Monday, May 5, 2008

Sorry for the inconvenience

Sort of an amusing tale from the office last week. I removed an appendix a couple weeks ago from a young "au pair" here in the States from (let's say Paraguay) on a work visa. Very straight forward case. Laparoscopic appendectomy. Went home the next day. She works for a family in one of the foo-foo sections of the east Cleveland suburbs. I usually see post-op patients 10-20 days after discharge just to make sure everything has healed well and there aren't any further problems. I had to cancel this young woman's initial post op appointment because of an emergency that arose. Within minutes the "lady of the house" (LOTH) calls the office and is just outraged. How dare we cancel the appointment of her au pair. Didn't we realize that she was vital to the smooth functioning of the household? My office staff, as always, was quite apologetic and made arrangements for me to see her between cases the following day.

They arrived twenty minutes early the next day and I raced upstairs to see her between gallbladders. The patient looked fantastic; smiling, pain-free, completely back to normal. Her incisions had healed perfectly and I told her to remove her steri strips the next time she was in the shower. Standing in the corner, hovering almost, was the LOTH. She didn't acknowledge me when I said hello to her except with one of those dismissive upward turned arched eyebrows you give to someone you pass in the hallways. She stood next to the high end stroller shushing the cute baby during the exam. She looked to be about 30-35 years old. Not an ounce of fat on her. Prada bag dangling off her shoulder. Dolce Gabbana sunglasses perched atop her head. Dressed like a female correspondent on Fox News.

I gave the patient my usual spiel. No specific restrictions other than avoiding activities that caused pain. You're not going to hurt anything, but you may find certain activities make you uncomfortable (muscle soreness, scar tissue, etc). The young au pair smiled and thanked me. And it was "au pair". Not nanny. Not babysitter. Au pair. In Cleveland, Ohio.

That's not going to be good enough, the LOTH hissed at me. Excuse me, I asked? I need to have explicit instructions. If she can lift the baby, then you need to write that down. I have been trapped in my own house for two weeks doing all the things that we're paying her to do! I've missed yoga. I don't see my friends. I haven't been sleeping at night. And I have no recourse until we get clearance from the doctor. So if she doesn't have any restrictions, you need to make that clear in writing.

Her cold steely gaze was one of pure contempt. I was incredulous. The poor Paraguayan girl was blushing silently on her chair. The baby started whimpering.

What I just said is what I'm going to write, I told her, slowly, standing from my stool. She may have pain when she does certain activities. If that happens she should stop what she's doing. Most of the time, people don't have any problems after appendix surgery. But I have to prepare her for the possibilities. It would be prudent for you to give her a little leeway and empathy in this matter.

Fine, she hissed. Are we done?

Yes, we were done. Amazing. Hopefully the poor girl is only there on a one year contract. And hopefully the LOTH has no plans to add to her brood. I should have written "no lifting anything heavier than toilet paper for 6 months".


rlbates said...

Do you think the LOTH would have broken the contract if you had? So glad I am a "manual laborer" and not a LOTH.

mark's tails said...


I laughed:
-And it was "au pair". Not nanny. Not babysitter. Au pair. In Cleveland, Ohio.

I cried:
-I have been trapped in my own house for two weeks doing all the things that we're paying her to do! I've missed yoga. I don't see my friends. I haven't been sleeping at night. And I have no recourse until we get clearance from the doctor.

I wanted more:
-I should have written "no lifting anything heavier than toilet paper for 6 months"

Bongi said...

where i come from i call this 'madam syndrome. these days i send them out, usually to great weeping and gnashing of teeth.

Devorrah said...

My son used to go to an expensive private school that we eventually pulled him out of because of parents like this. One time a third grade classmate came to play for a few hours. Nobody came to pick him up, and we weren't able to contact the parents for two whole days.

Anonymous said...

did you show her the picture of fournier's gangrene?

DKV said...

Our au pair arrives in 2 weeks; I hope she is not a vector for LTOH-syndrome.

I took care of woman who brought in her 18 month old, 12 month old, and 9 month old (they were all her kids; I didn't ask about the timing to avoid opening a can of worms), as well as her herself. They all had colds - an ED "four-for-one." When I asked her what she thought I could accomplish, she told me that she felt overwhelmed at home. She had sent the nanny home 2 days ago because the nanny had a cold. I told her the nanny could come back now that everyone else had the nanny's cold. I didn't tell her she should have thought ahead before achieving the biologically impossible feat of having 3 kids in 9 months.

Anonymous said...

Au pairs are highly regulated. If a medical emergency exists, employers are required BY LAW to follow doctor instructions explicitly.

Her demand that you write down instructions was quite reasonable. As was her annoyance: She paid for a functioning au pair, not a post-op patient. Further, she could have been absorbing the treatment's cost herself. While that's all part of the deal, it always stinks when you lose the odds game.

I think what really pissed you off was that she treated you like an au pair.

Jeffrey Parks MD FACS said...

J- Thanks bro.

Anon- I wasn't "pissed off" at all. I found the whole episode amusing. She didn't treat me like an au pair; I certainly don't recall being forced to change a baby's diapers or scrub a bathroom floor. She may have paid for a "functioning au pair" but that young girl also happened to be a..... wait for it.... a human being. Who deserved a little better, I thought.

DDx:dx said...

This is the GOAL, the American dream, as evidenced on Cable shows and Glossy mags, to be able to afford to treat humanity for the miserable poverty stricken beasts THEY are. And if you chose the right subspecialty and practice in 90210 and they do a cable series on your false-drama life, you've succeeded.
I guess as a Family doc I get treated like an au pair daily. At least I get to chose some of who I want to work for...If I displease my LOTH she can't deport me. Just spread her displeasure in the marketplace, or threaten to sue...

Tyro said...

give me a break. Didn't you hear what the lady complained about? That's called 'motherhood' and it sounds like she was pissed she had to 'endure' it for a whole two weeks while her helper was recovering from a life-threatening condition.

Besides, if she can afford all that extra crap, she can probably afford cover for a bit.

Another example of entitlement, see here:

Kacey said...

Was the LOTH from Pepper Pike or Chagrin Falls? Have had relative in both places and they are uppity!
Do you know what a Chagrin woman wears to a funeral?

A black tennis dress.
Do you know how many Chagrin women it takes to repair a burned out lightbulb?

Two --- One to mix the martinis and one to call the electrician.

Sorry you doctors have to put up with LOTH's.

Mamita Ive said...

Wow, seems like you hit a cord with 'anonymous'. Somebody needs a chill pill!

Indeed, there are regulations for au pairs. They are also medically insured through the agencies that bring them to the country. Even if the host family might have to pay up front (and most of the time the plan will reach a payment agreement with an 'in network' doctor), they will be reimbursed for the money. My family has hosted au pairs, so I know what I'm talking about.

This shocked me the most, however: 'She paid for a functioning au pair, not a post-op patient.'

Like the au pair deliberately caused herself a bursting appendix.

Is it too much to ask to treat au pairs (gasp!) humanly?

Unknown said...

Dr. I've read your post about your complaining about your arduous schedule. I don't feel sorry for you. What do you earn 500k a year or perhaps more than a million.

Give me a break.

Jeffrey Parks MD FACS said...

Jon- I wish I made that much money. If only I'd applied for a job as head of Aetna or Kaiser-Permanente.....alas