“Do You Miss Not Working?”

In the past two weeks, I’ve bumped into several of my old patients.  When we pediatricians say “patients,” it doesn’t mean just the kids we cared for.  It means the whole family.   In order to be a happy pediatrician, you don’t just have to love children. You have to love their families too.  It is important to fully understand family dynamics in order to enjoy practicing pediatrics.

The question I am most often asked when I see people from the past is if I miss working.   It’s been more than six years now since I retired, and there’s never been a day that I wished that I could go back to work. I have been very happy staying busy with so many other projects that it is hard to imagine having to work at the same time.  Additionally, in a very practical way, I would have found it impossible to wear a mask the whole day.  It’s not just the problem of my glasses fogging up constantly.  If can’t totally see a person’s face, I would find it hard to communicate. 

I would hate having to wear a mask since my glasses get fogged up!

More importantly, the one thing that I do miss is the personal interaction with the babies.  I used to pride myself on being able to take a crying baby and get them to smile within a few seconds.  My staff used to call me “the baby whisperer.”  Interestingly, this never worked as well with my own children, but with my patients, I loved holding a baby in my arms, and magically, they would smile.

My favorite age of babies was from six months to a year.   This is when you would observe the early signs of alertness and interpersonal connection, and it was so gratifying to be able to tell the parents that their baby was developing normally.  Nowadays, the biggest fear among parents is that their child may be on the autism spectrum.   The incidence of developmental disorders seems to have increased over the span of my career (starting in the 1980s), and parents are relieved when I would reassure them at a very early age that everything appeared OK.  I loved seeing the look of relief on parents’ faces, especially first-time parents. Experienced pediatricians can spot developmental issues earlier than most people, and we are well aware of how very young babies normally focus on facial expressions such as smiling and eye contact.

In our practice, we offered new parents who had not yet chosen a pediatrician to come for a “newborn consult.”  These new parents were hungry for information and guidance, and became some of the most loyal and trusting patients.  The bonding that occurred from that initial visit and then continued after the baby’s birth is something that many parents recalled many years later at my retirement party. 

I was very fortunate to live in a very diverse community in South Florida.   There were some patients who were attracted to my practice because I spoke Spanish, but I loved the assortment of other ethnic groups that I would see on a daily basis.  There were families from many Spanish-speaking countries, but in my panel of patients, I had patients from India, China, Brazil, Finland, the Philippines, Thailand, Viet Nam and Korea. 

Since the schedule of check-ups is heavily concentrated during the baby’s first year, I got to know the parents very well during those “well-visits.”  Many grandparents attended these visits along with the parents, so I would often become familiar with the extended family. 

An experienced pediatrician can do a complete check-up in a very short period of time, so the rest of the visit is left open for discussion about whatever concerns the parents may have had.  As the parents became less anxious and fell into a routine (especially after the babies started to sleep through the night after about six months), we had much more time to talk about other topics.  I was always interested in their native languages and their cultures, sometimes to the point that parents would invite me to visit their countries.

I was always interested in their cultures, sometimes to the point that the parents would invite me to visit their countries.

I used to joke with patients that I might take them up on their offers.  My wife and I have unique memories of Japan, Bali, Finland, Thailand, Hong Kong, China, Ecuador, Brazil, Turkey, Spain, Angola, Israel and India because I accepted these invitations.  Sometimes they were there while we were traveling, but more often, we had the opportunity to visit their relatives whom I had met in my office.  Every one of those visits was a special personal experience, much more than any of the usual tourist attractions.  At first, my wife was leery, thinking that it would be awkward to visit people’s homes, as she wondered if these people really had been sincere about inviting us.  After a few of these special visits, she looked forward to the meet-ups that I would try to plan into every trip. 

Early in my career, I started to give out small, framed photos of places that I had traveled to.  The kids enjoyed getting something to remember from their yearly check-ups, and surprisingly, many parents would ask for their own “Dr. Kraft pictures.”  This became a tradition so I would bring along these small pictures on our travels as an ice-breaker or as a way of thanking people for their hospitality or other special favors.

In Bali, Indonesia, where the children were showing off the gifts I gave them!

I loved teaching patients about the places that were seen in my photo gifts.  I would usually tell the school-age children to read up more on the countries where we had traveled. 

So back to the question about whether I miss working.  What I loved about being a pediatrician was that I was often considered a trusted friend to those families.  Since pediatrics is a long-term commitment (in my case, 35 years), I was very fortunate to have met so many marvelous families over several generations.   Now that even though I am, in a way, “out of the picture,” I have wonderful memories and several long-lasting friendships to savor.

Not me, but another happy pediatrician! Photo courtesy of dreamstime

“I Don’t Know”

I am a retired pediatrician who has had personal experience with a condition known as Chronic Idiopathic Urticaria (CIU), a diagnosis which was made after an exhaustive workup which included many visits to subspecialists.

About six years ago, after a long post-retirement trip outside the US including Europe, Africa and several islands off the African coast, I began to experience intense itching all over my body. 

The itching was unbearable

The symptoms were randomly distributed on different parts of my body and occurred without any warning or preceding ingestion of food. At times, the itching was accompanied by painful hives (urticaria) and the sensation of having been slapped.  It happened more often at night and prevented me from sleeping normally.

Hives (urticaria)

My evaluation began with a visit to my internist who suggested that I see an allergist. He explained that even after I would go  through an extensive workup, the final diagnosis might still be classified as “idiopathic” (of unknown origin) and “chronic” (not acute).

I wound up seeing a rheumatologist, a dermatologist, a cardiologist and an infectious disease specialist. The dermatologist biopsied the urticarial lesion and sent the slides to a pathologist who was a specialist in CIU.  He concluded that it looked like “normal CIU” (whatever that was) but that there were some subtypes of the pathology which occasionally go along with certain connective tissue disorders including lupus or psoriasis, or even worse, certain malignancies such as lymphomas. This fear encouraged me to pursue the workup even further.  It has always haunted me that I still had something undiagnosed that was more serious. 

At least the infectious disease expert was intelligent enough to ask me the right questions about my possible exposure to certain parasites.  After all, I had visited some South Atlantic Islands including the former Portuguese colony of São Tomé where I had walked barefoot on beautiful beaches where wild pigs roamed freely.  He ruled out that I had picked up a parasite.

The island of São Tomé, a very interesting place to visit, but there are wild pigs sharing the beach with you

The allergist brought it all together after about six months. He concluded that since no one had specifically found anything wrong, it would be termed CIU which in most cases,  the origin is never discovered . By that time, my symptoms were pretty much controlled by daily dose of an over-the-counter antihistamine, cetirizine (Zyrtec) and a dose of a prescription, hydroxyzine (Atarax) for the occasional, but thankfully less frequent and less disturbing painful flareups of the urticaria. He also gave me the option of using omalizumab (Xolair), a monthly injectable biologic treatment, but I rejected this option because the symptoms had lessened with a more conservative treatment.

Several times since then, I have tried stopping my daily dose of cetirizine to see if the problem still exists. Usually within a week, I would start to feel “itchy” and sometimes I would develop some mild hives, but these minor outbreaks are always controlled within a few hours with my plan B medication, hydroxyzine. I decided that it is just easier to continue taking the low dose of the oral antihistamine to keep things under control especially since I don’t have any side effects from the medication

I admit that I still have a nagging fear that there is an underlying problem which caused the original problem.  Time, however, is on my side since I haven’t really experienced any acute flare-ups in many years.  But having unanswered questions leaves me with the worry that it will eventually resurface and that it may represent something much worse. 

But as a doctor, I must tell myself that not everything in medicine has a clear explanation. I have been in the position many times in my career when I had to tell a patient, “I don’t know.” Some patients can accept this fact.  Others are upset when doctors admit that there isn’t an adequate answer. 

As I get older and the visits to the doctor unfortunately become more frequent, I have to admit that it’s not fun being on the other side of the doctor-patient relationship.  I believe that I was the type of doctor who understood patient anxiety, but unfortunately, now I am the patient, I hope that I can always find the doctors who will fully understand my particular fears or concerns.  I will try very hard to accept when my doctors say, “I don’t know.”

Don’t Lie to Your Patients!

I am a retired pediatrician, so my standards of choosing a medical professional are different than a lay person.

Many years ago, I had to see an ophthalmologist for an annoying chalazion (similar to a stye) in my upper eyelid. After I had treated it conservatively with soaks without success, I knew that I would probably have to have it injected or incised.

As I sat in his chair awaiting the procedure, he told me, “This is going to feel like a little mosquito bite.”

It was one of the most painful injections I have ever had and I jumped out of the chair and told him, “If you can’t even be honest with me, I will never refer you patients again.” I could just imagine the little children that he would lie to, and how they would blame me for sending them to such a dishonest doctor.”

This incident further confirmed my approach with patients to always be honest about any impending painful procedure.

Patients really hate to be lied to, including when the patient is a doctor!