Where does the medical interest come from?

I got a new reader (Hi C and welcome!) and she asked me a good question: why the medical interest.

I always wanted to be a doctor. My grandfather was a surgeon, family physician and ob-gyn. In his 90s, his hands were so precise that he would walk with a cup full of coffee from the kitchen to his room without spilling a drop. At 80 years old, he was doing a spinal taps, one of them right when a big earthquake happened. He was very respected and everybody was wishing that someone will follow his steps. I would have liked it, but when time came, the status of health care in Romania was pretty bad and doctors were not seen as having a bright future (he he, talk about the American healthcare being in bad shape...). On top of that the admission exam was extremely difficult and i never thought I would ever make it. Right now, I think I had good chances anyway, but at that time my self esteem was very low and no one around me told me otherwise.

Life seemed to take me farther away from medicine, until I got hit with preeclampsia. After the initial shock with this not well understood disease, I got every book I could find on the subject and some of the books were medical textbooks. I found the Preeclampsia Foundation and a group of people that were just as nuts about finding answers and learning more (even if that meant housewives reading medical textbooks).

I learned and understood a lot in those years: I learned how little is known about pregnancy, I learned that doctors are not Gods, I learned that we need to take responsibilities and to accept a degree of risk. After the initial: "you doctors are all idiots" phase, I learned to respect doctors and medical professionals and I tried as hard as possible to communicate effectively and help them help me. It was a long road with lots of bumps, but I ended up feeling very comfortable with the doctors I sticked around and I feel I have a good grip on navigating through the health system.

After my second pregnancy, when it looked like preeclampsia was out of sight for a while or maybe forever, I attacked the anxiety with a new set of health care system challenges: finding the right therapist, deciding on meds vs. therapy or both, etc.

While working on the anxiety, I realized that I had the freedom to have dreams and that no matter how unlikely these dreams are, I can still have them. There is no shame in dreaming. I found Paul Levy. Paul is not a doctor, but he does a great job being the CEO of a large hospital... so maybe my dream is not that impossible either. Add to that that I am working in a field (IT, database software development) that is needed like air in healthcare today, and the dream seems just around the corner.

Grand Rounds

For those of you interested in medical-related writings, be sure to check the Grand Rounds - the best of the medical blogosphere. Each week it is hosted by another blogger.

As a personal challenge, I submitted one of my posts this week and it was accepted. Check the rest of it

http://blog.vitummedicinus.com/2007/07/official-grand-rounds-volume-3-number.html

Many thanks to Vitum Medicinus for including me.

6 months update

There are 6 months since I started this blog and 1 year of therapy (no anxiety-related medication) and I see major improvements.

Anxiety is still here, but it has no steam. It really is like a roller coaster ride: gets me up or down quickly, a bit dizzy and nauseated at times, but 5 minutes later (or an hour... or a day), the ride stops and things are fine again. I am still shy around new people, avoiding to make phone calls, not sleeping when something good or bad happens, etc. but it lasts only one night, or a finite amount of time, I know exactly what it is, and I have the luxury of rationing through it. Whenever I get too angry, overly upset or too happy, I just question what caused this and I talk myself through being rational about it.

I am even more thrilled with my physical health. Everyday I am amazed at how well I am doing. Last year I used to have high blood pressure (mild, but still, without medication it would get into 130/100). I now take no medication and my blood pressure is around 115/75. I get spikes into the 80s when I am anxious or excited (like posting comments on other people's blogs ;o) ).

My recent diagnosis with ulcerative colitis has been an immense relief for me. Yes, it is a chronic disease, but it is manageable. I didn't feel really well for a very long time, and I always thought it was the anxiety that was causing it. Isolating the real problem made me me feel better (with medication) and relax about the anxiety messing up my life.

So I am very much OK with where I am... I did very well, I got very far. What is the miracle? What did I do? I did therapy, exercise regularly (aerobics for 45 minutes 3-5 times a week and yoga 2-3 times a week) and blogged. I also read a lot (LOL - I knew I was doing better when I put all my psych books back on the shelf and swore that I will not read another one for another year at least).

I hope that over the next couple of weeks I will be able to describe how each of these was beneficial for me, but all in all, I just attacked the anxiety with as many weapons as I could (other than medication) and I eventually won. I guess that how everything can be resolved in life.

Are you ready to use props?

When you are very fresh in a yoga class, you are usually told that you can use blocks and straps to help you through the poses. Unfortunately, when really new to it, there's no way you could do that without help: you try so hard to do some of the stuff, that you can't even breathe and much less scoot around for your block. If you go out of the pose, you feel that you would never go back in again. As you gain more experience and strength, you are able to breathe, move easier and figure where you need some help, and get your blocks and straps to help.

By reading medblogs, I found out that the new year just started for medical interns and residents and likely they are in completely new and scary roles and can't hardly manage to go through the day. Therefore I completely understand the poor resident that I am going to trash in the rest of this post.

OK, here's the story:

I'm going for my appointment to find out the results of the colonoscopy. I was very happy to finally get to talk to a gastroenterologist so I could put into perspective all the various complaints that I had during my life.

I get to do the vital signs part quickly and I am planted in an exam room. I wait there until about 1 hour after my appointment was scheduled. A resident and a medical student eventually come in. The resident states his name and starts asking me about my symptoms. Asks me to sit on the table and does an exam. I politely and slightly joking ask him what the results of the colonoscopy are. He pompously tells me that the doctor is going to talk to me about my results and the treatment and starts writing in the chart. I am amused and amazed at how little interest he has in me as a person. For this guy, I am just a set of interesting bowels... if even interesting (maybe GI is not his desired specialty and he just wants this over with).

The med student figured the awkwardness of the situation. She introduces herself. She asks me what other symptoms I had. I say a few things and then get frustrated with the resident's incapacity to treat me as a person. I stop talking. The med student asks me if this was my first colonoscopy. I answer yes. (what a great prop she handed the resident - first colonoscopy... she must have questions, right) The resident keeps ignoring us both. I am a bit frustrated, but things are still OK as I know that I will eventually see the doctor.

After another 15 minutes, the doctor and the rest of the guys come in. The doctor is quite young, but he looked bright and cute when he did the colonoscopy. He's telling me that I indeed have ulcerative colitis, and explains the treatment. I ask how long will the treatment take: he says he has no idea, it's a wait and see. He hurries toward the door. As all three of them almost head out, the med student asks if I had any questions. My frustration bursts out, and the doctor figures that something is wrong with this picture. He sends the resident and med student away and insists that I ask my questions. I get to ask my questions and understand a bit more about my condition. I am relieved and happy. I stopped being a set of bowels.

I am told that most patients are very happy with this kind of treatment.. as long as they have their prescription and their pain can go away. When I complain about the delay, I get apologies and I am told that's because he takes time with his patients. I had to laugh out loud at this one. Come on guys, do you still expect us to believe that? It's just bad management, not all that wonderful quality time that you give to your patients.

Many thanks to the med student that saved the day and I hope the poor resident will be able to get the props soon as he gets used to his new role. As for the young doctor, what are we turning these guys into? All in all, I think it was a learning experience for all of us.

My anxiety: I got very frustrated and I had my moment of emotional immaturity: I insisted that I leave upset and that I don't want to talk. Fortunately, I got over it and after taking a few breaths, I could concentrate on my questions. The whole experience was so emotionally intense for me that I cried as I got into the car, but I was OK with this and the whole event. I could have been more mature, but I don't feel that I needed to. I am happy with myself. I still have social anxiety, but I am not viewing it as a disaster, just living with it. I guess I got to the point where I can use props if I need to :)

We are not broken TV sets and you are not TV repairmen

I was planning to write a mini-series dedicated to computers and IT in general, but I just had another (rich in anxiety) healthcare experience and I neeeeeed to talk about it.

As I see it, having colitis is pretty straightforward for doctors these days in US. You have the symptoms, they have the luxury of seeing what's going on with a colonoscopy, they figure what's up. They give you ASA first, if it doesn't work, they give you steroids and so on. Just like fixing a TV: the image is flickering, so you get a flashlight, open the back cover, peek inside, find a burned something, replace it, still doesn't work, you go up the stream until you find something broken and the TV now works.

Just that we are not TVs, we are humans. And even though you have tons of pressures with administration, too many patients, too little time, and who knows what else I'm pretty sure you didn't go to medical school to find out how to peek in assholes and write prescriptions. I bet you went there to help people in need, and to have human contact. So where in the process did you lose this? Why did you become insensitive machines?

I realized today why would someone like to do Gastro/Enterology. I think you have the opportunity to offer more relief and be in more intimate human contact than almost any other specialty. Even more than gynecology, pretty much at the same level as obstetrics.

I don't know details about all the gastric/intestinal diseases, but in our culture, we put so much emotional content in our digestive system... think of all the bathroom jokes, of the big laughs on burps and farts. So, here you have someone that is scared enough to come see a doctor, after a lot of embarrassment at work or in public places, after avoiding to be too far away from a clean toilet because the bathroom becomes a very common place. Oh the growling stomach and the rushed trips to the bathroom, and the horror of checking what's coming out and the daily cramps.

Maybe you indeed do not need to know all the details of our symptoms, because you have your solutions, but we need to finally tell someone and there's a big trust that we put in you. Yes, we too are embarrassed to talk about our bloody poops and our smelly farts, but you are the only ones we can talk to about it; when we are finally ready to talk about this, please listen to us and try to empathise. And maybe, if you do listen carefully, you will eventually be able to tell us more than you tell us these days, one day you will be able to make connections between all that ails us and can suggest ways to prevent it in the future without drugs.

I ended up being listened to and I asked my questions and I got a few answers. And all is well if it ends well.

I will comment on the other aspects of my adventure in later posts, but, if you are a doctor, other medical professional or a medical professional to be, please always remember: we are not broken TVs, and you are not just repairmen.

More along the same lines in a post from new blog I added to my to read list: Surgeonsblog. Check it out:

http://surgeonsblog.blogspot.com/2007/06/shoefoot-other.html

And another one :)

http://www.memag.com/memag/article/articleDetail.jsp?id=438103&ref=25

Doctors don't need admins to show them how to do their job....

First of all, I need to say that I have no business or knowledge to comment on the stuff below, but this is my blog, so I'll do it anyway. I am just a software developer and a health care administrator wannabe... I will likely find other ways to fill my life before I'll ever get there anyway.

I mentioned a few weeks or months back that I like Dr. Wes's blog. I love his posts and I also learn new things about hearts (real ones). As with other people that I like, I find it very disturbing to read that there are things that we do not agree on. I need to work on this, but this post is a commentary on one of his posts that I don't agree with.

http://drwes.blogspot.com/2007/06/clipboards-or-care.html

I don't know enough about the exact details of the deal to be able to disagree with the entire post, but here's what I didn't like

Once again, it appears that hospital administrators would rather turn to
non-medical auto-industry "efficiency" and "safety" experts, rather than asking
health care professionals to recommend the best way to improve care.
...
Do we really need yet another company or administrator to tell us how to do
our job? Is it all about safety and efficacy? Or might providing a better
nurse-to-patient ratio be far better at improving care?

I am sure we are all frustrated with the health care status: patients, doctors, nurses, etc. But I think that a big part of the problem is the administration. If administration is telling doctors and nurses what to do, it is wrong, administration should empower them to do their jobs and take care of all the non-medical stuff so that they can do their jobs.

In software development, we say that the modern project manager is no longer a supervisor, but a partner that helps developers to do their jobs without needing to care about budget, time constraints, getting approvals, having the right hardware or software to do their jobs, etc. They just tell us what to do in what order and when and ask us what we need to get this accomplished in terms of time, and resources. Then they make that happen: they supply the resources and let us do our job.

That's what hospital administration should do, no more, no less. From my perspective as a patient, it's not the doctors or nurses that I am complaining about, it is the administration. I think that medical office staff is shortsighted, I think they don't get it, I think they perpetuate the idea of doctors as "Minor deities" (BTW, wonderful post, Paul! Yes, I too love my doctor but hate the system). They act as if they don't care about our time or our pains. Customer service is so poor. I doubt that I am the only one that is more annoyed about trying to get an appointment or try to get a doctor to call back then it is to actually talk to the doctor. In Romanian we have an expression: "on the way to God you get eaten by the angels"... I can't think of a better metaphor for what's going on.

So why not let the administration learn more from other industries? They do need to learn. They can't do it from their peers, most of them seem stuck in the same hole.

Just this week I went to the hospital to have a procedure. I love to look around and see what's good and what's bad. So while looking around I see a chart: customers satisfaction surveys for nurses: 100% ... my, my, these guys are already perfect, there's nothing better to be done.
(I think that the book "If Disney Ran your Hospital" - by Fred Lee is wonderful and right on target on this). And, of course, the poster with: if you can't give us a 5 just call the nurse manager and she'll fix it for you - guiltying us into giving them only 5s. Oh, well!

The hospital is wonderful and the nurses and doctors were great. It was a good experience, not a memorable one, but good enough. I don't have complaints about doctors or nurses.

But they call the patients one hour and a half before the procedure is scheduled... Why? Why not 30 minutes, maybe even 15 minutes? After all, all there is to do is to sign a bunch of papers, and get undressed. They take a medical history and they put in an IV, but all this stuff is done in L&D in less than 15 minutes.

I didn't get the impression that there were too few nurses... maybe they are overworked, I don't know. They do plan the same number of patients, so what difference does it make to them that we stay there an additional hour? All I can think of is that if someone cancels or comes late they want to be sure that the doctors and nurses stay occupied. But is it worth? Shouldn't administration ask and find a solution to this particular scenario without inconveniencing the patients? Maybe this is what "lean" should mean?

Next Disney ride: colonoscopy

Here's synchronicity in action: I have been in high anxiety for months: March, April, May. And I worried myself sick. Yes, you can get yourself sick by worrying.

So here I was feeling anxious and sick, away from home and having no clue what's wrong with me. One day, while reading a Grand Rounds post, I read about The Midwife with a Knife (a perinatologist ;) ) having a colonoscopy. The diagnostic was ulcerative colitis. I look it up and I figured: that's me, that's what I have. The post was very reassuring about both the procedure and curing the disease and it calmed down my fears.

The conclusion is: if you need a colonoscopy, go get it. It's not such a big deal. Yes, the prep is disgusting, but as far as the procedure goes, these days in the US they put you to sleep and you won't remember or feel anything. Fasting for 36 hours is pretty bad, but after the first missed lunch you get used to it. If I had to do it again, I would skip work during the prep, so plan for two free days for this: get a good book. My doctors also timed the medicine so that the worst of the cleaning happened before bed, so I could have a good night sleep. It's useful to make sure this happens. And make sure you have some disper rash cream handy... hey, isn't it grand to have a baby at home?

I indeed have colitis... why did I need a colonoscopy? I could have told them that because "I read about it in a blog" LOL ;) See how I'm using the taxpayers dollars and increasing the insurance rates unnecessarily!

Anxiety was under control and I feel like after another day at Disneyland.

A post on comments about the hospital to follow soon, this was just a if you're sick get thee to the doctor and don't complain about the colonoscopy.

Synchronicity

My therapist recommended a book about synchronicity about a month ago: The Tao of Psychology by Jean Shinoda Bolen.

I read a few chapters and I was bored. It wasn't such great writing. Then, one day, I got it. I read a chapter in that one day in which it was important to read it, in which lots of important stuff apparently unrelated came together.

Synchronicity is about events that happen and that we find connections between. The author suggests that noticing them as well as being more open to intuitive and/or emotional or artistic thinking uses a different part of the brain than the rational thinking.

I am an engineer, in a family of engineers, married to an engineer... so rational thinking was always big in my life. I started noticing synchronic events as a game, but it soon became a very important part of my growth and much of it has helped me crack the nut.

What happens to me, things people say, things I read in blogs that seem to have no connection whatsoever become very powerful nudges , eye openers or food for thought.

I wanted to talk about this in a separate thread because I will mention it a lot. It's been part of my thinking lately. If you're looking for something interesting to read give this book a try.

I hate anxiety

I hate to be anxious. When I am anxious I can't achieve anything. All I am able to do or think is to beat myself up and criticise others. A lot of procrastination too. I need to force myself to do anything: exercise, cook, eat.

These days I achieved a lot. I started a few projects around the house, made progress at work.

The only thought that worries me now is that this feeling good won't last. I think though that this was a bigger than normal threshold and I will feel better than before.

I cracked the nut!

It's been hovering around for the couple of weeks, but I only figured the whole thing sometimes this week. I cracked the nut. I understand the cycle of my anxiety. I know how to stop it. And it worked just fine for the last couple of days. Is this all? Will I be happy forever? I am sure not, but I got a new threshold and it is higher.

So what is it? It's me! It's all about me being unhappy with myself. It's all about me wanting to do or be something else than I am. That's the cycle:

• I want to be able to do something or be someone else
• I get frustrated when I don't get it
• I try harder and I say I can do it
• When I fail, I get angry
• I project my anger on someone else or I find a scapegoat
• I get very critical about someone else
• I either say what I feel - and I am smart, have good intuition and good memory - when I am critical, I am in general right on target and it hurts... badly
• I don't say what I feel and I accumulate so much anger that it explodes at inappropriate times and in inappropriate places
• I feel very bad about it
• I start beating myself up and I find lots of situations when I was inadequate
• I am unhappy for days and I hurt someone I care about.

That's it! Whenever I got angry or frustrated these past few days, I asked myself: what is it that I am unhappy with myself about? Do I really need to do this thing? And anger and frustration went away.

I wanted to communicate better with my mother. Because I didn't get there fast enough, I was annoyed and angry at her and me. I am OK now, but I had to let our relationship go where it will go without forcing it.

I got upset with my husband this morning because he was watching TV while we exercised. I realized that I was unhappy with me because I think I should encourage him to exercise more intense and I think the TV stops him from doing that.

I got upset when he asked whether we had spaghetti sauce... because I thought it was my duty to have the spaghetti sauce handy.

Is it really that simple? And why did it take so long to discover this? I have made so much discovery lately. There's so much to write, there's so much I understood! I hope I will be able to write it down these days and maybe help the next person visiting this blog.

I hope it lasts because the victory is so sweet and the long trip is all worth.

People go to Disneyland for this kind of excitement

You like Disneyland, don't you? All the fun unexpected cool stuff that you see and feel, the fear and excitement of roller coasters, waiting in line discussing about the next experience, the different atmosphere and environment then in real life.

I don't need to go to Disneyland for this. Roller coasters make me dizzy and I'm not easily getting into the it's fun time mood. All I need to do is go to a medical facility. I am strange, very strange, extremely strange.

I find it fun to notice what's good and what's not, I like to see good changes, I get all upset if something is not good. I find interacting with medical personnel as exciting as a roller coaster: the anxiety over meeting someone new, the possibility of an interesting conversation, the possibility of discovering or learning something new about me, the pleasure of learning new words that I can Google at home. I can then make new connections about my body and feed the hypochondriac in me. Then the failure of connecting, the things they don't get, the fear that i didn't express it the right way. There's always the challenge of saying everything concise enough to not waste their time and the satisfaction that it was the right way to do it.

After my pregnancy loss I got to visit quite a bunch of medical offices and had all sorts of procedures done. I had good experiences and bad ones, excellent interactions and not so good ones. I got to feel listened and understood and I got to feel frustrated.

I am having fun profiling them: I like places where they display anatomy charts and calls for research studies rather then places where they display notices over notices about what they won't do: they don't make medical records copies for free, they don't accept x insurance, they don't fill in x form more than once a year, they don't accept checks, or credit, or cash, etc.

I saw places where they get you right away, where the doctor apologizes if they run late, where the doctor says he/she won't apologize for being late because he/she is taking his time with patients, where they know your medical history details, and where they don't even know basic facts about you or don't bother to look at the previous page in your chart to see when you were there last time or when you got blood work done. I saw places where they tell you what they are thinking, planning to do, and places where they wouldn't tell you almost anything but would then ask a million times if you are OK.

I think that they are all only humans trying to do their best in a pretty bad system. They could of course do better, but they are trying and progress is made despite all hardship.

I get to anticipate what's going on: I like to know the diagnostic beforehand, know what's next, know what the speech of the day will be about. The downside to this is the blood pressure monitor and the stethoscope: they get to measure my excitement without understanding the reason. My heart rate and my blood pressure run too high over there. Oh, all the fun I would have if they didn't have a blood pressure monitor!!!

For whatever it's worth, for me you are like Disneyland! So when's my next appointment?

Don't miss Paul Levy's post

Please read Paul Levy's post from today. It is a very interesting comment about how girls/women act. I found myself in some of these comnments. Very interesting.

http://runningahospital.blogspot.com/2007/06/advice-to-referees-and-managers.html

As always, thank you Paul.

Dealing with emotional people - part II

In a post below, I was commenting that reasoning when talking to people in a highly emotional state is the wrong way to go. Empathising and trying to understand the emotion is so much better.

I need to add something that one should never ever say, especially not to emotional people: "It's all in your head." Fortunately doctors quit saying this or at least I haven't heard it lately.

If you feel the need to say it, stop and think for a minute. Maybe that emotional person is exaggerating, maybe her/his perception is way distorted, but there must be something that got the person so upset. And telling her/him that it's all in her head will not help at all. Clarifying the issue will help everyone.

Changing environments

We're visiting my home country - Romania. We also visited Turkey for a week. It is an interesting and revealing trip anxiety wise.

I am now relaxed enough that I can observe things. One of the things I noticed is that people's temperament is different from country to country. People in Romania are much more reserved than the typical ones in US. The people in Turkey are much more open than both. I am even more reserved than the typical Romanian, but I want to be as open as a Turk. LOL how's that for high expectations.

But this explains why coming to US I felt more out of line than I felt at home in Romania. I was never comfortable here either and I have my issues anyway, but at least I can feel I am not as abnormal as I think I am.

Right and wrong decisions

Did you notice that there are very few big decisions? Decisions that could change your life, decisions that are absolutely right or absolutely wrong. It seems that life gets you where it wants to no matter what decisions you make.


You can almost always turn around and try again another option. And no matter what decision you make there are opportunities and risks along the way. A decision might look perfect today and disastrous tomorrow due to some event that could not even be thought of.

So what's the right way to make decisions? I think you just need to figure what's good about each option, what's bad, then just make the decision and realize that either way it's about the same. An informed decision is occasionally better. So reading and asking around people who know is good.

A lot of people think though that there is a right way and a wrong way to do things. I am one of them. If things end up badly, I agonize over which one was the wrong decision. I also agonize while making the decision. And any person that expresses an opinion about what is right makes me cringe and doubt myself.

If I could only understand that most of the time it does not matter: any decision is good enough.

Backpain anyone?

I can't live without blogging... all of a sudden I have so many things to say. I guess I must be feeling better. After all a vacation is coming up soon.

In the spirit of more exercising that I wrote about earlier, I subscribed to a blog for fitness - The Fitness Fixer. It's a great blog with simple solutions that don't require gyms and equipment.

It explains one cool way to avoid backpain: tuck the hips under and straighten the back. This is using the abs some, thus resolving two problems in one. Check it out!

http://www.healthline.com/blogs/exercise_fitness/

And I came up with a trick. I straightened my back and set the rearview mirror in my car to that height. Now each time I try to use it it reminds me to keep a straight back. Very neat!

We've been working out some 30-45 minutes every morning this week - aerobics. And I went to yoga 3 times.... hmmm this looks like it's working, doesn't it?

Trip anxiety

I will soon take a trip. Any trip is anxiety provoking for me, but this in particular involves a lot of social contacts and is particularly difficult. I am back to waking up early in the mornings and being on the edge most of the time.

I exercised a bit more this week and that was good and I will wait until I come back to really step up on that project.

Until about two days ago the idea of the trip was so terrifying for me that I was paralyzed about doing anything. When anyone asked me what was I scared of, I couldn't even think what... I guess I made progress because now I am preparing some (getting little gifts, etc.) and thinking what got me so scared.

Amblyopia

This is in no way medical information, it's just a story that I made up to make sense of what goes on with me. As I read or hear more either from a doctor or some article or friend, I twist my story so it will fit that new information.

I have amblyopia - lazy eye - in my left eye. It runs in my family. This is not an eye defect, but a brain interpretation defect, the brain just doesn't want to "see". There is nothing physically wrong with my eye.

There are two ways that this is treated: an older idea was to abandon the lazy eye, so that it got lazier and lazier and you would expect to lose sight in that eye by the time you're old. This is the way I was treated for about 20 years. The lazy eye got worse and worse, but what was worse was that the good right eye would get tired by the end of the day. No nights spent learning for me, and quite commonly I would skip reading that page before bed. This is very painful for me because I love reading. Computer reading is much better than paper... woohoo for now having enough to read in blogs.

A more recent approach is to force the lazy eye to help. So they would increase the dioptries until the lazy eye is forced to contribute. This is what my current doctor is trying to do with me. I have a new pair of glasses and right now it's pretty difficult to read, but it gets better every day as the left eye is forced to do something.

I think there is a connection between the way my eyes work and my social anxiety. On one side I am so successful professionally and within my family, on another I am so unable to deal with new people and make friends. One part works so hard, the other needs serious pushing to do anything. So what is the right dioptry that I need to add to my lazy part to make it contribute to my well-being? And how do you apply this?

I went to a yoga class yesterday. At a certain point I noticed my neighbour's wedding ring: it looked like a plain wide white gold simple band. I went on with the class and 10-15 minutes later I notice that her ring was actually encrusted with little diamonds. So what made my eyes see much better this time? Was it the breathing, the exercise, the blood flow to the eyes? I think so. And I decided what my next step will be in trying to deal with my social anxiety: I am going to exercise... a lot. I will see where that goes, but it can't go wrong.

I exercised regularly since summer of last year, not much, but at least two hours a week. In February, I couldn't do much and since March I am in a maze anxiety-wise. It's time to get it back and do more of it.

That being said, I won't have much time left for blogging :( I will try to update weekly though! And I will keep reading my favorite blogs... while my left eye hopefully gets better ;)

Parenting joys and challenges

In our longer than normal journey to have a baby, lots of people told us how this is going to be the best experience of our lives. I knew that I will love it, but I never realized what it really means. You hear: my baby started crawling at x months and walking at y months. It feels like precise milestones that you need to get to. Instead there's a long journey for each of these milestones. The baby doesn't just start walking. There are so many little steps, you can see a tiny bit of advance every day. Sometimes you think it's never going to happen, and then one day it does.

Last week we heard the baby say a word in the right context for the first time: hot, hot. What intense happiness and joy. It gets even better because he understands that we talk about him and that we are happy and he looks so proud of himself. He looks at us with the hugest smile ever.

And the challenges... I think I am a better mother because of my struggles with anxiety. I understand how he feels and I think I react appropriately and help him go through it. When he cries without any apparent reason, I usually feel and understand where his pain came from.

Two weeks ago the baby got sick, then I got sick, then his father got sick. We struggled for a while and finally a week ago we all were well. However in the struggle the baby felt neglected and we had a period of fussiness and clinging. Once again we had to let him cry himself to sleep because it felt like we never spent enough time with him. I had such a hard time deciding where the right line is between being there for him when he needs me and taking some much needed time for myself and letting him soothe himself.

When I was sick and staying in bed one morning, he first enjoyed his new found freedom and played around for five minutes or so, then he came over, looked at me in bed and started crying. I could not calm him no matter what. His babysitter came half an hour later and all of a sudden he was happy again. I think he was saying: "Now my mother is sick and there's no one to take care of me so what am I going to do?"

For the last two weekends I have been very close to him, almost always there when he wanted me, and finally this evening we won: he went to bed without crying. Did I find the right balance? I will never know, but my heart isn't shattered this evening after a long time.

Acknowledgements

I've been posting for a while now and I'd like to take the time to acknowledge the blogs/Internet resources that I'm enjoying the most at the time.

Of course I need to start with Paul Levy. Paul is my mentor into blogging and I probably would have stopped doing this a long time ago if it weren't for his kindness when I started this blog. Paul's posts on Running a Hospital are always interesting and thought provoking. I am so glad that he is read so much and that he gets tons of comments on some of his posts. I am learning about hospitals and managing people and how different people have different opinions. It's always interesting to see that the other side has a valid point too. The link on his blog keeps bringing over readers on my blog. Paul, you are the best!

Maria at intueri is always fun to read. In the morning, when I open my news on bloglines, I read Maria's posts the last... I'm keeping them for desert, like a piece of chocolate. Maria is nice and kind and fun. She's a psychiatrist and I think she must be a darn good one.

I think everyone is reading Kevin, M.D., but just in case anyone missed it, if you want an idea about what's going on in the medical blogging world, or if you want to find interesting blogs, this is the place to go. Short messages, but with witty comments and very useful excerpts.

Other health care blogs that I find interesting and fun:

• The Angry Pharmacist -
• Pediatrics Now - Dr. Gwenn is in
• Dr. Wes - a cardiologist

Hospital Impact had a big impact on me by recommending the book "If Disney Ran your Hospital" - by Fred Lee

I'm also reading the Medical Economics magazine online. It is free and I think it has stuff that is readable by normal human beings.

And I need to add my dearest social anxious friends out there:

- SA Dave
- Shy and quiet Drew
- Successfully Shy

For news and fun reading, there are free RSS feeds to the New Yorker, the New York Times. The Wall Street Journal requires a subscription to see the whole articles, but their Health Care Blog is interesting and free.

And finally for those of you that check every day your favorite blogs, I am using bloglines to store my favorites and see when anything is new or updated. It saves a lot of time and it's fun.

Many thanks to all my new acquaintances mentioned here and to all my readers!

Emotional immaturity

When I got my driver's license, a new test was recently introduced: the psychological test. The result for me was "emotional immaturity". I keep remembering those two words anytime my anxiety spikes. What a good way to put it.

It feels like for me anything either doesn't matter or matters more than life itself. When I do something I am all in it, when I like someone I love them, when I hate I really hate. The smallest encounter consumes me.

How did I get here? Early on I start noticing that my reactions are different than those of other people, so I started controlling them: I don't show that I am happy or sad until I decide what amount of that emotion is appropriate to show. Excitement, anger, joy, pain... it's all under control. Now I need to smile, now I need to be nice, now I should show that I'm upset. It's a lot of pressure and work. It's hard work and the results are not very encouraging: people think you don't care, when you burst out they get surprised and become uncomfortable with the emotional overflow. Then there's always the lag: something happens and I don't show any emotion until I decide what the appropriate emotion is. So everything looks good 5 minutes after it happens, but the next day a storm comes out: quite confusing for everyone around, isn't it?

I'm pretty sure this is not only me: I see it on the other blogs: someone tries to increase their likeability, we all think about how we reacted to something and try to control it.

And it infuriates me. It infuriates me that we shouldn't have to do this. It's unfair that we need to make so many conscious decisions about everything. Can we just not do it? Just let it go? It gets you on things you care about the most: you lose friends, relationships over it... maybe those friendships and relationships never had the chance and you're blaming yourself for it, but you will never know and you swear that the next time you meet someone you will not let it happen again.

March update on social anxiety

March has been a bad month as far as social anxiety goes. Judging from the lack of posts on the other social anxiety blogs, I wonder whether everybody is in the same bucket. Maybe it's spring-related or equinox related or something like that. Back in Romania they used to say there's a spring anemia.

I've been up and down, but mostly down. I forced myself to do a few things, I abandoned scores of other communications. As usual, for my failures, I blamed everybody around me, my life, the universe. I expected people around me to do specific things for me, but did not tell them what they had to do.

Now that spring is finally here, I hope to be able to get over this period and find my way again.

"No act of kindness ever goes unpunished"

This is a follow-up from my last post. My kid has been sick for the last two days... poor guy, I keep thinking it must have been a present from those nice kids he hugged.

LOL

Hugger baby

I need to share something wonderful with you: my 15 months old baby is a hugger. We met a group of about 5-6 kids yesterday and he went on and hugged each one of them. At the time when he should be at the peak of his stranger anxiety he's showing and demonstrating affection for others.

I was so scared that he will either inherit or learn the anxiety and shyness from me. I guess there's still time, but right now it looks like he's just fine, maybe even a bit more social than kids his age. I got the book on helping shy children and read it even before he was born, I watched his every interraction with everyone. and now I got to have a big sigh of relief. Hey, he can get all our other deffects, but if he won't be painfully shy, it will be so much better for him.

And I'm happy that he learned that hugging is nice. I can tell how he learned that: he's hugged and asked to hug a lot and he sees us hugging a lot too. In my family that didn't happen. I can count on my fingers the number of times I remember my mother hugging me. I guess some families are like that. I'm happy ours isn't!

Successfully shy

A great benefit to having statistics counter... I could find this nice blog from someone that liked and linked to my blog.

http://successfullyshy.com/

Thanks you for reading my blog. I like yours too. I will dig into it some more.

Why would you do something so stupid

Today I noticed something that my babysitter glued a page of a baby book back to the book with lots of pieces of scotch tape and I thought to myself: "Why would you do something that stupid?"

And while thinking about it, I realized that I am doing that a lot: when I see something that somebody (including me) does I notice right away what's stupid with it, actually I try to find something stupid in that. You can always find pros and cons to any action that anyone is doing... if somebody did something, it's done, so what's the point of labeling it?

I remember I heard that CEOs of big companies have 2 advisers: the yes person (that will tell him all the good stuff about a decision that he needs to make) and the no person (that will find all the bad parts of it). This way the CEO would be able to see both sides of the coin and make an informed decision. I would be great for a no person. I can find faults with anything.

I need to get back to zen.

Dealing with emotional people

I am reading If Disney Ran Your Hospital by Fred Lee. It is a wonderful book. I am surprised. I am surprised that such a great book on health care management exists and so many hospitals and medical offices seem to not use these simple, common sense ideas. I am surprised to see people criticising the book so harsh: that's exactly what we need, another health care administrator teaching us how to do our job or how can you compare Disney with a hospital. I think the book successfully demonstrates that health care (and actually any domain that deals with people) can use some of the techniques that Disney is using.

I guess I'm learning one more time that in health care just like in any other field some people will just not get it. And I am sure there are other great books out there that deal with all these issues.

I was amazed to understand why I loved the hospital where I had my first baby and loss, and wasn't impressed by the one where I got home healthy and with a healthy happy baby. The outcome doesn't matter, the people and empathy and caring does. I thought it was more a matter of people cutting us some slack because we were having a loss, vs. being the whiny, healthy woman in labor that is anxious and crazy. You would think that a good outcome should cause a good impression, and a bad outcome would cause anger and need to revenge... not necessarily.

I was happy to also find a useful idea on understanding my anxiety. The author was discussing how when dealing with an angry person, it is important to imagine what the person goes through and empathize with them rather than rationally demonstrating that they have no reason to be angry. This is so right...

I am very proud of being logical and using reason to resolve problems. It is tough on me to realize that when I am anxious and emotional I seem to lose this. Things that seem unresolvable now might seem clear in an hour if my anxiety subsides. I can convince myself how that person did something completely wrong and an hour later just realize that it was just an opinion. So when I talk to someone and I am all emotional and their rational response demonstrates that I am wrong, I feel very bad. I hate myself and get into a spiral of anxiety. If the other person understands that I am emotional and knows that I wouldn't say that under normal circumstances, if the other person lets me know that they get it and I am OK, I feel good, my anxiety dissipates and I can see the world for what it is.

I think that is a lesson for me too: do not argue with people that are obviously emotional, just try to understand where they come from and let them know that you do.

Welcome back, Ileana

I'm back! Where have I been? In my anxiety world. What did I do there? Not much: mostly bitched about everyone and everything, pushing everybody away. Not fun to be there for either me or anyone around me.

It was my birthday. Happy St. Patrick's day! I don't like birthdays, I don't like Christmas. The burden of putting a happy face for everyone is too much for me. I don't know why. Over the years I got to almost perfection in pushing everybody away. It is my leave me alone day. I can't understand why people like parties... It's not that I don't like attention on me... I love to teach or present to a conference.

The blog... I have statistics counter now and I can see that some of you faithfully came over to check what's new on the blog. I wanted to write something, but it wasn't nice and I felt guilty to burden you that are persistent in reading my blog. I know everybody has bad days, but this was so dark. I felt there's nothing to say anymore. All my dreams were gone, all the good stuff I could do was gone. I wanted to delete the whole blog, I wanted to run away and disappear in the dark.

Today I went for a long drive. I love driving. It helps me think things through. And life is so much better. There's inspiration for the blog, there are nice ways to say things I was critical about before. Openness is possible again. The impossible dream didn't die after all.

Thank you so much my friends for checking on me. I'll try to keep above the sea level from now on... at least until Christmas... and then, I'll plan a long drive the day after Christmas.

About perception - from another blog

My dear anxious friends, please don't miss Maria's post at intueri.

http://www.intueri.org/2007/03/12/perception-spectrum/

I love Maria's writing, but this post in particular is such a good reminder for us worriers.

Dependence and independence

There' s a great article in today's New York Times that discusses whether dependency is healthy or not. It suggests that a controlled dependency on a spouse can actually make for a happier marriage. I must admit that I agree with the statement.

When I started feeling better about myself, first it felt great that I don't need to run to my husband to help me get through this or the other crisis, but by the end of the month I realized that we missed on the quality time together. Readjusting our relationship to the new me and still keeping close together is maybe the most challenging part of this process. We spend quite a lot of time with our son though: eating dinner and bathing him, and playing with him and reading stories (Winnie the Pooh is our favorite - the jury is still out though if I am shy Piglet or wise Rabbit). And probably having a child would have been a challenge to our quality time anyway. I think we are adjusting well though.

We had a great relationship before and I am happy that nowadays the thinking is pretty much that a bit of dependency doesn't hurt. I wonder if when I'll get to the bottom of my social anxiety, I will discover that nothing was wrong to begin with.

I went shopping yesterday... first I noticed that when I'm outspoken people realize how strange I am. Then I got annoyed at their bad database design (you know, when they ask for your information even though they should have you because you already gave them identifying information). The service is bad and it takes a lot of time... So I guess I will continue to do Internet shopping not because I avoid it from social anxiety, but because I think it saves time.

The same with friends. I was very unhappy because I couldn't make friends. Now I don't want some of those friends because they have a dose of negativity that I don't need in my life right now. The friends I had before are still around and they seem closer now that they know about me.

It feels like the world is just the same, only my perception of it changed. Hmmm, nothing new under the sun.

Positive trends in anxiety

I feel funny about posting all these positive messages all the time, but I am doing better, I can see it from month to month. I am afraid that I will break the luck... we'll see, here comes another one.

I notice a difference in the way I am feeling and handling anxiety these days. I first noticed this in December and now it just happened again. When I have an event that is causing me big anxiety, I used to ignore it. When the event was close, I started being ballistic against anyone around. I would finally accept that I am anxious, not sleep for a night or two right before the event. When it finally happened, I was exhausted and tired.

Now, my anxiety starts way before the event: two weeks in advance I keep thinking about it, about all the bad things, how I'm not going to do the right thing, etc. It is really painful: I'm thinking about it all the time, I can't sleep well, I get IBS symptoms. This happened to me this last week. All of a sudden the world became unbearable. I was wondering what is going to happen if this will go on for another week.

And then, out of the blue, in the shower one morning, after two sleepless nights, I thought: if this is so painful, I'm resisting it. If I just let go and stop resisting, it will get better. My anxiety dissipated right there and then and now I can't even believe that my last week was so difficult. It felt like I lived so much anxiety that there was no more left to feel. I ran out of anxiety :D

My meeting is will be in a few days, but I am sleeping well, feeling great and having no problems. The same thing happened with a party back in December. I love this. It is getting so much better.

Extract from Singuratate (Solitude) - Mihai Eminescu

Mihai Eminescu is the best-known romanian poet... more details in the wiki.

...
Ah! De cate ori voit-am
Ca sa spanzur lira-n cui
Si un capat poeziei
Si pustiului sa pui;

Dar atuncea greieri soareci,
Cu usor-maruntul mers,
Readuc melancolia-mi,
Iara ea se face vers.
...
(March 1, 1878)

...
Oft I thought, the lyre forsaking
To depart and change my mood,
And to leave off writing verses
In this wasting solitude.

But then mice with tripping noises,
Chirping crickets bring and nurse
My old thoughts, my melancholy,
And this soon becomes a verse.
...
(Translated by Petre Grimm)

2 months - highs and lows

Paul Levy gave up his Blackberry two months ago... This was the first post I read on his blog. So what did I do these last two months?

• Started the blog and shared it with my close friends
• Emailed Paul to visit the blog
• Accepted his suggestion to post a link to my blog on his
• I got nuts when he posted the link and advertised it
• I got over it and lived with it
• I started commenting on Paul's and other blogs with a link to my blog - first I forced myself to do it, but now if I have something to say, I say it
• Paul added my blog as the first on his personal stories link and advertised it again - I was ok with it this time (I felt a bit uncomfortable, but definitely didn't have the strong reaction I had the first time)
• Saw my profile count increase every day and did not blink about it

...I wrote this last week. This week I was a bit down. I need to have constant approval and confirmation that I am not writing anything stupid. Two of my consistent approvers were gone and couldn't comment. As it happens, nobody chimed in with any comments. And on Paul's blog there were some really negative comments. Hey, if anyone posts comments like those on my blog, they're gone! I'm no CEO (other than in my house) and I won't publish c... Plus work was not as good as usual last week. I think part of what keeps me floating is the fact that I am so good at my job, and any issue becomes a big problem and drags me down.

It's pretty neat that I discovered this though... so if you guys are interested in reading new stuff, keep the positive comments coming. Having two readers that I can always get feedback from and an occasional comment will keep me going. It's amazing how everything changes meaning depending on my emotional status. I'm still not great, but at least I am on an ascending trend.

While I was reading to my kid this evening, I found a great poem that works so well with how I'm feeling about writing or not on the blog... I will post it separately along with the English translation...

Cognitive Behavior Therapy

I imagine that the first advice I will get will be to try Cognitive Behavior Therapy (CBT) because research proved that it is the most efficient for anxiety in general and social anxiety in particular. All my books on social anxiety are unanimous about this (mind you, I just read three or so).

So I dutifully looked for a CBT specialist. I found someone that teaches CBT at a large New York University... I was sure it's going to be a winner. I was wrong. Five sessions later he declared victory and I declared stupor at the idea that we actually resolved anything other than me buying a sandwich and asking for help in the bookstore. It was a great start that I did those things, but it definitely was only the start. He declared that maybe I have some issues with my conception about life and that maybe another kind of therapy is right for me... I just think another therapist was right for me. I think part of his indifference had to do with the ridiculous amount that my insurance company was reimbursing him, but if that was an issue, wasn't it more fair to say so rather than make me feel bad?

Before that I wanted to help with research. I felt it was my duty to help other understand this condition. I went to get screened at an Anxiety Institute, and they were ready to enroll me in a study. Unfortunately, the only study they were having involved using drugs (Paxil) and therapy vs. drugs alone (anyone guess where the funds for this research comes from?). The researcher doubted that my doctor would agree with that because I was planning a pregnancy. I didn't even try to find out my doctor's opinion - the idea that I would end up with six months of being drugged didn't sound compelling. Oh, yeah, I asked whether I can read self help books during that time LOL - the answer was: what a good question, I think not... I guess their study subjects didn't have this issue before.

I am sure there might be a CBT therapist out there that could help me, I heard of one in Phoenix, and others in St. Louis. It doesn't help that there seem to be a therapist at each street corner and they all can treat it and are busy all the time. Very difficult to find someone : look for the needle in the haystack.

That was my state of mind when I read: Health and Suffering in America - The Context and Content of Mental Health Care - Robert T. Fancher. It presents each therapy method with its advantages and disadvantages. CBT might be the latest trend, but it has issues as well. The book also describes how valuable research in mental health is excluded because it is not studied in a randomized double-blind manner. The conclusion of the book is that the therapist's personality and the way (s)he relates to the patient is more important than the method, and that likely a combination of methods would work better.

I cannot agree more with this. I have been in therapy for about 8 months with a new therapist and I see the light at the end of the tunnel. No, I saw the light months ago, now I see the walls of the tunnel :o) And I wouldn't change my therapist for the world.

If you read testimonials about this or the other method: tapes, self help books, meditation, CBT, etc., there are always people that succeeded with that particular method. I think we succeed when we are ready and ripe to succeed. The rest: "When the student is ready, the teacher will appear"

Blog housecleaning

I would like to specify that I welcome any opinion, comment or advice. Hey I am willing to try anything that sound at least a bit rational and I definitely welcome challenging ideas...

I enabled comments moderation. I noticed that I have no control over current comments, I wasn't even able to delete them when the owners requested it... so now they are moderated.

If you wish to leave a private comment, please specify that at the bottom of your text and I will not publish it. I reserve the right to delete any messages that I am uncomfortable with.

It worked

It worked! It worked! The babysitter came back... on time, called me at work, picked up the phone when I called, did lots of stuff around the house. And I talked to her too. She tried to tell me something and I interrupted. I realized afterwards and I was sorry about it... so two days later I asked her about it. I think she felt heard, it's never too late to be nice and acknowledge your mistakes.

I decided that I don't need a big discussion, just small things every day, just don't forget to communicate. And I will use the advice they give for dieting: if one day things are not going well, not everything is gone, just start over the day after.

I wish I had a God that I can pray to to give me power to keep this going, but I'm afraid I will have to go through this alone and carry all the burden LOL.

Good news on the SA front

Hey, I have good news for my cheerleading squad: I think that the blog is working, I am seeing progress! It's amazing. Thank you for the wonderful notes to all my old and new friends!

First you will need to bear with me and read about my theory on why it is working... In my last post I quoted a book: The Gift of Therapy - by Irvin Yalom, MD. If you ever consider going into therapy, read this book first. This is the way it is supposed to be like. My therapist recommended it and I could hardly put it down when I started reading it. It is a wonderful book that I strongly recommend. Did you ever feel that even when you have no idea about the details in a certain area of knowledge when someone knows their stuff it's all logical and you can understand it? This is one of those books.

One of the cool ideas in the book is that there is no need to start investigating deep into the patient's relationships because sooner or later any dysfunctional patterns will emerge in the patient-therapist relationship and can be explored "here and now". The feelings and events can then be analyzed in a lab-like environment.

I think that the blog helped me to further extend this idea. The virtual environment and off-line mode allowed me to breathe and reason between interactions. This helped me to analyze my feelings and gave me the opportunity to take my time in responding. Pretty much everything that happens to me in real life happened while interacting here, but it happened in slow motion: the overly emotional response, the fear of rejection and the need to run away, the pain of not getting any feedback almost as bad as getting feedback that could be interpreted as neutral or negative. I didn't have anything to lose though so I plunged into it and occasionally forced myself into doing more. I am going to take each of these issues separately and discuss them (it helps me clear my mind in the process) in the next week or so.

But today I had a real-life success. I am trying to talk to the babysitter for months and months. Short successful discussions always ended pretty bad. She's very shy and very scared of me. I am confused how can someone be scared of me, when I am scared of my own shadow... But it is not uncommon, I am a scary person. Anyway this girl is really nice: very good to the baby, keeps my house spotless, and tries to do what I ask her to do if she can hear me through her fear. She is however getting sick or missing days quite often and unexpected.

So I finally think that I got to talk to her and tried to express my feelings and tried to encourage to think about her needs. I left the discussion open-ended, but told her that we both need to get over our fear and anxiety and start communicating. I hope that I was gentle enough: we'll see if she makes it tomorrow.

Oh, yes, did anyone see the irony in here? I am talking to the CEO of one of the largest hospitals in Boston, but have trouble talking to the babysitter.

About openness

Quote from Gift of Therapy - Irvin D. Yalom, MD (Emeritus Professor of Psychiatry - Stanford University School of Medicine )

[In therapy] we try to help the public cell grow larger at the expense of the
other three [blind, secret, unconscious] and the secret self to shrink, as
patients, through the process of self-disclosure, share more of
themselves-at first to the therapist and then judiciously to other
appropriate figures in their lives.

If the mentally healthy human is an open human why is openness such a big deal? Of course it is a big deal, but it is something to be admired and praised rather than criticized and presented as the sensation du jour.

In a couple of newsletter I received, there was a title: "Paul Levy did it again". Big sensation, he posted the results of the central line infection rates for the last year for his hospital.

Why does it feel like so few people get it? It is better for a person to be open. A relationship is better when it's open, based on trust and mutual respect. Each of us carries the burden of family secrets that were never shared with us. Is anyone doubting that an open person or relationship is better?

So why not generalize this and accept that organizations that are open and transparent are more successful, that hospitals that publish their data will be trusted more. This feels so obvious to me that I don't even imagine how can anyone doubt it is a good idea.

Between two doctors that have the same knowledge, I would choose the one that is able to honestly accept that (s)he doesn't know when (s)he doesn't. On a flippant note, with preeclampsia this is a great selecting doctors test cause I would never go twice to a doctor that acts as if (s)he knows everything about it.

It feels though like so few people get it. In the organization I volunteer for I keep asking for better communication and more transparency and I get polite thank yous for expressing my opinion. It does make me feel like a freak...

I am so happy that Paul's hospital is having such great results and I have the proof that openness works and that I can keep thinking like this.

Personally, I started this blog in an attempt to open up and I never regretted it. None of my good friends went away, most of them are closer to me now. In addition I now communicate with more people and I find it much easier to talk. It also feels like now everyone knows the worst of me, so there's nothing else to lose. Openness works: for me, my family and my world.

What I would do now if I had my impossible dream

This post is an answer to Paul Levy's invitation to throw out ideas about what can be done to improve safety and quality in hospitals.

Maybe 10 years ago I attended a course in implementing the quality standards ISO 9000. It was a big surprise to me that the course did not seem to teach us methodologies, forms, etc., but was more about finding common sense solutions to enterprise functioning. The most important idea that I learned and kept haunting me ever since that course was: ask the people that do the work to tell you how can their work be easier, how can things work better: they know, just listen to them. It's that simple.

So my answer to Paul is that I have no clue what can they do better, but I know who does: their patients, nurses, doctors and other staff. If someone digs into this collective knowledge and interprets it intelligently, you can find out what you need to do.

I would send a smart analyst (no need of medical knowledge) in the trenches and talk to the patients in the waiting room: ask them what should be changed, what is good, what is bad. Ask the inpatients, ask the nurses, ask the doctors. Don't send a kid with a prewritten questionnaire or survey, the person that does this needs to know what question comes next, needs to know how to interpret the findings. The analyst needs to bought by what he's doing: understand it's importance and believe that he can make a difference.

I would first screen the people I interview by selecting the ones that are good patients, are literate, and that can give reliable feedback.

If you care about patient safety, I would send someone to gently talk to persons that had something bad happen to them. Talk to them even years after the fact. There are some of us that keep searching for answers and would know exactly what doctor/nurse did what mistake and how it can be avoided in the future. They would tell you what hurt them and what helped them heal.
____________

The other day I was reading a pharmacist blog. He was complaining about the old patient that was yelling at him about a problem with the voicemail system. I could understand how he just wanted to do his job - fill in prescriptions. And I felt guilty for all the silly little things, non-medical related that I was telling the nurses and doctors... they don't care about these things, they shouldn't care about these things, but there is nobody else that I see that cares... If I tell the receptionist, she is trained to be nice to me and mind her own business.

Maybe I am a dreamer, but in my ideal world I see an office manager being in the waiting room a lot asking what can be done to improve the patients experience. I think this non-medical oriented person that is empowered to resolve issues that she finds can ease both the patients lives and allow the nurses and doctors to do their job.

There are a lot of patient satisfaction surveys these days... I never found out that I can really give a good feedback in the rigid structure or that my comments had a positive effect on the institution. I personally was seen by more senior doctors and I was treated better because I complained, but that was it. Pretty much like what Paul is describing: if the board only sees green the Board is bored and loses interest. If the only survey result is that we are treating the most critical respondents better, it doesn't make us better overall.
_________

And my conclusion with a sigh: oh, how I'd love to be that analyst!

Monique

Monique left a wonderful message on my post Now I'm public. I think I know who Monique is. I think she survived breast cancer and wrote a funny book about it.

This got to me on two levels. The personal one is that she is saying that losing a baby is the most painful experience that a woman can have. It is very painful indeed, but beating cancer is not a walk in the park either. You get hit like that and then people admire you and say that they couldn't have the courage to go through that... courage? what courage? I didn't choose to have a dead baby or get cancer... Once you get it you either go through it or you don't. Did I try to make good out of it? I did, but I didn't feel brave or courageous.

When we were a month or two out of our ordeal, my husband's friend just got diagnosed with Hodgkin's lymphoma. I never met him before and you can imagine that I was quite anxious. We got along very well... we seemed to be in the same emotional spot: me after my baby's death and him after finding out that he had cancer. We visited him again a few months later... after a couple of series of chemotherapy he was much deepened in the pain and really hard to get to. That's when I realized that I am doing better: I was going back towards life. Cancer eventually beat him.

The other reason why finding Monique's story and book pleased me is that someone I work with is going through breast cancer right now. Breast cancer seems to get closer and closer: a good friend's mother, my own scare a few years back that got me reading about it, my mother's cancer found and resolved in a very early stage... I am not so close to this woman, but I admire her trying to keep working through this and I wanted to find something nice for her. I have problems expressing my feelings (duh), so I need a nice something. A funny book about going through cancer seems like the perfect something.

Thank you, Monique for writing the book and touching my life!

Anniversary blues

I am feeling a bit overwhelmed right now. I have a million things to write and I am too tired by the end of the day to do anything other than crawl into bed.

I just realized that our baby loss anniversary is now less than 10 days away. It is ironic that I got into the hospital on Valentine's day. Everybody is celebrating and we are mourning. I thought I'll have no problems with it this year, but I learned in time that we all say we are OK and then we realize that we should not have forgotten the anniversary.

I had 2 difficult interactions yesterday and they both ended up bitter-sweet, just as expected. Somebody got upset and someone else blew me off completely, but both of them were done gently enough that I realized it's outside circumstances that caused the responses, rather than rejecting me. But the roller coaster of emotions to go through this killed me and I was in tears by the end of the day.

I think the traffic on my blog decreased significantly and I am glad. Maybe in two weeks, when I'll be over this, I'll start inviting more people over. For now, I'll just be good to myself.

I found more blogs of socially anxious people and sent little messages: an email, a few comments. I never heard anything from them... I guess I must be the only one that feels comfortable in this environment.

Why all the preeclampsia talk on a social anxiety blog

I'd first like to thank everybody that sent comments. I wanted to email you all personally and thank you for your kind notes, but most of you logged on anonymously. I got one or more comments each day and they all kept my day going. Thank you so much! It means a lot to me.

So why all the talk about preeclampsia? Because I've trying to talk about this for a long time, and it always seems inappropriate, the wrong time, the wrong person, or there's always someone that knows better, is smarter or can talk better than I do. I'm taking the spotlight here... and maybe this will be a good rehearsal and some day I will be able to say these things to other people.

I will linger for a while on preeclampsia and see how it feels. I might move it later to their website in a more professional format.

And a disclaimer: any opinions expressed on this blog are my own and do not represent the view of the Preeclampsia Foundation.

On preeclampsia

I'd like to share a few ideas on preeclampsia. It is a disease that affects pregnant women. It affects about 10% of all pregnancies, being as common as breast cancer. It usually happens toward the end of the pregnancy and can cause emergency delivery, but sometimes it happens in the second trimester and it can cause severely premature babies or stillborn babies. It can get dangerous enough that the mother can remain disabled or even die.

Paul Levy reminded me of an excellent article on preeclampsia written by someone at his hospital. It appeared in the New Yorker this last summer and it is worth checking out

For a great summary on preeclampsia and the research done at the Beth Israel Deaconess MC, check http://www.newyorker.com/fact/content/articles/060724fa_fact

If you want to read more and preeclampsia stories, check the Preeclampsia Foundation's website

If you want to chat with other people that had preeclampsia, the Foundation's Forum is a wonderful resource. I basically learned everything I know about preeclampsia from there and it was a tremendous support while preparing for my second pregnancy after a loss.

I think there are two ideas that I'd love you to remember:

• It can happen to any pregnant woman, so if any family member or friend is pregnant, send them to check the signs and symptoms. If they have any of those symptoms after 20w, send them to their doctor or take them to L&D. This is no joke.


• If you had it once bad, there is still hope that you will succeed in a future pregnancy.

We lost our first son at 24w gestational age. He was very small, less than a pound. We took 3 years to prepare for another pregnancy. We got medical textbooks, we read all that we could get our hands on about preeclampsia, I got fit and got as healthy as I could, I selected the best doctors I could get, I got a second opinion from a specialist in hypertension in pregnancy... we did all we could to help it.

When I got pregnant, I took my blood pressure twice a day, logged it and graphed it. When things started to be interesting (after 33w gestation), I was the one that told my doctors that things are going downhill. Here are my charts and graphs

After all this graphing and charting... here's the result: 5lbs, 13oz born at 36 weeks gestation, healthy mother, healthy baby, 13 months later still healthy baby. This is the perfect outcome for any pregnancy, the rest doesn't matter!!!!

Now I'm public... maybe

Paul Levy made me public. And if you wonder how I feel about it, I feel pretty bad. The kind of bad that makes you talk to yourself in the parking lot and laugh out loud all alone. I felt very embarassed. And the only reason I am out here is that the online environment is allowing me to cool down before saying anything. I am frightened and excited, and maybe this is my blog's moment of glory.

Paul just publicly announced his salary yesterday, a figure that left me breathless for a couple of minutes. I was feeling comfortable knowing that a guy that earns that much wouldn't think twice about a too shy person... oh well, in his blog he asked people to visit mine... and asked me to install my statistics counter. I am not going to install the statistics counter, not tonight. I will be in the comfort of the fact that there are no comments and maybe there are too many interesting things on the web for anyone to pay attention to me.

[ETA: Just to be clear, Paul offered to put a link to my blog and I took his offer. I am very grateful for his outreaching out to me. It is the nature of social anxiety that the emotional responses to any kind of exposure are very strong. I think it was important to acknowledge and face my emotions. At a rational level, I fully understand that creating this blog, having a link to it from another place or even having the whole world see it is a big thing only for me.]

Now enough about my embarasment, I am going to use the free publicity to talk about a subject dear to my heart: preeclampsia. It's almost 4 years since we lost our first son to this disease and the weeks to follow will be quite difficult for us. They are much less difficult now that we have a happy and healthy baby then they were 2 and 3 years ago, but we will always remember our Angel.

About communication and friends

As I wrote a few messages ago, I emailed 3 authors asking them to look at my blog. I read their books and loved them and felt very connected to them. I am putting my sole in these pages and so I figured that if I invite them here, we will instantly become good friends.

I got short answers from two of them and I understood a few things: first is that love at first sight does not work with ideas: no one will fall in love with me by reading 2 sentences... it might be interesting, amusing, whatever, but we will not become friends.

The other thing I understood is that I always think "if only I could talk to people I would have much more friends"... and because I am not a big talker, I can't have friends. I guess friends come over time, when you spend time with them, and, talky or not, I could have friends if I spent more time with them. And I am valuing too high the ability to talk a lot or express everything I am thinking.

And with my work and household load, it is not easy to find time for friends. When family and all your college and childhood friends are far away, I would not be too surprised if anyone would be just like me if they walked in my shoes. That's why family and college and childhood friends are there forever: because we had time to share with each other at the time.

What works and what doesn't in hospitals - a patient's perspective

Paul, thank you so much for answering my email and your suggestions on how to play with the blog.

My dream started when I was a patient in a hospital and I kept thinking that something can be done to make these people's life better. Here's the story:

My baby was 9 days old and his pediatrician was afraid that he's not gaining enough weight (diagnostic: failure to thrive). He sent us to the hospital to get some blood tests done. If the tests were not good, my baby could have been admitted back in the hospital and be fed through IV.

At the hopital, I ended up in a big waiting room with maybe 50 other (sick) people waiting to go through the admission paperwork. I was told that I will have to wait at least 1 hour to get the paperwork done. I asked if they had a room where I can breastfeed my (hungry) baby. I was told that there isn't one and the person at the desk suggested the restroom.

This is a very nice hospital where I delivered, I was encouraged and helped to breastfeed and I was really satisfiedw with their services while I was in. Their L&D (Labor and Delivery) admission was very friendly: they just sent me to L&D, gave me a bed, and after all the medical stuff was cleared, someone came in with a laptop and got my paperwork. I thought this was very thoughtful and cool.

I imagined that maybe the restrooms are like hotel restrooms, where there would be a quiet, clean room with comfortable chairs. No chance of that... The baby was becoming fussy and I got over my embarasment and everything and started feeding him. (When babies are that small, they need to learn how to feed and you are encouraged to not give them bottles) I imagine that this offended them, because I was called to register within 5 minutes, just 30 minutes after I got in.

Imagine that the waiting room was full of sick people. My drama might have been the least dramatic in that room.

Why can't hospitals do something about this? Why don't they create an electronic check-in like the airlines do? Why don't they have a room for breastfeeding and have that kid with a laptop do our paperwork? If this process works so smoothly for L&D why can't it be made to work for the general admission?

I'm feeling that I can help this somehow and the more I read about the status of helthcare the more I realize that this is one place where I can help, where a difference might help, where something needs to be done.

What is that impossible dream

The impossible dream is getting a job... in a field that I have no qualifications or experience. I would like to work as a hospital administrator... Paul Levy, President and CEO of Beth Israel Deaconess Medical Center in Boston is my hero. I don't want to be CEO or President, but I'd love to help someone like Paul. And I think I have the talent to do it.

This is reaching as high as the sky. This is all so new to me. I am a software developer with no training in medicine or management. I am managing large software projects and I am very good at it. I imagine that the job is the same, but rather than dealing with software, you deal with sick people and people that care for them. I know I need to learn a lot, and this doesn't scare me. I can read, research and learn. What scares me is the interview... oh, no, not the interview.

I'm just starting to see what's under the covers and it is scary. I thought it's all about patients and caring for them, but there's so much else going on: uninsured and universal health plan and HIPPA, and pharma companies, and unions, etc.

But when I was in Romania, working for a leading US software consulting company seemed like reaching for the sky... and I did it. It seems easy now, but it wasn't, and I know I can do it again.

Thank you for hanging out with me while I dig through all this and prepare for THE INTERVIEW.

Random thoughts in the middle of the night

I did not go away, I just had a very long day yesterday. We went and saw a show in NYC - A Chorus Line. We loved it!

Going to NY is exhausting and of course I need to make out of it more than it really is, so it's also emotionally exhausting. It was cold and traveling with a 13 months old in the train and then subway its an adventure in itself, but for me, the adventure started the night before with thinking about all the disastrous scenarios: what if I will get lost, the baby will lose his hat, I will need to ask for help, I will need to call my husband and admit that I am lost, I will need to ask strangers to help with the stroller, how do you get a stroller through the subway doors anyway, and how should I behave with these people that I'm seeing once a year and know nothing about. They are all nice and I'd like to be nice to them, but what is there to talk?

It all went smoothly, and yes I asked that stranger for help, and he helped, and I asked for help in Penn station and I was guided the wrong way, and I think I did ok with "these people that I only meet once a year" even though I didn't say much, nor shared intimacies.

That being said, I am back to waking up every night at 3 AM or 3:30 AM, but I am not exhausted yet.

And I told 3 more people, getting the total count of people that know about this website to 5. I am now annoyed that nobody is having any comments. I added anonymous comments, so please comment. I have a plan to add some outside players: people that don't know me, but write about social anxiety. I'm curious where this will go.

And just to let you know, I have a draft of "what my dream is" in work, I will likely post it one of these days...

First night as a blogger

Last night while being awake and checking my email and the website every 5 minutes, my husband and I wondered whether this is going to cause more anxiety than it resolves. Keep in mind that only 2 people knew about the blog and one of them was in bed with me. LOL What will happen when I will have 20 or 200 people knowing about it?... oh well, I went through sleepless nights before, I'll go through them again.

The Impossible Dream

from MAN OF LA MANCHA (1972)
music by Mitch Leigh and lyrics by Joe Darion

To dream the impossible dream
To fight the unbeatable foe
To bear with unbearable sorrow
To run where the brave dare not go

To right the unrightable wrong
To love pure and chaste from afar
To try when your arms are too weary
To reach the unreachable star

This is my quest
To follow that star
No matter how hopeless
No matter how far

To fight for the right
Without question or pause
To be willing to march into Hell
For a heavenly cause

And I know if I'll only be true
To this glorious quest
That my heart will lie peaceful and calm
When I'm laid to my rest

And the world will be better for this
That one man, scorned and covered with scars
Still strove with his last ounce of courage
To reach the unreachable star


... or, if you prefer French:

http://apo.cmaisonneuve.qc.ca/villanova/emilie/Quete.html

Not so glorious start, but dealt with AAA

I was dreaming to start this blog with a glorious introduction on why I started it or a poem or something... instead I ran into a situation that I feared for a long time: I had a flat tire.

Nothing happened that was really exciting: it was daylight and I got to a Burger King parking lot. But it was cold and snowy and I was about half an hour from home, and even though I technically know what I have to do to change the tire, I did not feel like getting all cold and dirty doing it... and having the kids from BK laugh at me. So now the question: what would have caused me more anxiety: do it myself or ask for help?

Anyway, I called AAA, they came, changed the tire, I went home... What was it that I was anxious about?

That's me: any human interaction makes me cringe: I'm dreading talking on the phone, having anyone do anything for me, saying hello to a neighbour, and the list can go on forever.

Why did I start this blog? Because I think that I need to face my anxiety and this can be facing a lot of it if I will keep writing and I will let more and more people know about it.

So far 2 people know about my blog.