what you say and what you do matters.

On Friday I received an email notifying me that one of my colleagues had suddenly passed away.  He was a fellow OBGYN, a father and a friend.  He was presumably healthy and not elderly. To say that it was devastating is an understatement.  As my phone, my email and my social media sites fill up with questions, comments and memories from colleagues, former coworkers and friends; I was impressed by the themes that ran through this dialogue.  Of course there were stories of his work in our field and the lessons he taught us in obstetrics, but more than that almost everyone mentioned his effort to really know you, know your family and be kind to you.  To ask how you were doing and to listen and to be honest.

I left work that day having both given and received bad news.  I struggled to reconcile all the good in life with the events of the day.  That evening was my 20 year high school reunion.  Pastor Jason and I met there and I saw faces and heard voices that brought back lots of wonderful memories.  Someone who was very dear to me mentioned that she was proud of all I had accomplished and another friend asked me about the meaningfulness of my work.  Those words were especially important to me at the moment.

You see, what we do and what we say matters.  And I don’t mean in the sense of what our job title is or how many important decisions we get to make.  I think it’s more about how we speak and listen to those around us.  At work, at home, at church, at the grocery store.  Our actions towards our spouse, our children, our friends, our enemies and the least of these among us.  Those of you who know me well, or know me at all, understand that I am almost NEVER at a loss for words.  I am full of stories I think are charming, opinions I think are correct and ideas I’m sure are fantastic.  But over the last few weeks I have felt the spirit move me to really consider what I say and what I do.  No gynecology today.  Just my own breed of the theology learned being married to the pastor for 15 years now.  And here are my thoughts…

  1.  Say “thank you” instead of “sorry to bother.”  And mean it.  We have become a culture that doesn’t say thank you enough.  If we need something that inconveniences another we say “I hate to bother you but…” instead of saying “thank you.”  If you say “I’m sorry to bother you” then the other is obligated to say “oh that’s ok” even when it’s not.  If you say “thank you so much” to those who take the time to help with your need, you have expressed what you feel and the other owes you nothing in return.  Thank you.  These two words can change you.  They can change people around you.  So the next time you need something from someone and they oblige you, don’t apologize for the need, thank the other for the response.
  2. Tell people you are proud of them.  At my reunion my friend Julie looked me square in the eye and said she was proud of me.  It was the best moment of the week.  It reminded me that my kids need to hear it, Pastor Jason needs to hear it, my friends needs to hear it and I needed to hear it.  I am all too guilty of saying “good job” to the residents and students I work with.  A job well done is fine but to know that someone is proud of you is not just about the work you have done but the person you have become.  Replace as many of your “good jobs” as you can with expressions of pride for those around you.
  3. Sacrifice for others.  Be the kind of person who can be counted on.  Whether you tell someone you will pray for them or you ask what someone needs from you, make sure they know you can be counted on.  I told one of the church girls that I think when people say “what do you need?” or “how can I help?” we always say “oh nothing” because we assume our need won’t be met.  Be the person that meets someone else’s need.  The saints in my life are the friends and coworkers who can help out in a pinch; they will make an extra trip to grab something to feed my kid when I’m running behind, they will change their schedule to help me out at work or answer their phone with a willing yes.  And if a friend tells you they don’t need anything during a difficult time, don’t believe them.  Do something anyway.  Show up, bring coffee, watch their kids, feed the dog or just sit and listen.  Next time you ask they will be honest with you and grateful you showed up.
  4. Ask more questions than you give answers.  I learned this from the Pastor.  When you have a meal with him be prepared not to eat.  He will come at you fast and furious with questions.  About your work, your kids, your background, your hobbies.  You will walk away with value and having shared what is most important to you.  It is easy to get caught up in our own daily struggles and achievements that we forget to ask about what is happening in the lives of those around us.
  5. Care deeply.  One of my favorite things to say is “remember the un-squeaky wheel.”  Just because someone doesn’t need to be taken care of doesn’t mean they don’t need to be cared for.  This is one of my go to soap boxes.  But I won’t belabor this one as you can read my previous post on caring deeply here.IMG_4136
  6. And maybe, most importantly, as Mr Rogers said, love others.  Try to drown out the criticism and the anger, the violence and the sadness by loving those around you.  It sounds silly I know, but people who are really loved will be people who say thank you, who tell others how proud they are of them, who sacrifice and ask questions and care deeply.  Your family, your community, your world will be better for it.

For those who had the opportunity to know my colleague who just passed and the fellow OBGYN we lost to cancer last year, they will tell you that as much medicine and surgery as we learned from these two men, they were people who knew what they said and what they did mattered.  And all of us were better for knowing them.

Schooled.

Last Friday I had the privilege of leading our resident education session.  We spent 2 hours together learning how to become better educators.  I say ‘we’ because, despite being in medical education for the last 12 years, I still have a lot to learn about teaching.

I think for a long time I bought into the myth that anyone can teach.  And that anyone can be an excellent teacher.  Like once you have mastered a subject, let’s say addition, that you will be great at teaching addition.  Well, you’re not.  Or at least I’m not.  I can distinctly remember my oldest child attending preschool and being sent home with a packet of sight words.  Until that time I had no idea how children would get from having a cry or smile as the only method of communication to speaking, reading and writing complex words.  Thankfully my child’s teacher knew the path.  In fact, her 2nd and 3rd grade teachers have more experience teaching than I have in being alive.  They knew where she had been and where she was headed in her educational journey.  And her 4th grade teacher will as well.

I teach adult learners.  Medical students and residents.  Medical Education is wonderful and also amazingly challenging.  When a new 3rd year medical student begins with us they have literally spent about 25 hours per week in the classroom in addition to the dozens of hours a week they spend studying in the library.  They soak up all the knowledge you give them.  They are early in their journey toward their final career goals and eager to learn all that medicine has to offer.  They want to know their patients and help create tangible positive outcomes for them.  My residents spend even more hours at work and in the learning environment than the medical students.  They are responsible for patient care as well as a huge chunk of the medical student education as well as making sure they learn all they can before leaving the training environment.  It’s a lot to accomplish.

What I have learned in medical education is that being a teacher is a huge responsibility.  It isn’t enough for me to have passion for the subject matter.  I have to translate that passion into meaningful experiences and into a format they can understand and retain.  It means more than just making sure the medical students know the basics about caring for women; it means that we have taught them how to have respect for their patients, to care deeply for the broken and hurting around them and to find a way to always have compassion.  The challenges come when you are consumed with your own work and you find it hard to stop and teach someone else.

I think this is a challenge for everyone in education.  Teaching is hard.  Being an excellent teacher is even harder.  For me, I stay in the Medical Education environment through the struggles because I remember the faces of the teachers that taught me empathy and compassion, because I still have a lot to learn and those medical students and residents challenge me daily to be better than my best, and because I hope that my community and my state are healthier and better cared for through the work we do in our teaching institution.

Hug a teacher you know. Hug all the teachers you know.  Or bring them a snack or send them a note of encouragement.  They leave each day having given all they can to some who will receive and some who might not.  They are not only teaching subject IMG_2943matter they are often teaching the life lessons of respect, empathy, compassion and kindness even when their own runs low.  They are the feet with which He is to go about doing good.  They are caring in places many of us would not dare to invest.

And if you know a medical student or a resident physician, give them a hug too.  Or maybe a cup of coffee.  They are always being challenged to learn more and do better. They spend themselves each day to do their best for others, using their hands and their heads and their hearts to care.    They teach me something every day and for that I am grateful.

 

the problem of prematurity.

If you know me at all, you know I love completing a to-do list.  I am task oriented.  Sometimes I will make a to do list at the end of the day just to cross off everything I have completed already.  You’d think I’d be embarrassed about that…but nope.  But sometimes your to do list gets interrupted by meaningful conversations with friends.  That happened to me this week with my friend Jenny.  Jenny is a labor nurse, a mother, an entrepreneur and a friend.  Jenny is also one of the 10% of women in my state who has given birth prematurely.  She is the inspiration for this post which is a mix of medicine and miracles of God.

(please note that Jenny is not my patient and has seen and approved of this blog.  Here at gynecologyandtheology we like to remain accurate as well as HIPAA complaint.)

You see, each year in our country about 10% of babies are born premature (preterm) or before 37 weeks of gestation.  These babies fight for survival and then many of them face a myriad of health problems that can be life-long.  The problem of premature birth costs our nation about 26 billion dollars per year. Parents of these babies carry a huge emotional and financial burden.  In many cases we don’t know the cause of preterm birth and have few interventions to stop it from happening.  Age, pregnancy spacing, smoking, health complications and many other factors contribute to preterm birth.  For some of these problems we can help our mothers with education, contraception to appropriately space pregnancies and interventions to improve their health prior to and between pregnancies.  In some cases we don’t have any prevention methods such as preterm birth in twins or other multiple gestation pregnancies.

For my friend Jenny, her preterm birth story is particularly devastating.  You see Jenny’s first born daughter was born so extremely premature that she was too young to survive.  Jenny has a condition called cervical insufficiency; one of the many causes of premature birth.  Payton Marie was delivered in September of 2011 at 23 weeks gestation.  She was too young and too small for any interventions that would be life saving.  By the miracles of medicine and Jesus she now has two more beautiful healthy children.  Her story is filled with pain, suffering, the “what ifs” and more.  She had very few, if any, risk factors for preterm birth.

So what can be done?  First, be informed.  For those of you who are planning their first or next pregnancy, know the risk factors as well as signs and symptoms of preterm birth.  But for those of us who don’t plan to gestate anyone else in the future, we still need to be educated.  The problem of prematurity affects each of our communities.  You can find your state’s report card on preterm birth as well as a whole lot of other great information about prematurity from the March of Dimes.  The website has information about risk factors and symptoms of preterm birth as well as information about the problem of prematurity around the world.  And speaking of the March of Dimes, you can get involved.  I had the privilege of walking in an annual march for babies campaign to honor the friends and coworkers around me who have had a premature birth.  So get out and walk, mail that envelope back in with a donation, or become an advocate.  My state’s grade on preterm birth is a “C” so we have some work to do people!  I bet each of us know someone who has had a preterm birth.  Remember these families.  I know prematurity was probably not on your radar of problems to work on to make our world a healthier place to live…but it is a super important one!

As for Jenny, she is her own miracle.  I think my best evidence for God is that we can suffer unimaginable loss and pain and walk out the other side with continued love and compassion for those around us.  Why did Jenny have to lose her first born?  I can’t answer this.  It’s the problem of systemic evil and I will leave that one to Pastor Jason.  Jenny will Screen Shot 2016-07-17 at 7.58.47 AMprobably tell you that her two other children will never “replace” her firstborn.  She will always have 3 kids; one of them just didn’t come home with her.

I have been listening to a beautiful version of “It is Well” by Bethel Music and Kristene DiMarco.  Ironically I hated the song growing up.  People would always sing it at funerals and I just thought it was crap.  People were sad someone died.  I was sad someone died.  I really didn’t feel like it was well with anyone’s soul, nor should I feel like I was obligated for it to be well with my soul.  But I listen to this version with a renewed sense of hope.  It speaks of the power of Christ to move with us through incredible grief and pain and emerge on the other side knowing that He who suffers with us is working with us to make all things well.  This is Jenny and so many others close to me who have suffered incredible loss and heartbreak.  I think they would tell you that their friends, their families, their faith communities were the hands and feet of Jesus.  They were the grace, mercy, hope and love they needed.  That although it will never be OK, It is Well.

O09.521

If you don’t recognize it, the number above is the ICD10 code for “Supervision of elderly multigravida, first trimester.”  So what is an ICD10 code?  It is the International Classification of Diseases, 10th Edition.  The World Health Organization (WHO) owns the ICD system and it is adopted by the US Healthcare system.  Basically, these ICD10 codes are how we tell coders, insurance companies, government regulators and so many other what diseases or diagnoses a patient carries as well as what procedures were done for the patient.  Each version gets more detailed, and therefore, more complex.

Enough about ICD10.  The real point of this post is to discuss this awful designation of ELDERLY multigravida.  ELDERLY.  Sounds depressing, huh.   So what makes a pregnant woman elderly?  Get this…being over the age of 35.  No, seriously.  35. Most OBGYN’s refer to this as “advanced maternal age.”  It’s nicer.  Apparently the WHO is not nice.  But even then, when did 35 get old?  I just turned 38 and I still feel like I’m trying to figure out my life.

About 15% of women in the US give birth at the age of 35 and older and are considered AMA (advanced maternal age.)  Less than 3% give birth at age 40 and older.  Why the big deal about age?  Well, age comes with some risk.  Women who give birth in the US who are AMA have an increased risk of stillbirth compared to women under the age of 35.  Additionally, women in the AMA category are at increased risk for miscarriage, an increased risk for chromosomal abnormalities, an increased risk for high blood pressure, gestational diabetes, growth restriction of their babies, c section and other complications of pregnancy and delivery.  Once a woman reaches the age of 40 each of these risks sharply increases.  For women over the age of 40 we have special protocols to monitor their pregnancy and recommend they deliver by their due date or sooner.

So why would anyone have a baby after the age of 35?  And who are these nutty women having babies after the age of 40?  Surprisingly, I don’t hear this question a lot.  What I most commonly hear is “when should I stop having babies?”  I always ask the patient if they want my personal or professional opinion, or both.  If you know me, you know my personal opinion.  I love babies…when they belong to others.  Two of them was more than enough for me.  But seriously, what I tell the patient really depends on where they are in life and how many children they have.  When I am seeing someone who is over 35, has no children and wants to start a family I try to carefully counsel them on the small risks of complications for their age.  What about women approaching the age of 35 who already have one or more children and want to have “just one more”…or just two or three more?  Again, I counsel them carefully on the risks of their age.  This includes risks to both the mother and the child.

Last week I was asked “in your personal and professional opinion, what age is TOO OLD to have a baby?”  I loved it.  I told her that personally I am WAY TOO OLD AND TIRED to have any more kids (can I get an AMEN from Pastor Jason??).  Screen Shot 2016-07-10 at 4.44.26 PMBut then I went on to tell her that I think someone should carefully consider whether or not they want to have children once they reach the age of 40.  I think when most women think about having a baby over the age of 40 they think about the possibility of having a child with Down Syndrome or some other chromosomal problem.   But for me it’s all the other risk factors that make me nervous for my patients.  You see the risk of a chromosomal problem is about 1 in 70.  (For more information on screening for chromosomal problems go to a podcast found on perinatal quality.org ) That’s something I can personally live with.  But the increased risk of high blood pressure, diabetes, stillbirth and c section…that’s what gets me.  So what did I tell my patient?  I told her that if she wanted that “one more baby” I would advise her to be done by age 40.  What if she had no children?  Well, that’s a harder conversation for me to have.  I want her to know the risks, but I also want her to know that I support her strong desire to have a child despite life’s circumstances that have not allowed it to happen before the age of 40.

My best advice?  Try never to call a pregnant woman “elderly.”  Secondly, don’t ask women when they are going to be done having babies or if they are going to have babies.  But if you are considering when to begin or when to end your childbearing, ask your OBGYN or your MFM (high risk OB specialist).  I’m sure they will be oScreen Shot 2016-07-10 at 4.43.49 PMpen and honest with you and support you in your decision whether or not to enter the “elderly pregnancy” category.  You see, we all make different choices in life.  When we have kids and how many, where we send our kids to school, what we like on our pizza.  Some of these decisions are trivial, some have important consequences in our lives.  But we all deserve to be given compassion and understanding.  May we strive to understand our opposite, those that would choose a strikingly different path than us.  The kingdom will come near when put aside our differences and see each other as we are: people just trying to make the best in a world full of hurts.

get over it. period.

If you know me, you know that I am full of opinions and strong feelings.  Some of them are about “important things” like atonement theories, HPV vaccination, standing up for victims of abuse.  Most of them are about the “not important” things like what crust you should get on your pizza, naming your baby something that you know how to spell, wearing appropriate shoes for your outfit.  I buy clothes fairly swiftly because I know exactly what I like.  If you ask me to pick something for dinner I might not know what I want, but I will certainly tell you what I absolutely don’t want to eat.  When I picked out furniture for my home a few years ago I told the guy what he had picked that was atrocious and what was fine and he went from there.  I’ve been this way since I was small; my mother spent her mornings struggling to get me into a dress that was “too itchy” “too tight in the neck” or “just didn’t feel right.”  I would eat rice for dinner because nothing else was acceptable.  When my youngest tells me she knows best and I should stop helping her or telling her what to do my mother just smiles and I know that this is exactly what she went through.  I think many of us have stuff we feel strongly about.  One of my practice partners hates all white condiments, grammar errors, giant baby hair bows and spray tans. (love me some spray tan for my ultra-whiteness).

When does my “stop helping me, I know best” voice come through the strongest?  When I’m tired, when I’m stressed, when I’m hungry.  Oh, and when I was pregnant.  Ask any of my work friends about the day prior and the day I went into labor with each of my daughters.  I was full of opinions and strong feelings.  Most of them involved making a plan to fatally injure who I felt were the most annoying among my co-workers.  Yes, that’s right.  My friends knew I was going into labor because I threatened to kill people.  For one of my besties, it’s when she’s about to start her period.  Yes, that’s right.  PMS.  Three letters that strike fear in the hearts of husbands everywhere.  It’s what teenage boys use to blame girls for having any strong opinions.  “She told me I was out of line.  She must have PMS.”  Premenstrual Syndrome is like the government.  Everyone thinks they know how the country should be run but they have no idea how government works.  So with PMS.  They think they know what it is and what we should “do to fix it” but in reality for most it is a mystery.

Screen Shot 2016-07-03 at 7.03.25 PM.png

Does PMS exist? Why of course.  You see, your brain is a wonderfully strange organ.  Besides keeping you alive everyday by making sure you can breathe and swallow and move in an organized fashion, your brain is your regulatory system for your emotions, your thoughts and even your hormones.  Oh we’d like to blame our ovaries for everything, but it’s the brain that drives your body to work in the way it does.  For women, our brain is constantly “talking” to our reproductive organs, sending pulses of hormones trying to get them to spit out hormones in the hopes of getting us pregnant (no thank you).  That results in a lot of peaks and valleys throughout the menstrual cycle.  I like to tell my patients that for some women it’s like a horrible roller coaster and no one will let those bars up so you can get off the ride!  Some women have such bad symptoms that they are classified with premenstrual dysphoric disorder (PMDD) based on what poor quality of life they have during this time in their cycle.  Ouch!

So what is my response when usually well meaning spouses and significant others ask me to “fix” my patients PMS?  Usually I start with (surprise) my strong feelings about understanding what it means to be the sex that was created to carry and deliver another human being.  Give us a break.  They also give us the ability to bond with tiny humans that scream at us the moment they are born, they give us the ability to feed that tiny screaming human from our own body if we choose to do so.  Those same hormones are probably a big reason my bestie tolerates her husband who inspired this blog post with his eye rolling PMS commentary!  The truth is there aren’t a lot of options for treatment of PMS, especially if symptoms are severe.  While there is a lot of money to be made fixing erectile dysfunction, curing premenstrual syndrome just isn’t a sexy sell.  Fortunately for many women starting on a birth control pill, taking scheduled NSAID medications or even using medications to treat other disorders like depression and anxiety can help with PMS.

In the mean time, get over it. period.  Stop using PMS as an excuse for anybody like me who has lots of opinions and strong feelings.  I would never accuse Pastor Jason of having something like PMS if KD leaves OKC and he spends hours sobbing uncontrollably.  I choose not to buy into the belief that opinions and strong feelings are all bad.  Strong feelings get things done.  I hope my passion for the “important things” will be the reason we eliminate cervical cancer or domestic violence or sexual assault.  I’m sure my passion for the “not important” things keeps the church girls entertained on a daily basis.

So ladies, keep your strong feelings.  Make time for self care, even if you don’t have PMS.  Husbands, boyfriends, friends, significant others, partners, give grace to those around you.  It might be PMS.  It might be lack of food, lack of sleep, a looming deadline or some other stressor.  If you have terrible PMS talk to a physician you trust.  Hopefully you can find relief.  But most of all, give yourself some grace.  I won’t say that I have never regretted sharing my opinions or having strong feelings about something.  I am certain that a lot of my opinions are probably not correct or based on anything sound.  My opinions on lots of things have changed over time and are probably just as strong in the opposite direction of what I once thought.  And I probably won’t ever stop with the “don’t help me, I know best, here are my strong feelings” during those times of mental fatigue.  And maybe neither will you.  No apology needed.  I’m over it.  Period.