bottle of Balvenie, people and automobiles generally don’t improve with age. As my husband once said after visiting my great aunt in a nursing home, 

“There is nothing glamorous about growing old.”

While attending graduate school, I drove an ancient Honda Accord that was held together by a lot of prayer and encouragement. The cassette player would run even when the car was turned off. Rain would get trapped in the moonroof and proceed to gush onto my lap when I put the car in reverse – soaking me to the point where I would have to go inside and change. It also seemed that as soon as I had one of its parts replaced, another would decide to break.

How I hated phone calls from my mechanic! As soon as the phone would ring I would squeeze my eyes shut and brace myself. He always started the conversation with,

“Hullo, it’s Karl, I’ve got some bad news. Your  _____ is shot.”

Your front wheel axle is shot. Your alternator is shot. Your motor mounts are shot. Your master cylinder is shot. Shot. Shot. Shot.

As I age, I have noticed how people are not so different from cars. Our body parts eventually become “shot” – just like my old Honda.  Arthritis is the human form of rust and corrosion. Our hearts – the fuel pump of the human body – stop pumping efficiently. Unless we can afford the services of a cosmetic surgeon (auto body shop) our exteriors become dented, scratched, and faded. Akin to transmission fluid leaking, we need to use the bathroom frequently during the night.

Some men tend to upgrade their cars – going from a practical Ford to a speedy red Porsche. Similarly, some men have the nerve trade in their wife for a newer version. One who doesn’t have dents or scratches. One who is younger, sleeker, and peppier. One who is fresh off the lot.

Ambulances are the human version of flatbed tow trucks. The mechanic – or car doctor – uses terminology we don’t understand. Similar to CAT scans and MRIs, your mechanic will run diagnostic testing that costs a bundle. A new car warranty is the automobile version of health insurance.

Food is our gasoline. The cost of filling a car’s gas tank can be equated to the expense of a large grocery order. Opening the refrigerator and seeing its bare shelves has the same feeling of frustration as noticing your gas light is on.

Cars are also like people in that there are big ones and small ones. Black ones and white ones. There are high maintenance, complicated people (Mercedes) and low maintenance, easy going people (Toyotas). There are people born in this country (Ford, GM) and people who immigrate from Europe (BMW, Lamborghini) and Asia (Mazda). Lastly, some people would rather avoid the snow (front-wheel drive cars) while others enjoy winter sports (the 4×4).

Thankfully,  that is where our similarities end. When a car reaches the end of its lifespan, it is sent to a scrapyard and crushed. When we reach the end of our lifespan, we are put in an overpriced box and buried in the ground.

It is unfortunate that cars and people don’t age as gracefully as say, a bottle of wine or a Redwood tree. But a bottle of wine and Redwood tree won’t drive your family on vacation or share the memories of their childhood.

Pardon Me. I Just Need to Press Your Mute Button

Wouldn’t it be nice if everyone came equipped with mute buttons? That way, when you realize a conversation isn’t headed in the direction you had planned, you could simply lean over and press the button and not hear what is coming next.

You would need to use these mute buttons wisely, of course. For example, you wouldn’t necessarily want to hit your doctor’s mute button when she enters the examining room and says,”We have the results of your CAT scan and it appears that you have cancer of the – BEEP!”

You also wouldn’t want to use the mute button with your boss. It probably wouldn’t be the smartest thing to hit your boss’ mute when he starts to give you a new assignment: “Starting tomorrow, you will need to – BEEP!” (Let’s be adults about this – the risk of unemployment far outweighs the pleasure of pressing his mute button.)

The mute button would be very beneficial with family – including children. “But mom! I just cleaned my room! It’s not fair! I – BEEP!” The family mute button comes with an extra benefit: Muzak. Instead of listening to your children whine and cry, you would hear Rod Stewart’s “Forever Young” performed on a synthesizer, which is the lesser of two evils.

Oh! And with coworkers. And Toppers. You know the kind: you have a headache, they have one too but much worse; you decide to take a vacation, they suddenly decide to do the same, only the vacation is fancier. How delightful if Toppers came with mute buttons!  “Oh you think THAT’S bad? Well! Wait to I tell you about – BEEP!

Mute buttons could also be used on yipey dogs next door. This would save you from those awkward conversations where you have to knock on your neighbor’s door and say that even though you think Pebbles is just so adorable, could they please not leave her outside for sixteen hours a day when she would clearly rather be inside?

Spousal mute buttons need to be handled delicately. As tempting as it may be, you shouldn’t hit this button willy-nilly. They may catch on. Be forewarned that spouses can also ask follow-up questions to make sure you were truly paying attention.

Lastly, we can’t become indignant when someone hits our mute button. It’s gotta work both ways.

Bumper Stickers and Vanity Plates: They’re a Commitment

A friend of mine said, “Bumper stickers are a commitment.”  She has a valid point.  I mean, you’re really putting yourself out there with bumper stickers. Similar to road rage (when you can flip someone the bird and then drive off knowing there will be no consequences), you’re not held accountable for whatever you plaster on your car. Generally, people don’t retaliate based on what your bumper stickers say.

But what if they did?

Take the bumper sticker I recently saw: My Other Car is a 747. Clearly this person must be a pilot.  Now, what if I had pulled alongside the pilot’s car, rolled down my window and started frantically waving my arms while shouting, “Hey you! Yes, you!  You’re a pilot? What airline do you fly for? It better not be US Air!  They lost my luggage and then left it out in the rain.  Oh! And my plane had to sit on the tarmac for two hours.  Real nice!”

Or how about those oval black and white bumper stickers that advertise where you have gone on vacation? (They are usually in code too.  Instead of simply saying “Jackson Hole” they say “JH” or “OBX” instead of “Outter Banks.”) Picture driving up next to a car sporting one of these stickers: “You-hoo! Excuse me!  I notice you have been to Martha’s Vineyard. How was it? Where’d you stay?”

Then there are vanity license plates. Personally, I happen to find these a bit troubling. While bumper stickers can be more general, with vanity plates, you’re sort of announcing yourself. One time I noticed a car in the grocery store parking lot that had a vanity plate. I then recognized the same car in the parking lot of another store the following day. Then at the gym. Normally, I would never have paid attention, but it’s hard not to notice (and remember) a car that has a license plate that reads “PINGPONG.”

I have always found MD license plates a bit irksome. What is the purpose?  Do they simply want people to know they went to medical school? Because I don’t know about you – but whenever I pass a car accident, I have never seen a car with a MD license plate at the scene.

What if we tried to solicit free medical advice from these physicians who advertise their profession? Honk! Honk! “Hey! Thanks for letting me know you’re a doctor!  I need to ask you something.  I’ve had this awful cramp on my right side for about a week now.  Any idea what it could be?”

Vanity license plates could also get you in trouble.  It’s hard to be discreet when you have a license plate that is memorable. Imagine attending your kid’s 6th grade violin concert. You pull into a parking spot and as the family climbs out of the car, some buffoon calls out, “Hey!  It’s JOEYD72! I see your car outside of Pleasure Island strip joint all the time!”

In the interest of full disclosure, I must confess I had one of those black and white oval stickers on my previous car.  And I would have been thrilled if someone had honked their horn and said, “Hey! You went to Aruba?  How was it?  I hear it’s awfully hot there.” “Oh it is hot!” I would have hollered back, “but there is a lovely breeze that always keeps you comfortable.”

When I traded in my old car for a newer one, I didn’t transfer the Aruba sticker.  Why?  I didn’t want to take the chance of someone pulling up alongside me in traffic, rolling down their window, and shouting out, “You went to Aruba? Congratulations! Like I care!”

The Waiting Room Zoo

At a recent doctor’s appointment, I was struck by the similarities between a doctor’s waiting room and a zoo. I’m not using the word “zoo” to describe craziness or disorder.  (“Whoa. It’s a zoo in there!”)  I’m using it literally: as in the zoo you visit with your kids and end up spending way too much money just to watch some strange animals sleep.

When you enter a doctor’s waiting room, the receptionist is sitting behind a glass shield. This is similar to a cage – only more civilized.  You stand at the glass, hoping she notices you (she usually doesn’t).  If you tap on the glass, she simply ignores you as though you are the hundredth person that day who has tapped on her cage.  When at last you are acknowledged, you hand over your co-pay. This is your “admission ticket” into the zoo.

As you survey the waiting room in your attempt to find a chair that is the farthest away from anyone else, you can’t help but notice the chattering monkey.  This is the person who talks non-stop on their cellphone. They are often very loud and seem to have no qualms about the world knowing their personal business.  The chattering monkey certainly doesn’t seem sick, and you wonder why they are even there in the first place.  Once the phone call has ended, the chattering monkey calls someone else or turns to the nearest person and initiates a conversation.

Sloths are another common inhabitant of the physician waiting room. Without fail, this person falls into such a deep sleep you wonder if he has mistaken the waiting room chair for his couch at home.  The sloth awakens every now and then, only to glance around the waiting room with heavy eyelids before nodding back off to sleep.

In the middle of the waiting room is the owl.  This person looks around the room with large, wide eyes.  She will watch as you check in with the receptionist, as you select a magazine, and when you look at your cellphone.  God forbid you cough or sneeze, her eyes grow even bigger.  She also has the unique ability to turn her head almost 360 degrees to look at the people sitting behind her.

At last your name is called!  It is your turn to see the doctor, who is the Siberian white tiger of this zoo-like experience.  The Siberian white tiger is the reason why we are here. Comparable to a Siberian white tiger, the doctor is also endangered: There are so few of them and so many of us.  And just like the Siberian white tiger exhibit at the zoo: we can only see the doctor for a limited time.

When the Siberian white tiger enters the examining room, he seems disinterested and bored.  You are simply one of many who have waited to see him. Your sore throat and nagging cough that you felt was so important?  Not to the Siberian white tiger. There is a true sense of disappointment, and you can’t help but feel a bit gypped.  You paid $25 for this?  That 30 minute wait was for nothing more than a 4 minute viewing of the Siberian white tiger.  As you leave the Siberian white tiger exhibit, you find you feel a little sulky.

You are eager to return home, and as you leave you notice the waiting room has filled with more animals.  You silently thank God your turn is over, not knowing that you’ll be returning in a few days because you are now harboring all of the germs that were festering on the waiting room magazine you pretended to read.  But when you return, you won’t be able to see the Siberian white tiger. Heck, no! That exhibit is sold out.  Instead, you’ll have to settle for the red panda – otherwise known as the nurse practitioner.