the five year plan.

If someone asked you what you will be doing in 5 years could you answer?  What about 1 year, or 1 month?  I’m not sure I could.  I’m happy if I can remember what I’m doing 5 days from now and whether or not I’ll need a backup plan for childcare or dinner.

I was recently privileged to participate in an initiative to increase access to long-acting, reversible contraception (LARC) in my state.  These products provide extremely effective contraception for an extended period of time after placement and rely on little to no effort on the part of the patient. Almost half of pregnancies in the United States are unplanned.  Half. 3.2 million pregnancies where one or both partners didn’t intend to become pregnant. For some of these women and their families another pregnancy may have a lot of unintended consequences such as economic instability or a need for new housing.  By using these LARC products we can reduce the unintended pregnancy rate. Each of these methods has less than a 1% pregnancy rate per year (some as low as 0.05% per year).  Many of them are also safe for women who are otherwise not able to use forms of hormonal birth control.

I have previously revealed my feelings about having another baby in the blog post “when are you going to…” and it has not changed.  So. Many. Tears. In fact a colleague and I were in the surgeons lounge this week waiting to operate and literally laughing about the disaster that would be us as old ladies having babies.  But reducing the unintended pregnancy rate isn’t just for the “old lady gynecologists” but has a real impact on the health of our nation.  Appropriate spacing of pregnancies reduces the likelihood of preterm birth and low birth weight babies.  In addition, women who have planned pregnancies are generally more likely to enter pregnancy having attempted to improve their health by doing such things as quitting smoking or avoiding alcohol and taking a prenatal vitamin.

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So what’s your plan? I had someone recently ask me if they thought having kids was a good idea.  My answer?  “Depends on how many of my kids are having meltdowns when you ask me.”  My current plan involves no more diapers, no more daycare, and enduring 5th grade social studies homework and kindergarten readers. Think about your five year plan and talk to your doctor.

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i live here too.

It is one of the most clear memories I have from early on in my career.  Some friends were over and asked how long we had lived in our home.  When I answered, my eldest, in the sincerest of voices proclaimed “Mom, that’s not true.  Dad and I live here and you live at the hospital!”  It’s pretty hilarious now but at the time I was crushed.  CRUSHED.  I remember the days in residency when I felt like I hadn’t been home in forever.  Let’s be honest. Sometimes it still seems that way.  Home in time to eat and sleep and then back up before everyone else and off to work.

September is designated as Women in Medicine month by the American Medical Association. One third of our nation’s physicians are women. Many of these women chose medicine as a career during a time when they had very few role models who were women.  Many of them delayed starting their own families to learn to care for the families of their community. I have the privilege of training with, working with and knowing some incredible women physicians. These women spend many years training for a career in which they will give countless hours to improve the health of others. Most do it for a salary that is less than their male counterparts.  They juggle rounding and homework and office visits and basketball practice and charting and so much more.

Women are under-represented in leadership in medicine; and a recent survey of physician mothers revealed that most women have felt discriminated against because of pregnancy, breastfeeding or motherhood. Does this make men at fault?  Certainly not. But we work in systems that have long overlooked that its workforce is changing. Fortunately, physician moms are working to improve policies and procedures so the women that come into medicine after us have the opportunities to lead their communities to better health.

So here’s my shout out to women in medicine.  You are some of the toughest, smartest, most caring and passionate women I know. You will change the future of health. And you are unstoppable.

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transformation.

You can make all sorts of arguments about whether or not the world is getting worse. When you look back at events like the Holocaust and periods of history like slavery and segregation you could make the case that we are not more violent and worse off than in the past.  And then, Charlottesville.  It’s tragic and shameful.  It’s almost hard to believe it really happens.  Almost.  Except, it happens every day. This might be the worst we’ve seen, but every day people would rather take for themselves than give to someone else. People chose to fear the other and decide that a message of hate is going to save them.

First, may we all condemn white supremacy and the events from Saturday.  Secondly, let’s admit that violence and hatred and suppression happens every day.  It happens in big huge giant ways and in the smallest of small ways. It happens every time there is an incident of domestic violence. It happens every time we refuse to condemn amisogynistic statement or a racist joke. It happens every time we tolerate a gender pay gap and a minimum wage that leaves families below the poverty line.  It happens every time we give in to the fear that someone will come and take away the life we have ‘built’ or our security. In both big and small ways we are guilty of putting our own well being above all else and deciding that someone else’s life matters less than our own.

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What then, must we do?

Open our mouths.  Dare to say something when your friend, your neighbor, your fellow church member or even someone in your family privately or publicly says something that is oppressive, racist, supports gender bias or invites hatred. We must say something. It won’t be easy, it probably won’t be popular, but it will be right.  But it must go beyond just our voices.  If we really want to be agents of change in our society we can’t just use our voices but must embody justice, equality and peace with our whole selves.

For those in my tribe called Christian and especially Nazarene, IMG_0635it means putting your money where your mouth is and then making sure your hands and feet follow your money.  That’s right.  It’s not enough just to send your money to the after school program or the food pantry or the non-profit.  Giving your money is necessary and sacrificial but not necessarily transformational. To be transformed means you take an afternoon off from the comfort of your office where you are paid more than you probably ever need and find yourself  sitting next to a child that looks remarkably different than your own and help them learn to read or finish their homework.  To be transformed means to bring your kids with you to serve a meal to someone for whom life has not given many opportunities and forge a friendship.  Not only will it transform you but your kids will grow to understand they aren’t the only people who matter. Transformation is to remove the “us” and “them,” to eliminate the fear of someone who believes differently or looks differently or behaves differently than you.

Today, if you find yourself saying “I haven’t done anything terrible” think about those first 4 words.  Have you done anything at all? Be generous.  With your time, your money, your life. Put the needs of someone else above your own. Condemn anything that represents hate of the other, fear of those who look differently than you or closing doors and windows to the poor, the widow and the orphan. Instead, may our lives reflect a God who would rather arm his people with food, with health and with life than with weapons. A God who looked beyond gender, race, age or anything else when He came to offer healing and hope.

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this day.

Seventeen years ago today I got engaged. 17! It was the Pastor’s birthday so of course I had no suspicion because who does something besides bask in the celebration of themselves on their birthday? We were in the mountains of Idaho on vacation.  He proposed on the beach.  There were lots of tears.  Finally, we went to the local gas station and used a pay phone to call my parents.

Seriously!  A pay phone…at a gas station. My kids don’t even know what a pay phone is!

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Less than a year later we were married. I was in medical school and the Pastor was finishing his undergrad degree.  We lived off 99cent frozen pizza and 49cent cornbread from a box. We took almost all of our cash from wedding gifts and went out and purchased the most amazing piece of technology known to us at the time.  A DVD player.  We are talking HUNDREDS of dollars. It was enough that we had to save up again to rent DVDs to watch on it.  Well, within the last year we needed to purchase a new DVD player. So, of course, I went to my best buddy Amazon.com.

Guys…you can buy a DVD player on Amazon.com for $25 and get it at your house in 2 days.  2 days!

Fast forward 12 more years and it’s the Pastor’s birthday again.  I’m 38 plus weeks pregnant with baby #2.  The baby spent 3 years in the making and the one who seems larger than life when just a week earlier our state had the hottest day since 1936.  ONE HUNDRED AND THIRTEEN degrees, people.  So, I send him off to have a great day with friends while I take big sister to school and then am off to work.  Only baby BK decides it’s her day to come. Despite my insistence at my coworkers (read: screaming) that I was not going into labor, it was happening.  When my first child was born I didn’t even have a Facebook account! 6 months after my second child was born she was the subject of my first Instagram post.

Imagine a world with no FB and no Insta…that same world had pay phones at gas stations and $250 DVD players.

In the last 17 years we have seen many changes. Most of them for the better.  But some

IMG_6535.JPG.jpegthings stay the same.  Kids still love their birthdays and daddy is a five and ten year old’s best friend.  For 17 years the Pastor has put our family and his church above his own interests.  For 17 years the Pastor has created space for friendship and hospitality better than anyone I know. So, on this day, we celebrate the Pastor and my favorite 5 year old. This day we reflect on what it means to live in a rapidly changing world while finding time to celebrate the things that never change.

 

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we hold these truths.

The Pastor and I don’t have many absolutes in our lives.  At our house you can count on things never being the same.  Our schedules are always changing.  One of us is likely to get called away in the middle of an event or have to rush off to work.  But there is one thing you can count on.  One thing that always remains the same. We cannot, I mean CANNOT, watch America’s Got Talent without both ending up in tears. EVERY. SINGLE. TIME. I mean, there is the kid that used to be blind; the girl who lost her hearing; the 9 year old who is getting a little sister and for goodness sake a sweet girl from my home state and her puppet.  On stage stands someone who is probably in one of the most vulnerable moments of their lives.  Sitting across from them are those whose job it is to pass judgement. These people muster up all the guts they can find in their body and get on stage and hope and pray that they will find success.  And then, when they are finished, the most wonderful thing happens.  The words are spoken.

If you’ve seen the show you know what I’m talking about.   It’s more than just telling these performers they were excellent.  The power of the words they speak is life changing. Because of the enormous weight with which they are delivered, the words “you are a winner” or “you have a gift” or even “you are beautiful” seem to penetrate into the very heart and soul of those on stage. You can see it in their eyes. It’s as if all the sudden they believe in the person they have always been.

And cue the tears.

Over the past few weeks the Pastor has been teaching our girls about the Sh’ma. It’s an Old Testament Scripture or prayer that contains the Greatest Commandment.  And then goes on to remind God’s people to bind the words onto their hands, their foreheads, their hearts.  To recite it morning and night. To never forget those important words.

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It is not lost on me that the lesson in all of this is that words matter. And as someone who likes to blog and helps keep both the post office and her local Hallmark® store in business, I am a big believer in the power of the written word. But a spoken word is different.  It seems to be more weighty, more full.

I hope someday I have the opportunity to speak the truth into someone’s life and change them for the better.  Even more I hope someone does the same for both my girls.   And I hope they learn the Sh’ma and I hope they know their own words matter. That in a digital world full of memes and gifs and over the top OMGs, that you and I and even they, will have the opportunity to look someone in the eye and tell them how incredible they are and how much they are loved.  I hope none of us miss the opportunity.

be safe this summer ladies.

Summer is in full swing and yesterday was the first Sunday of the Pastor’s sabbatical. For as long as we have been married he has worked at our church.  16 years.  For most of those years his weekly day off was my longest day of the work IMG_3307week.  And my days off after being on call overnight were the Pastor’s busiest days.  So this year he gets to take two months off to rest, recover and reconnect.  For the next 8 weeks, Sundays and postcall days will be filled with brunch, swimming, day trips and, hopefully, some other fun adventures as a family.

 

In honor of all things summer….here are the gynecologist’s list of “Summer DOs and DON’Ts”

DON’T go without sunscreen.  Especially you pregnant ladies.  I know what you’re thinking…”sunscreen is for people who look like you and those red headed kids of yours.” WRONG.  Sunscreen is for everyone.  That is, everyone who doesn’t want to get skin cancer or look super wrinkly when they are old.  And, sunscreen is for year round. I thought my dermatologist was going to whack me when she found out I wasn’t using a moisturizer with SPF.  Don’t worry, I do now…every day…I’d like to avoid looking 100 before I retire.  I used to know someone who used hand sanitizer on her kids like a zillion times every day but then those same kids would swim for hours at the peak times of sun exposure turning brown, brown, brown all summer.  Just because you don’t get red doesn’t mean your skin is safe friends.  Tips for everyone: use broad spectrum SPF 30 or higher; reapply every 2 hours; find water resistant formulas.  Pregnant women should opt for oil free (your skin is more prone to break out) and opt for a lotion instead of a spray.  (Never spray anyone’s face…esp your kids and remember sprays make it easier to miss spots!).   And when your baby comes ask your pediatrician about how best to protect that brand new skin from the sun.

DO wear your seatbelt. This seems obvious to me. The Pastor and I took a recent road trip and you’ll be surprised to know that Missouri and Indiana will tell you how many people died in auto accidents that month.  The 10 year old reading road signs alerted us to the number.  Ouch.   But lots of pregnant patients choose to go without.  I wish you could hear how loud I am screaming this at you.  Pregnant ladies!  For the love of all things including your baby!!!  Wear your seatbelts!  Put the lap belt UNDER your belly and the shoulder strap across your chest. Auto accidents are a leading cause of death for pregnant women.  Your uterus, placenta and fetus were not made to sustain direct or indirect trauma from an accident and you can imagine the increase in magnitude if you are thrown from your vehicle because you failed to wear your seatbelt. A quick search of the CDC will tell you that those without a seatbelt are 30 times more likely to be ejected from the car during an accident and 3 out of 4 ejected individuals will die as a result of their injuries.  So let’s all just buckle up, ok friends?

DO use insect repellent. I have no problem with blood and guts.  You know this.  If you follow along, you also know that I think bugs are the worst!  Actual conversation with my dad.  Me: Dad, killed a spider outside.  It was like the size of my face, I promise.  Pastor is out of town, can you spray my house?  Dad:  If it was outside it was one of the good ones. His death will be on your conscience.  But yes, I will come and spray.  (end scene). However, as terrifying as spiders are…mosquitos carry all sorts of diseases including zika virus and west nile virus.  Then there are ticks.  I don’t know if you have seen a tick up close but this image is not for the faint of heart.  Tick borne disease are the ones you learn about in med school that have the cool names and then you learn about them and are terrified. Tips: Use your bug spray with DEET (even you pregnant ladies), cover exposed skin, avoid standing water and if you are out doing some crazy activity like sleeping in a tent (no thank you) make sure you check your skin for ticks.

DON’T overgroom. I’m not even sure overgrooming is a word.  But for today I am making it one and asking you ladies, pregnant or not, to stop it.  Summer is a hassle. Shaving your legs and armpits all the time, wearing a swimsuit; I get it. But let’s not go overboard. Not only are there literally THOUSANDS of grooming related injuries each year, the good Lord gave you pubic hair for a reason.  (I know, commence freaking out that the gynecologist said pubic hair in her blog.  Resume reading when over freak out moment).  And while none of us know the exact reason, it is most likely to keep dirt and other stuff out of your vagina and to reduce irritation of that sensitive skin.  So be swimsuit ready.  But overdoing can result in lots of skin irritation or even infection.

So there you have it.  Summer safety tips from the gyno.  Oh, and in case you were thinking about blowing off one of your fingers with fireworks, here’s an OBGYN joke just for you…

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Summer of fun.

I’m back!  It has been almost a month since my last post.  In that month I have felt TERRIBLE.  At one point I thought I would never stop coughing and that I would get diabetes from my cough drop consumption.  Don’t worry, I switched to sugar free. But now I’m about 89.32% better and have found the time to write again.  (Which is code for I can stay up late and finish things).  And so here we are.

It’s July.  For most people July represents the middle of summer.  Vacations, lazy days at the pool, short days at work.  In medicine July means ALL THINGS NEW.  As in, all the things are new.  New medical students, new residents, new academic calendar. You see, I work in Academic Medicine.  Which means that I work at an institution of higher education where we train medical students to become competent, caring, ethical physicians and then train physicians to be competent, caring, ethical specialists in their chosen field.  Sounds easy, right?  I will try to briefly introduce you to what the summer is like for those of us insane enough to participate in this great adventure of education.

Medical school is 4 years long and almost exclusively completed after a 4 year bachelors degree is achieved.  In the first 2 years students spend their time in courses learning anatomy, the complexity of each organ system, structure and function of the body and its cellular systems, human behavior and so much more.  They come to class, have small group sessions, read and read and read some more and take lots of exams. By the time they come to the third year they are ready to see how all they have learned can be applied to patients and diseases.  Oh and did I mention they also have to pass the first step of the 3 step medical licensing exam? In the third year our goal for a student is to be able to see a patient, perform a basic physical exam and formulate a differential diagnosis.  What that means is that when they hear a patient’s symptoms and know their history they can think about what diseases they are most at risk for and/or most likely to screen-shot-2016-09-25-at-6-38-08-pmhave.  Only once that is done can we as physicians begin to think about what testing and treatment someone might need.  Medical students don’t do anything without supervision.  Sometimes patients will ask if the medical student is going to perform their surgery or deliver their baby. I can answer that with a resounding NOPE.  What a medical student will do is participate in surgery with me where they will learn the hows and whys of that specific operation.  They will check on their patients in the hospital and often serve as an extra set of eyes, ears or hands to ensure that all the details of patient care are taken care of and nothing has been overlooked in making sure a patient makes it safely home after surgery.  In addition to all this they are reading, going to lectures, taking tests.  At the end of the third year we hope they have chosen a medical specialty.  Then they spend their final year of medical school spending time in areas of their chosen specialty, as well as interviewing for a residency position and taking the 2nd step of that all important medical licensing exam series I mentioned before.  So for me July means making sure the syllabus and all the materials our third year students get and use equip them to learn the most they can about women’s health.  It means making sure those 4th year students who have chosen my specialty have the best opportunity to train at the institution of their choice for residency.

July 1st also marks the day new residents begin their training.  These are recent medical school graduates who have gone through a very competitive process to secure their place in a residency training program. Each specialty in medicine has residency training and each specialty decides how long that training should be.  For example, OBGYN residency is four years long. Neurosurgery residency is 8 years long. (no thank you).  While in residency these doctors have a focused practice where they will learn every detail of their specialty.  It is also the time when they are trained to perform procedures and surgeries all in a supervised environment with the intention that at the end of their training they are ready to care for patients on their own.  In the meantime they will spend up to 80 hours a week in the hospital where supervising physicians will provide guidance, support, and supervision.  At the end of those at least 10,000 hours of training each resident will decide whether to join a private or hospital based practice, become an academic physician or, for those brave/crazy enough, pursue even more specialized training.  One of our greatest privileges is to watch those residents graduate and know that they will provide the kind of patient care you would want for your family and friends.

It’s a long journey into a career as a physician.  It can consume more than a decade of your life.  In truth the learning never stops.  For those in OBGYN we have a written and then oral exam to become board certified after residency.  To maintain our specialty certification we read articles and participate in chart reviews each year. We attend conferences and workshops to learn from one another and maintain and improve our skills. We read articles and travel across the country and collaborate to find the most effective ways to educate our medical students and residents.

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So if you see a medical student or a resident, give them a hug or a handshake or a pat on the back.  During a time when there is a lot of uncertainty in healthcare they have made the choice to commit their lives to the service of others. When no one can seem to agree who should have access to care or who will pay for that care, they have dedicated a huge chunk of their lives to ensure that care is available no matter what.  Now if you’ll excuse me, it’s July so I need a nap.