Friday, November 25, 2016

Seasonal Changes and Mind Games

Does anyone else think that the change from summer to autumn is the most drastic of the seasonal changes we experience?

I was driving late yesterday afternoon and I could not help but be struck at the "all of a sudden" differences I saw and felt as I made my way home. A sea of red tail lights from the traffic slowly moving with me stood out in contrast to the wave of white headlights approaching from the opposite was barely 4 pm. Surrounding us all, dusk, with its rich hues of purple created by the sun setting through both thick and thin cloud layers, rapidly disappeared as night fell.

The busy surface streets, lined with shopping centers, brilliantly lit with a variety of colored lights displaying restaurant names, gas stations, grocery stores and pharmacies, became brighter as the darkness increased. Residential neighborhoods, illuminated by streetlights, were also starting to glow as residents turned on lights both inside and outside their homes.

Here and there people dressed in light coats and hats -- resilent North-westerners armed with an umbrella, a flashlight or a dog, walked along the sidewalks not bothered by the occasional drizzle. Some, the more athletically determined I suppose, dressed in running shorts and shirts, passed and out distanced the walkers with their rhythmic and almost effortless strides. Still the darkness silently enveloped us.

This growing lack of light did not stop many people from continuing their work-related activities either, be that yard clean up, garage cleaning, or in many instances, putting up Christmas decorations. Yes, Christmas decorations. As November moves out and December moves in, we enter the Holiday Trifecta: Thanksgiving, Christmas and New Year's celebrations.

What happened to those long, lazy days of spring and summer? The hours of daylight beginning around 5 am and lingering until 9 pm or later? Not that I utilized the gift, mind you, but that flexibility to be able to be outside to enjoy a sunrise or a sunset was sort of always there should I make use of the opportunity. The busyness of the days, it seemed, could begin or settle like waves gently lapping on the shore.

The shortened days of autumn and winter -- especially as the year closes -- bring an almost frantic state of mind as the holiday activities loom ever-closer on the daily horizon. Morning light delays its arrival which means I am less inclined to move from the warmth and reverie of bed. Once up and moving, the race to complete daily tasks before early sunsets is much more like trying to get to  safety as waves crash the shore ahead of a coastal storm. The added holiday activities, simple ones, really, like decorating our home, the office, just seem to add to the frenzy.

It really is an interesting contrast that we talk about the "lazy" days of spring and summer, in spite of the fact that the days appear longer; while the shortened days of autumn and early winter are crammed with activity that puts an ant farm to shame. It is the same 24 hours. Nothing more. Nothing less. The challenge is making the most of the daily gift we are freely given, which for me means getting out of the mind-game of light and darkness and just doing what needs to be done.

Thursday, November 17, 2016

In the Clinic Building Relationships

Remember the scene in You've Got Mail when Joe Fox (Tom Hanks), having put Kathleen Kelly (Meg Ryan) out of business, visits her after learning that she is sick, and the conversation turns to relationships? The conversation went like this:

Joe Fox:  It wasn't...personal.
Kathleen Kelly: What is that supposed to mean? I am so sick of that. All that means is that it wasn't personal to you. But is was personal to me. It's "personal" to a lot of people. And what's so wrong with being personal, anyway?
Joe Fox: Uh, nothing.
Kathleen Kelly: Whatever else anything is, it ought to begin by being personal.

This is at the heart of all things....being personal. In the clinic we see this every day. Going to the doctor is of all things personal, right? Patients new to the practices may, in a matter of a half hour's acquaintance, be asked to get undressed or otherwise expose parts of their body to near strangers....zooming from, "Nice to meet you," to "Let's take a look at that sore on your___________. Would you please take off your shirt and pants?" Pretty darn personal.

In today's healthcare culture, the trend seems to be heavily focused on the "science" of medicine. We are blessed to be living in an age where technology advances enable practitioners to identify with greater clarity not only a patient's medical problem or condition, but also hone in on the severity of the condition. A cough can be a cough, or it can be the symptom of something more serious, which might be identified by imaging studies. The ability to use this technology gives medical doctors information that helps them better treat their patients' medical problems. It seems that the advances in both technology and drug therapy should improve the quality of medicine. Or not.

Certainly the ability to diagnose and treat conditions has improved and lives are saved, for which we should be grateful. The price paid for these advances can have an unseen but perhaps a negative effect. We see this every day in the clinic: Imaging reports from X-rays, CT, MRI tests, lab results and consult reports flood the office fax machine, mail, and email. Our providers spend much time each day reviewing data and planning the next steps in treating the patients who come through our doors. Ours is a small office; I can only imagine what the larger clinics must see, and wonder how the providers deal with the tsunami of paperwork in a practice panel of 2000 or more patients. Time consuming tasks that either bring the provider into the office hours ahead of clinic time to complete, or keep them hours beyond the time the clinic closes can negatively impact both quality and work satisfaction.

All the paperwork and reports needing to be completed for specialist referrals, insurance companies and the government pull doctors, therapists, counselors away from the "art" of medicine; the intangible something that should really be at the heart of working in a medical setting. Asking a physician or nurse why they chose the profession, the most common answer is not because they enjoy reading medical test results, completing forms to justify medical treatment for a patient, or even the money. The most common reason, almost to a person, is that they want to serve others by using their knowledge and skill to improve their patients' health and wellbeing, to treat them when they are not feeling well and to be there ready to help when needed.

So for what it is worth, patients don't know or remember that our doctors spend a great deal of time behind the scenes shuffling papers and jumping through hoops to get services or prescriptions needed in patient treatment. This is science and now bureauracy of medicine. Patients do know and remember, though, how they felt after seeing the doctor; the time spent in conversation with them; the caring touch received on physical examination or even in a handshake or hug; the tone of their voice; a smile. This is the art of medicine. It is building the relationship and feeling valued. It begins, grows and thrives by first being personal.

Sunday, October 30, 2016

The Unintended Realities of Getting a Song Stuck in Your Head

It is probably a safe bet that most of us, at one time or another, have heard a song only to have the melody stick in our heads for hours (or maybe days) on end. It is the sort of thing that can drive you nuts.

This very thing happened to me the other day. Paper Moon found its way into my brain after seeing a clip from A Streetcar Named tormented me for three days. It was while driving home from work with the melody playing over and over in my mind, I began singing along to the tune running through my head.

Then I started to think about the lyrics I was singing, trying to figure out what (if anything) this song meant.

For those who do not know the lyrics or have even heard the song, Paper Moon was written by the song team Harold Arlen (music) and E. Y. Harburg (lyrics), with Billy Rose in 1933. The song has been recorded many times in a variety of arrangements by such notable singers as Nat King Cole, Ella Fitzgerald and Frank Sinatra. The verses are as follows:

It's only a paper moon
Floating over a cardboard sea
But it wouldn't be make believe
If you believed in me

It's only a canvas sky
Hanging over a muslin tree
But it wouldn't be make believe
If you believed in me

It's a Barnum and Bailey world
Just a phony as it can be
But it wouldn't be make believe
If you believed in me.

Many people have looked into the meaning of the song, and there are a few theories out there. For a broader discussion on this  click here

For me, though, my perspective is quite different. As most speculate that the lyrics are driven to explain the relationships we experience on a human level, be that between a man and a woman, or, in the case of the feature movie Paper Moon with Ryan and Tatum O'Neal, parent and child, or in A Streetcar Named Desire, looking back on our life and getting back to those places and things that gave us happiness, I look at it in that most important relationship between us and God. What if we look at this as if our Creator speaking to us through these verses?

Could God be telling us that everything we see and do in this life is nothing without Him? Is there an emptiness, a shallowness, a facade in our existence without knowing and loving God and His loving us in return? How many of us are truly ever happy and content believing that what we have is the result solely on what we do and create?

Our modern world is filled with the "famous and beautiful people," who spend time and money in the attempt to stay "famous and beautiful." Can they truly be happy? Is their life one of simplicity and reality, or do they live in a world of make believe?

The world is also filled with those who have amassed fortunes and then spend their time and effort trying to keep it. Can they truly be content? Is their life one of fulfillment, or do they live in a world of make believe?

Or, those people whose primary focus is on gaining more and more power, then having to spend yet greater energy staying there. Can they be truly happy and content? Is their life one of continuous inner peace, or is their life like a Barnum and Bailey circus?

The refrain breaks the verses, so instead of God speaking to us about the triviality of life without Him, from our perspective, in the refrain we acknowledge the idea that living without the mantle of God's love and guidance, we are destined to spend our lives in in a world of shadows and illusions:

Without your love
It's a honey-tonk parade
Without your love
It's a melody played in a penny arcade

So for what is worth, that irritating event when a tune plays over and over in my mind may not be so bad after all. I can't say for certain if the writers had any other intention than to amuse the masses with a cute little tune and clever lyrics. Isn't it funny, though, how the audience reacts to the piece and takes away something that touches their own life? The unintended reality of this common human experience for me has been the realization that my life would really be less full, less meaningful and less real without the Greater Good. If you are interested in hearing a version of the song -- performed by the fantastic Ella Fitzgerald, you can find it here.

Thursday, October 13, 2016

In the Clinic with Exercise

One thing about it, you have to love the habits of health and the ripple effect they have on those around you.

In the office we try as often as possible to model those activities that support good health and overall wellbeing. This "do-as-I-do" attitude lends credibility to the things our providers tell their patients when discussing medical problems related to lifestyle choices, such as diabetes, metabolic syndrome, high blood pressure and the like, but is often easier said than done.

To facilitate this healthy focus, I purchased a Nike FuelBand several years ago and was immediately depressed by the paltry number of steps I achieved in the course of a day. I found that by 5 pm (when the clinic closed), I failed to come close to my goal of 10,000 steps a day, which meant that I had to find time to add those 6000-7000 more steps I needed to track before midnight.

In our small office it is difficult to hide much of anything and my comments about the lack of progress I was making soon became a topic of general conversation. Our ever-energetic and enthusiastic medical assistant Andrew caught quite an interest in my healthy endeavor and also decided to jump on the 10,000 step per day bandwagon.

Armed with his own Fuelband, he started tracking his steps and we enjoyed comparing notes throughout the day as to our step-status. Eventually this led to a friendly competition to see who could clock the most steps before quitting time. As late afternoon approached, we would call out to each other as we passed through the clinic our current count, and there were times when we were quite literally within dozens of steps of each other. All of this produced a frantic push on the one of us behind at that point to be as active as possible, and I have to admit that I found myself stepping in place while I waited for a fax to come through or some such other menial task.

Not to be outdone, Andrew decided that he would build himself a workstation where he could stand to do his work, and keep in "perpetual motion" as he answered phones, completed forms or did computer work. Mary, our administrative assistant, soon joined in the fray, creating her own workstation where she had the flexibility to either sit or stand. She soon upped the ante, and with her FitBit firmly planted on her wrist, twice a day both she and Andrew took time to complete the "7 Minute Workout" from an app Mary had downloaded on her phone. Attempts, by the way, to get Jeannine involved in this, were hit and miss -- but this is the topic for another story.

Since I still have too much pride to lend myself to doing crunches on the floor in front of a few onlookers, I had to figure out something else to improve my FuelBand numbers. It was at this point that I made the decision to haul myself out of the comfortable reverie of slumber and begin my quest for 10,000 steps at 5:30 in the morning.

Puffed up like the Stay-Puft Marshmallow Man, I began greeting Andrew as he entered the office each morning at 8:15 with my 3000+ steps already showing on my FuelBand. My good-natured friend would with humor acknowledge his deficit and the day would move forward.

All of this effort on healthy movement lasted for about two months. Not sure how or why it happened, but we all sort of lost our competitive spirit. We still get plenty of movement in during the course of the day, but the teasing and tormenting has fallen by the wayside.

Most of us in the clinic still embrace the habit of healthy movement. Andrew has replaced his office chair with a huge blue ball -- core training at its best during office hours. For me, I can still find time to run in place as I wait for a fax or am taking a lengthy phone call, but I now find that the best movement I get seems to be when I have waited too long to use the restroom and, at the point of almost no return, am sometimes forced to dance around waiting for the room to be less occupied.

Wednesday, September 21, 2016

Best Party Ever

By far, the best party ever was "The Run for the Roses" party we hosted in May, and it is one that I would do again or attend in a heartbeat.

Normally, we host events for our church group, and there is no particular theme: we just want to bring together our faith community of friends for informal fun and fellowship. An April trip through Kentucky, though, with a stop at Churchill Downs, inspired my husband and me to plan a party with a Kentucky Derby theme.

It may have been learning that there was really something to "the most exciting two minutes in sports," or it may have been a greater understanding of the history and tradition of the Derby -- I don't know -- we just came back home and the idea just grew.

The Kentucky Derby is always on the first Saturday in May, so with literally less than an month to pull this off, we went to work. Online invitations made it easy to create a theme-appropriate evite. Less easy was organizing how and what we would do once the party gathered. Wanting to have our guests get into the fun of the party, our first idea was to encourage anyone interested in placing a "bet" to download our version of the "racing form," complete it, and send it back before the actual race. There would be prizes for anyone whose horse won -- or who actually scored the trifecta: all three horses in winning order.

As fashion is as big a deal at the Derby as the race itself, guests were invited to dress Derby-style in any way shape or form they chose. A simple (or not so simple hat), elaborate dresses and suits, ties and the like were encouraged, and the guests did not disappoint. I am sorry to say that we did not take photos of our company as they arrived, because it was delightful to see how our group of about a dozen embraced the challenge. My favorite, if I had one, was our friend Dennis who came decked out in a white suit, black string tie and a hat -- clearly the image of Col. Sanders!

For the bill of fare, our potluck assortment included many bourbon-inspired dishes: fruit salad with a bourbon dressing, BBQ ribs, a spicy sausage casserole, Benedictine spread and, of course, Derby Pie.

No Derby event would be complete without the famous Mint Julep, and we did not overlook this important detail. As we are not cocktail drinkers, we had all the ingredients necessary for the potent potable, along with the recipe. Our guests were encouraged to build their own, or just use the pre-mixed Mint Julep we found at the local liquor store.

Completing our party activities were two multiple choice trivia contests: one on the Derby itself and the other on Kentucky history (who would have thought that Johnny Depp was born in Kentucky??). Prizes for winners of these contests, as well as for the race itself included a Southern Living magazine, a bag of glazed pecans, and a bottle of Kentucky bourbon.

The highlight, though, was our Kentucky Bourbon tasting. Anyone who was of a mind could bring a bottle of their favorite Kentucky bourbon for a little competition, and our party closed with our spirited (literally) group enjoying conversation on family, work, life and the Derby.

So for what it is worth, our spur-of-the-moment, themed party was a great success. Bringing together our friends is always fun, and while we do not need a reason to host such gatherings, this one will be remembered for a long, long time. Next year? Well perhaps we will all be inspired to put together a Triple Crown event!

Tuesday, September 13, 2016

Perfect View (Writing Challenge 6)

The view from my office window does not afford me much in the way of a tremendous scene in as much as it is obscured by a very large leafy tree. From the second story window, though, I am the proud observer of the many weather changes that come and go throughout a workday in Portland and am surprised by the connection I feel to the natural world on the other side of window.

Today the view is green. The tree, with its many long branches rife with leaves of both green and yellow, is dancing as a brisk wind moves through, pushing the branches back and forth. Looking through the sheltered branches closest to my window, I see the wind roughly playing with the branches on the wide open other side.

Occasionally the wind calms to a gentle breeze and the branches slow to imperceptible movement, but the leaves continue fluttering on their limbs. Beyond the tree and across the parking below, three tall fir trees stately stand, guarded, as it were, by several Aspen trees. These trees perform their dance, entertaining the majestic conifers while the wind swirls around them. When the wind picks up, these trees join in the dance, their movements slower, clunkier than their smaller attendants.

On sunny days like today the morning sunlight brightens a flawless blue sky that provides a nice backdrop to the scene. As the day moves, and the sunlight along with it, the blue will deepen its hue, forcing the trees to pop in contrast. At this point in the day I am able to shut off the small desk lamp, as the sun offers ample illumination to my tasks.

I like this view. It matches my moods through the day. The shade afforded in the early morning facilitates the quiet, steady desk and computer work I do. As the light creeps around the building, the perception changes as the light forces its attentions on the tree outside my window, and in sync, my mood shifts to more active tasks -- so much so that by the time I am once again settled at my desk, I feel the sun in its late afternoon westward travel. The wind may have calmed or even died, and the trees, no longer happily dancing, shut down for the evening -- just like me.

Monday, September 12, 2016

Before and After with My Water Container (Writing Challenge Day 5)

Given the fact that the human body is roughly 60% water, you would think that we would naturally gravitate to any and all ways to replenish this vital fluid. Yet many of us don't get close to the amount of water we need on a daily basis. Until a little more than two years ago, I could have been considered among those who avoided water (almost) at all costs.

I really convinced myself that unless there was some fizz to it, I couldn't drink water. Coffee? Sure. Tea - iced or otherwise? You bet! Soda? Ah, soda...there you had me. There was nothing like popping the tab on a can of cold pop to hear the escaping pressure of carbonation, or seeing the bubbles rising to the top as I twisted the cap on a bottle of Diet Coke. And I didn't wait for a reasonable hour of the day to indulge in this, either. While so many others grasped that cup filled with the black gold of coffee as soon as they arose, I was completely happy grabbing  a can of pop.

Of course it did not help that I never really felt thirsty as the day progressed. I would have to say that for the most part, hydrating through the day, be it iced tea, coffee or soda generally was attached to eating something, or, even in an effort to avoid eating something.

A little more than two years ago, I engaged the help of an optimal living coach, with the goal in mind of keeping my (good) health ahead of the aging curve so that I could continue to be Jeannine's primary life manager and ease the burden of my other children who I knew would step up if needed should I crump. It was not an easy decision,  and it was not pretty when, as we progressed through my health assessment, I had the humiliating confirmation that I had no consistent habits of health.

The first thing we tackled was this very issue of hydration. My coach told me that I needed to deep six the pop and replace it with water - half my body weight in ounces each day. Thankfully we put some strategies in place that would facilitate me drinking this much, which is the standard habit of water health. This is when my water container became my favorite thing.

My container is nothing really out of the ordinary: these 24 oz plastic glasses can be found in high-end department stores, coffee bars and dollar stores. Mine has a permanent straw and a screw-on lid. Armed with this, I began this change to healthy hydration -- drinking at least 85 ounces each day.

Ironically, I found that it was really quite easy to dump the soda. As long as I had my container filled with ice water, I was fine. After about a week, I was routinely consuming not only 85 ounces, but 90 ounces or more! There was the slight drawback during that first week of bathroom running, but it was not very long before my body adjusted to the new and improved hydration system, and my "visits to the necessary" decreased.

I also found that my skin looks better. I have had many comments about how I look younger and I even seem to have more energy. I feel better focused on everyday tasks. By taking the container of ice water to bed each night, I can sip on it if I happen to wake up, and seeing it sitting on my nightstand when I get up encourages me to start my hydration routine for the day. The biggest plus, though, is that by making this change to water, I have lost weight and am better able to maintain the loss.

There really has been no downside to having this water container. As a matter of fact, if I happen to forget it, I feel lost without it!

Sunday, September 11, 2016

" I don't know where my manners are. Here it is, nearly 11:30. You must be parched."

This is one of my favorite quotes from The Money Pit. That is not to say that there were a great many other lines from the movie that are equally funny, it is just that this particular line, delivered to perfection by Tom Hanks, pulls together his character's frustration, annoyance and resignation to his growing realization that the house he purchased was a monumental mistake.

Now this could have been written and delivered as one statement, but the fact that it is broken into three separate sentences allows Hanks, as Walter Fielding, to subtly express his bewilderment that the plumber he wants to hire to fix the rotten pipes in "The Pit," actually asks for alcohol so early in the day. The viewer also sees Fielding as the helpless victim -- not a potential customer ready to do business, and who would otherwise have the upper hand -- and the lines give him some measure of control in a situation where he sees himself almost begging for this guy to do the repairs he desperately needs. What is even more funny is that he doesn't even know if the plumber is any good. And of course the plumber is quite oblivious to Walter's remark.

I have used these lines (or a variation thereof) many times in the course of the years. Most of the time they are aimed at Tim whenever I feel that he thinks I have overlooked some minor something in attending to his needs. In these instances, I feel (as Walter did), I have no control of that immediate moment in my life, and this happens to be a great way for me to let it go. Unlike the plumber, Tim is very much aware of having annoyed me, and making this statement allows us to take a moment, relive the scene and then laugh.

So for what it is worth, this is one of the best movies I have seen on many levels: the story itself, the acting (it is Tom Hanks, after all), and a well-written script. Turner Classic Movies suggests it is a loosely done remake of Mr. Blandings Builds His Dream House, and if so, Hanks does a wonderful job recreating the Cary Grant character (Mr. Blandings). While not an apples-to-apples version of the Cary Grant movie, The Money Pit, is a humorous, light-hearted film most people will find enjoyable. There are far too many scenes of both disaster and stupidity to detail here - and far too many funny lines, but this is one movie that I would take the time to view again and again...and actually, I have!

Saturday, September 10, 2016

Himaylan Salt Grinder

There really is no end to the healthy eating trends that come and go. One craze, it seems, is using Himalayan Pink Salt in place of regular salt or sea salt, or even the Mediterranean variety. Since beginning my journey to healthier living, I succumbed to the trend and purchased some a while ago because it was supposed to be mineral rich, thereby being of greater nutrient content than the more common white variety. I use it mostly to season cooked food, and not a lot in actual prep (like salting water for pasta, etc.,). The really nice thing is that I found it in crystal form with its own grinder that matches grinders for pepper and regular salt....which is pretty cool.

I have to say that it is really quite beautiful. I bought this grinder at Costco, so you know that there is enough salt to last at least five years. The container itself is more or less cube shaped, about as tall as a dinner knife, clear plastic, mostly, but the grinder at the top is round and black with a narrow cap to catch the fine powdery salt that at one time were pink and dirty white crystals before grinding.

The whole thing is 2/3 container and 1/3 grinder unit. Two of the container sides are smooth and the edges are rounded. A brown, pink and black label on one side identifies the Kirkland Signature Himalayan Pink Salt, and an almost identical label on the opposite side has the requisite ingredient and nutrient facts. It is fairly light in weight and there is an almost imperceptible "give" if the container is squeezed.

The container is now about 1/3 full, so upending it to feed the crystals into the grinder sounds like one of those children's toys that are filled with small beads or pellets -- and if I turn it on its side and try to roll it along the counter, it sounds remarkably like one of the FisherPrice push toys on a stick (remember the FP Vacuum Cleaner???). As I actually use the grinder, which is not so easy to twist, I am reminded of the sound made when trying to turn the handle on the penny gumball machines commonly found at the entrances to grocery stores when I was growing's versions are filled with M&Ms and cost a quarter!

Unlike the pepper, the salt has no scent, so the container has no odor -- although there have been times when I have wiped it down with a cleaning cloth so that it doesn't smell like the salmon (or any other raw protein) I had been handling. Ten or so twists on the grinder creates about a 1/2 teaspoon of finely ground salt, which, when tasted, is not as pungent as its more common variety.

I really have no clue if my health is better for using Himalayan Pink Salt, but I have to say that it does look neat standing proudly on the counter at the back of my cooktop next to the Kirkland Signature Black Pepper Grinder and the now less-favored Kirkland Signature Mediterranean Sea Salt Grinder.

"Born This Way" ........or Not

Young adults born with Down syndrome pursue their passions while defying society's expectations. 

The statement above is the synopsis for the "docu-series" Born This Way.  At my daughter Mary's suggestion, I watched an episode of the program because she thought I would enjoy seeing how a group of seven young adults with Down syndrome interact with each other and the world. She also thought I would appreciate the connection between the cast and Jeannine. After viewing the episode, I have concluded that there are some significant problems with what is presented.

First, it was difficult to watch the episode "Bachelor Pad" without feeling pretty much like a failure. Two of the young men, Sean and Steven, are buddies and their parents decide that it is time for them to exert some independence. They find them an AirBNB house to rent, and, having enlisted the services of a company that provides live-in support, Sean and Steven move in together.

Of course the plan is not without its bumps: Steven packs everything except his pants, and both young men want dibs on the same bedroom. Sean wins the room in the end, but his mother makes certain that he knows he will have to compromise when the next conflict comes.

The fascinating thing about this was the scene where the guys are sitting down to a burrito lunch they prepared themselves and opened up to each other about being nervous living without their parents on site. Could I see Jeannine in a similar situation? I don't know...I might be able to see her living independently from me, but I certainly could not see her expressing herself with the insight these two men did.

In a side story, John, who wants to pursue a career in entertainment as an R&B songwriter-singer-dancer, performs at an event and his mother comes right out and tells him she was disappointed. Ahead of his performance, she tried to encourage him to practice, but to no avail...and his performance showed it. She was all about how he could do better and she knew it. To his credit, he said he did not want to disappoint her and the "next time" he would be better. Again, could I see Jeannine making a choice to do something -- and do something well -- simply because she did not want to disappoint me? Nope. The flaw here is not that these wonderful people do not have dreams and aspirations. They do. Jeannine does. But what they see in their dreams most people believe are attained simply because they want it. There is no hard work, practice, training and discipline. It just happens.

I see this quite often with Jeannine. Her latest passion is that she wants to participate in Special Olympics swimming for the first time in several years. Inspired by the events of the latest Olympic Games, she is determined to swim as well as Katie Ledecky and win as many gold medals as Michael Phelps. While she is a decent swimmer, having won her share of medals and ribbons from past meets, the reality is that others can and have surpassed her in skill and speed. When gently suggesting that she do more during the limited swim practices than hang on the side of the pool chatting with others, she becomes irritated; yet she sees herself swimming with speed and ease, earning that precious gold medal.

Then there is Elena, a young woman of Japanese descent, who not only deals with Down syndrome, but, like so many others, has to work through other emotional issues. In this episode, she talks with her mom about her emotional "roller coaster" and in the end, agrees to start some medication that might help get her emotions under better control. Do I believe Jeannine has that insight into herself, her moods, her emotions? Do I believe that most people with Down syndrome have that great capacity of self reflection that leads them to a conclusion like Elena's to do something to help make their situation better? I just don't see it happening in the majority of instances.

So for what it is worth, it was really depressing to watch Born This Way. I kept trying to tell myself that this could not be real: these people with Down syndrome could not have such great insight into who they are, with an ability to articulate how they are feeling.  I wonder how much of this was true and how much was scripted. I kept trying to see myself having these sorts of conversations with Jeannine, but the reality is that she does not have that maturity shown by these characters in the program. My conclusion is that either these wonderful individuals who happen to have Down syndrome must function at a much higher level than most, or, there is much more going on behind the scenes of this "docu-series" than the viewing audience is given to understand. Perhaps, though, the fault is all mine for making choices for Jeannine throughout her life that maybe did not allow for her to develop to the fullest all her wonderful talents and abilities....but I doubt it.

Tuesday, September 6, 2016

The Fine Skill of Reading Aloud

Part of the fun of social media sites like Facebook has to be reconnecting with people and places from my childhood. There is a Facebook group of hundreds of people who "Grew Up in Overland Park," and the memories that brings when someone posts a photo or a news clipping from some part of my growing up years there is such fun.

A closer-knit group I see on Facebook are those of my classmates (and teachers) from both grade and high school. It, too, is wonderful to jog our memories of times past -- sometimes happy, sometimes embarrassing -- but always interesting to me. One of the nicest connections I have made in recent months is with my third grade teacher, Mary Wiles. While I have had many teachers who have inspired and challenged me; some who I never appreciated either as an educator or human being, Miss Wiles was just plain kind. She had a way of engaging me in learning that I (obviously) never forgot.

Perhaps the best memory I have of time spent in Room 103 were those afternoons after noon recess when she read to the class. Be it a hot Kansas spring or snowy winter, it was pleasant to sit and listen as she read from one of the books from the school library.

My favorite was St. Therese and the Roses by Helen Walker Homan. I could not say why I recall this so clearly, except that it had to have been the most perfectly written children's book on a saint I had ever seen. I remember Miss Wiles, whose voice was soft, kind and friendly, reading perhaps a chapter each afternoon, and I would hang on every word. It was amazing to me how this great saint could be brought to life first in the way the story was written, but even more so as Miss Wiles read it out loud to the some 32 of us in the class.  I still recall hearing about St. Therese as a small child, and how in childlike simplicity wondered why that little "baby Jesus wouldn't toss that ball He was holding" to her, even after she "promised" to toss it back to Him. Of course, as an adult I understand that she was referring to a statue of the Infant of Prague, who holds the world in His hand, but at the time I remember thinking how incredible it was that a child as young as she was would like "to play catch" with the Little Infant.

More than that, though, it was evident that Miss Wiles was as engaged in the story as any of us. Some parts she read with enthusiasm -- especially when Therese approached the Pope to petition joining the convent as a young teen; at others, particularly when the young saint lost her mother to cancer, she read with sadness and pain -- as if she were there witnessing the event.

It wasn't too long before the story came to a close, with the beloved saint promising to "shower the earth with roses" after her death. In the weekly visit to the library, I remember searching for that hardbound book with the blue cover and the simple illustrations scattered throughout the story. I wanted to hold it in my hands and read the words that Miss Wiles had brought to life.

I know that I checked the book out multiple times during my grade school years; I never tired of rereading the blessed life of this young saint.

So for what it is worth, I don't believe that I was ever much of a reader before third grade; it only took one very compelling and well-written story, read with simplicity by one of my favorite teachers to spark an interest in the written word that I still have today. Amazing.

Saturday, September 3, 2016

In the Clinic with Pandora

When we first opened Cleary Medical in 2004, the office design included a sound system that allowed either radio or CD music to play throughout the office. Once settled into a daily routine, I quickly discovered that the CD option was cumbersome. The player did not shuffle the songs between the CDs in the player and then Jeannine figured out how to have songs repeat. Not amusing to keep hearing Bobby Darin's "Beyond the Sea" for an hour or so until the song was stuck in your head for three days.

The challenge for the radio was finding a radio station that satisfied both employees and patients. I would have been happy with the classical music station, but the signal was too weak for a clear connection. Employees preferred the harder rock stations, but Tim did not think his elderly patients would appreciate it. After some trial and error, we settled on a middle-of-the-road station that was popular in most offices and businesses in the Portland metro area.

The "soft rock" station worked worked well for us for many years until last Christmas season when the station decided to play nothing but Christmas music from November 1 to December 26.  In the years leading up to this, the station would start interspersing Christmas songs throughout the day, beginning the day after Thanksgiving, and then reserve a 24-hour Christmas music marathon starting Christmas Eve -- they even had a catchy little title "A K--- Musical Christmas Card" to promote it. Last year, though, they started playing Christmas songs just after Halloween and full-blown 24-hour Christmas music from Thanksgiving to the day after Christmas.

Coupled with the preprogrammed run of music that cycled over and over though the day during the regular course of the year, we finally had it, and began searching for options. We considered purchasing programs like Sirius, but it was an expense I really did not want to incur. Then I discovered Pandora. What a really nice app! Like Celtic music? have a station! Weird Al?...there it is! Zither music?'re covered! Not that I am interested in any of these styles, I was just amazed that there was a station for them (or that there was a following for zither music). I settled on the "Solo Piano Station" because it was easy on my ears, not distracting, no singing....just soothing music. Since no one complained, I won an easy victory!

Not gifted with a mind that quickly grasps technology, but very high on getting things off my "to do" list, I opted for the lazy-person's version of piped music and put my iPad in a strategic place concealed in the waiting area. I downloaded the free version of Pandora and we were set to go. It seemed, though, that no matter where I placed it, patients would typically find it and ask if someone had left it. To another point, the free version peters out after an hour or so and it became a chore to unearth the iPad and restart it. The other problem was that, while the sound quality was quite exceptional, it wasn't playing throughout the office, and when on the highest volume setting, it was really loud in the waiting room.

I decided that I would place it in the back office hallway where the music could diffuse in a larger space. This way, any phone conversations, patient conversations and the like were less likely to be overheard. Even though I still had to restart the program every so often, it was much better than the waiting room option. We have been using this for months now and it works very well.

The program has also been a source of practical joking as once Andrew and I changed the station to "Celtic Music" and our ever-so-British Danika almost immediately called us on it, saying she thought the music was depressing and please change it spite of the fact that on occasion the Solo Piano Station we will occasionally play an instrumental version of "Scotland the Brave" (and we take great delight in increasing the volume just to annoy Danika.

So for what it is worth, while the "thrifty" version of Pandora has its drawbacks in terms of starting and restarting the program, it is yet another way staff connects with me. When the iPad goes silent, it is usually the cue for me to call out, "Are we 'STILL LISTENING'?"....and more often than not, Andrew will chime back, "Still listening!" as he opens the iPad and restarts the music.

Friday, July 29, 2016

The Age of Reason Revisited

"These are the times that try men's souls."

Thomas Paine, one of many patriots in America's fight for independence, wrote that famous opening sentence in The American Crisis, and it is indeed a fitting statement for our times, I believe. While I did not engage in gavel-to-gavel viewing of either political convention, from the social media comments and slanted media reporting of events in Cleveland and Philadelphia, I have come to the conclusion that the "great American experiment" is in its final throes of life.

The pundits drilled into our heads that the Republican party was fractured and its eventual presidential nominee is too much a "loose cannon, angry, unprincipled and shady businessman" who has no experience for the "top job in the land." On the other hand, it seems that the Democrats were more fractured and divided: Bernie supporters were very openly told to "get over" their beliefs and support an "untrustworthy, lying, unscrupulous" woman who has never worked outside of government in her life (even her legal career was attached to some government entity or another), but somehow has the experience for the "top job in the land."

America has drifted very far from the early years of our republic and the reasons why our ancestors embraced the noble cause of freedom, to the point that we now find ourselves at a crossroads. As over the top as this may sound, that crossroads will take us either to renewed freedom or total enslavement.

Consider: the continuation of Mr. Paine's opening paragraph describes in very simple, yet clear, language how tyranny grows in a society, and, in my opinion, like a cancer in the human body, "is not easily conquered." Once given an opening, tyranny becomes an all-consuming monster until, left unchecked, fully enslaves its this instance the United States. For some perspective we only have to look at the spread of government influence in our lives to see that our situation is dire.

Mr. Paine wrote, focusing his attention on the "tyrant" Great Britain, that she "has declared that she has a right (not only to tax) but 'to bind us in all cases whatsoever.'"  Is there not a resemblance today? Has not our federal government become the Great Britain of our age?

When our elected representatives, in the early part of the 20th century, allowed for the creation of the Federal Reserve System, with the power to tax, the nation put itself on a path to destruction. For in that one action, Americans were placed on that slippery slope to slavery. Mind you, it was not easy; even cancer has a difficult time progressing when the body itself is healthy and strong. So, with the help of a Congress that has abdicated its Constitutional authority, this tyranny -- this cancer -- has metastasized to other parts of our national body and now we find ourselves bound in just about "all cases" -- all aspects of our lives: education, housing, public welfare, health -- there does not seem to be a part of our lives that does not have the stench of this tyranny on us.

The very sad thing is that the failsafe, that antidote called the Bill of Rights which is the chemotherapy our country needs, is somehow too costly and painful for Americans to embrace. States rights? ....they have none when the Supreme Court reverses decisions on matters that are Constitutionally reserved to the states. Freedom of speech? ....well, that depends on what you say. Religious freedom? ....only (it seems) if the religious beliefs are subjugated to the will of the state. The right to keep and bear arms? ....only if you report everything to some government body to regulate.

It goes on and on, and "we the people" have an ever-diminishing voice as the cancer of tyranny, emboldened by division and class warfare, now rapidly moves to take the very breath of liberty from us.

Perhaps we as a nation have come too far from those days of our ancestors, and we have obtained too easily the freedoms previous generations of Americans fought to preserve, and therefore, as Mr. Paine says, we "esteem it too lightly." While the trendy idea would be to place blame of some sort or another as to why and how this happened, it is really in our own best interest to remove ourselves from the comfort zone of victimization and toward the active task of treating this cancer before it consumes us.

Should we as a nation truly believe in the ideals of freedom, then we must, as Mr. Paine again says, embrace that our current situation is that of our own making and that "by perseverance and fortitude we have the prospect of a glorious issue;" and freedom will yet ring again between our borders; but that, by doing nothing, "by cowardice and submission, the sad choice of variety of evils - a ravaged country -- a depopulated city -- habitations without safety, and slavery without hope" will be our lot.

I know that many will not subscribe to the picture I have painted of our current reality, but I hope some will see that my heart and affection for what was bought by the price of blood and nurtured by the dreams and ideals of our ancestors is true and pure. I can only add that at this crossroads, we can somehow find our way back, or, to conclude with Mr. Paine, we shall "look on this picture and weep over it! And if there yet remains one thoughtless wretch who believes it not, let him suffer it unlamented."

Tuesday, July 12, 2016

Watching Old Movies

Not unlike many of my friends who grew up in the 1960s and stumbled through adolsecence in the early 1970s, I earned spending money babysitting. I must have been pretty good because I found myself keeping quite busy from Friday nights through Sunday afternoons (and sometimes on week nights) managing children so that parents could get away for a few hours to enjoy a "date night," engage in community charity events or fulfill some social or business obligations.

Once the children were settled for the night, I would clean up any messes we made, then I would either work on homework or check out what was on television. Keep in mind that in the early 1970s there was nothing close to 24/7 news and sports coverage, cable with channels dedicated to food, movies, DIY programs, or reality shows which are so common now. Depending on where I was babysitting (some families had better television coverage than others), I was fortunate if my choices expanded to four channels.

One thing I could count on, though, was that Friday and Saturday nights typically aired old movies after the 10 o'clock news. I'd check in on my little charges to be sure all was right in their dream world, then I would switch on the TV, ready to be transported to wherever the film would take me.

Most of the time the movie was what my Mom used to call "a B movie" -- the ones starring the less than high profile actors and actresses of the time or the early pictures of rising stars. Fred MacMurray, Barbara Stanwyck, June Allyson, Kirk Douglas and Van Heflin, were the headliners, although every now and then I might see Rosalind Russell, Katharine Hepburn, Clark Gable, Lana Turner and Spencer Tracy. It really didn't matter too much; I was content to see a good story brought to the "screen" with great dialogue, costumes and pretty good acting. It really didn't matter what sort of movie it was: I liked comedies, dramas, historical costume extravaganzas, musicals......westerns, military, horror and sci-fi, not so much. Every now and then the television station would throw me a curve ball and I would find myself watching some movie starring Elvis Presley or one of the post-studio driven movies of the late 1950s or early 1960s. On those evenings, I always prayed that the parents would be home early.

Sometimes the parents did arrive home at their stated time and I would leave before seeing a movie to its conclusion, which was a real bummer if I was enjoying the film. Never fear, though, my mom would not go to bed until she knew I was home and it was not uncommon for me to get in the door to see her sitting in front of the TV watching the same movie I had been viewing. Rather than call it an evening, we would sit together to see the movie to its conclusion and she would recount to me where she had seen the picture in a movie theater "when she was a young thing" and what people thought of the movie at the time.

It was not often that my mom would talk to me much about her life growing up, but those moments shared watching a movie were pretty special. It is funny, now that there are channels dedicated to those "classic" films I have chances to watch them again. I can't see The Ballad of Cable Hogue or Desk Set or Love Me or Leave Me without thinking about her. She would share much about what it was like growing up during those years and when I see these old films again, I can't help but have a richer experience of those years gone by simply because I connected with her.

Now that these classics are so readily available through television and DVD, I still get to be transported to the diverse times and enjoy seeing not only old favorites but others as well. I also am enjoying that I get to see Jeannine enjoy these films. I have been amazed, but she readily enjoys old movies (newer ones as well), and if she happens to catch me folding laundry while watching a Fred Astaire and Ginger Rogers marathon, or whatever "star of the month" is showcased, she will usually watch for awhile and then suggest that when I finish folding clothes we put together some snacks and watch some more. More often though she will suggest that we go online to order the movies so that she can watch them anytime she wants. Her interest was not really in the plot details or the clothes or any of the things that film critics assess. For Jeannine, she likes the relationships she sees, especially those characters who exhibit the qualities of kindness, concern, helpfulness and love.

So for what it is worth, what started out as a means to pass time while children slept has become a lifelong interest and really a passion for me. Movies are a wonderful vehicle for entertainment, escapism and in many ways learning and understanding history. Films like Gone with the Wind, The Buccaneer, Anna and the King of Siam, or The Desert Fox, whose historical settings bring to life the events of previous times and  deepen our understanding of the people and places which cannot be gleaned by mere facts and dates alone. From the comedies, especially those starring Cary Grant, Danny Kaye or Doris Day, we are able to tap into many of the foibles and inconsistencies in human nature that we all share. Beyond all of this, though, I have a tremendous fondness for what film has done for me in connecting with others; first my mom and now Jeannine. On one level it was a way to know and understand my mom that could not have been communicated otherwise; on another, it is a way to stay engaged with Jeannine even if it costs me playing Fred Astaire to her Ginger Rogers as we recreate some dance sequence from The Barkleys of Broadway.

Thursday, July 7, 2016

To Serve and Protect

A sad and appalling incident making headlines today brought back a flood of memories for me. It seems that any news story involving some disabled person can elicit a strong response from me -- be it joy and wonder, or in this instance anger and pain.

Many may have read about Hannah Cohen, a disabled 19-year old woman who was beaten by TSA agents at the Memphis airport.  Complete details of the story and subsequent lawsuit are detailed here.

All of this brought to mind an incident we had at Portland International Airport two years ago. Jeannine, my daughter with Down syndrome, her father Tim and I were flying to Tucson: I was attending a health coach training meeting and Tim and Jeannine were tagging along to spend some time together at "a nice hotel," as Jeannine likes to say.

I have my own opinion about the current political state in which we live, but that aside, we had all our "papers" in order and proceeded to the cattle line to go through the security check point. It was all lovely as one of the TSA attendants, likely seeing we were traveling with a special needs person, approached us and invited us to go through the Pre-check line. "Wow," I thought to myself, "this should give Tim some relief that he won't have to worry about me making a scene!"

That was short-lived. Tim and I breezed through the line; then came Jeannine. She bantered with the agent, telling him that she was going to Tucson and would be staying in a nice hotel and going swimming and having a good time. What he responded I do not know, but the next thing I knew he was asking her how old she was. "Eighteen," she replied, and of course added that "I am going to be 19 next February."

He stopped her there and asked if she had any identification. She looked up, bewildered. He asked again if she had any identification. At this point I figured out what was going on and asked Jeannine if she had her identification card with her. She carries the "state issued" card with her, and just needed to have the question asked in a way she understood. She then told me she did not have her wallet with her.

Jeannine does not understand the concept of "traveling light," and when she goes anywhere, even if it is just an overnight, she will carry more clothes than she needs, more books that she will read, office supplies and photo albums. I will own this mistake; I told her that she did not need to bring everything with her on the trip and she decided she really did not need her purse or wallet. One has to have priorities, I suppose.

Anyway, the ensuing half hour was one that I do not want to have to relive. I suddenly found myself on the floor at the checkpoint, tearing my own things apart in an effort to find something that would satisfy them as to her identity. Did I have her library card? Yes, that wouldn't work because, while her name was on it, it was in her handwriting. The agent asked if we had any medication. Well yes, but it was in her checked bag.

By this time other travelers were backing up in the "Pre-Check" line, so we moved aside still trying to figure out what to do. Tim kept watching me: he was well aware of my opinion of this sort of violation of our rights, and I knew he was in fear that I would create a horrible scene. The agent made a phone call but would not tell us to whom -- I supposed it was to some next level up agent to get some direction. Seriously, this should be a no-brainer. Here is a young person with clear physical indications of developmental impairment, traveling with two adults who happened to have all the "proper papers." Couldn't there be reasonable accommodation afforded here?

The agent then approached me and Tim to let us know that they would have to take Jeannine aside and question her -- alone. My heart sank. I knew that this was going to take a very long time, as Jeannine's anxiety level increases in stressful situations. To be taken apart from her parents to go with strangers in uniforms? I knew that even if they asked straight-forward questions, she might not process them correctly and start giving answers that might not be 100% accurate. Things like her phone number (she knows several), her address (she can transpose numbers), where she was born (in a hospital and it rained hard that day).

Thankfully, this interrogation took place just a few feet from where we were standing. One agent was at a computer, another faced Jeannine to ask the questions. She was able to answer her name, birthday and how old she was. Then the agent asked her which parent she knew better, Mom or Dad. She looked toward me for clarification and the agent told me I could not help her. I just prayed that she would pick me, because of the two of us, Jeannine has more accurate information about me than Tim (she thinks Tim is 45 -- another story).

She chose her Dad and I just thought that we would end up -- all three of us -- in some FBI office being held on suspicion of something or other. What happened next was quite surprising. The agent behind the computer apparently had access to a database and funneled questions to the other agent. They asked her his birthdate (thankfully, not his age), what he did, where he worked (the specific address). She answered most of these questions without glancing our way, and apparently her answers were fine, because the next thing I knew, the agent asked that she and I go through the "special" screening process where we were wanded down, had our hands screened and Jeannine's backpack tested for I don't know what. We were dismissed with the caution that we needed to have some sort of identification for Jeannine on our return flight (duh).

By this time, our flight was getting ready to board and Tim sent me on ahead, the thought being that it was more important for me to get on the flight than either him or Jeannine. In the end we all made it; I called daughter to have her overnight Jeannine's wallet to us at the hotel in Tucson, making certain that her identification card was in it.

While I can appreciate the "efforts" our government is taking to keep us "safe and secure," in this age of "terror," somewhere along the way reason and sanity have been lost. Even though our incident with TSA did not end up with physical injuries like what happened to Hannah Cohen, I know exactly how Hannah's mother must have felt as she helplessly watched her helpless child, confused and upset, became a victim at the hands of those who are supposed to serve and protect us. It is also disturbing that at the click of a mouse, any information these agents need about us is available for use or misuse. At the end of the day, I know that in spite of Jeannine's need to be free and independent, I will just have to suck it up and continue to harass her about the things she needs to have to be a strong, independent woman (that is, her state-issued identification). I also know that when it comes to "serve and protect," we cannot and should not depend on anyone but ourselves to shield the most vulnerable in our lives.

Monday, July 4, 2016

In the Clinic at Monthy Staff Meetings

It took me a very long time to actually schedule regular staff meetings for the office. Quite frankly, when the staff was just me and a medical assistant, there was little need to have a formal time set aside to update workflows or disseminate information and address any problems that surfaced. As we added more administrative and back office support, however, there became a crying need to keep everyone on the same page as well as provide a place where general clinic workflows could be handled.

Not that I was consistent, mind you. There were years where three or four months passed between meetings. Even then, the meeting agenda seemed to focus on upcoming changes to our computers or, most often, my efforts to redirect employee behaviors in a non-confrontational manner. As we grew from a staff of two, with one provider, to a staff of four and a half supporting two and a half providers, it just became necessary to be consistent with these monthly meetings.

The first Thursday of the month is the chosen day for this monthly gathering and we try to get things started by 3 pm. We block the schedule out at 1 pm so that the providers are able to finish with any patients coming through the office, and enable all of us to work on our desktops so there is no last minute rush to finish work after the meeting concludes. In order to make the event less threatening, I decided that a light bill of fare, complete with wine might be helpful. Tim had no objection to this, and we encouraged staff to contribute whatever they might like to the meeting snacks.

Little did I know that this would throw a salvo of panic through our otherwise merry little band of coworkers. In an attempt to model the behavior, Tim and I would try to contribute healthy choices like veggies or fresh fruit, cheese, crackers or bread, along with one bottle of red wine, one bottle of white wine and a sparkling cider for those who were interested. All Thursday morning, the banter heard throughout the office swirled around who was bringing what and if someone needed to go out at lunch to pick up anything. By the time we gathered for the meeting, though, we were able to settle in and tackle the agenda.

The biggest hurdle in these meetings besides the food, that is, has been to find a way for Jeannine to be part of the discussions in a meaningful way.  As much as we have worked on her "conversation" skills, she still has a remarkable way of grabbing the floor and launching a stream-of-consciousness stand-up act that covers anything from her organizing the patient confirmation calls, to Danika taking her for a "spa day" sometime in the nebulous future, to how she is going to be getting another job somewhere else because her job at Cleary Medical is too stressful.

Thankfully we are more family than coworkers, so Danika, Andrew, Mary, Maureen and Tim patiently sit and nod as she takes over directing the meeting. At length, however, I have to intervene, at which point she rises from her seat and storms out of the meeting. Understand that our meetings are held in our patient waiting area where there is the most room for all of us to gather, and as she bolts through the door to the reception area, we can all see her running -- flailing, really -- her head tossing from side to side until she disappears to the back office.

As I regain control of the meeting, Jeannine decides that I have not been punished enough. We hear her talking to herself, mostly quoting movies and television programs that are amazingly germane to the situation. Quotes like, "You weren't invited," or "Nobody asked me...." can be heard quite clearly from the back office. It doesn't help that everyone but me starts laughing in a kind and knowing sort of way. Luckily as we are closing in on the end of the meeting, which is reserved for the "I Spied..." comments, and as the staff really look forward to going home right after the meeting, we refocus.

We instituted the "I Spied..." comments for two large reasons. In an attempt to do some team building, I thought it would be a good idea for us to place little handwritten notes in a box, each note beginning, "I spied....." and completed with whatever the person spied someone doing. "I spied Dr. Cleary cleaning an exam room," or "I spied Andrew making Mary laugh," are some of the things shared. This worked well for a time, especially if we had a new person join the staff and wanted to be sure they felt welcomed.

The second big reason we did this was for Jeannine. Many of the comments were about Jeannine helping by making copies, or printing patient paperwork, or just giving hugs and kindness on busy days. So getting to this part of the meeting always brought her back to the waiting room. Not only did she like hearing about how she was truly a part of the team, she also liked when I read her "I Spied" comments about what she sees, hears and appreciates about each of us....and she was not one to leave someone out: each of us could count on hearing about what she had "spied." The most amusing aspect is that many of her comments have nothing to do with clinic doings. Andrew can count on being told that he is "cute and funny." Danika is her "Cheeto" and when will they go out on a spa date again? Mary is "pretty" and she likes hanging out with her. Dr. Cleary is "handsome" and the greatest man. Maureen is "beautiful" and she likes sharing cookies with her. I, well I am her "beautiful Mom" and the "best cook ever."

So for what it is worth, our monthly staff meetings are much more than going through an agenda of items. It is a time for working on those things that will bring better patient care to the clinic. It is a time for us to come together in what I always hope is a relaxed environment to share ideas, concerns and updates on clinical medicine. More than that, it is fun to watch and hear staff as noon approaches, each offering to help each other get work done so that we can get to the meeting sooner and thereby perhaps leave a little ahead of clinic hours closing. Once again, though, Jeannine steals the show. She provides comic relief as she vents her frustrations with me in particular; she celebrates each of us as individuals with her sometimes out of the blue "I Spied..." comments; and she brings us all together as a team by reminding us of our unique talents and value to the clinic.

Tuesday, June 28, 2016

The Harvest of Engaged Minds

How often do we have the opportunity to actually engage in doing something that we love and be able to see the fruits of that work to the harvest?

In a previous career, I taught middle school. I had the honor and privilege of teaching Writing and Grammar and Social Studies to sixth, seventh and eighth grade students. It was a complete joy to watch students begin the course of work in September and see their progress through until the end of the school year. I always had a special fondness for the end of term reflections that students were required to submit.

This "reflection project"  was not mandated by the school or the school district, the state or the US Department of Education to meet some subjective outcome-based agenda. I required it as a way for students to see what I had been able to observe during those months of school and finally the end of the year: their growth not only for the "grade" they may have earned, but for their growth as thinkers and writers. Students were required to look at and reread their writing assignments at the end of each quarter, then at the semester, then the end of the year. They then selected those pieces which they considered their "best" work and kept them in their portfolio. At the end of the year, they opened that portfolio of their self-described "best" work, reread each assignment and selected what they believed was their overall best effort.

As a way to engage them in this process, -- and to be completely objective --  each student had a questionnaire to guide their reflection. Many students chose work they remembered as being fun (like the poetry or other creative writing projects they did); others chose work that was a "writing across the curriculum" project where they could combine writing (which they did not like) and another subject like science (which they did like).

Funny though, I read reflections where the student could not believe that they "actually wrote that essay in September" and "thought it was my best work" because, compared to their "best work" in May, the September work was "terrible." They reflected on the process of writing, be it an essay of some form, a poem or a story -- the process was the same. From the initial brainstorming to the rough outline, first draft, revisions and final product, each step was part of the process and this paper trail was part of the work to be turned in for a grade.

Of course there were those students who were more engaged in this process than others; that is to be expected. What was amazing to me, however, was that by the end of the year, all of them felt that they were better writers and better thinkers. As they looked back on the year some expressed amazement that they groused and complained at the writing process as the assignments were given (sometimes four completed writing projects each quarter) when they saw how successful they had been by the end of the year.

As a teacher I experienced the wonder of sowing the seeds of learning to (sometimes) reluctant minds, cultivating and then seeing the harvest, but it wasn't what I expected. The greatest satisfaction for me came not by successfully completing the curriculum by the end of the year; the greatest joy was watching the students realize their own success as writers and being able to share in that success through their reflections...a wonderful life experience.

Thursday, June 23, 2016

In the Clinic with Groupies

Being part of a small practice allows us to build strong relationships with people....a good thing by and large. We have a happy working relationship with our staff which has on occasion spilled over into personal things.

In the office, the relationship between Danika and Andrew is that of lead medical assistant and medical assistant. They are also mother and son, which provides some great interactions.

Now Andrew is an exemplary employee as well as outstanding medical assistant. His skills are second only to Danika, who also had the honor of teaching him as he went through medical assistant training. His work ethic is beyond reproach and he takes very seriously each patient encounter. He has a pleasant, friendly, caring personality and has a way of connecting with patients to make them feel at ease.

There is one patient, for example, Fred, who loves Hawaiian shirts. He has never come to the office for a check up or urgent complaint that he is not wearing one of those bold colored, big floral pattern button-down shirts. This is a source of conversation between him and Andrew, especially as Andrew is getting Fred ready for his appointment...checking vital signs, height, well as performing any lab work necessary. The chit-chat goes back and forth and Andrew invariably will make a comment about the shirt. It was not surprising, then, when one morning Fred showed up, without an appointment, asking to speak with Andrew.

It so happened that Andrew was busy with another patient, so Fred had to wait. I noticed that in addition to his hallmark Hawaiian shirt, he was carrying a small parcel. Once Andrew was free, he met Fred across the front office window where Fred presented him with the parcel which contained a Hawaiian shirt. The details surrounding this gift I do not know; Andrew and Fred obviously shared an affinity for them, and Fred's generous nature moved him to do something kind for someone who had shown him kindness. Danika finds this mildly amusing and, I think, feels some maternal pride at how much patients respect and appreciate what we do for them.

There are other patients, however, whose attentions to Andrew provoke that maternal defense mechanism akin to a lioness protecting a cub from some dangerous predator.

Our physician assistant, Maureen, is a tremendously hard-working and skilled practitioner. She is thorough in her examinations and proactive in patient care. She also has a large number of middle-aged and elderly female patients (MAEFP). As Andrew is Maureen's primary medical assistant, it falls to him to take care of things like prescription refills, reporting lab results and the like, as well the usual tasks for patients here for appointments. The "desktop work" typically done by phone and many times he needs to leave a message to call back.

If one of these MAEFPs calls back, they quite reasonably ask to speak with Andrew; however, of this large number of patients, roughly half will speak to no one but Andrew. When they come to the office they can become openly hostile if Danika or another medical assistant have charge over supporting Maureen in the course of their appointment. On top of this, if they call back in response to a voice message some of them will speak "only to Andrew."

Danika, being not only Andrew's mother but also a stiff-upper-lip, proper British lady, is fun to watch and listen to as she "takes on" these "predatory patients."

"Cleary Medical Associates, this is Danika, how may I help you?" she will say as she answers the phone. "I'm sorry, Andrew is not available now, Irene, how may I help you?"

"I'm sorry, Irene, what is it you need? Andrew is with another patient; what can I do for you? Yes, I know that he does a great job with blood draws; many patients have also commented that his skills are very good. Yes, I know that he pleasant and has a good sense of humor. How may I help you today?"
"I see that he called to give you some lab results. I can do this; the results are on your chart. No, Irene, I am capable of giving you these results; Andrew is not available," she continues, an edge to her accent becoming more pronounced; her eyes narrowing as she fights back the impulse to hammer the telephone receiver against the desktop.

By this time, Andrew is free and says he can take the call. As Irene is now on hold, Danika, addressing Andrew says, "NO! She is not going to manipulate us! She thinks that she can only talk with you, and she needs to understand that anyone in the back office is able to address her questions or take a message."

Danika gets back on the phone call, now a little more composed, and very professionally lets Irene know that we work as a team, and the most important thing is that patients receive their testing results in a timely fashion. Obviously Irene agrees and allows Danika to give her the test results, which will necessitate her scheduling a follow up appointment. Danika sets the appointment and ends the call saying, "So we will see you next week, Irene..... Oh, Andrew works everyday and he should be here on Wednesday, but I can't guarantee it. If he isn't, there will be a medical assistant here helping Maureen. Have a nice day. See you next week."

So for what it is worth, it is a blessing to have back office staff who possess outstanding clinical skills. We have struggled for many years to bring together people with a strong work ethic, diligent, caring and personable. It is also a blessing to work with staff who provide not only great medical support, but who are hugely entertaining.

Monday, June 20, 2016

Whatever Happened to Flag Waving?

We are in one of my favorite times of the year: those weeks between Memorial Day and Independence Day. Spring moves into summer, days are longer and with Flag Day falling between these national holidays, we have three opportunities to recall those things unique to our American heritage.

What we have and what we are able celebrate in the 21st century is the direct result of generations of Americans, many of whom, in spite of the disparate cultures and beliefs, came to these shores in optimistic hopes for something better. What they did, and what so many immigrants who come here today are unwilling to do, is set aside their native heritage to become part of and pursue a dream of health, life, happiness and freedom only possible here. Immigrants of the past made the active choice to leave one culture for the hope of creating something greater in a country that valued and rewarded ideals like honesty, integrity, hard work and giving back.

The best example to illustrate this point is Frank Capra. The renowned movie producer and director immigrated from Italy to the United States with his family (parents and six brothers and sisters) in the last decade of the 19th century. As a youngster he sold newspapers, fruit, played the banjo in saloons and worked other odd jobs in order to save money for college.

While studying chemical engineering at Cal Tech, he worked as a waiter, ran the school laundry, worked in a power plant. He also edited the school newspaper and served as a captain in the Cal Tech ROTC unit. The rest of this biographical background can be read at click here

His journey took him into the film industry and most people will remember Capra for his "screwball comedies" of the 1930s and 1940s. What I appreciate about his body of work, though, is how he melded a sometimes crazy storyline with the ideas of social consciousness -- entertaining audiences and at the same time bringing home points of optimism and really, the innate goodness of people. He made movies at a time when people needed to see and feel good about the circumstances in their world, particularly the Great Depression. During World War II, and like other movies made in this time, the undercurrent theme was unabashedly American. With battles and warfare scattered across the globe, Americans still suffering the economic ravages of the Depression, the stresses families felt as loved ones were sent overseas to fight, Capra's movies provided an escape from the harsh realities of life.

Many of the stories Capra brought to the screen portrayed the idea of the struggle of the "little guy" when confronted with those corrupt powerbrokers of business, finance or even government. Besides that now standard Christmas favorite It's a Wonderful Life, those interested should check out You Can't Take it with You, Mr. Deeds Goes to Town, and one of my new favorites, Mr. Smith Goes to Washington. The theme of American individualism, American honesty, the ideals of hard work, being a good neighbor -- those things that are now considered "so much sentimentality" and not so much "reality" are lost on at least two generations of Americans who have little knowledge of our American heritage and what it truly means to be an American.

Francois Truffaut, the iconic French filmmaker, (director, screenwriter, actor and film critic), had this to say about Frank Capra:

In recognizing the facts of human suffering, uncertainty, anxiety, the everyday struggles of life, Capra, with his unquenchable optimism, was a healing force. This good doctor, who was also a great director, became a restorer of men's spirits.

In these very uncertain times with the threats of war and global terrorism, American cities suffering the ravages of unemployment, increased crime, widespread corporate and government corruption, wouldn't it be great if another Frank Capra -- immigrant-turned-American -- emerged to remind us of the optimism and hope that really is what America is all about? Everyday struggles are the plight of all humans, but what America offered was an ability to build a brighter life in spite of the obstacles, simply because American culture fostered the idea that hard work, honesty, ingenuity and the value of the individual are the things that the human spirit needs to thrive in this life.

So we fly our American flag from Memorial Day through Independence Day. It is a simple thing to do and a wonderful reminder of what it is to be American.

Thursday, June 16, 2016

In the Clinic the Struggle for Understanding Can Be Humorous

One of the nicest benefits to being part of a small medical practice is that patients come to know each of the staff, and the interactions can be pleasant and, at times, amusing.

A few years ago, when the only "associates" to Cleary Medical Associates were our medical assistant, Jeannine and me, Dr. Cleary had a middle-aged gay patient who unfortunately had a host of chronic care diseases. When Barry came to the office it was typically an extended appointment. Barry did not drive and really came a long distance to see Tim.

One afternoon, Barry came for his appointment and with him was his partner, Jess. As Jess was not a patient and Barry declined having him come back to be part of the office visit, he remained in the waiting room. Jess was a gruff sort, apparently not interested in any of the magazines or other reading material we had available. He just sat there staring at me as I worked at the front desk. I decided I would try to talk with him, but all my attempts to engage him is some light conversation fell flat. His reticence may also have been increased when another patient, an elderly gentleman named John, came in for his appointment.

At this point Jeannine emerged from her after school spot in a little room we set up for her complete with books, games and a DVD player so she could watch her favorite movies. She had grown tired of being at the office, so she came out to see if there was anything of interest to do. She saw John, and having seen and talked with him before, immediately went to the waiting room to say hi. After chatting with him for a few minutes, she turned her attention to Jess.

"Great," I thought to myself, "she is going to try to talk with him, and he will rebuff her." Jeannine doesn't take being put-off very well, and I was not at all sure how he would react to our little soul or how she would respond to his gruffness. Braced for the worst, I watched as Jeannine went across the room and sat in the chair next to Jess.

"Hi," she said, "My name is Jeannine. Are you here to see my dad?"

"No," Jess replied, "I am waiting for Barry."

"Oh, so you are not a patient."

"No," came the brief response.

"What is your name?" she asked.


"Oh, so are you married?" she inquired.

"No, I have a partner," he said.

"So you are married."

"No, I have a partner, Barry."

"So what is your wife's name?"

"I don't have a wife; I have a partner."

"OK, so what is your wife's name?" she asked again.

"I don't have a wife. I have a partner."

"Oh, so what's your wife's name?"

At this point I am trying not to lose it as this question and answer session carried on for about three minutes. It was amusing to me to watch Jess struggle to get Jeannine to understand the very different relationship he and Barry shared with an audience intent on following this conversation. He was clearly at a loss to find the words she might understand, but was surprisingly very patient with her.

John, for his part, sat quietly trying to concentrate on the book he brought to read. Every now and then, though, Jess would glance his way, then mine, not in an attempt to plead for help -- perhaps it was just to see how we were reacting to it all. At length the medical assistant came to call John back and Jeannine knew that Jess would be leaving soon.

As she moved from her perch next to Jess, she turned back to him to thank him, and would he please tell his wife "Hello."

"Sure," he said, finally giving up any hope of having her understand.

So for what it is worth, I am glad that I did not interfere with Jeannine's interaction with Jess. As much as I would have liked to divert Jeannine to something else, I knew any efforts would only lead to her becoming upset with me, with an uncomfortable scene likely to ensue. Besides, it was far too funny to watch these two go back and forth in what might have been an unending conversation. In the end, Jess became a patient in the practice and without fail, when he would come to his appointments, if Jeannine was not immediately present, he would always ask where she was...."the real manager in the office." And, without fail, she would pop out from wherever she was and go out to talk with him.

Thursday, June 9, 2016

In the Clinic: Let the Saga Begin

Tim and I are so deeply blessed to be able to work together. For about 20 years our daily work occurred in two places: his at his outpatient clinic location and mine in the endeavor of herding children on their daily adventures. A dozen years ago, though, he made the decision to chuck corporate, large clinic medicine with its myriad of physician administrators, pharmacists, clinic administrators and referral committees to go back to a solo practice. The caveat was that I would be called on to manage the day-to-day business so he could do what he does best -- build relationships with his patients to serve them when his skill was needed and partner with them to keep them healthy.

It was at this point that I could see first-hand what it means to be a physician, and it was a huge education for me trying to manage Tim's schedule with no fund of knowledge. I mean, I could manage my schedule and keep the children on task with theirs, but I had never thought it was rocket science to put a patient on his schedule and it not create a major problem. How difficult could that be? More challenging than it appears.

The number of times I scheduled a patient to be seen, and only allowed 10 minutes for Tim to diagnose and treat "just a sore throat," or "right-sided back pain" is epic. It never occurred to me that a pain in someone's back, or side, or head could be anything more complex than what it is, so it should be a "no-brainer" to be able to quickly come to the conclusion that the patient may only need something simple, say, some over the counter remedy or possibly just rest.

Little did I then understand that each patient who comes to be helped brings a unique blend of health and wellness, the strength of which can, in most cases, be related to lifestyle. From Tim, I have learned that treating a sore throat in an otherwise healthy person is not at all like treating a patient who comes to the clinic with diabetes, hypertension, anxiety, depression or some combination thereof, complaining of the same sore throat. He needs to listen, question, examine and consider treatment options based on the patient's overall health, medications (including supplements) they may be taking, drug allergies and the like -- all of which cannot be done in the span of 10 minutes. Indeed, the major reason he left large group practice was directly related to administratiion's pressure for providers to "push through" as many patients as possible in the course of a day, with the requisite patient paperwork to be completed before leaving the clinic.....and here I was doing the same thing to him.

We clipped along for a year or so, just Tim, Jeannine, me and a medical assistant in one form or another. As the years passed, though, Tim's reputation as a caring, compassionate physician grew and we found ourselves with a many, many patients to help. The push for implementing more technology into the practice, what is now called "health information technology," required additional staff and we soon found ourselves with not only a medical assistant supporting Tim, but another full-time administrator to support me. God is certainly good, because after trial and error we were able to secure an outstanding medical assistant, Danika, as well as bring into the practice our eldest daughter, Mary, to support me.

A primary care practice of around 3500 patients, of which roughly 2000-2500 are actively seeking routine medical care, still requires additional support, so it wasn't long before we were looking for another medical assistant to work with Danika and our physician assistant Maureen.

We advertised, sought recommendations from the technical training schools, used externs, but we were just not able to bring another medical assistant into the fold and have it work out longer than six months. Then we found Andrew, who happens to be Danika's son.

So for what it is worth, our merry little band at Cleary Medical Associates solidified about three years ago. Tim and Maureen of course manage the very clinical direct patient care while Danika and Andrew admirably support them in the back office. Mary's administrative duties cover any and all aspects of front office work, helping me in too many ways to mention here. At the heart of it all, though, is Jeannine. Her value is beyond measure as she manages all of us, patients included. God is certainly good. More later.

Making Each Day Count

Our days and our nights come and go pretty quickly. In between the sunrises and sunsets there are countless diversions and interruptions in our work or play -- the noise surrounds us and our brains are continually filtering and refiltering the static and activities in a effort to make sense of it all. This can be both mentally and physically exhausting.

The ability to pull away from time to time in the course of the day is a wonderful habit of health and many people will meditate, chant, take deep breaths or other things to move their minds ever so briefly away from the activities and concerns of the day. For me, I like to pray.

The best regimen I have adopted surrounds intentional prayer. Waking early, my thoughts will focus on those century-old prayers which remind me that the day is "not all about me," -- that my "prayers, works, joys and sufferings" will be offered as I serve others throughout the day. I will call on the Guardian Angels and others of my favorite heavenly intercessors to guide me through the day as the seconds tick into minutes, then minutes into hours.

The problem is that I then get going on the day and inevitably Tim will start his totally annoying morning yammering of nonsense or break out in song, followed by his comment, "I could have been an opera star." Yeah, he could have been something, but quiet doesn't seem to be among the choices.

If not him, then there is Jeannine. I never know exactly what awaits me as I make my way down the hall toward her room each morning. Sometimes she is wide awake and energized for the day -- up and getting the morning ablutions completed without me nagging. Most mornings, though, her reply to my cheery "Good Morning, Fuzzy!" is a groan or some unhappy mutterings I don't understand and she declines to repeat. All of a sudden those great intentions that started my day are forgotten as the noise begins to creep into my brain.

Life really intervenes and I find myself putting out brush fires and reacting to the activities of the day; furthermore, I find that I have lost that mindfulness of purpose I set as the day began to serve those around me with an open heart (you know, forgetting the it's not all about me attitude). This has really bothered me as I truly wanted to be able to live each day as positively and lovingly as possible. That infernal static just keeps getting in the way of my good intentions.

I finally had an idea to reset myself and I used the alarm on my phone to sound at 3 pm each day in order to do some intentional prayer. Those in the office, particularly Jeannine, are now accustomed to hearing the etherial harp sounding from my phone as my reminder to exit the busy-ness of the day for some intentional prayer.

I like to do a short version of the Divine Mercy devotion and meditate on the sufferings and death of Our Lord. Those few minutes in contemplation will many times reorient me and in the meditation of what He endured for He served me to the fullest measure of His life...I renew my sense of purpose and many times I am able to close out the day at the office much less negative and irritable.

Making my way home at the close of each work day, and knowing that our evening routine may not quite be routine, it is nice to be able to recite my daily Rosary. In the time it takes to arrive home, I find that I can almost complete five decades, and if Jeannine decides to join in, we can finish the few remaining prayers before taking on the "real" business at hand: dinner.

You would think that the evenings at home, those few remaining hours before sunset, would be happy and productive hours. Sadly this is not always the case. Without intending to throw Jeannine under the bus, the nights are often fraught with contention as I struggle to encourage her to get some exercise done (taking a walk, dancing to her dance DVD), or goodness knows, take a shower, wash her hair and brush her teeth. My frustration builds and it is only as I leave her room after night prayers that I recall what Someone did for me, without complaint, but with humility and meekness. I have often turned to go back to Jeannine's room just to give her a hug and let her know I am sorry for any injustices I inflicted throughout the day, only to be met with a distinct look of bewilderment and impatience that I was "back again" to cause her more grief. Oh well.

So what it is worth, there will always be noise and static filling my days. Striving to avoid it is not practical unless I want to live in a cave by myself. Avoiding people and situations that impede my progress isn't the answer as it does not move me out of any comfort zone, encourage me to be brave and above all make me a better person. The answer is to embrace the noise, the static and commotion that fill my days with the idea that everything I do is a "prayer, work, joy, and sometimes a suffering."

Monday, June 6, 2016

Walking Jeannine

Walking Jeannine
Barbara Cleary

Walking is considered one of the easiest and most affordable habits of health a person can embrace. In fact,  Dan Buettner, author of The Blue Zones, identifies "moving naturally" as one of the Power9 Strategies of those living to be 100 or more -- and what is more natural than walking and walking with a purpose?

I have always loved walking as exercise. In those years when Jeannine was in preschool, I would often take part of that three hour block of free time to go to the local mall and walk with the senior citizens before the stores opened. At first the challenge was to be able to keep up with them as they walked their laps. All too often, though, a new window display would catch my eye and before I knew it, a dozen people had passed me. How could I lose my imaginary Indy 500 walking race around the mall to a group of seniors? Ever the competitive spirit, I disciplined myself to avoid such distractions and before I knew it, I was lapping even the most dedicated of those walkers.

I then turned my sights on timing. With a basic pedometer, I calculated that walking the mall -- including all the "cul de sacs" -- I could get a little more than three miles completed in about 40 minutes. I could log almost 8000 steps all before 10 am as well!

Those were the golden days. Life has moved on more than intervened, and my daily travels around Portland no longer take me near that mall. My daily schedule prohibits me from walking with the seniors. It has been difficult to get back to committing myself to a walking schedule, and I have tried many creative ways to once again bring this habit of health back into my life.

I tried walking the neighborhood, which would really be ideal because we live in a very hilly place and the interval training this naturally brings would be perfect for me. The problem is that I am at heart a "fair weather" athlete: I will do any outdoor activity if the weather is optimal. It doesn't help that I live in Portland, Oregon because many days here do not inspire that motivation to get out and click off those steps. Then I went to Plan B. I could "Walk On-Demand" from the comfort and security of my own home.

Plan B did not last very long, either. The wonders of cable TV could have been the catalyst for my return to a walking regimen, but sadly I discovered that as much as I was a "fair weather" outdoor walker, I was even more of a "fair weather" riser. I was great at popping out of bed at 5:30 or 6 am if my husband had decided to go to the gym to get his workout completed before going to the office. I found, though, that I was much less inclined to move if he decided to postpone his exercise until later in the day. It wasn't so much that it was too comfortable to move, as much as it was that I didn't want Tim to catch me looking pretty silly at 6 am gyrating around our bonus room as I followed the lead of the "instructor" in a pathetic attempt to get a "2 Mile Walk" completed in 22 minutes. On to Plan C: enlist the help of our young adult daughter, Jeannine.

Jeannine has Down syndrome, and like me, sees walking as one of those things she can take or leave (mostly leave). There have been mornings when she will be inspired to walk the neighborhood, headset and music in tow, no matter the weather. The problem is that she wants to exert her muscle of independence on her own and really balks at the idea of a walking partner. In the end, I allow her to win "The War of Jeannine Independence" and I still don't get my walking done.

In a rare mood about two weeks ago, Jeannine happily agreed to walk with me to the grocery -- a journey of about a mile and a half. My purpose was just to get a cup of coffee from the in-store Starbucks. As it was a bright, warm and sunny early fall day, and, when Bales Thriftway is the incentive, Jeannine is up for the task.

One does not walk "with" Jeannine as much as "walk" Jeannine. Other walking companions will keep a flow of conversation going about any number of topics, or otherwise engage in some social interaction...not so Miss Jeannine. When she is really up for the walk, though, she dons her headset and iPhone and bops along ahead of me employing any and all dance moves she can create as well as singing at the top of her lungs. Sometimes I wish I was in one of the oncoming cars just to be able to see what she looks like from the front. Her Down syndrome characteristic small ears and ear canals prohibit her from using the earbuds most people now wear, and it has to be quite comical watching her from the front, because every now and then she has to readjust the bright blue headset as it begins to slip off her head. This, combined with her need to pull up her pants as they fall down makes for a very interesting sight.

We managed to make it to the grocery in about 40 minutes, where she promptly sat down at one of the outdoor tables and chairs. As I explored the flower baskets and plants in the garden area, I lost track of her. Thinking that I would find her in line at Starbucks, I made my way into the store where, not seeing her in line, prompted me to head to gluten-free aisle or the candy section....where she was not to be found.

There is not one person working in the store who does not know Jeannine and pretty soon I saw her holding court to three or four employees at a check out stand. After receiving my usual, "Not now, Mom," from her as she continued plying her captive audience with questions, I asked if she wanted any water before we headed home. She was not interested in hydrating be it water or anything else, so  I firmly prodded her to end her interviews and we made our way back home.

The trek home was a night and day difference. No happy dancing. No bouncing ahead of me. No singing to her music. As a matter of fact, she carried the headset home, walked behind me and grumbled about how her "feets hurt." Amazingly, though, when we reached the entrance to our neighborhood (some 60 minutes later), ready for the 6-degree climb to the top of hill where home is situated, she gained new energy and chattered her way up the sidewalk, anticipating a large glass of water, tossing off her shoes and resting on the couch.

What have learned? Well, while walking and walking with a purpose may be a terrific habit of health, I may have to consider a "Plan D" -- as in "deep-sixing" it for something else. Ideally this would be something that would involve Jeannine because we would dearly love to instill this habit of healthy movement in her. Perhaps my Plan D should involve dancing; then we both could look comical, but we would definitely have some fun!