this is forty.

At the beginning of June I turned 40.  And on the last day of the month the Pastor and I celebrated 17 years of marriage.

A few weeks prior to my birthday a good friend Jennifer asked me about my plans for the weekend.  I wanted to have a party. She asked if I liked surprises.  My response?  “I don’t like to be disappointed.” So there’s that.

Jennifer was smart enough to know that even though I had big plans, my life is just too busy to execute any other big events.  She is also just bossy enough to take over and plan something great. The best memories of my adulthood are moments when lots of people I really care about from the different aspects of my life are all having fun together.  So we had a party.  A big party; with music and food and dozens of friends….and it was totally worth it.

I have been alive for 40 years.  I remember thinking that being 40 meant you had been alive forever!  It has occurred to me that I have spent roughly half of my life in medicine. Studying, testing, learning, preparing, practicing. Twenty years of sleepless nights and long days and lots of restless moments.  Twenty years sprinkled with memories of incredible joy and terrible tragedy.   The profession of medicine can be a deep sea where the waters cover over you, and not just over your head but push you deeper and deeper down and into more than you intended.  Some of those years were true immersion. Some years you manage to keep your head above water; and some you might even feel like you are riding the waves. This year I was surrounded by water.  Completely immersed. It didn’t matter where I looked.  Up, down, left and right as far as my eyes could see there was work to be done. And if you know anyone in medicine, when there is work to be done we do the work. And so I did.

My 40th birthday was an opportunity to lift my head above the waves and take a deep breath.  I spent 5 whole days away from work.  Not just away from the hospital and the office, but away form my computer.  The Pastor was very concerned to see me detached from the laptop.  In fact, he panicked and asked if I had left it at home on purpose.  It was the first time in a long time I was away from email, away from charting, away from creating schedules, answering questions and solving problems.Screen Shot 2018-07-01 at 4.42.07 PM

The thing is, I don’t think we even realize how far immersed we are in the work until we come up for air. I suddenly found myself in the midst of conversations about books and parks and outings and all the rest of life.  And I literally could not think of a single book I had read or a non-scheduled activity or even a day without work in the last few months.  The opportunity to take a giant deep breath and put my head above the water and look around was both a moment of relief and a moment of sadness. You see, the work needed to be done.  It still needs to be done.  And I will continue to do the work. To get to thebottom of the to do list. To find a day when there are not problems to be solved, schedules to be made, charts to be completed or projects to be fleshed out.

The truth is that the work will never be done. But I can do better and be better balanced. As a part of our anniversary celebration, we went to see the documentary about the life and career of Mr. Rogers.  One of Fred Roger’s lifelong virtues was to “love your neighbor AND yourself.”  In my forty years of completed life, my 17 years of marriage and 20 years in medicine, I more than believe that you cannot love your neighbor if you do not love yourself well.  And you cannot love

Screen Shot 2018-07-01 at 4.44.29 PMyourself if you do not know you are loved. Every Sunday as I sit by the Pastor on the front row we hear the phrase “God’s mind about you is made up.  And the news is good.” What a great reminder that we are constantly and consistently loved. For me it is a reminder to have the birthday party, to celebrate with friends, to go see the movie, to play the game with the kids or take them to the park.  To sleep in or be still and accomplish nothing on a rare day off.

We are at our best when we know we are loved and take the time to take care of ourselves.  With so much bad news infiltrating our news feeds and our tv’s and radios these days it is critical that we remember we are loved and that we care for ourselves so in turn we can love and care for our neighbor.  So in the next forty years I will try to live a more balanced life.  Take the nap, read the book, write the note, shoot hoops with the kids host the friends, take the vacations. Then go back and work fiercely and care deeply.  Solve the problems, cure the diseases, publish the research, set the standards and, most importantly, love our neighbors.

Here’s to the next forty years.

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what are you afraid of?

I was texting with my favorite blog editor who happens to be my sister-in-law about what to write next. I am simultaneously captivated by humans who have spent their lives to be among the best in their sport and horrified by humans who seem to have no regard for anyone’s life but their own.  On one channel are images of men and women from all nations who sacrificed their bodies in many ways to achieve their dreams and make their nation proud.  On the other channel are images of a young man who managed to leave 17 young people dead and many more bodies harmed.

If you are anything like me your social media and news feeds are full of debates about what, if anything, should be done.  Or what, if anything, CAN be done.  I have my opinions…which should come as no surprise to anyone who knows me. I have an opinion on almost everything and share it freely with anyone who will listen.  But today I’d like to speak more about what shapes those thoughts and feelings.  I believe it’s a matter of what you fear most.  You see, when I look at those athletes coming out of the gates taking a nine foot drop onto a mountain to race around corners and over jumps or taking off down that giant ski jump, I am afraid.  Afraid that if you asked me to do either of those things I would end up with great bodily harm (think broken femur and ruptured spleen, for example).  But for those Olympians, fear of failure was greater than the fear of falling or of injury. Day in and day out they decided that what they feared most was not giving their all or doing their best.

For me, at least at the moment, I have some serious fears.  I fear my kids won’t have properly educated teachers in their schools because my state can’t figure out how to pay them a living wage. I fear that a university official somewhere will choose their own career or financial gain for their institution over protecting women from assault and harassment. I’m afraid that my kids will need to use their skills learned during intruder drills and find their way into their designated hiding spaces in their classes…or worse. I’m afraid that when we see something we don’t say something…and even worse, when we do no one listens.  And what I’ve noticed is that these situations all have two things in common: selfishness and power. Over and over again our news feeds are filled with the powerful and privileged making choices to satisfy their own agenda. You see, when someone decides their desires, their needs, their well-being is more important than a child, a woman or even the person across the aisle, then everyone loses.

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Imagine a world in which, in every choice we made, we were allegiant not to our own interests or desires but to the needs of the other. Imagine if, when faced with the plight of children, those in poverty, or the mentally ill, we were careful to ensure that their needs and their safety and well-being were placed above our own. What if we were careful to do so even if it came at a personal cost to ourselves.  If we relinquished our power and our clenched fists and opened our hands to the possibility that we exist to serve the other more than to serve ourselves.

But we are afraid.  Or at least I am.  Afraid of giving up what I’ve worked hard for.  Afraid of suffering if I relinquish power or privilege.  Let us be challenged each day to be more afraid of a world where we fail to report inappropriate behavior or where we don’t speak up when someone is being harmed or where we won’t sacrifice part of our lives for the sake of the generation behind us.  Let our fear of failing to create a better world for our kids be bigger than our fear of anything else.  Or better yet, stop being afraid and start changing the world.

[photo credit: @drromie on twitter]

 

your grandma ain’t my grandma.

If you recognize this line from Chance the Rapper’s song “Sunday Candy”….bravo and let’s hang out.

I’m on the return leg of a few days away from work with the Pastor. We enjoyed a good bit of rest and reprieve, but I couldn’t help to notice that people are people no matter where you go.  I saw a man spend 10 minutes complaining to the pregnant hostess at a restaurant because his waiter didn’t stay at the table long enough after bringing out their meal.  I watched a woman tell other patrons at a breakfast place that her waiter just couldn’t understand that she wanted “CRISPY bacon!” and how this was completely unacceptable. People were anxious to be the first in line to get off the plane just to stand around waiting for luggage with the rest of us.

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At work I often refer to myself as “grandma.”  While I’m not the oldest member of the faculty, each year I find new situations where a resident or medical student will ask me about how a technology or medication was used during my training to which I will reply, “um, well, that didn’t exist when I was in training.”  Then comes the look.  The one with the big eyes and the raised eyebrows indicating that my learner just realized that their attending came “before.”  Before topical hemostatic agents were commonly used or available.  Before targeted cancer therapies.  During my training the HPV vaccine was introduced and we added sub-dermal contraception to our regimen of just 2 other long acting reversible agents.  Now we have an even better HPV vaccine and our patients have more reliable contraceptive options than ever before.  Residents are now trained in robotic surgery. In the last dozen years since I started residency the number of female physicians has grown by 40%. We’ve come a long way.

Certainly being a grandma isn’t all bad.  You have the benefits of time and experience on your side. One thing I learned from my grandma is that as much as things change…things also stay the same.  Narrow the differential diagnosis. The basic principles of surgery such as sterile technique and proper tissue handling are always going to be important.  People are still people from generation to generation. No amount of technology or scientific advancements will replace careful listening to your patient’s history and learning to do a detailed physical exam.  Nothing will replace what you accomplish when you put patients first.

I was fortunate enough to know both of my grandmothers.  They cooked whatever food their grandchildren had in mind for that day or that meal. (Seriously- potatoes and chicken for me, spaghetti for my brother.  Two entirely different meals!) But more than that they were generous with their words, their love and their lives.  They put others before themselves.  They made sure those around them were cared for and had their needs met. Above all, they treated others with kindness.

Maybe if we focused a little less on “me first” we could help eliminate a lot of the “me too” and the “not for you” we see across our screens on an hourly basis.  If we could eat less crispy bacon, be a little more patient, move to the back of the line or give up our seat we just might notice our neighbors in need of help or our friends who are suffering.  The world just might change.  While we excitedly embrace new technology and advances in the world around us, may we also embrace the helpful lessons from our grandmas, like always choosing kindness and putting others first.  In those ways, may we all strive to be the “grandmas” of our professions.

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what comes next.

Near the end of the summer the Pastor and I went to Chicago to see Hamilton© the musical.  The Pastor had listened to all the songs, knew the story, listened to podcasts about Lin-Manuel Miranda and just about everything you can do to prep for seeing the musical.  Then there was me.  Did I remember that Aaron Burr shot someone?  Yes.  Did I remember it was Alexander Hamilton? Maybe.  Did I have any idea what role Hamilton played in history or who he was at all?  Nope.  So I went in blind.

The other thing you should know is that the Pastor has been known to overhype things.  Cajun restaurants, songs, TV shows, people.  Occasionally he will find something he enjoys so much he is just sure it’s going to be life transforming for me as well.  So, you can imagine that while I was thrilled to take him to see the show I wasn’t so sure that this would be the wonder that he had prepared me for.

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Score one for the Pastor.  Hamilton© is genius.  Amazing, incredible, moving.  It would be impossible to over hype this thing.  Impossible.  It is massively creative, funny, tragic, thoughtful and uses the word “afterbirth.”  What more could you ask for?

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Near the middle of the show there is a song called “What comes next?”  It’s about what will happen after the colonies have gained independence.  You’ve worked so hard and sacrificed almost everything to get where you wanted to be…and now what?  As I have (repeatedly) listened to this soundtrack these words have resonated with me.  It’s the beginning of a new year.   What now?  Where do we go from here?

What comes next?

It holds both prospect and peril.  What awaits us on the other side of an accomplishment, an anniversary, a new dream or a new year?  Some of us are holding our breath hoping this year will be nothing like the last.  Waiting for the new year to break in and disrupt the disappointments and distress of the last. Time will only tell.  How do we embrace the hope of possibility and push away the anxiety of the unknown?  Will our efforts in the new year be enough? We will have enough? Will life be different this year? One of my favorite strategies is something I think Hamilton himself employed when he thought about the future: Never. Stop. Moving.  [the man was non-stop].  I am more than uncomfortable sitting still.  And I’ve convinced myself that if I move fast enough and never stop working, reading, thinking, doing, writing, running and more working (whew)…there will be no time to worry about what lies on the other side of the horizon.  The problem with this only comes when either you are forced to slow down or you simply run out of gas.

As we emerge over the horizon into 2018, this year holds much promise.  A year for us to eliminate some of the hate, discrimination and harassment in our world.  A year for collaboration, cooperation and tolerance. For equality and equity. A year in which we will certainly have mis-steps and failures alongside of our triumphs and treasured moments.

Maybe there is a better way.  Maybe there is a way that we; you and I, find the balance between “non-stop” and “being enough.”

In my last post I wrote about finding hope in the midst of hopelessness, peace in the midst of anxiety.  In the same sentiment, the Pastor preached last Sunday about the journey of life we are all on together.  He spoke of those moments where we carry each other when we simply cannot carry ourselves.  If we live our lives in “non-stop” mode we will move too quickly to notice those around us who need help along the journey. In the same way, when we learn to “be enough” we allow others on the journey the joy to carry us during the moments we simply cannot make it alone.

Maybe this year we can slow down, learn to be enough, and share life with one another.

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O Holy Night.

It’s Christmas!

What a year it has been.  I was working on our (last minute) Christmas card and trying to decide which of the ten thousand designs to choose from and wasn’t sure how to wrap up the year with just a few words or a phrase.  I finally settled on these words from my favorite Christmas carol.

“A thrill of hope…the weary world rejoices! For yonder breaks a new and glorious morn!”

The world certainly has been weary for many whom I call friends and family.  It seems like each day the news is filled with hopelessness for so much of the world. Poverty, hunger and war dominate the headlines both at home and abroad. We harm one another and look out for our own interests first. Yet, despite all the tragedy the world has seen and experienced, these words are never more true.  Just beyond the horizon is a glimmer of the morning sunshine.  You can almost feel its warmth.   The love extended to us by God is a light that cannot be extinguished and breaks through the darkest of nights.

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Today may we all be warmed by that light breaking into our lives.  May we find hope in the midst of hopelessness, peace in the midst of anxiety.  Remember that no matter how weary you are today there is hope on the horizon.  You are never beyond the reach of the light of Christ in your life.  Merry Christmas my friends!

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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.

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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