• A Good Start.

    Despite myself, I am optimistic.

    My job brings me to court twice a week to work on child support cases. The cases we see are predisposed to be the the worst of the lot. They can be the ones which no other form of persuasion has prompted someone to be a good parent. We are taking the action of last resort, we are going to court. If that were not enough, the atmosphere is charged by the inherently difficult issues of money, children, abandonment, and love unrequited.

    Recently I was working on a case which was tragically typical: a man was summoned to court to legally establish paternity and child support for a child he had not met. Only after learning the results of a DNA test, six weeks prior, did he even know that he was a father to this two year old child. We worked out an agreement to pay support without having to go to an actual hearing. As we were finishing up he asked a common question: “what do I have to do to see this child?” I gave my usual answer: “the easiest way is to work it out with the mother.” He allowed that they were not on the best of terms, and I noticed that they both had new “significant others” in attendance, to give them moral support. I’m no great authority on anything, and having just sat on the opposite side of the table on a deal to take an additional couple hundred dollars from his paycheck, I didn’t feel I was in the best position to give him friendly advise (and have it heeded). However, I could not help myself. At this point the meeting usually ends one of two ways. After I tell the parent that the payoff may be worth the try, I get a look which says “yeah, sure”; or, I get a response that goes something like “you may be right” – followed by the mother and father ignoring each other on their way back to their lives. This time however neither happened. It was a busy day, so I kind of hurried off to the next case and didn’t notice what they did right after we were done. However, about twenty minutes later I noticed the four of them in the hallway outside the courtroom. The mother, father, current boyfriend and current girlfriend were all talking together. I heard the mother say to the father, “give me a call. . . .” I saw the father and the current boyfriend shake hands. I saw what looked like a sincere, friendly wave mirrored by the mother and the current girlfriend.

    The cynic in me would say that it was but a brief moment, and it will be awfully tough – maybe too tough – to keep that up for very long. But there was something about them all, something that I can’t put my finger on which makes me feel that they have got a chance. It is moments like these that make my job worth while. The thought that if I had anything at all – however small – to do with something that may enrich the lives of several people, it would be special beyond explanation.

    Optimism ruled the day, and I am hopeful for a good start.

  • You’re Never Too Young

    Beth started the day, like nearly every other weekday, at 6 am. Although this is not out of the ordinary, getting up any earlier than 8 am is inherently bad. I’m neither looking for, nor do I expect any sympathy from those of the medical persuasion, but I think we all can agree to this in principle.

    From there, Beth went to school and suffered through a long day. When she arrived, she discovered her teacher would not be there. Instead, she had a substitute – which is almost never a good thing. She didn’t get in a nap which is definitely never a good thing.

    Tired from a lack of sleep, and already weary from suffering through a substitute teacher, Cheryl picked her up early to go to the dentist. It was her first time with the poke, prod, scrape, and polish routine. When the pain in her mouth was still around an hour later, we called on our good friend Motrin.

    Not until later that night, when Beth was on the potty struggling with something too gross to describe, Beth pitifully announced: “Mommy, I’m having a bad day.”

  • The Big Poke.

    (Note to those of the medical persuasion: I think puncta is the word I’m looking for, but I’m not sure. If I’m wrong, then it’s the word I’ve made up for the little holes in your eyelids, near your nose, that carry tears away from your eye.)

    I relented. I gave in to the suggestion that plugging my puncta would solve my dry eye problems. This despite the failed temporary plug test run a month or two ago. You don’t truly know what it’s like to get poked in the eye until someone as tried to plug your puncta. After yesterday, I now know.

    It turns out that puncta plugging is a two step process. First you “size” the puncta to determine what size plug is needed. You begin by instructing the patient to hold still, keep the eye open, and look straight ahead. You then do everything you can to get the patient to disobey. You accomplish this by thrusting a “sizer” into the puncta as forceful as you can without rupturing any soft tissue. Once you have simultaneously sized the suspect puncta, and taken away all of the patient’s hope that this will be easy, you insert the plug. The plugging device is a long thin stick with a small silicone object at the end, and which has “you’ll poke your eye out” written all over it. You retrieve the device and thrust it in a manner similar to step one, only this time, take your time. A little lingering builds the suspense. When you feel the slight popping sensation, stop. To make the experience a little more exciting for the patient, don’t tell them the popping feeling is normal until after the first plug is inserted. This makes for some amusing reactions from your patients. You can almost see the blood returning to their faces when they find out nothing important has a new hole. Now that the plug is in, choose your next words very carefully. They can satisfy the little sadist in all of us. “There, now we’re half done” often works quite nicely. As you may have guessed, I was unable to keep still, keep my eye open, or look straight ahead. I was 0 for 3. Afterwards, the good doctor said that my difficult puncta were in between sizes. He said to me, “I decided to try the smaller ones . . . I didn’t want you to pass out or anything.” To borrow a term favored by one of my co-workers: I’m a woos when it comes to my eyes. But in my defense, that was some major league poking. If I were a prisoner of war, it would have been illegal. . .and I would have talked. This evening when it felt like there was something in my eye, I had the comfort of knowing that there really was.