Bad Number Daze

First thing in the morning, the worst morning of the week, I am faced with the unpleasant task of telling someone of a cancer diagnosis, something k had to do last week with another patient, and that was first thing in the morning also, but not on Monday. Having been on the receiving end of that sort of phone call myself, I am keenly and personally aware of the impact such words have, even if you sort of expect them. When I first started practicing medicine, I used to bring patients into the office to tell them they had cancer, thinking it would be insensitive to relay the information by phone. I no longer am sure there is much of an advantage to doing it that way. I thought I should be with the person to make sure the person was somehow ocque, but really, would my being with someone face to face be any more reassuring, make the person less likely to feel hopeless or depressed than being with him/her over the phone? Face to face visits are often very important for gauging the nuances of someone’s reaction, especially if you are like me, and are good at reading body language and other cues which are not accessible by phone. However, the news must be given expeditiously and if I have put a plan together for the patient, specialists to call, tests to schedule – they have something to occupy them immediately upon disconnection of the phone call. Either way – in person or by phone – works. With today’s technology, I can get group e mail conversations going, and ask specialists to review the electronic health record, and they will recommend the best process, and will always offer to get folks on their schedules quickly. Everyone is so connected to their iPhones these days that I get responses day and night, holidays and weekends. Much easier than trying to page someone. Offices sometimes give me docs’ cell phone numbers if I identify myself as a colleague, which also helps a lot. Since I have been a member of the Pittsburgh medical community for so long, I have developed relationships with so many excellent specialists. Often, I wish my folks had lived here so I could have set them up with some competent physicians: their docs in the Sleepy Hollow area were, without exception, lazy, incompetent, uncaring, and dismissive. I don’t think there are all that many good doctors in New York, seriously. My brother and sister in law have had terrible luck finding a decent internist; Richard’s brother has also told us some horror stories. My friend Amy seems to like her docs, and knows at least one orthopedic surgeon whom I have met and get a sense he is ocque. One of my cousins is an internist in Northern Westchester, and I know he is good. But that just about runs the gamut. Now here in Pittsburgh there are definitely some scary, killer docs, but enough outstanding ones that it is easy to steer clear of the bad apples.

Yesterday I spent the entire day cooking for company, and felt very stressed out, working against the clock. By guest arrival time, everything had somehow pulled together and it all went smoothly and I could relax. I did indulge in a bit of extra dessert and two big glasses of wine, but otherwise only had very low calorie appetizers and only one plate of food, mostly veggies. Even so, I was 1.6 pounds up today. One might have been tempted to advise me not to weigh self today, and I was tempted not to, but all in all, I have found that it is far better to weigh self daily than to be in the dark. The problem is, the number on the scale always always always colors my mood for the entire day. Let me rephrase that: if number is bad, my mood is invariably horrible, and all day long I feel like the biggest and fattest of big fat bunnies; if the number is good, I feel ocque for about five minutes, but then begin to worry about other things. Still, on good number days. at least I do not feel like the very fattest of bfbs. My feelings which depend on the number on the scale occur despite my intellectual awareness that it is ridiculous to let the number on the scale dictate how I feel about myself. In fact, this is often something I discuss with my patients, attempting to persuade them to focus more on “non-scale victories,” as Weight Watchers calls them. Focusing on the scale can be so discouraging as to send someone trying to loose weight into the dreaded downward spiral of lapse, relapse and collapse. And, like so many others, I get discouraged, too, and sometimes feel like giving up. Weight loss maintenance just gets harder and harder. Being satisfied with less food seems increasingly difficult; every year, my metabolism becomes incrementally less forgiving of even the smallest indulgence. One rich meal can screw me up for the entire week, even if I am on track for the 20 remaining meals and 7 snacks, and with exercise. About exercise – even with five days a week at the gym, each session is only half an hour. The rest of most days, I am pretty much sedentary, especially this time of year. My job entails mostly sitting. with intermittent walking up and down a short hallway, and standing while examining patients. In a twenty minute follow up visit, five minutes, if that, are spent examining the patient. In a forty minute visit, maybe the exam will take 10 minutes, and the same with an hour visit. Lots of computer time. Today, I went to the gym, and to Target and walked around the whole store, but that was the extent of my activity. Yesterday, I was on my feet for all but about two hours, but that is a rarity. I spoke to my friend Jenny, who just moved to San Francisco. The weather is great, they run every day outdoors, and they walk to and from work, to and from Whole Foods, have put ten miles on their single car (they sold the other) since moving there about ten days ago. Now that is a very healthy lifestyle. Would I want to move there? Not really. Too expensive, earthquakes are an issue, and I have far too much going on in Pittsburgh, which I really love in so many ways. Work and personal life could not be better. But I could really do without the minus six degree weather and the disappointingly cloudy, cold and rainy springs and falls and even summers. The weather here is the main disadvantage.

This entry was posted on Sunday, February 22nd, 2015 at 9:49 pm and is filed under being a doc, Big FAT Bunnies, compassion, Eating Behavior, Exercise, fitness, gluttony, jealousy, weight, Weight Gain, weight management. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.

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