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.

" 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!

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.

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, weight...as 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.

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.

"Jess."

"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.

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.