I have a great group of friends that I run with. They keep me both encouraged and entertained. We often run together on Saturdays; usually between 6 and 12 miles when we are training for a half marathon. We have these unwritten rules for those weekend runs. They’ve developed over many weeks and months. First rule is that what is said on the run stays on the run. You can complain about whomever or whatever you’d like, tell your most embarrassing stories about yourself, brag on your accomplishments and get mad about your failures and it stays there. Second is that no one runs alone. If someone is struggling then another from the group will hang back and make sure they make it to the finish line. The last rule is that someone always brings water. Always.
I didn’t get to run with my friends this week because I injured my right hip. It’s no fun missing out on the weekly run. I was tempted to try and run anyways but truth be told I tried that theory out earlier in the week and it didn’t work out so well…so I will sit out for a week or so and recover and hopefully be ready for the next long run and then the race. So running is on my mind. And so is recovery.
Being a gynecologist is a lot like Saturday run with friends.
No really, hear me out.
First, almost exclusively, what is said in the office stays in the office. I have a duty to report anything like harm to a minor, suicidal ideation and elder abuse. There are a few other caveats but really, what patients tell us we keep. People I know are always surprised when Pastor Jason has no idea that they are my patient or that I haven’t disclosed their pregnancy to him or anyone else. It’s in the rules. Your gynecologist and your pastor are similar in that regard. They both get paid to hold things close to the vest. Sometimes we hear things that need “fixing.” In those cases we try and come up with the best possible intervention. Sometimes just sharing what’s on your mind is relief enough.
The second rule holds true as well for gynecology. No one runs alone on Saturdays and no one should run the steep hills of life alone. I hope my patients know that I will do my best to support them through the sorrows as well as the joy. Pastor Jason has taught me so much about the power of listening to those who are broken and the healing that can occur when you sit with someone who is suffering and really be present.
And finally we all need a source of water. Your body is somewhere around 60% water. So it’s pretty important to survival. But in addition to actual hydration we all need something that fills our cup on a regular basis. Many of my patients are busy working, taking care of their families, spending time being stressed over finances, health or world events. I tell them they need to make time for rest and recovery. For me, I have lots of water stops. Running with friends is one. Dinner with my favorite girlfriends on a monthly basis is another. Jumping on the trampoline with the pastor and our girls is good too. But my main source of refreshment is church. I get a weekly reminder of the unconditional love available to me by God and His people.
I hope you have a running group. First, because exercise is important. But if you prefer the elliptical or yoga or whatever then I hope you have a tribe for your own mental and spiritual health. I hope you have a people in your life who will sit with you and listen, or sit with you in silence. I hope you don’t have to navigate life alone, that someone will come run alongside you. And I hope you have a source of water…and if that source of water includes church, say a prayer for this gynecologists leg to get better soon so she can get back to complaining to her friends on Saturday.
It’s Easter weekend friends.
Friday night we attended our Tenabrae service. It’s a service of music and candles where we listen to the story of the life and death of Christ and leave in darkness and silence after the last candle is extinguished. My almost 9 year old sat next to me with wide eyes waiting for each flame to go out and nervously held my hand as the Christ candle went dark. As we rode home Pastor Jason and I talked with the girls about how, on this night, we remember that Jesus was put to death. They were quick to remind us that Easter Sunday was just around the corner and He would soon be alive again.
For us, it’s hard to be immersed in the darkness of Friday. In the back of our minds we too know that Sunday is coming soon. In fact, I was on my long weekly run Saturday with friends and we were winded and tired and cranky near the end and I joked “it’s a great day to suffer. Jesus is dead.” But I think it’s important for us to remember that the Son of God was put to death by the culture around Him for doing things that were unpopular. He associated with the wrong crowd, He asked people to move outside of their comfort zone. He never accepted the status quo and the “that’s the way we’ve always done it” from those around Him. Those in power were suspicious of Him. His mandate to always care for the poor, widow, the orphan and the outcast among us put the normal pecking order at risk. And it got Him killed.
He died in a way that was painful and humiliating. He friends turned their backs on Him. His mother was devastated. Why is it so important to remember Friday? Well, without the death of Christ there can be no resurrection. Friday reminds us that when we are in our deepest suffering, when we seem to be surrounded by darkness, that, in fact, Christ has suffered and is suffering with us. He walks with us through the darkest hour and reminds us that light has overcome darkness and He has overcome death. Friday reminds us that when we are unpopular for acting outside of our comfort zone or caring for the least of these around us, that Christ walks alongside us. Friday reminds us what sin is capable of doing but also what God is capable of overcoming.
And then Sunday comes. Jesus is not dead. In fact, He is alive. He physical body beaten and killed is restored with a beating heart and a familiar voice. A voice His mother recognizes when He speaks her name. Even death itself has no power over Christ. How easily we forget. Today Pastor Jon preached about overcoming the fear of death. He told us that when we don’t fear death, when we don’t fear suffering, we are truly free to live as Jesus asked us to live. That’s the power of Sunday. As I looked around this morning I saw dozens of faces in my church community that make life better. People that remind me on a weekly basis of God’s love and His mercy. People that truly believe He is alive and we are charged with continuing the work He started. As Pastor Jason and I served communion to some of the least of these in the sanctuary I was reminded that not everyone will understand our actions or our words. Not everyone will agree when we reject the notion to fear and embrace the mandate to love. It will make people nervous when we reach out to the poor, the widow, the orphan and the sojourner in our midst. It will certainly cost us but I can’t help but believe it will be worth it.
On Friday is was easy for people to say that Jesus was wrong. On Sunday it is hard to deny that He is right. May we never forget Friday but always move forward in the hope of Sunday.
(photo cred: pastor jason and jimmy midd.)
I got a text message this week from someone that read “I hope to be like you someday.”
We are closing out the season of Lent. It is a season of 40 days between Ash Wednesday and Easter, marking a time of preparation, a time of growth. If you’ve known me for any amount of time, you probably know that one of my pet peeves is the phrase “that’s just the way I am.” It irritates me because I believe it is mostly used as an excuse for bad behavior. I also believe we should always be changing and growing.
I am convinced that most people, really most adults, don’t change. Growth is difficult and often uncomfortable. To grow we must acknowledge and accept the past and then move on. For me, Lent is a great time to reflect on where I have been and where I hope to be in my spiritual life, my health, my work and with my family.
I haven’t always felt this way. I used to live in the “that’s just the way I am” camp. It was a great excuse for a bad attitude, a bit of unkindness, a moment of selfishness. Now, not to say that I am free of ever having a bad attitude, being unkind or acting selfishly. But there is something about just sitting in the rut of those habits that wears on you. At some point I decided that growth was good. Sitting with Pastor Jason each Sunday during Lent we have been learning what it means to cut away dead weight. We are most dangerous to ourselves when we refuse to change and grow. I think we have to find a way to let go of “just the way we are” and find a way to be something more, something better.
My response to that terrifying text was to tell my friend “just work to be a better version of yourself every day, every year.” That’s the wonderful thing about growth. You’re not trying to be someone else, or someone else’s version of who you should be. For me, it means to try my best to be faithful to Jesus and the Gospel, to be generous with my time and my family, to be kind and patient with those around me. It also means accepting that others can grow and not holding them to their past choices or mistakes. Of course some things about me will probably stay the same. My voice will get 3 volumes louder when I get stressed or excited, my desk drawer will always have a secret stash of candy and my love of chai tea latte doesn’t seem to be going anywhere anytime soon. But I hope that loud voice will do more cheering for others this year. I hope that sweet tooth of mine sends more cards, texts and words of kindness and love to the world around me. I hope my love for the least of these and my neighbor is greater than my love for myself and my coffee. I hope that I continue to grow into a person who reflects an image of hope for the future. And I hope you’ll join me.
Heart disease, or cardiovascular disease (CVD) is the number one killer of women. In the US alone, about 1/3 of women are living with CVD. As a gynecologist, heart disease is not something I routinely treat but it is something I ask my patients about. It’s important because most heart disease can be prevented through education and lifestyle modification. And because many women don’t survive their first heart attack, waiting until something happens or symptoms start just might be too late.
We don’t educate women enough on their risk of heart disease or the symptoms of cardiovascular problems. Most women don’t think that nausea, back pain, or jaw pain might indicate a problem with their heart. But the truth is that most CVD is preventable. As physicians we can encourage our patients to exercise and lose weight as well as make sure their cholesterol and blood pressure is well controlled. As little as 30 minutes of moderate exercise (think brisk walk around the neighborhood) 5 days a week can help reduce your risk of heart disease! It is routine for me to discuss cervical and breast cancer screening with my patients…CVD prevention should be just as important. I try to always ask about exercise habits and find out when the last time the patient had cholesterol screening.
One of the things I don’t think about much is how chronic stress can affect your heart. I think many of us spend our days fearful about what the future holds, worried about what our friends and neighbors are doing and buying, angry about how the world and it’s occupants have dealt with us.
The quote in the picture above is from the sermon at my church today. Taylor’s dad Jon is our senior pastor. Pastor Jon reminded us that what we know from the past shapes us, but, no matter what we must move forward with hope. I would add that I think we are paralyzed by our past, our present and sometimes the future. What does your heart need? Maybe to let go of fear and embrace faith. Let go of your anger and hostility and embrace grace and hospitality. I need to be reminded of this frequently. I let my fears overcome my faith. I am held captive by anger and resentment. For my heart, both literally and spiritually, may I be reminded daily to let my faith be greater than my fear. May we all move forward in hope and courage.
I have a colleague who loves to ask eager medical students whether they believe health care is a right or a privilege. It’s a question that many of them have not really thought about. I have enjoyed listening to their thoughtful answers as they work through the complexities that go along with a question like this one. Quite a few of them, after giving their best answer, ask my physician friend if they got the “right answer.” It makes me smile.
It doesn’t take a medical degree for you to figure out that the healthcare system is broken. It is a problem for which there is no easy fix. We know that the cost of healthcare is going up. We know that the health of Americans is not really improving. Medical knowledge and technology is expanding at a rate more rapid than ever before. How do we keep up? Who gets access to what? On top of all this we are facing a physician shortage in the near future.
Is healthcare a right? Does a patient who hasn’t taken care of themselves when they were younger have the right to access to expensive interventions to restore health later in life? Or is healthcare a privilege…something that you get to access because you have put yourself in a position to get affordable care. As a society we have already chosen to ensure access to almost all our children and pregnant women…but what about everyone else? For a nation that is in the top 3 countries in spending on healthcare we cover a significantly lower number of people with that huge dollar amount.
One of the best answers I heard from one young medical student was “healthcare is a right that we should treat like a privilege.” It’s one of the truest statements I have heard. Your health really is a privilege. Ideally we would cultivate a nation where our young people take care of themselves, engage in a healthy lifestyle and we promote preventative health and disease prevention. But what else can be done? I think we can each do our part. For me, it means talking to moms about promoting healthy behaviors not only for themselves but in their children. It means that I advocate for my patients and work to improve the system I work in. It means I support the after school program at my church so that young children around me can have access to healthy food and support for their education. It means supporting my community in efforts to improve public health.
Everyone should have access to good health. Does that mean healthcare is a right? Yes. Sure, how we improve the health of our society is a complex problem. But I believe that each of us can find a way to improve our own health and the health of those around us. Let’s start treating our health like what it is…a privilege.
“May we be prisoners of hope in an evidence based world.” – Pastor Jon Middendorf
Last Sunday I got to hear an excellent sermon out of Genesis 15. God comes to the very old, very infertile Abram and Sarai and promises them something they have no shred of proof for…a child. And he offers no real evidence or proof that He can do it. It’s a beautiful passage where God makes a covenant with Abram by walking him through a suzerain treaty: where God essentially says I will risk my life for you. There is no evidence. Only faith.
Pastor Jason operates most of his daily life in this faith based world. He prays for the sick, welcomes the newborn, brings communion to the homebound. He doesn’t need statistics or textbooks to tell him how to do this business, he uses faith. Me, I operate, mostly, in an evidence based world. You see, health care providers rely on evidence to try and make the best decision possible for our patients. Some clinical scenarios have a tremendous amount of medical evidence that back them. For example, we used evidence to determine when to screen for cervical cancer, to know whether or not to give antibiotics prior to performing a surgery or what kind of treatment is best for certain types of cancer. Medical evidence can change; sometimes what we thought was true is shown not to be through rigorous scientific studies. Sometimes two scientific studies will contradict each other. Sometimes there is very little evidence to guide certain clinical situations. As physicians we try to use the best available evidence and our best clinical judgement to guide care.
But there are places in life where there is no evidence. That’s where faith steps in. Sometimes people don’t need evidence…they need hope. You can tell a mother who just experience a miscarriage what the evidence says about her chances of future successful pregnancy but she doesn’t want numbers…she wants hope. When you diagnose someone with cancer you can give them evidence based survival rates but what they want is hope. Faith and hope is when you reach across the exam room and give a hug, a handshake or a tissue.
Where hope and evidence intersect is where medicine really happens. To use the best evidence available to take the care of your patient and then to give them hope that you will do your best. To have faith that what you do each day adds value to your community and the hope that your best efforts will bring health to your patients. To commit to be a prisoner of hope that believes they can make a difference in the world.
I often catch myself doing something that one of my family members would do. For example, when I heat up my coffee in the microwave and forget about it for the next hour. When I begin to search for it I think “that’s what Grandma Gilbert would do.” I will use the same hand mannerisms as my mother or work through a tough decision in a similar way that my dad would.
Ultimately you are your family. In both nature and nurture. Not only do we, at many times, behave like our parents but we inherit part of their genetic makeup. This is pretty common knowledge, right? We expect our children to have similar hair or eye color as ours, to be of similar height, to resemble one parent or the other. But you give more than just your dark hair or your hazel eyes to your kids and your pick up more than just your eye rolling and coffee misplacing skills from your elders.
We as gynecologists care about your family history. Why? Because your risk of certain diseases, including cancer, could be increased based on your family history. We know that about 5-10% of gynecologic cancers are hereditary cancers. What is a hereditary cancer syndrome? It is a genetic predisposition to a certain type of cancer so the patient is at a largely increased risk of developing a certain type of cancer and these cancers are often diagnosed at a younger than expected age. When I talk to medical students about what I do every day, I tell them that one of the most important things I do is try and prevent disease. When I ask, “Do you have any family history of breast, ovarian, uterine or colon cancer” not only am I going to remind you about how often and when to screen for these diseases but if your family has been affected with these cancers we will talk about how you might be a candidate for genetic testing that could save your life.
For example, if your family history includes women affected with breast and ovarian cancer, you or your relatives might be affected with a BRCA mutation. Or if you or your close relatives are diagnosed with uterine or colon cancer then my mind is on alert to think about Lynch syndrome testing. When we identify women affected by a hereditary cancer syndrome we can offer those patients early and more intensive screening and in some cases even perform risk reducing surgery. Every month we learn more and more about how cancer develops and discover better ways to treat and prevent cancer.
I have a cousin who was diagnosed with stage 4 ovarian cancer in 2012. She’s pretty much a rockstar. She spends her days running her nonprofit caring for patients and their families. You can check her out at http://www.tteal.org. She is an advocate for early detection of ovarian cancer as well. She is inspiring to me. You can be an advocate as well. You can advocate for yourself and your own family. Learn your family’s history. Talk with your physician. Find out if you or someone in your family is a candidate for testing for a hereditary cancer syndrome.
You might still turn out like your grandmother leaving your coffee to sit in the microwave. That wouldn’t be so bad. But you might also find out you can reduce your risk of cancer by simply sharing your family history with your physician. Something to think about.