October 2016 – Gynecology & Theology

above all, choose love.

I am, literally, tired of everything. Anyone else? I mean, can I get an amen? And not just in the “I’m gonna go home and take a serious nap after church today” way. Today I am keenly aware of the huge volume of things in our world to be weary of.

If you haven’t been paying attention, people are upset. And in the same breath, they are doing perfectly fine. We are in a season of paradox. A time when our lives lived out on social media are full of “totes adorable” and “to die for” and our children are well dressed and even better behaved. At the same time we vilify those who don’t belong to our political party or whose religious beliefs, skin color or patterns of behavior don’t match up to our own. We don’t apologize to anyone or for anything because we are certainly right or at least more right than everyone else. So we sip our lattes and use our best instagram filters and bask in the glow of the number of likes our candidate or our favorite team or our favorite belief systems receives. And it all comes at once. And I refuse to believe that I am the only one who is really just over it.

On top of all of this I think our digital age has made us keenly aware of all the wrongdoing that surrounds us. October is domestic violence awareness month. An entire month to educate our community on a societal problem that we can’t seem to shake. This month also contains a day to remember our lost children and the families who mourn them daily. We are constantly faced with a newsfeed filled will murders of our young men and women, the exclusion of our most vulnerable, the exploitation of women and children in our culture and the corruption of the most powerful.

So what then, are we to do?

My friends, do your best to choose kindness. It isn’t easy. Believe me, I am often the first to choose anger and judgement. But when my children are fighting in the back seat I remind them to always choose kindness. I can think of dozens of time when I regret choosing something other than kindness. I can’t think of anytime I regretted the opposite choice. Also, practice empathy. Take on another person’s perspective. Make the choice to be open to their thoughts and feelings as valid and important. When we practice empathy we learn to believe that the hurt of others is as important as our own hurt. (I recommend Brené Brown’s YouTube video on empathy).

And, above all, love others. What does this look like? For me, in my faith community, it means being the hands and feet of Jesus like my friends and neighbors were for me this weekend.

While I was at work yesterday my dear friends came to give respite to the Pastor from my two wonderfully rambunctious children so he could rest. And then my neighbors brought those same loud and crazy kids dinner so they could all rest. And today my children will be loved and cared for by my own church community so I can rest from a busy night of welcoming babies into the world. And while these simple yet profound acts of kindness have and will bring much needed physical rest to our families, more than that these are the tangible expression of a body of people that choose kindness over rightness, vulnerability over social media perfection. So, friends, today instead of my usual “I don’t look like I’ve only had 3 hours of sleep lipstick and heels” I chose “messy bun, no eyeliner
and stretchy pants” for my church outfit. And I let my four year old wear her sparkly crown and my 9 year old wear non-matching shoes because, in the end, only these few things matter.

The truth is that our world will continue to saturate us with filtered images of what is good and what is truth, but you and I can choose show grace to those around us by choosing kindness, empathy and love. And friends, when life makes us tired, we can rest in the assurance of a God who knows us and chooses and His people who are the tangible expression of His love.

the sound of silence.

The room is almost always quiet. Whether it is early in pregnancy or near the end, you can feel everyone holding their breath waiting to hear it. And then it doesn’t come. There is no heartbeat. You take a deep breath to explain what you see but everyone in the room already knows. And then the silence is broken. Sometimes with sobs, sometimes with sniffles, sometimes with a deep sigh. My heart never fails to break in these moments.

October 15th was Pregnancy and Infant Loss Remembrance Day. The term “rainbow baby” refers to a child that is born after a woman experiences a miscarriage, stillbirth or the death of her infant. I am privileged to know and journey with many of these mothers. Their heartbreak is overwhelming to consider and at times their grief is immeasurable. Yet these mothers and their families are a treasure to care for. About 20% of pregnancies end in miscarriage. That’s 1 in 5. Stillbirth occurs in about 1% of pregnancies, which is about 24,000 babies in the US every year. That means if you’re reading this then you know someone who has had a miscarriage and many of you will know someone who has experienced a stillbirth or the loss of a baby sometimes in the first few months of life.

These women share many different versions of the same story. They are ushered into a sorority of sorts that they did not choose and would endure any amount of pain to be removed from. For most of the women I know, they will tell you about arriving for an early prenatal visit with hope and anticipation and leaving in heartbreak. Some of these brave women will tell you about that” longer than it is supposed to be” ultrasound in the middle of their pregnancy and the even longer wait to hear from the doctor that all is not well. But their wait isn’t over. Instead, it has just begun. They wait to see how many weeks they will continue to feel their baby move, how many more appointments they will continue to hear the quick and swishy heartbeat until the disease or malformation takes its toll. And the women who lose their soon to be born or recently born child, their grief is so heavy you feel it long after you have left the hospital. They are often left with little explanations of what has happened and uncertainty of what is to come.

As if this wasn’t enough, women who experience pregnancy loss are often met with painful messages from people telling them that God brings tragedy into life for some twisted purpose of growth or need. We feel the need to explain away the parts of life that make us most uncomfortable. What follows these messages is silence. Why? Because we find it difficult to speak about the parts of life that disturb our sense of our cultures best expectations. We seem to have no idea how to walk alongside this deep sense of loss and grief.

Rainbow babies are the ultimate symbol of hope. These precious children do not replace the ones that are lost. But they do give us a daily reminder of the grace that continually winds its way through our lives.

In the Bible a rainbow is a symbol of covenant and commitment. Families who have lost children deserve our commitment to honor them by acknowledging and remembering their past and holding a candle of hope for them for their future. Ask them about their grief. Have them tell you about the child they lost. Sit with them in the quiet and tell them you are deeply sorry for their loss. And mean it. When you sit with them in the silence you will begin to hear the story. What you will find is a group of women who will change your life with their courage, their strength and their hope.

pounding on the door.

I’m not sure I knew what I was getting myself into when I married Pastor Jason. Nor do any of us who sign up for marriage, children, medical school, semesters abroad, adopting a pet or any other new venture we begin in life. There are lots of pastors and preachers in my extended family but I didn’t grow up in a pastor’s home and really didn’t think it would change my life that much. After all, I went to church a lot. Like, almost always. That’s got to translate to something right? I figured I would show up a lot and volunteer for a few things and call it all in a days work. Sounds fine, right?

People, being a pastor is not for the faint of heart. And neither is being the pastor’s family. One of my running buddies Brent says I really only meet 1 of the 10 requirements for being a pastor’s wife. To this day I’m not sure what the 10 things are or which one I am fulfilling. What I do know is that sometimes the phone rings in the night and it’s not for me. I know that pastors get caught late at work dealing with the hurting, broken and disheartened just as much the gynecologist does. I know that some days at the church are full of joy and some are full of doubt.
Today I sat next to Pastor Jason as we heard a challenging sermon from Luke 18. In the passage we hear of a relentless widow who will not accept injustice from her society. In the parable recounting this vulnerable woman’s experience we learn about the hope and restoration that God aches for. I was reminded that this is really what the pastors I am surrounded by are doing. On a daily basis the men and women in clergy are working to restore peace and bring mercy for the rest of us. They usher us into worship, bring us the truth of the gospel; they teach our children to love others and be brave and kind, they shape our young people into adults who can change the world. Or, like Pastor Jason, they sit with the wounded and weak, pray with the sick and dying and listen to our deepest fears and hurts.

October is clergy appreciation month. Each week I am thankful for the faithful and thoughtful community we are surrounded by, in our local church and by those in ministry near and far. The work clergy do is wonderfully exhausting. It happens at all hours of the day and night; it interrupts meetings and dinner and sometimes even other church work. Your pastor deserves to know that you recognize their work is difficult and valuable. When I really reflect on what life as a pastor is about I am faced with the profound words of Isaiah 58: 6-7.

“6 Is not this the fast that I choose:
to loose the bonds of injustice,
to undo the thongs of the yoke,
to let the oppressed go free,
and to break every yoke?
7 Is it not to share your bread with the hungry,
and bring the homeless poor into your house;
when you see the naked, to cover them,
and not to hide yourself from your own kin? ”

If you have a pastor or other clergy leader, please know that they are working daily and weekly to undo the injustices for the most vulnerable in this world. Please know that they sacrifice their time, their families, their financial gain for the work of the Church. If you don’t have a clergy member in your life I hope you find someone to lead you in your spiritual life who will pound on the doors of injustice, who will share bread with you and with the least among you, who will do the most for the least of these. Then you know you have found someone who will lead you into the ways of God. And if you, like many of my dear friends, have experienced injury and hurt from the church, take heart. Find one of the many voices of truth from across the nation and listen to them in the hopes that your faith in the people who do the work of God is restored (see my list below).

I hope this week you find yourself being ministered to and being thankful for those who do the hard work of ministry. I know Pastor Jason deserves more thanks than his family of girls does on a daily basis and we could not do life without him. After all, your pastor is human, hopefully doing the best he or she knows how to do. And just like me when I said a resounding “yes” to the Pastor, they probably didn’t realize what they were getting into when they answered the call to ministry.

A few of my favorites you can find on twitter and listen to on their pods

@D_Quan87 and his pod HCN Weekly Sermons

@RichardRohr_OFM and his Homilies podcast

@jonmiddendorf and the pod of Oklahoma City First Church of the Nazarene

@bobgoff and bobgoff.com

@shawna_SG and shawnasongergaines.com

@michaelrpalmer and michaelrpalmer.com

@tarabeth_82 and tarabethleach.com

modern feminism.

I grew up in a household where I didn’t know that I might be disadvantaged in life because I was a girl. I don’t remember being told “you can do that even though you are a girl.” I don’t remember being told “you can do anything your brother can do.” I remember feeling that I could do and be anything I set my mind to. Period. I remember being the only girl at a basketball camp I attended in the 5th grade. I remember being the youngest and the smallest. I remember shooting a hundred three-pointers and not making any of them. I absolutely remember that this was the first time that I wasn’t sure I belonged because I was a girl.

Not long ago I told one of the church girls that I am a modern feminist. It was in the midst of me telling a story where I was in a meeting and presented an idea. A gentlemen across the table from me repeated my idea about 2 minutes later as if it was his own. I wish you could have seen my face. The craziest part was that everyone just moved on like it didn’t happen. Why? First, I think because it’s a sad but common occurrence. Secondly, I don’t think anyone feels empowered to say anything. I read a recent article where women at the White House repeat each other’s ideas and give the author of that idea credit to ensure it is heard. It’s a genius and embarrassingly necessary idea. I attended a town hall meeting of sorts with two women in local politics. They both said they were “recruited” into running by their community. I couldn’t help but think that maybe these women needed a group of people to lift their voices before they could be accepted into the political arena.

And don’t think that men in our culture are the only ones who limit the ability for women’s voices to be heard. Many women still believe a wife “allows” her husband to commit infidelity by not engaging in enough sexual activity or being too busy at work or caring for children. Many women and men believe that a large amount of alcohol or a small amount of clothing “allows” women to be the victim of sexual assault. These men and women have bought into the lie that women must change in order for the culture to change. I just don’t buy it. It’s not a woman problem. It’s a world problem. I shouldn’t have to dress or talk or walk or do anything differently to not be treated like I matter less. Our culture says “Women, just be different and the world will then recognize your worth. Stop screwing things up for yourselves by some of you wanting to work and some wanting to be stay at home moms; some wanting to be single and some desperately wanting to be married.” These statements aren’t blatant of course. They are inherently biased in so many of the arenas we live and work in. The subtle and subversive notion that if only my voice was less loud and not so high pitched then maybe I would be “heard” more often. The creeping feeling that my outfit or my hair is noticed more often than my skill as a surgeon or my innovation as a researcher. The indignant feeling I get when the men in the room during a delivery seem surprised to see me take excellent care of their wives and partners. We all have inherent biases and until we are brave enough to admit them we will never move forward.

Why do I believe I am a modern feminist? Because when I read the Bible I am drawn to the women who were incredibly faithful and brave in a culture that did little to acknowledge their existence or worth. A young Mary who bravely accepted the calling of being the mother of Jesus. The women who faithfully stood by Him during his trial and execution. Who took him down to be buried and showed up to tend to his grave. Who knew He could change the world because the poor, the widow and the orphan were just as valuable to Him as the priest, the tax collector and even the king. Because I want my Christian community to take up for the most vulnerable and recognize that women in the modern church can and will do the praying, the preaching, the spiritual disciplines and the heavy lifting required to move us toward the Kingdom of God. Because the church girls, my patients, my sister in law and my coworkers deserve better.

I have two daughters. God bless the pastor. When Pastor Jason is at a golf tournament with our oldest there is no “you can beat those boys” talk. Instead, he reminds her that she has the best golf swing he has seen in a 9 year old. Better than her dads. And that she can beat anyone. Why? Because it’s the truth. And the pastor knows that she is more valuable than to be compared to a reference group of men. My 4 year old believes she can do anything. And from the short time she has been on this planet I’m not convinced she isn’t correct. Our world will closely reflect how we treat its women and its most vulnerable. I want my daughters to live in a culture where no one has to repeat their ideas for them to be valid. My greatest hope is that my daughters will have a voice at the table. A voice in the classroom, the boardroom, the operating room. This modern feminist believes women have the ability to change the world.

(photo credit: smart physician moms plus the internet plus the tribute to the holocaust victims and survivors in Boston)

the worst part.

I got my flu shot on Friday. The worst part? My office nurse made me weigh and take my blood pressure before she would give me the vaccination. Talk about ouch!

“Should I get my flu shot?” is one of the most frequently encountered questions I answer between the months of October and February. My answer; almost always a resounding “yes.” Why? Not only because the flu is terrible to have, it kills people. And I’m not talking about the “my husband has the flu and now he acts like he’s dying but I might kill him instead” kills people. Like it really kills people. While the current reporting systems don’t allow us to know exactly how many people die from the flu in the US annually it is likely to be somewhere around 20,000 people including about 150 children. The young, the old, the pregnant and the immunocompromised are the most at risk.

So why would anyone question getting their flu vaccine? Oh, let me count the ways.

Many of my patients think the influenza vaccine can give them the flu. Wrong. It does create an immune reaction and you develop antibodies in about 2 weeks that should be protective against the flu. Most patients receive either the trivalent (traditional) or quadrivalent flu vaccine. Trivalent vaccines protect against an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. The quadrivalent vaccine (what my nurse was giving me in the above photo) has protection against an additional B virus. These are inactivated or recombinant immunizations which means, in short, they won’t give you the flu. And remember, it takes 2 weeks to be immune, so if you get the flu 2 days after you get your shot don’t blame the vaccine. Blame the person who exposed you to the flu virus before you were protected.

Some patients just don’t think they need the vaccine. Maybe they have never had the flu. Well, trust me that it only takes one week of feeling incredibly ill with the flu to convince most people they never want to skip out on vaccination again. I also tell my patients that even worse than getting the flu is giving it to someone else. If you have a child, a pregnant woman or a person over the age of 65 you care about then the influenza vaccine is for you. If you have friends or a family member who has cancer, asthma, diabetes or another immune disease then the flu vaccine is for you. Giving the flu to someone who is at high risk of hospitalization or death is not nice. Pregnant? Pregnant women who get the flu are more likely to have severe illness, be hospitalized or die from the flu. Scary much? Trust me, I repeat that line on a weekly basis. Plus, the infants of pregnant women who are vaccinated for influenza in pregnancy have protection that can last up to 6 months.

So what do I say when asked by someone if they should get the flu shot?

Yes. You’re pregnant and I don’t want to risk seeing you in the ICU with the flu. Plus your baby can’t receive a flu vaccine until 6 months of age and you want to protect your infant until they can protect themselves. You can be vaccinated in any trimester so trust me when I say if you don’t do it today I will ask you again at your next visit.

Yes. Immunizations carry much less risk than the diseases they protect you from. Does the flu vaccine guarantee that you will not get the flu? No. But it does significantly reduce your risk. You still need to wash your hands, avoid sick people, cover your mouth when you cough and all those good things your grandma has been telling you since you were small.

Yes. Getting a flu vaccine is more than just about protecting you. It’s about avoiding the flu so you don’t spread a virus to someone who can’t get vaccinated. Or spreading the illness to someone who could get very sick and hasn’t had time for their vaccine to be fully protected. Or your wife. Husbands, get your flu shot. If you give the flu to your wife no one will be happy. The Pastor had the flu last year and I literally locked him in one room of the house until he was no longer contagious.

Yes. Because you care about your kids and your family. My kids will be disappointed to learn the nasal spray isn’t recommended this year. The needle stick will be the worst part for them. But the good news is this…first, they get excited when they get on the scale at Dr. Melissa’s office (unlike me!) Second, they think doctors and nurses are awesome and trust that they will be protected. Finally, there are stickers…and probably treats on the way home.

So go get vaccinated. There are about 150 million doses available so I’m sure you can find one. Some more news for those of you still skeptical. Now you can be vaccinated if you are allergic to eggs. There is even an intradermal version: which means the needle is about 90% smaller for those adults in the group who are afraid of sharp things seen above. No matter if the weight or the blood pressure measurement or the waiting in line to get it done or the actual needle stick is the worst part. This gynecologist and pastor’s wife thinks it will be worth it.

(photo credit my arm, Heather’s hands and Erika for being the photog.)

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