The Woman Who Walked into Doors

Guest Discussion
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It’s a strange time on several fronts.

A pedophile is running for senate in my proud state. My old classmate, a decent guy, a pretty competent prosecutor, but a DEMOCRAT, is running against the pedophile, originally just as cannon fodder, and probably he still is, the evangelicals hell bent on getting their man in, and the black belt isn’t coming out. Nothing is black and white in Alabama, everything is black and white in Alabama.

Meanwhile, back in the real world, the worm has turned.

A quaalude rapist whose comedy I loved for decades has been brought to bay. Suddenly, it was Katie bar the door: rapists, creeps, gropers, fanny patters, tipsy mistletoe smoochers- mainly the foul, but maybe some of the fair- all lumped together, and run off the reservation. An accusation is hard wrought in most cases, I believe that, but it is harder to confirm that with certainty thirty years out, especially as this pendulum gathers momentum. Accusation is tantamount to conviction. Try them in public, screw due process. I should be sympathetic to the victims, I know this better than most- but really, Garrison Keillor?

The air is thick with hysteria, hypocrisy, “Why, I NEVER!”…the mark of every successful political movement.

At the risk of being branded a creepy old white guy, I wait for somebody to respond “At long last, have you no decency?”, and McCarthy, we’ll find a new normal.

Meanwhile, I’ve got problems of my own.

McKesson be gone, we adopted Cerner for computer records, beginning last Monday. All Ascension hospitals did it at once, presumably so we can all be hacked simultaneously, or so it seems.

It’s as though some god of entropy descended, and said:

“Y’all have been doing a very good job with all your record searches, making nice notes and summaries, easily accessed, Thank you. Beginning Monday, you must do them all in Portugese. Here, take this 4 hour course in the language- hey, if you know a little Spanish it’ll help…or, I don’t know, Italian, maybe.”

So… Monday came, and I walked through the whole mess of it. The admitting clerk made 200 keystrokes to get the first patient in the door, it took an hour. That’ll get faster, but it’ll still be 200 keystrokes.

Then the admitting nurse took another hour. That’ll get faster.

Then my stuff, took 20 minutes with a guide at my side. That’ll get faster, too.

Then the endoscopy, 5 minutes. Then it was time to go. Nobody can make any money at this, ever.

Chaos, mostly due to unfamiliarity.

But it is also partly due to excessive data mining- with this huge capable program and with prevailing fashion, the impulse to correct all societal wrongs must have been irresistible.

An aside:

If you think Irish writers can really knock the ball out of the park, you are correct. It’s a talent lavished disproportionately on the emerald isle.

In the modern era, start with Yeats, a personal favorite because he got even better when he was old, which should resonate with the Cirrus pilot population. Don’t forget the obscure Joyce, or especially the modern Nobel laureate, Seamus Heaney, who stuck to his knitting, and can turn an ordinary dig in the garden into something ethereal.

But the point of all this- Roddy Doyle can write his ass off, he’s an incredible talent. No language, no perspective, is beyond him. From “The Commitments” a rock band story told in the vernacular, youda thought you were a roadie, to “Paddy Clark, Ha, Ha, Ha” seen through the eyes of a bright 5 year old, where you’ll be back in kindergarten reading it, to the subject in question here- “The Woman Who Walked into Doors”, a first person singular tale told by a 45ish woman whose husband had been beating her their entire married life, one dreary ER visit after another. Being Irish herself, she might have had a pint herself before he threw her down the stairs, so the ER docs looked over her head to the husband with requisite sympathy for HIS plight, standup guy married a sot- the whole thing plausible, painful to read.

Somewhere in the middle there’s a long paragraph every doctor should read, a simple list of her ER visits- broken wrist, broken ankle, broken zygomatic arch, teeth knocked out, broken finger, concussions, burns, another broken wrist- the terrible list droned on and on until I was squirming in my seat. Powerful, awful to read.

And then the punchline: “They never asked.” That slammed us, now we were complicit.

A short book, my wife and I read it the same weekend, and swore we’d ask.

We did, she in the newborn followup clinic, me in my GI office. In the first 10 minutes we were both 1 for 1, her’s with a live in babyDaddy who beat the mother until she’d kicked him out, leaving that teenager broke with a premie in marginal condition, and my patient, now 35, having grown up with a pederast stepfather and a mother who just needed to look at the whole picture… Let’s see if I could sort out her irritable bowels now.

Pandora’s box, and both of us asked if anybody’d asked before- they both said no. But I already knew that answer, the easy answer. The patients struggled on with it, we tried to join the fight, but we were adrift at sea, untrained. It’s a mess. The world is a hard place, or can be. They don’t like to tell any more than I like to hear.

So I can sort of understand how the social welfare computer geeks feel they should ask these questions of a patient in here for a screening colonoscopy. Dump that load somewhere, hope that next guy feels like PIC.

My third patient Friday was a hit.

I never met her before. Good thing I have photo ID, as she wouldn’t know me from Adam. I guess the question needs to be asked, even in what seems clearly the wrong setting

Here are the relevant questions:

IMG_1407.JPG

So, there it is. Way too deep for the 30 minute turn around. What made her say yes now? I have no idea, she’s somehow ready, Anyway, it counts, we’ll have to think of something.

I took off a polyp and asked the good looking, well turned out, and not too anxious looking 60ish suburban housewife to see me in the office next week to talk about the histology. If she comes alone, we’ll talk about it, I’ll figure out where to send her for real help, and tell her I’m sorry this happened, on the advice of an earlier victim. If her very reasonable upper class looking husband of 35 years comes with her, we’ll have a tougher go- at an impasse, nothing to offer but guilt, or start a fistfight.

We have a “how much money do you have wrapped up in airplanes” survey thread going, should be interesting, but it’s drawing some flak for less than immediate results. I wonder if it may have similar problem- more data than can be easily analyzed, rendered to a guy with an already full time job, whose portfolio might have nothing to do with the data.

It’s a tricky moment, I’m asking around for help, called my oldest friend, an MSW, she’ll know what to do.

Well, Merry Christmas to all!

Hey, I already told you I was way behind the times!

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Thank you for raising this issue of pervasive domestic violence and, frankly, hatred and disrespect of women that pervades our society. It’s a national conversation men need to have (Women have already been talking about for ages. Perhaps men just need to shut up and listen). Those who would deny that it exists, are ignorant. Anyone who seeks to minimize it is complicit in the violence being perpetrated.

Ask! Darn right.

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It is everywhere; I am so glad the conversation is beginning, or continuing (priests, college campuses, now business and government). Women suffer in silence, and it is outrageous. Thank you, Doc, for breaking into this with your patients.

I first became aware of the issue when a high school friend was raped, which turned up my awareness. Employee harassment is omnipresent, and pathetic at best, horrific at worst. Men misbehave outrageously, and almost always get away with it. Strong women who don’t need their jobs tell them to go to hell; but most people need the work or don’t want to make a scene, so they suffer the indignities in silence or even go along with it to reduce risk.

By the way, the due process issue is highly relevant where there is one victim coming forward, or multiple victims who could be working together. But the New York Times reporter seems to have done a good job making sure the victims were unrelated, and that their stories had enough common elements to be credible. Note that Roy Moore’s victims were consistently young, for example. No one could disbelieve them.

I am completely unsurprised that Hollywood and DC are filled with such predators. Slimy places with disproportionate numbers of men fueled by power, greed, ego and money.

One problem for organizations is that when extramarital affairs are condoned and/or viewed as being irrelevant to the job (eg Bill Clinton’s situation), then the opportunities for crossing over into harassment expand exponentially. What if Weinstein or the politicians had been afraid they would lose their jobs for evidencing general bad ethics and character? Maybe they would have worried about preying on subordinates, and/or teenagers like Monica. But no one raised hell about infidelity where they worked, as a general precurser to the rapes that occurred. If you work as a CEO, or as a senior government official where trust and judgement are relevant, does no one care if you cheat on your spouse? How is America’s trust level these days for the Justice Department or the SEC?

I would fire any employee who pressured a subordinate or young person, whether it happened in my office or anywhere else. But I also would fire someone who “simply” cheated on a spouse, or who abused others outside work.

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It ain’t just Hollywood or DC. The unspoken truth is that you can ask any woman about it and they’ll have ‘their stories.’ Like most women, I have been groped at, pawed at, whistled at, uncomfortably stared at and yes, more, which I have never before and never will speak of.

It’s everywhere. Grocery store, Gym, Church, work, etc and yes, flying. How many times have I heard the ‘cockpit’ joke in my flying career…ha ha. My mom always told me that it was just how men are ‘wired’. While you were getting the birds and bees lecture, we were getting the ‘keep a quarter in your bra’ warnings. I still remember my mom’s face as she told me “women are men’s bird seed” Her face looked resolved to the fact that this is just the way it was.

Look, I’m not a prude. I know how things work and 99.99% of the time, it’s just harmless ‘frat boy’ stuff, but unfortunately, it’s that damned .01% that kind of sticks with you.

I’m hoping that the recent spotlight on this issue will have some lasting impact. It does surprise me though, that the ‘equal pay for women’ issue came up in the 1960’s and now almost 50 years later, we’re getting around to the ‘equal treatment’. I certainly wish for a world where my two daughters don’t have to go through what we all did.

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There is a cultural shift occurring that will surely settle back into better behavioral norms than existed in the past. That is a good thing. But I will go out on the limb with a more nuanced view.

It is easy to denounce the black-and-white situations that involve children, physical force, unexpected open robes to strangers, etc. But haven’t those things always been crimes? I sure HOPE they still are unacceptable! Maybe there will be more contemporaneous reports, starting now. But we have to keep in mind that not all of the in-the-news misdeeds fit those ugly profiles. To me, it seems the complicated issues will be “Where the lines will be drawn when behaviors evolve over time?” Sometimes, what used to be called “rakish” behavior or edgy male demeanor is tolerated or even welcomed. Much later, if that behavior or demeanor evolves to cross some previously-unidentifed line --OR when a relationship does not evolve in the way it might have been imagined – the previously tolerated or welcomed behavior might be re-interpreted based on updated perceptions.

For consenting adults, I guess the deciding issue is whether or not something is welcome or unwelcome. That makes sense. If so, then for behavior that evolves over time, it seems to me that there has to be a cultural and legal standard of some kind for making clear when lines are crossed and behavior becomes “unwelcome.” Maybe it is as easy as “Just say no.” OTOH, maybe that standard is unrealistic given the power issue. If not “Just say no” then what? I don’t know. I just know there has to be more definitive lines and definitions in the future than there has been in the past.

Declaring that all males need to act like stiff gentlemen seems unrealistic. As long as there are workplaces there will be workplace romances. What’s more, I am so damn old that I still remember when young women seemed enamoured of “bad boys” just because they were…well…“bad boys.” When I was younger, I was amazed – and dismayed – when the jerks were the ones who got the attention of the girls. Has that changed?

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Thank you Richard.

I’m far from the fray here, but I saw there was a billboard, supporting your old classmate, with the quote “There’s a special place in hell for people who prey on children.” Ivanka Trump.

I’d almost like to immigrate to your fine state so I could vote.

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Well, yes. Maybe. Let’s think about it.

I don’t know how many times I’ve seen it. A guy comes to California on business, say from Iowa. He starts acting like a pig around women. Or maybe an ass. He starts saying crude things and doing things he’d never do in his small Iowa town. It’s clear he thinks the social mores that keep him from doing this at home don’t exist in ‘Hollywood’. In the Hollywood state of mind. Ultimately he gets it, perhaps somebody says something, that the same universal mores exist here, the same as Iowa. Maybe he is embarrassed, maybe not, but he returns to normal.

At least to me, this is what we’re seeing. We all know how men should behave. Our society has ordered itself to make this happen. But at the seams, at the cracks, at the edges, it can break down. A man sees an opportunity, with his position or power, where the rules may not apply. Or he is an ass, and slides through life ignoring the rules.

These times, this movement, #metoo and beyond, is calling out the men not following the rules. If we’re lucky many of these cracks in our society will be patched over, and life will be better for women. But the best part, women are speaking out, and learning to speak out. Nothing is stronger than a woman putting a man in his place. I’m pretty sure this is how our social mores originated to begin with.

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Doc,

I can empathize with your pain as I have my Cerner up on the screen opposite me as I type this screed. I’ve been at an Ascension facility since July and we started our Cerner in October. All I can say is that it does indeed get better over time so hang in there compatriot.

You inspire me to ask more of my ER patients the big question re domestic violence. Not sure I can say that I ask it on a regular basis. Sometimes I’m afraid to ask. The fact that the perpetrators of these crimes make it to the highest levels of our society(politics/business/entertainment) shouldn’t be a surprise to me…but it is! I’m convinced that a big part of the reason for this is that good people remain silent. Let’s hope in the spirit that is this holiday season that silence will no longer be an option.

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Thank you. You are making a difference.

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WOW!

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Congratulations! Sanity prevailed.

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And a huge sigh of relief has passed this way over us. Whew!

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That’s a pleasant surprise.

Several interesting things happened. The black leadership was very lukewarm about Doug Jones, but every black person I talked to about this was anxious to vote, the most enthusiastic and unified I recall since Obama first ran in 2008. I think they sensed a chance to make a real difference…and they did. Jones didn’t offer them much. It’s tough to run as a Democrat here, where the perfect can ruin the good. If I were Doug Jones, I’d spend every Sunday from now until he goes to DC in a black church, keep that going for 2018.

The suburban Republicans I talked to just couldn’t stomach Moore, even at the risk of making the Senate tighter. So they stayed home or wrote in, mostly for coach Nick Sabin (it’s still Alabama, after all). The write ins exceeded the difference between the candidates. Over all, it was a pretty good turnout- better than any special election I remember.

Moore was trouble as a twice removed state Supreme Court judge, where he couldn’t seem to abide by or enforce Federal laws, which tendency has a dark history all its own in Alabama.

I read an interesting article written by his former law professor, who said Moore was vehemently argumentative and a shout down obstructionist as a student, a sort of hot section potentate who, singlehanded, made this teacher abandon the Socratic method and just teach by lecture. All these years later, he remembers it.

I don’t think Moore plays well with others, and the Republicans in Washington are breathing a sigh of relief as well.The Democrats were salivating over the easy target, or should have been. Here’s hoping we can have fights over issues instead of personalities.

They can do better than that. I’m glad to see that Alabama can too, if only by a whisker.

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On days when I was wearing my Cynic Hat (which seems more frequent these days) I might wonder if the net effect of doing that, between two different audiences, would be plus or minus.

Obama tried mightily to represent all equally. That did not work out all that well. These days, divide-and-conquer seems to be the only strategy that can work. Maybe Jones could figure out how to represent two groups, keeping it it all on the downlow, while retaining his soul? Would that be possible?

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Wait…what?? ‘LOL…you believed that?’ The One told the opposition to shut up and get on the back of the bus. ‘Elections have consequences. I won.’ [:D]

Would you join us in the HS? [;)]

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Carlos, this thread IS the HS, just without the vehemently argumentative shout down obstructionism.

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An update on the spousal abuse part of the thread.

St Vincent’s used to be a Catholic hospital, now morphed into a sort of vaguely Christian related corporation.

The notion of putting spousal abuse questions into a screening colonoscopy intake form is consistent with this vague do gooder impulse. The #metoo movement no doubt had an effect, and that movement may also have afforded my patient the freedom to say what she said.

So far, so good.

Like a lot of do-gooder notions, it has an unfunded mandate component, in that the ball is in my court.

I called the beautifully named Mary Anne Liberatore, an MSW, and my oldest friend, and asked her advice for how to handle this.

She gave me quite a bit of good common sense advice about keeping things confidential and safe for the patient, suggested I may have to consider things I hadn’t thought of at all (suicide risk, legal exposure, etc), and said I should have a written list of numbers and trusted advisors to refer the patient to.

I called St Vincent’s social work department (named case management nowadays), for the numbers and names, and whatever else they thought I should do.

Two days later the department secretary called back for further information, said the patient was an outpatient, not their concern, call DHR. That didn’t sound like the right answer. I asked her to have her favorite social worker call me back, I’d go through my list with her.

Late yesterday afternoon, the secretary called back, said her original position was correct, and I should call DHR, the social workers were not going to call back, as they weren’t responsible for outpatient care.

That can’t be right. DHR is where DMV workers go when they get too unpleasant for human consumption.

I’m going to have to kick this higher up the food chain.

Time is ticking. The patient is due for an office visit next week.

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Sorry Carlos. I really should have posted “Obama said he was trying mightily to represent all equally.” Would that wording have been OK?

I do not recall him saying that. Could you provide a link?

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https://www.mediaite.com/tv/obama-to-gop-%e2%80%98they-can-come-for-the-ride-but-they-have-to-sit-in-back/

http://www.foxnews.com/politics/2010/10/25/obama-tells-republicans-sit.html

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Thank you David. I really was not aware of that. Not cool.