Encounters of the work kind...

I guess like all of you who blog, there are always posts swirling around in my mind. Then I come here and nothing comes out (surprised?). But I'm going to make an attempt to write about a few things that I have learned on the job that have nothing to do with lipids and heart disease.

In the type of work I do I come into contact with a variety of people all day long. And maybe because we're talking about their health, and I'm their health care provider, they feel like they can open up to me...sometimes divulging things I don't want/need to know, sometimes just sharing, sometimes crying. Sometimes the moments are intense.

Some of my patients I have been seeing for nearly four years. I help manage the complex dyslipidemias at my practice, which means I see the folks who had their first heart attack as a supposedly healthy 35 year old, or the person who has an LDL cholesterol level of 300+ despite being on six different medications. You get to know these people over time, over the years. But patients always seem to want to know a little bit about me and, well, I'm guilty of oversharing (I know--shocker.)

So you know where this is going.

As unprofessional as it may have been in the past, I've told some of my patients that we were trying to start a family.

Usually it would just be in casual way--they would see my pictures of my dogs and ask if we had any children. Four and three and two and hell--even one year ago I might have responded with "Not yet, but we're working on it!"

Obviously they've seen me every six months for four years they're going to notice I've never been pregnant. Some of them gently ask "How is that going?"

I no longer say "we're working on it." I'm getting comfortable with the truth. With hearing the words "We cannot have children" come out of my mouth, spoken by my voice, spoken about me.

I say it, I don't tear up, the words are out there, and saying it every time makes it more real, more concrete, more fact.

Because 81 eggs retrieved, eleven embryos transferred, five IVFs and still no baby had not quite made it real enough as just saying those words out loud.

"We cannot have children."

My patients--God love them--they pat me on the arm and give me a sympathetic look. Some of them hug me and say "I'm sorry." Some of them say stupid things but that's ok too. I'm learning to be more forgiving, to just roll with it.

"We cannot have children." It's a hard thing for people to hear. But it's getting easier to say.

On a different but related note, I also gingerly ask people about their family histories, which has led to me to hear some delightful, some sad, and some just plain heartbreaking accounts of adoption.

"I do not know my family history. And I have hurt my whole life for not knowing anyone who was genetically connected to me--I have felt so alone in this world"--this a response I got early on that left me tearing up as my patient--a middle aged man--teared up, too, the pain in his eyes so deep and raw I could barely keep it together.

Or this:

"I finally connected with my twelve brothers and sisters. I was the baby, the one they couldn't afford to raise." I remained quiet to see if he would continue. "But it was nice to finally meet someone who looked like me, to get a sense of where I came from, to get a small sense of who I am."

Or this:

"My parents are absolutely the people who raised and loved me, no ifs ands or buts. I adore them and they are wonderful people." And then laughing, continuing "But they both have heart disease so I'm glad they didn't give me any genes!"

Of course I also come across cases of infertility. From the patients who tell me that "they had to do infertility to get pregnant" which I then find out means they took one round of Clomid (!) to reading in someone's history of about the loss of triplets at 21 weeks I realize there are a lot of us out there and there are myriad painful ways to experience infertility.

But yet I haven't met myself yet. I haven't had a mid-30s vegetarian with high cholesterol, a thyroid disorder, a wicked family history of heart disease come in, sit down in my office and tell me she can go on medication without also having to take birth control because, come on, she's NOT going to get pregnant. She did, after all, fail five in vitro cycles with nary more than a chemical pregnancy.

If I did meet myself, I guess I'd be gentle with me. I'd probably want to hug me.

Thanks for hanging in for the mindless ramble.