You might have noticed by now, my dear readers, that I am a bit of a storyteller. I just love recounting the funny, the emotional, the angry, and the evocative tales from my life. Yet there is one area that has been almost completely off limits, and that is the tales from my many years as a teendoc.

The main reason that I've not blogged these stories is that contrary to when I am sharing such tales in person, I cannot be sure that blog readers who do not know me as well are as clear about the enormous respect I have for my patients and their families. Caring for teens for those many years was such an honor. At the risk of sounding truly hokey, taking care of teens was much more than a job or even a career...it was a calling. It was something that I loved doing and something that I found myself almost naturally skilled at doing. The kids were part of my heart (and soul). And because of that, I would never, ever want any of my stories to be seen as being at the expense of any kid or parent.

Yet, as I was reminded again last night by my dinner companions, these stories are often hysterically funny and fun and should be shared. We can allow ourselves to laugh not at the kid, but at the absurdity of the scenario, or my dumbstruck reaction, or any other good natured enjoyment of the humor in everyday life. My hope is that I'll be able to craft my recounting skillfully enough that you'll share in the wondrous adventures of adolescent medicine, without any wrong notes being hit. And with that brief introduction, let me begin.

Teens (and Their Parents) Are Funny

There's a lot of laughter in adolescent medicine. It helps the kids relax, the parents chill, and can diffuse tension like nobody's business. I used to have a lot of standard riffs to break the ice, like asking my new male patients, "When was your last menstrual period?" (completely deadpanned).  You should have seen the looks! Some guys were like, doesn't she know I'm a guy? While others gave me the is there an idiot sitting in front of me? look. Yet a few younger guys would ask, "should I have a period?" And then I'd be like, "I'm just making sure you're paying attention," with a chuckle. The kid and the parent would relax into their chairs a bit more, smiling as if to say, she's not as boring or goofy as the other docs. They hadn't seen nothing yet.

But the hard part for me was when the teen (or parent) would say something that was dead serious, yet at the same time was hysterically funny. During these times, I had to learn to maintain my equanimity. It was not an easy task.

Once when I was a medical student, I was talking to a mom and her kid about his bowel habits. Things had been pretty uneventful until she looked at me and said, "You know, sometimes he goes to the bathroom and makes a number 2 and then the steam comes up from the toilet...is that normal?"

My head is like, WHAT THE FRACK?!! STEAM?!! FROM THE TOILET BOWL?!!

Instead I said, "Huh, steam. Interesting. Does that happen often?"

She started giving me an answer and I was talking to myself: don'tlaughdon'tlaughdon'tlaughfortheloveofgoddon'tlaugh! As she went through the intricacies of the steam rising after his defecation, she concluded with, "You know how that happens, right doctor?" By now, the laugh was perilously close to the surface. I was truly struggling (and feeling ashamed at the same time).

"You know, I'll bet Dr. Conley can explain it better than I can," I managed. "Let me get him."

I stumbled out the door, closing it hastily behind me. I took two steps down the hall and started laughing so hard that I slid down the wall to the floor. Dr. Conley was like, WTH? But I was simply unable to speak. After another minute I regrouped enough to recount the conversation.

"When the what comes out of the toilet?" he asked, dumbfounded.

"The steam," I answered, perilously close to another giggling fit.

"Where's her toilet?" he asked, "in Alaska?"

And with that, he got up and we returned to the room where he had no giggling fits and managed to keep a straight face answering the questions. This, my friends, is the difference between a trainee and an attending physician. Eventually I learned this equanimity myself.

My 13-year-old patient said to me, "My friend likes to masturbate with a sausage. Is that OK?"

She was waiting for the shock, the outrage, the evidence that I'm not as cool as I pretend to be. My face gave nothing away. "What kind? Polish? Italian?"

She grinned and shrugged.

"Well as long as she's not leaving it in there for hours, it should be fine." I concluded.

Now truthfully I had no idea whether she really had a sausage-humping friend or whether this was a grand test of how much she could trust this new doctor with her questions and truths? The bottom line is equanimity always. And usually, I was the master.

Sometimes, though, things do come so far out of left field that you may react a little bit...after all, I'm not a robot, right?

A mom and her 14-year-old daughter were in my office. I was getting the history from the kid like I usually do. At the end of my questions for her, I turned to the mom and asked if she had any concerns that I didn't cover already. And then she said it...

"Well you need to examine her breasts because to me they feel like gristle inside."

WHA??!!! went my head. But I sat back, put down my pen and said smiling, "Ma'am, there are so many things wrong with what you just said, I don't even know where to begin." We both laughed. "My first question, 'why are you feeling your daughter's breasts?' and my second one, 'gristle?! Did I seriously hear that?!'"

We all ended up having a good laugh and the visit was really productive (with some teaching about boundaries, not doing BSE on 14 year olds, and, oh yeah, boundaries).

You might now wonder whether there has ever been a time when I was just unable to contain myself and laughed at the expense of a patient. I'm sorry to say that yes, one time my equanimity failed me terribly. I still feel bad about it, though I believe I did make amends to this long-time patient.

Tanya was a young lady I had cared for since she was 12 years old. She had some minor immune problems and was very slightly developmentally delayed. She and her sister lived with her grandmother, a woman who thought I walked on water. I thought she did too, so it was a mutual admiration society. But on this visit grandma was quite upset. It seems that Tanya, who had recently turned 18, had begun acting out. She described a multitude of risky behaviors while Tanya sat in the other chair laughing. All she wanted to contribute to the conversation at that point was, "I'm 18. I don't have to listen to anyone." Hmmm, seemed like a behavioral intervention was in order.

When I had Tanya alone, I decided to tackle the sexual risk behaviors first. You work in the order of what's going to kill them first, and with her immune disorder, STIs posed a major risk.

"So Tanya," I began, "you know how it works in here. Our talk stays private except for 3 things. Do you remember what those 3 things are?"

"Suicide...um...abuse...um...I always forget the 3rd one," she giggled like a 10-year-old.

"If you're going to hurt someone else," I helped her out. "So I'm concerned about the things your grandmother talked about when she was in here. Sounds like when you turned 18, you decided to start having sex and doing a bunch of other things."

"Yeah," she replied petulantly, "I'm an adult. I can do what I want."

"So how many people have you had sex with since you turned 18 three months ago?"

"You really don't want to know," she said coyly, like a kid being asked how many cookies she had taken from the cookie jar.

"Well I do want to know," I said gently. "I always want to keep you safe and healthy, but you have me a little worried. So can you tell me please?"

"Twenty-seven," she said while peeking through her splayed fingers covering her face.

Holy crap, I thought to myself, but my face remained neutral and engaging.

"Do you think that's a lot?" she asked timidly.

"What do you think, Tanya?" I deflected.

"I dunno," she shrugged.

"So why do you have sex?" I asked, deciding to try a different approach. I always try to get to the whys of the behavior.

"I like it," she answered, the defiance back in her voice.

"What do you like about it?"

"Everything."

"Well do you have orgasms when you have sex?"

"What's that?" she asked, furrowing  her brow. I expected that response. So I decided to get more colloquial.

"Do you come when you have sex?"

She thought for a moment, still looking a little confused, but then she abruptly brightened. "No Dr. C. I don't come. I go over there..."

And this was where I momentarily lost it. I laughed. Not a fall on the floor, pee on yourself type of laugh, but a surprised chortle. Her face wilted. My brain was like holycrapLianafixthisnow!!!

"Sweetie, I'm so sorry for laughing and I know that you weren't trying to be funny, but that was the cutest thing I've heard all day. You just cheered me up so much. Let me explain what I really meant..."

In short order, her smile was back and we were back on good footing, at least until I got her grandmother back in the room and made some pointed suggestions to her about what she should do regarding keeping herself and Tanya's sister safe until Tanya regained some behavioral control. Despite that, when I saw Tanya 3 months later, she had returned to pre-18-year-old Tanya, sweet, compliant and more respectful. There she remained until she aged out of my practice at 23.

I'm so ashamed of my laughter, but damn was that funny!

Adolescent medicine...live the adventure!