red hair…don’t care.

I got the “red hair…don’t care” award from my residents a couple years ago.  I loved it.  They decided this award was best for me because I shoot pretty straight on most things; especially when it comes to the residents and medical students I work with.  I say things like “here’s a great way NOT to impress your attending.”  Or  “how about we try not to say that in front of the patient.”   I also have a thousand funny memes and sayings and have been known to let loose with my sarcasm at times.

In the spirit of all things “don’t care” I thought I would share with you what myself and my fellow OBGYN’s don’t care about that our patients seem to be all worked up over.

That your legs are not shaved.  No seriously.  I’m not giving you a leg massage.  It really doesn’t bother us.  We usually don’t even notice unless you bring it up.  Confession: our legs probably aren’t freshly shaved either since most of us prefer to use that extra few minutes for sleep instead of time in the shower.

That you are on your period.  I’m sure you hate it but we signed up to deal with it.  Like every day.  Remember we deliver babies and perform surgeries and see hundreds of women who are bleeding.  We got this.  Thanks for worrying about us but we will be fine.

That your socks don’t match or your toes aren’t manicured or you aren’t wearing your cutest undies.  For the most part we get dressed in the dark.  We come into the hospital in the middle of the night.  Our socks might not match.  Wearing underwear is considered enough.  Please do wear it.  You don’t have to wad it up and hide it from us under your other clothes, we don’t care what it looks like.

That you might see me in public.  One time I saw someone bolting down the aisle at Target to avoid me.  It’s OK if you see us at the grocery store or the gym or the PTO meeting (who am I kidding we are always at work during the PTO meetings) we will do our best to remember your name correctly and say hello but it won’t be awkward for us because we take very seriously protecting your privacy and honestly we don’t remember every detail from every patient…that’s why we take good notes!

That you have a ‘weird’ question.  Trust me.  Patients often say “I have a weird question” followed by something that is totally normal/common/not weird at all.  There is not much we haven’t seen or heard.  Not much we haven’t dealt with, walked patients through or bailed someone out of.  What might seem weird to you is probably routine for us.  So hit us up with your ‘weird’ questions.

What the internet (or your bestie) told you.  If you come to the doctor with a plan in place for yourself then it makes our job harder.  Instead of focusing on listening to your problem and making decisions on the best available evidence we spend time re-educating you about what you have read or heard.  We are happy to provide you with that information but we really want to spend our time helping you get better.

So, here’s what we DO care about.

That you are honest with us.  We can’t take care of you if we don’t know what is really going on.  While most OBGYN’s are friendly and inquisitive by nature, we ask about who you are sleeping with and what medications you are taking because we want you to be safe and healthy, not just because we are nosy.

That you know we want what’s best for you.  If you are honest with us we will listen, we will empathize and we will be honest with you.  Sometimes that means we might tell you something that is hard to hear.  Or give you bad news.  But through it all we are doing are best to do what is best….for you.  For your health and for your family.  Try to remember that when the answer we give you isn’t necessarily what you wanted to hear or involves hard work.  We want you to be safe so we are going to ask about any history of violence or dangerous behavior.  We want you to be healthy so we are going to ask you about your diet and exercise habits.  We don’t want to harm you so we might not be able to give you a medication you want or perform a procedure you would like to have.

That you know we are doing our best.   Sometimes we run behind, we get stuck at the hospital or are dealing with a difficult situation.  I can’t promise you won’t have to wait in our waiting rooms or that your surgery won’t be delayed or even that everything will turn out perfect, but know that we are doing our best to make sure you are taken care of as best we can.  We are mothers, fathers, husbands, wives and most importantly, human beings.

screen-shot-2016-09-25-at-6-38-08-pmSo there you have it.  The truth from blonde covering gray hair who don’t care and will tell you how it is.  Go ahead, don’t shave your legs. (Please note that my obgyn friends do ask that you please have clean feet when you arrive.)  Ask the embarrassing question without even saying it’s ‘weird’.  Say hello when you see us at the grocery store with our screaming children and sweat pants. And come to your physician with honesty and an open mind.  Grace and peace, friends!

 

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the answer is 11,900.

It’s my favorite question to ask.  “How many women are diagnosed with cervical cancer annually in the United States?”

I ask it almost weekly to a medical student or a resident.  I’m not sure why or when it became my favorite question to ask.  Maybe because the answer keeps being the same.  Maybe because it launches me into one of my favorite lectures about how we have failed to eradicate an almost absolutely preventable disease.  Probably because I don’t think I will reduce these cancers so much as will my students and residents as they become advocates in their practices and communities for gynecology cancer awareness and prevention.

September is Gynecologic Cancer Awareness month. Thousands and thousands of women will be affected with gynecologic cancer each year.  Many of them don’t know the signs and symptoms of Gyn cancer, they don’t have access to screening for these cancers or they  aren’t aware that they are at risk.  A few facts you should know about Gynecologic Cancers.

  • A woman can be affected with cancer of the ovary, uterus, cervix, vagina or vulva
  • Cancer in each of these organs can occur as different types and those different types of cancer may have different risk factors
  • As women age their risk for gynecologic cancer increases.
  • About 45,000 women will be diagnosed with uterine cancer, 20,000 with ovarian cancer, almost 12,000 with cervical cancer, and about 6,000 with vaginal or vulvar cancer.
  • Many if not most cervical, vaginal and vulvar cancers can be prevented by vaccinating young men and women against HPV.
  • Uterine cancer is associated with obesity and excess estrogen.  Abnormal bleeding is the most common symptom.
  • Most women with ovarian cancer are diagnosed at a late stage due to the lack of a reliable screening test and its vague symptoms.
  • The later stage the gynecologic cancer is diagnosed the more likely the woman is to die from her disease.

Most of my clinical work with cancer centers around the prevention of lower genital tract disease.  Cervical, vaginal and vulvar dysplasia and cancer.  I started working in this area in residency and was given opportunities by mentors and colleagues to build my knowledge and skills for patient care, research and education in this area.  But about half of my research focuses on the early detection and prevention of ovarian cancer.  The picture above is my cousin Tara.  She was diagnosed with ovarian cancer in 2012.  I remember my mom telling me that she had ovarian cancer and thinking about how impossible that seemed.  She was younger than I was and very healthy.  Tara has persevered through a massive surgery, intense chemotherapy and more surgery in addition to countless scans, doctors appointments and other medications.  Tara is the reason I love collaborating with my research partners to try and better understand how to reduce that number of ovarian cancer patients from 20,000 annually to as close to zero as possible.

So here’s the advice.  The “to do list” if you will.

Get an HPV immunization: If you are between the ages of 11 and 26, if you know or love someone between the ages of 11 and 26, if you are the parent of someone between the ages of 11 and 26 then you need to know about and advocate for HPV vaccination.  It’s the best way for us to reduce or eliminate those 11,900 cases of cervical cancer.  Plus if you don’t do anything my favorite question will never have a different answer and then how will I stump my medical students.  It’s safe.  It’s effective.  You can read more about HPV vaccination here.

Know your family history.  Some ovarian and uterine cancers are genetic in nature.  My family loves to share this kind of information.  My mom’s favorite kind of text: “Did you know so and so was in the hospital for such and such?”  This is usually followed by me asking who she is talking about and how they are related to me.  If this isn’t your family start asking questions.  Talk to your doctor about the cancers that have affected the men and women in your family and they can talk to you about genetic testing.  You can read more here.

Take care of yourself. See your doctor for regular and preventative healthcare.  It’s no fun going to the gynecologist.  I mean even I don’t love going.  But, it’s worth it.  First of all, OBGYNs are awesome.  Secondly, we can’t diagnose things we don’t see you for.  Besides seeing your doctor, exercise most days of the week, eat your veggies, don’t smoke.

Most importantly, take care of others. 

Tara has established a non-profit organization to support otscreen-shot-2016-09-02-at-6-22-54-pmhers diagnosed with cancer. You can find out more about over at Tenaciously Teal.   Tara is a huge advocate for cancer prevention, screening and early diagnosis.  As a physician I am called to improve the health of my patients.  As a Christian I am called to care for the poor, the widow, the sojourner.  I can’t do it without you. Many women I see don’t have access to healthcare.  They don’t have insurance, they live far from a healthcare facility, they don’t have transportation or childcare.  Be a voice for those who don’t have one.  Take action for someone who doesn’t have the courage.  It will take all of us to make a difference.

fearless.

What is your biggest fear?  What are you most afraid of?

That was the question of the night when the church girls and I went on a weekend trip this summer.  It’s a question I would have never thought about asking.  But, if I’m honest, there are a lot of things I am afraid of.  Like spiders.  Those guys are creepy and fast.  And most other bugs.  “Blood and guts” as my girls say, are fine but bugs are gross.  My friends all had different fears.  Losing the people they love, dying, rejection.  All super legitimate.  I don’t know that any of us are fearless.  And maybe that’s a good thing.  We should be wary of wandering out into the street, feeding wild animals, playing with matches and all the other things your mother told you not to do.  Fear and worry sometimes work to my advantage.  In my line of work you prepare for the worst case scenario.  You think of all the things that could possibly go wrong and then work to avoid them and then figure out how to fix them if they occur.

But, in general, I’m not sure fear does us a whole lot of good.  When we are afraid we move away.  We walk to the other side of the street, we go to the end of the line, we don’t raise our hand.  We miss out.  One of my best girls painted a canvas for my youngest when she was born.  Her life verse.

Psalm 46.

“God is our refuge and strength.  A very present help in trouble.  Therefore, we will not fear.”

Say whaaat?  I will not fear. Um, I’m not so sure.  I will not fear…except for when I face something new or unexpected.  And maybe when things are tough.  Oh and spiders…still fearing spiders over here Jesus.  But what do I fear most?  What seems impossible when it comes to “I will not fear?”  Suffering.  Loneliness.  Failure.  You see I’m not afraid of deathScreen Shot 2016-09-11 at 7.51.48 AM.png but I am afraid of suffering prior to dying, getting defeated by illness, and then no one showing up to my funeral.  Funny how fear works.  It seems to find the things deep inside you where you are most vulnerable and remind you of why you put them there.

Today pastor Jason and I went on an adventure course.  We did a 75 foot high tower ropes course, a vertical drop, zip line, fun slides and a rapid rafting course.  I was afraid and thrilled all at the same time.  I’m wearing a harness and watching other people older and less agile than me do all this stuff and manage to not die…but still.  There’s a part of your brain that just can’t quite shake the feeling that flying 80 feet in the air over a river and then back is not that safe of an idea.  That place deep inside begins to creep up and tell you to be afraid.  But then you do it.  Mostly because the old guy in front of you managed to be courageous enough to do it. Partly because your dad has done it and you can’t chicken out on something your dad has conquered.  And it’s amazing.  You realize what you would have missed out on had you not stepped off that ledge.  And you’d take the step a dozen more times.  The fear doesn’t disappear but knowing what is on the other side makes it seem so much smaller.

I think fear keeps us from taking that first step in so many places in our lives.  When I am afraid of suffering I will never move out of my comfort zone.  When I am afraid of loneliness I miss out on those quiet spaces of rest and refuge.  When I am afraid to fail I miss out on all the good things that come with doing something hard, something new. When fear controls us we are powerless to change.  Will I be killing all the spiders at our house from now on?  Nope.  But the next time fear creeps in I’ll try and remember what it felt like to take that step off the ledge and into the air today.

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(photo credit ultimate selfie at Riversport adventure in okc)

life in the margins.

It snuck up on me.  The way that a virus sneaks up on you with a slightly scratchy throat and that little body ache.  And then all of the sudden you are overwhelmed.  You never saw it coming and then you’re down for the count.  That was me this week.  Not with a virus but just with life…my life.  The busy-ness, the listening, the work, the productivity, the juggling of schedules and priorities, the bearing of burdens for others, the overwhelming brokenness of our world.  I was over it.  So I did what any one in my position would do.

I had a meltdown.

It was not pretty.

The pastor was there to sit with me when I got home and tell me that life would be ok, that I would be ok.  And I was.  Or at least I think I am.

Then came a profound statement from one of the church girls.  When I told her that all of the sudden I had nothing left to give she said to me “friend…where are your margins?”  It knocked me off my feet.  A margin.  White space.  The leftovers on the page where stuff doesn’t go.  We don’t think about margins.  They are hard to notice.  They just exist in the space around what you have filled the page with.  They can be made larger or smaller depending on how much space you need for all the words and things.  It’s easy not to notice them until they are gone.  When the margins are suddenly wiped out then all you have is an overflowing page in your life.  Words and phrases and ink running from top to bottom, from side to side.  No blanks, no pauses, no space to breathe.  And that, my friends, is where I found myself this week.  I had no margin in my life.  No space for anything else.

How did I lose the margins from my life and how do we get them back when they are gone and then keep them in place?  I’m not sure I have the answers but I will try my best.  (And since when did not being sure stop me from sharing opinions on anything).  We lose the margins in our life when we let them go.  Or better, when we fill them with things we think are good or worthwhile.  We take what little time we have left and fill it with the extras of life. For me it’s saying yes to everything and everyone.  Picking up work that someone else didn’t do.  Being constantly available.  Sometimes it’s not activity that fills our margins but instead they are filled with expectations to do and be and act in ways you are not.  To fit some mold created by social media or the couple next door or even our families.  How do we regain the margin?  For me, it’s naming my discontent.  It is asking for help.  It’s learning to value the work and not the end sum.  It’s finding peace instead of isolation in the uniqueness of being a pastor’s wife and physician mom.

Why do we need margins in our lives?  Because without them we have nothing left to give.  And we must have something left.  We need space to be refueled and revived.  We need time to refocus and find contentment.  When our margins are filled the ink starts to run and we can be pulled into a puddle of dark.  It’s in that place where we lose the ability to be a light to others.  So I’m looking for my margins on this long weekend.  Because when we have space in our lives we have room to be light.  We have room to care for the poor, the widow, the orphan and the sojourner around us.  When we find contentment and peace in our own lives we have space and strength to stand up against domestic violence, sexual assault, hunger, poverty and so much more.   If our margins get too wide then we have little substance left in the middle.  Margins create balance.

So may we find margins in our life.   I’m sure when I worship with my church tomorrow my margin will start to show up again.  But it will also remind me that between the margins matters as well.  What lies between is not not what I have created but what God has created through me.  May my margins not grow so wide that I am not able to see the dark places and move towards them and may it not grow so small that my light has no fuel left in it.

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