“when are you going to…”

 

So I have this friend.  I have known her since college but wouldn’t call her a friend until maybe the last 5 years or so. Our friendship has evolved in that time and I can honestly say that I like her more with each passing year.

We both have 2 kids.  Her oldest and my youngest are the same age.  She used to ask me all the time, “when are you going to have your 3rd baby?”  At first I would literally laugh out loud and roll my eyes.  But she would still keep asking.  Like ALL the time.  It just kept coming, the same question.  You see my friend can’t wait to have baby #3 and maybe #4.  She has a plan for when she wants them and her life after that.  I can’t imagine managing my life with another child, let alone 2 more. Pastor Jason and I with 4 kids is the stuff sitcoms are made of. Pure chaos I’m sure. I think for a long time my friend didn’t really believe me that I wasn’t going to have another baby.  And for awhile I was sure she was never going to stop asking me about it.

My friend challenged me.  While I was adamant to her that there was “no way in he##” I was having a third baby, and I had a hundred reasons why, I had to ask myself “was I at peace with that decision?”  You see, my friend challenged me to seriously examine what I wanted out of life, and be OK if it didn’t look like what everyone else was doing.  What will probably come as no surprise to you is that we live in a world where all of us are harshly judged for being stay at home moms, for being working moms, eating GMO or non-GMO, for having too many kids, no kids, not enough kids, and everything in between.  And we buy into the thinking that what everyone else is doing is what we were made to do.  We are looking for that one thing that will make us just as happy as our favorite “frenemy” on social media who we imagine has a life just that much better than ours.

Identity is an interesting thing.  We were all created to be and do different things.  I can’t wait to see her toting around her 3 or 4 kids, serving in church, encouraging others and finding ways to show her kids what is most meaningful in life.  Me, I’ve got research to do and papers to publish, podcasts to produce, medical students to educate and stuff to do at church with pastor Jason.  My two kids think it’s cool that mom “does surgery and gets the babies out” and “teaches the almost doctors” and that makes me proud.  I think Mother Teresa said it best.  I cannot do what my friend does and she cannot do what I do.  What were you created to do?  I hope this post gives you permission to examine your own life and ask yourself “when are you going to…” and fill in the blank with what you were created to do.  I am so thankful for my friend.  She inspires me and I hope I can challenge those around me with the same question.  So when are you going to…?  Together we can serve God, serve others and we can change the world.

we can do better.

Yesterday the US Preventative Services Task Force made a recommendation regarding screening for depression in adults and specifically addressed postpartum depression (PPD).  This is in alignment with the American Congress of OBGYN (ACOG) recommendation to screen women at least once during the pregnancy or postpartum period.  The official recommendation is below.

“The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.”

Seems pretty obvious, right?  Women have babies and we should screen them for a disease that is twice as common in women as it is in men and can have devastating consequences for families.  But it’s more complicated than that.  One: we don’t talk about postpartum depression.  Two: we don’t allow women to admit when they need help.  Three: we don’t have good systems in place to give women with PPD the comprehensive care they needs.  And by “we” I mean us, as in you and me, Oklahoma, America.  All of us.

Postpartum is a really bizzare time.  You spend approximately 40 weeks, if you’re lucky, carrying another human being inside you.  You devote a large portion of your blood supply, nutrients and other resources keeping this person alive and growing them into someone that can survive in this world.  Then you give birth to them.  Which is a huge deal no matter how you do it.  Walk in and drop out a baby in 30 minutes, labor for 4 days, have a c-section…it’s all a big deal.  If you don’t get that, let me know.  I’ve got stories for you.  And then you get to experience the strange period of time called postpartum.  For those of you who’ve been there, you know what I’m talking about.  You sleep for anywhere from 30 minutes to 2 hours at a time, someone is always crying or needing to be fed, you are leaking fluid from literally everywhere, and you’re body is trying to figure out where that person who used to live inside you went. Weird, huh?  But baby’s here so we instantly forget that the mother existed and focus on the cute bundle of joy who’s drooling all over your shirt.  We don’t begin to consider that the mom might be overwhelmed, and for most it wouldn’t cross our minds that she would be depressed.  We can do better.

Our culture doesn’t do well with mental health conditions.  We see depressed or anxious people as “weak” and “crazy” and those that seek psychotherapy as someone who “can’t keep it together.”  If you have high blood pressure or diabetes you don’t get this flack.  We treat you with lifestyle modifications or medication or physical therapy for your conditions…your mental health should have the same priority as your physical health.  It should be treated with the same respect and compassion.  We don’t roll our eyes at people with cancer; we come alongside them in prayers of healing and hope and support then in every way we can.  Why can’t we do the same with PPD and other mental health issues?  Let’s start the conversation.  The USPSTF and ACOG has recommended we screen because we as physicians can make a difference by asking women about PPD.  The community at large can make a difference by accepting that women with PPD are no different than moms who aren’t affected: both of them care deeply for their families and want to be the best possible mothers.  We can do better.

I used a validated screening tool (EPDS) in my clinic for postpartum depression.  I haven’t always done it.  But then I had patients come back one or two or three years after having their baby and tell me about how they suspect they were suffering from PPD and didn’t know who to talk to.  So now I try to screen everyone I can.  But we have to work to create access to resources for these moms.  Yes I can counsel someone about the risks and benefits of taking medication for PPD.  But many moms just need a therapist, or a support group, or even just a community of faith or a community of friends to share the burden with.  I hope the USPSTF recommendations will encourage my partners in healthcare to increase our efforts to screen and treat women during pregnancy and postpartum.  And I hope that those of you outside of healthcare will lend a hand, share a story or take a turn holding a baby for that new mom. I hope that all of us have the courage to ask postpartum women how they are coping and be accepting of any answer they give us with a willingness to listen and help.  We can do better.

The picture above is me and some of my residency classmates (sorry guys) literally hours before I had my first baby.  I was a 3rd year resident training to be an OBGYN.  I thought I knew what I was getting myself into.  Now I look at that picture and see someone who had spent the previous 3 years working 80 hours a week and cramming her brain full of all the information it would hold…but had no idea how things were about to change.  I was a (postpartum) hot mess.  I struggled to care for my baby and certainly didn’t care for myself.  Fortunately I had friends and family who made sure I ate, slept and was wearing clean clothes (thanks mom).  That baby reminded me of what a vulnerable human being I was.  Of how much grace I needed. She is now doing multiplication and her sister is giving me sass about anything and everything.  I love them dearly and am grateful for the opportunity to experience the bizarre part of life we call postpartum with each.  But we can do better…let’s try.

kms

 

wheelhouse.

What’s in your wheelhouse?  If you’re not familiar with the term, the wheelhouse in baseball is the part of a batter’s swing range where they can make the best contact with the ball.  It’s an area of expertise.  Something you’re great at or feel really comfortable with.  Something you’re excited about doing because you know you will kill at it.

I spend a significant amount of time diagnosing, treating and counseling patients with HPV (human papillomavirus) related diseases.  And while I love delivering babies and doing surgery on women, HPV is in my wheelhouse.  Like, I read everything I can about it, I go to the scientific meetings, I have literally seen hundreds of women (or more) with these problems.  Now don’t get me wrong, no one bats a thousand so I still see things that I haven’t seen before, I still have patients that don’t fit the rules for their disease process and I have to really think hard and ask my experts around me about what is best for management…but I feel pretty comfortable with most things in encounter in this arena.

If you follow me on twitter you know that I love to retweet scientific articles.  All my twitter crushes are people who write about OBGYN topics and post articles of the same.  Many of those I retweet are about HPV and the diseases caused by the infection.  You see, HPV is responsible for almost all of the 12,000 cases of cervical cancer diagnosed in the US annually.  About 4,000 of these women will die of their disease.  So, I give this lecture to our second year medical students.  They show up with their MacBooks and their phones ready to record what I say and I get to talk about how to better take care of the women of Oklahoma.  Well, first I tell them that the information won’t be on their test…so I’m instantly a better speaker and much more popular.  Then I tell them how at least 29 states do better than us at HPV vaccination of both young men and women.  How our death rate from cervical cancer in Oklahoma is among the worst.  How we fail to educate our young people about human sexuality, sexual health, HPV and HPV transmission, and how to care for themselves over a lifetime.  It’s really just me mic dropping for an hour as I get louder and more excited as the lecture goes on.

The summary of the lecture is that we don’t do so well taking care of our women in lots of areas, but one of them is in regards to HPV vaccination and cervical cancer prevention.

So where’s the good news, right?  There is good news…right?  Of course there is!  In fact, my Sunday School lesson to the third graders this week was on good news.  These 8 and 9 year olds are excited about no cavities at the dentist, getting good grades, opening presents, and getting dessert, among other things as good news to them.  The good news for the women of Oklahoma is that we have very safe and very effective prevention against HPV.  The good news is that my girls will get vaccinated around their 11th birthday as recommended by their pediatrician.  The good news is that the vaccine is safe, effective and does not increase the chance that my kids will become sexually active as adolescents.  The good news is that their mom will continue to tell medical students about how they can eliminate cervical cancer and HPV related diseases in Oklahoma and that those medical students will go on to be leaders in their community and tell people about how they can help prevent HPV related diseases…maybe one of them will even be a pastor’s wife.

So that’s my wheelhouse.  In addition to OBGYN care, education and research in women’s health. HPV vaccination, abnormal Pap screening, evaluation and treatment of cervical dysplasia…I plan to continue to try and learn all I can stay on top of my game.

Also in my wheelhouse: eating sour patch kids, hand written notes to friends, drinking coffee, eating bacon, shopping at nordstrom.com, knowing song lyrics (imaging me karaoke rapping) and finding good memes to use in boring powerpoint lectures to my students.

Enough about me.  This post was much more gynecology than theology, but pastor jason would tell you to figure out what’s in your wheelhouse when it comes to church, or to serving your community…and I agree.  Find your passion, find what you’re good at and use it to make your community of faith and your community at large a better place.  Because being great at karaoke rap is pretty awesome, but making sure the vulnerable and marginalized around you know and feel loved is even better. What’s in your wheelhouse?

kms

steps and stairs.

A few days ago I posted an instagram photo of my fitbit stats for the day…(see above).

I average about 5-7k steps per day at work or about 2 miles or so.  I try to get my fitbit to think I exercised by walking faster from one hospital to the other.  I try never to take the elevator because I work with a surgeon who is probably 20 years older than me or so and walks up 7 flights of stairs to see her patients…if she can do it so can I (#humblebrag).  At the end of the day referenced above my feet and my back hurt.  Most days those miles I walk at work weigh heavy on me.  Most days involve 10-12 hours of work, email or paperwork at home, phone calls and left over worry from the days work…so I have little to no sympathy for others who feel their days are long and hard; feeling mine was longer and certainly more challenging.  Most days…

But this day was different.  For some reason I remembered to be grateful for the wonderful colleagues that surround and support me daily, for the gift of being able to participate in the healing of bodies and hearts, and for the privilege of being able to participate in the birth of new life.  Why today?  Most days I spend more time remembering how few thank you’s I hear, how I have more paperwork than you can imagine and how I am usually still at work when most of my friends have gone home to enjoy their families.  Here’s the thing…I can’t tell you why this day was different.

That’s the way Grace works.  And Mercy too.  It creeps in on you when you’re not looking or expecting.  Or at least it does for me.  I’m minding my own business, being selfish and self-righteous, and all of the sudden you’re wading in it.  The heavy realization that I am who I am, where I am, doing what I do as an extension of grace and mercy.  That my successes are not my own but are simply a result of His grace and mercy.  And the wonderful flip side to that same coin: my failures aren’t too big for that grace and mercy either.

So now I am left with the puzzling question of how to live in that pool of grace and mercy every day.  It is too easy to forget.  In a world where it seems that everyone has picture perfect lives spread neatly across social media platforms, there isn’t much need for grace. But in reality, life is messy.  And hard.  So we desperately need to practice extending grace and mercy to ourselves and to each other.  What does that look like?  I’m not sure but I think it’s writing a note, extending a hand or a hug, giving someone else the benefit of the doubt and reminding yourself on a daily basis that you don’t walk through the hallways of life alone.  I don’t climb those stairs in the hospital alone.  He has given me a wonderful community of people to walk and climb through life with and He walks alongside me as well each day.

So here’s my advice to myself.  Maybe it will work for you.  I hope the next time I find myself in an eye-rolling situation…think bad internet medical advice, people complaining about how hard they work, picture perfect life posts…maybe I won’t roll my eyes as hard.  Maybe I’ll give just a moment of thought to reflect on what today’s graces have been and how I can provide mercy to someone around me.  No promises…I mean I’m pretty good at eye rolling…but maybe.

kms

the beginning.

My days are full of beginnings…

The beginning of pregnancy, the beginning of life at birth, the beginning of a surgery or even a research project.

So today marks a new beginning.  The birth of this blog.

Why gynecology and theology?  Well, I am an academic OBGYN who has a busy practice, teaches resident and med students and who is also a researcher.  I have been married for almost 15 years to a theologian who is basically one of the best pastor’s around.  Like, the pastor you want with you when you are having your best day or your worst, the one you want around when your child is born or when you’re about to take your last breath.

So that’s what I know.  Gynecology by formal education and theology by informal education.  So I hope this blog will be a collection of knowledge and opinions about both.  I suspect there will be sarcasm, vulnerability, confessions and complaints as well as a few #humblebrags.  Hope you enjoy.

kms