A Bath With Chard
Who Knew
People tell me things all day. I don’t know what’s going to come out of their mouths.
Today, December 9th, 2024, a lady told me at 1:43 pm, that she had had a miscarriage. “This year,” is when she had it.
We were doing a quick telehealth visit. To refill her Zoloft. Or so I thought. She hadn’t had a visit with me in over a year. Last time I saw her was May 2023. And even then, she wasn’t in the office.
She was on the screen. A virtual visit.
I reviewed the notes from May 2023. I had started her on Zoloft for postpartum depression and OCD.
She ran out, about a year ago. She was doing “okay,” off it.
But now she’s noticing her mood is bad. She wakes up angry. And she’s “just acting mad.”
I get it.
I try to tease out if it’s more depression or anxiety. If it’s more depression, Wellbutrin might be a better fit than Zoloft. Especially if she’s trying to lose weight.
She is.
She brings up the weight loss desire on her own. She’s been trying so hard to eat right and exercise, and yet . . . it’s just not working. It’s really wearing her down. She wants her body back.
“What about Ozempic?” she asks.
Oh goody. This will not be a short dicussion.
We discuss.
It helped her friend. But the drug is still so new. And expensive. We don’t know all of the long-term side effects. Or the short-term. I got an email from the American Medical Association two months ago saying that Ozempic can cause hair loss. And suicidality.
I say, ”Let’s get some labs first, and see if you have impaired fasting glucose. If you do, we can try it. Even if you don’t, perhaps we can still try it. But first, get the labs Then come in for a physical exam. If we decide to go the Ozempic route, and insurance doesn’t cover it, I know a nurse who sells a compounded GLP-1 agonist online. She even offers a deal for nurses.”
My patient is a nurse.
All of a sudden, I feel like I’m selling her on Ozempic. Even though it’s not my goal. But I mean, she asked.
I do have patients who have a lost a lot of weight on it, and it’s changed their lives. I also know that when people — especially women — feel stuck with their weight, it can affect everything. I know this, because I have been there, and I have seen many patients struggle with this.
At the same time, it’s not my job, and it’s not possible, to convince her that she is okay as she is, within a matter of minutes.
Especially when I can’t even see her.
I barely know her.
And literally, I can’t even see her, even though we are doing telehealth . We were supposed to see each other on a screen, but she couldn’t get the link to work.
So we just went with the phone.
We circle back to discussing her depression. This is where she tells me she had a miscarriage.
“And we aren’t trying anymore,” she adds. “One is enough.”
She has a two year-old boy.
It breaks my heart.
I don’t have time for a broken heart. I have to see the next person now, and I don’t know how to fix it. I am already twenty minutes late for the next person.
But I know that now, more than ever, an additional five minutes is essential for me to hold space for her.
So I listen. I run more late. I help her heal, a little, over the phone. I reflect back to her that this is a terrible loss.
I tell her that I hear what she is saying. She wants to move ahead with her life. No additional baby. She wants her body back. After doing all of that waiting and delaying and trying and losing and recovering . . . she wants herself back.
She also wants a muscle relaxer and a prescription for 800 mg tablets of ibuprofen for her back — the urgent care prescribed that for her when she saw them two months ago. Can I do that, too?
And a refill of an albuterol inhaler.
Oh, and her right hand is tingling. What do I think of this?
I think she needs to come in for a visit.
I put her on Zoloft. If it’s not “doing the trick” after six weeks, we can switch it to Wellbutrin.
She’ll see a counselor.
She’ll come back to see me in January.
In person.
I come home at the end of my day. I’m tired. Writing notes takes longer than seeing patients. I had to write an extra letter at the end of the day, asking why did the inpatient psychiatric unit treat my patient so badly when she was there for suicidality two weeks ago? They should have done better! I site specifics. I print the letter. It comes out with a ghetto-appearing vertical streak of font that is lighter than the rest of the font, running one inch wide on the right side of the paper. The printer needs a new cartridge.
I can’t handle this. That will have to wait ‘til tomorrow.
I call the patient who I wrote the letter for. We end up talking for half an hour. She is eager to use the bad experience in the mental health system, for good. Her voice is animated. She wants to change the system. She sees herself as running a psych unit someday. I tell her this is amazing. I’m glad she’s feeling stronger. I tell her she’s gifted. There is a brighter future for her!
I hang up the phone. I am almost done. Just a few more things to do, so I can leave with a clean slate for tomorrow.
I think about my cat, outside in the cold. I let her out when I went home on my lunch break for eight minutes. I live three minutes driving from my clinic, and it’s worth it to drive home to see my cat and stretch my legs — not be a doctor for a second. It was sunny at 42 degrees Fahrenheit eight hours ago, when I let Bella out. Now it’s 27 degrees, and I hope she’s okay. I hope she didn’t run away and leave me for good.
Bella does not run away. I come home at eight o’clock, and she’s there. This is all that matters.
I had hoped to be home by six.
My cat is (still) so in love for me. She holds no grudges.
There’s dishes left over from yesterday in the sink. I’m cold. I want a hot bath.
I want a suana.
I want a marriage.
I want done.
I want funny and fun.
I want out.
But I’m in this mess.
While doing yoga in my flex room, I’m thinking of my patient. I should send her a card. What will I say? I’ll say she’s been through a big loss, and yet there’s hope. There is more on the horizon for her.
Do I wish her happy holidays? Can you have happy holidays after you have lost a baby?
Probably not.
I go downstairs to my desk and pull out a stack of hand-painted cards, made by two artists who are sisters. I chose to support their business by purchasing a “surprise medly pack” of cards a couple months ago. When they came in the mail, I realized there were only three out of the fourteen cards that I could use.
The rest were too sappy or specific. Overly intimate. What a waste, because the imagery is beautiful.
I take them out again, to see if any of them would work for my patient.
Nope.
One of them says, “You have bravery in your bones.”
She does.
But so what? She lost a child.
Another one with a picture of a red flower held in the palms of two cupped-together-hands, says, “These things I cannot change,” and it then it describes how hard it is to go through hard times. It ends by saying, “But what I can do is offer my whole-hearted and present self to walk with the people I love through the fire and the mess.”
Uh.
No.
Sometimes I just take a gummy or a Xanax.
Who wants to put in all that effort, all the time? It’s not realistic. I believe it’s good to feel feelings, but also, to pace yourself. A buffer is not a bad thing, sometimes.
I certainly will not send her that card.
I picture myself going to a store and buying her another card that is more simple.
When will I do that?
This patient is just one of the fifteen hundred patients I manage, who come to see me every year. Some of them come five times a year. I carry them home with me. Not on purpose, and not not on purpose.
I just do, because how do you throw these stories away at 8 o’clock when they’ve slipped into your bones, along with all the other irritations of the day?
I to try rinse my spirit by running a hot bath and strumming guitar. I google the chords to, “I Just Called To Say I love You.” The John Prine version is a lot easier than the first version that comes up on Ultimate Guitar. That one has a Cmaj7/G chord in it. I’m gonna go with the John Prine one version. I strum it a few times.
Something starts to shift.
I take a sip of whiskey poured over ice, from the single mini-bottle of Henesse that I bought at the liquor store on the way home. As I was pulling into the parking lot, and as I walked into the liquor store and smelt the stank of poison, I said, “Anita, is this what you will be doing? Indefinitely?”
Leaning on alcohol?
No. Because I have a brain. And tools. I have family. And friends. I have the big outdoors. I have yoga. And my cat — my favorite person.
I trust that the crutches I use — alcohol, sugar, what-have-you, will fade if and when I’m in another place with more sunshine and warmth. Ideally, with a lover who can swat me on the butt at the end of a hard day — who can playfully shove me on the bed and crawl on top of me. Help shake all this sadness out.
All I know, is my brain was stolen by my patient tonight. I am not my own person. I am covered in the feathers of feelings of people I saw all day, and I don’t have time to shake them before the night falls.
It’s time to hop in the tub. But it’s also time to get dinner going. And it’s getting late. Maybe I can get dinner cooking while I soak. I want to sauté rainbow chard, but in order to do this, I’ll have to wash each leaf before chopping it up. The idea of standing on the cold lineolum floor by the sink and doing this task of rinsing the leaves, irks me.
So.
I bring the bunch of chard to the bathroom. Take off the purple twisty, and drop the leaves in the tub.
It’s gonna be a two-fer. The leaves get washed, and so do I.
I get in the tub with chard. The leaves float in the water next to me. They are like dolphins, brushing against skin on my thighs, abutting my back. I lean back and plunge under the water. The chard surrounds me. There is a pungent smell — earth, vines — as I emerge with my head tilted back.
I am a mermaid. This is my warm ocean. The candle on the bathroom counter makes merriment in the mirror in a dim, steamy bathroom. I swish the water with my hands, caressing the leafy fronds, soaking up the oddness of soaking with vegetables.
When I am done, I lift each stalk ouf the the weater, and lay it on a towel next to the tub. I take in the scene with untold satisfaction.
How weird is this?
I love weird!
Now I don’t have to wash them at the kitchen sink.
My cat is next to me on the edge of the tub. The chard is a new thing for her. She observes it with the neutrality of a cat. She wants to hop down, but the chard is lying all over the towel, and I can see she is keen on avoiding it. What will she do?
I fix it for her. I lay another towel on top of the chard. Now the chard is covered like a baby — tucked in. Bella hops down.
Whatever I do the rest of the night, it’s gonna be okay. Because I’ve been cleansed.
I wrote this December 9th. On December 10th, I listened to the news. That is to say, I checked Instagram.
I had no idea about Syria until December 10th. All of the horrors uncovered in the Sednayah prison, and other prisons, with the liberation of Syria. Indescribable. It first hit me when I heard this man share his account of entering prison at age twenty-five, and being released forty-three years later. He says, “I spent the prime of my youth unjustly and unfairly.” Eight of those years were in solitary confinement!
The whole time he was in captivity, he hoped to see his mom, dad, and siblings, when he was released. He envisioned that day. When it arrived, they were gone.
Imagine this. The faces you most love — the ones you call home — disappeared forever, once you are free.
He had joy in re-uniting with other family members, and new family members.
His attitude is positive. He speaks with a smile. And weariness.
He is my hero.
His reality puts mine in perspective.
If he can be this strong, I can put up with my hardships. They pale in comparison.
On January 4th, I receive this message from my patient:
“Oh man I have to tell you that going thru that lady to get the ozempic compound was easy/awesome. The pharacy sent me the meds and everything I needed two days after my appointment in a cold packed package. The compound is working SO WELL!”
I write back, “That is great to hear! What dose are you on and how long have you been on it?”
“I just finished my last lowest dose 2.5 mg and next week 5 mg for 4 weeks. Side effects were nausea and a few times I felt tired but other than that it’s been amazing. I have lot 12 lbs in a month. Pretty stoked!!! My mom was SHOCKED when I didn’t have dessert on Christmas. She said she has never seen me pass up desert.”
I write, “Hahaha. I LOVE that! You are getting yourself back :) I’m glad it’s working.”
“Yah I honestly feel like everything has turned around for the better since I got badk on Zoloft and the ozempic compound. Huge improvement, I do feel like myself again. Thank you, Dr H!”
I write, “Awww. Goooood. You have yourself to thank for 95% of it! I just provided the tools. It takes effort to lose weight even when you are on Ozempic. It’s not like it falls off magically, so good job. I’m so happy to hear this.”
And. I did sent her a card. Two weeks prior to this exchange. So now when I go for a walk, and she pops into my head, I have a lighter heart, knowing she is making her way, and I am a part of it.
“My work matters,” is written on a bright pink sticky note on my fridge. My therapist gave it to me five months ago. He said, “Put this up somewhere, if you want to.”
I put it up, hoping and wondering.
He gave it to me, knowing I wish I could do something more creative as a career. Less taxing. Knowing I think I am replaceable, as a family doctor.
Welp, here I am. It is what it is. I do what I do for work, and sometimes the wins put a pep in my step.
And sometimes I still make the time to post on Medium. Alhamdulillah.
