to my friends in white.

Thursday was Doctor’s day. It has been celebrated since the 1930’s when handwritten notes were mailed to physicians and flowers were placed on the graves of doctors who had passed. Today Doctor’s day is usually celebrated with free breakfast in the hospital and snacks and cards from office staff.

I have the privilege of helping to educate medical students and residents.  Doctors to be and doctors in training. When you’re in medical school or residency I think you try to keep your eyes forward, always looking toward the next step, the next goal.  Don’t think about the mountain you are climbing, just put one foot in front of the other. Looking back, for me, it would have seemed insurmountable to approach it in any other way. There is more to learn, more work to do, more complicated patients to care for today than ever before. The long hours and hard work don’t stop. The struggle to balance education, work, family and your own health never ends.

My youngest loves to sing. She can learn the words to most songs pretty quickly. Which means you can’t let her listen to anything you don’t want repeated.  That being said today she was singing songs from the Disney movie “Moana” at the top of her lungs in the car. “and the call isn’t out there at all it’s inside me…like the tide always falling and rising.”  Every time she sings the words they stick with me. Medicine is a calling. Yes, while it is often exciting, intellectually stimulating and on most days rewarding, none of those extrinsic things will be enough to keep you in it long term.  It seems like it should be, I know. But the pressure, the paperwork, the volume, the hours add up to some grueling days. We know that physician burnout rates are more than 50%. We lose the equivalent of a class of medical students to suicide every year. Conferences for physician educators are now filled with sessions on how to increase resilience in our trainees. We have committees on how to promote wellness in our profession. We desperately are seeking ways to make medicine meaningful again and redeem what has been lost in our profession.

So for my friends in white coats both short and long, in wrinkled scrubs, sitting behind books and laptops and electronic medical records and paperwork of all kinds. For you, every day is doctor’s day. You will get up early and pour yourself into your work and the lives of your patients, your coworkers, your students. Remember to be kind to yourself. Some days the call to medicine will feel far away and you will struggle to remember how and why you got here and why you should stay.  Other days you will celebrate the work you did, the people you met, the things you accomplished and the calling will be close to your heart. But never forget that your white coat does not ultimately define who you are. Last week I had the opportunity to hear Friar Richard Rohr speak at a conference the Pastor hosted.  He will tell you that in the second half of life you really only learn anything from your suffering and from love; not from your successes. I have come to agree with him. I know more about who I am by listening to those who love me and experiencing the suffering that life brings.

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When I think about how to foster wellness and resilience for my friends in white, I think maybe we can do best by reminding them, reminding ourselves, that while your work is meaningful and important…that YOU are meaningful and important. Without your white coat, without the initials behind your name. Medicine will be a huge part of who you are. But it will not be who you are. You are more than medicine.

find the big spoon.

About a week or so ago I was talking to some girlfriends about work. The subject came up about how long I would work and if medicine would be my only career. It got me thinking about what I might do when they stop letting me show up at the hospital every day. The short version is, I’d make spaghetti.

It’s March. In Oklahoma that means we are getting our first look at severe weather warnings, hours and hours of live shot cloud formations and lightning strikes and reports on damage from such severe weather. Unfortunately, Oklahomans are all too familiar with the aftermath of tornadoes and other severe weather events. Damage, destruction, deaths, Screen Shot 2015-07-19 at 10.05.19 PMdevastation.  But that’s not all that comes in the aftermath.  What also arrives are people and organizations. People and organizations who bring trucks and tools and supplies and food and hands and grace and love. One of the most recognized organizations in disaster response is the American Red Cross.

And that’s where the spaghetti comes in. For as long as I can remember I enjoyed making food in large quantities.  I’d get out a big pot or pan and chop and stir and boil and whatever until a great big amount of something was made. It’s problematic when you are a household of 2. So in the first years of our marriage our condo would be full of hungry college students or hungry medical students who would eat and eat and then take food home. Over the years I have learned to taper down and not make enough food to feed the neighborhood. March is Red Cross month. Buildings across the US will be lit up with red lights to honor the 300,000 volunteers who respond to over 60,000 disasters and bring with them life saving food and water. The Red Cross supplies about 40% of the nation’s blood supply. And almost everyone who serves with the Red Cross is a volunteer. Can you believe that?

I can remember being a kid and seeing news coverage of tornado damage in my state. And I remember the trucks.  The trucks with a big red cross on the side. And in my mind I would imagine all the volunteers unloading those big pots and pans and making big pots of spaghetti or soup and sandwiches and all I wanted to do was go and stir something with a giant spoon.

Let’s take a moment to honor and support the thousands and thousands and thousands of people who make the American Red Cross go. Maybe they love making giant quantities of food.  Maybe they feel a call to make a tangible difference when people are at their most vulnerable point of need. Whatever it is, they have chosen to serve in a disastrous time. So donate blood. Give money. Volunteer. Take a class to learn how to help. Do something now. Don’t wait for a second career.

What will I do when I stop being a gynecologist? I hope whatever it is the Pastor and I are doing we will be serving people in need. And that just might mean climbing out of a big truck and stirring a pot of spaghetti.

clear and present danger.

Last Wednesday I was home from being on call and watching ESPN.  The popular show “First Take” was on and they showed two videos of NFL players in what I will describe as “compromising” circumstances with women.  What followed was commentary that included phrases such as “two consenting adults” and “clearly she is giving consent.” During the 15 minute debate on who was behaving worse than whom and if the two situations were different I was feeling the heat rise up around my neck and feverishly beginning this blog post.  In short, that’s not how consent works.  That’s not how any of this works.

If you follow this blog you know I have written about sexual assault. Lots of assumptions are made when non-consensual contact occurs. Lots of victim blaming. Often times the focus is on what she wore, how much she drank, what she “implied.” The truth is it doesn’t matter what someone wears or what they drink or how they act. Consent isn’t implied.  Consent is either given or not given. And more importantly consent can be revoked at any time.

As physicians we gain consent on a daily basis.  Sometimes it’s as simple as saying “I am going to listen to your heart and lungs now, if that’s ok.”  Other times we are making a decision to perform a surgery.  In that case we have a long discussion about the risks, the benefits, the non-surgical options.  And more importantly, we confirm that the patient understands what is happening to their body and confirm before we start that surgery that the patient still wants to have the procedure.  Even in the case of emergencies we do all we can to make sure our patients or their families understand what is happening. We do all this because consent matters.

So what would I say to the hosts of ESPN’s First Take. To Stephen A. Smith, Molly Qerim and Max Kellerman. While we can debate the professionalism of the behavior of these professional athletes and if their past behavior, their race or their status in life makes a difference in how their actions are seen or judged, we cannot make assumptions about whether or not either of the women involved gave consent. Just because someone doesn’t seem upset or angry doesn’t mean they have given consent. So let’s stop making statements that imply that we can look at someone and know whether or not they are giving consent. Instead can we make sure we are sending a message that consent is important and as adults we should make sure we understand that.  How about the people at First Take try a second take on this one.

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march madness.

Talking to patients about disease prevention and improving their health isn’t always easy. It’s like when your mom told you to eat your fruits and vegetables and you would roll your eyes…or was that just me?  Every day doctors are faced with the challenge of not only caring for the patient’s immediate issues but reminding them to exercise, nudging them to lose weight and recommending appropriate screening tests. For me, I often get to recommend the ultimate trifecta: a mammogram, pap test and colonoscopy.  Patients look at me like I have offered them a few hours locked in a small room with screaming children.  Seriously.

March is colorectal cancer awareness month. Despite being a preventable disease, it is the second leading cause of cancer death in our country.  Colon cancer screening is recommended for everyone age 50 and above. The polyps that become colon cancer usually don’t have symptoms which means you need a colonoscopy to find them and remove them.  Some patients are at an increased risk of colorectal cancer above the rest of the population.  Patients with inflammatory bowel diseases or a family history of colon cancer are at increased risk. About 5% of patients with colorectal cancer will have a genetic predisposition for the disease, such as Lynch syndrome, which is a genetic condition associated with an increased risk of colon, uterine and other cancers. Patients who are overweight or have poor diets may be at increased risk.

Therefore, your favorite gynecologist gets to recommend such tests and you get to roll your eyes at me.  See the pattern here? In all seriousness, about 1/3 of adults who need colon cancer screening don’t get it.  And I understand the eye rolling, I really do. It’s not like IMG_6422people look forward to having a colonoscopy.  Or going to the gynecologist at that.  I tell my patients that at least when I go to the dentist I feel like I’m a bright, cleaner person at the end of the visit.  I’m not sure anyone leaves my office, or their mammogram or colonoscopy with the same thoughts. So I get it.

But here’s the deal.  We don’t recommend these uncomfortable tests because we like seeing you squirm around on the exam table.  We do it because cancer screening saves lives.  March for myself and the pastor means lots of basketball and brackets and yelling at the tv. We love the madness. But when you think of march, think about reducing your risk of cancer.  Know your family history.  Eat your fruits and veggies and go to the gym. See your doctor.  And get your colorectal cancer screening. It won’t be the best day of your life, but it just might be the day that saves it.

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my hands are full.

Short and sweet today.  Ok, maybe just short.

Sometimes I go to the grocery store and fool myself into thinking I don’t need a cart.  I think “I only need like 4 things so I’ll just carry them.”  And then I end up getting 12 things and now I’m the distressed lady with the arm full of things and one of them keeps dropping and when I go to pick it up another one falls out of my arms.  But I can’t put anything down.  Somehow I’ve convinced myself I need all of them. I finally make it to the cash register and swear I’ll never go cart-less again…until I do.

How many of us are experiencing life that resembles my grocery shopping? Your arms are full and you keep dropping things but you can’t seem to stop picking things up. Maybe it’s just me but my hands felt more than full these last few weeks. There is this illusion that you can find the perfect balance and nothing will fall, but in reality there is no way to arrange all the things you have accumulated in your hands that will hold them all.

Today I read a very compelling article by Jessica Hagy addressing work-life balance.  It’s an illusion really.  The notion that if you put things in just the right spot that you can achieve it. The reality is that there is no balance. Some days you just have to set something down. And only you can decide what you set down.  All I ask is that you remember that everyone else is trying to set something down too. You see, what you choose to put down might not be what I choose to put down. And that’s ok.

 

the things that linger.

For a long time people asked me about why I became a doctor.  The reality is that I had no good answer for them.  It bothered me a lot. I felt like I should have this great answer about how I had this transformative experience where some giant ray of light broke through the clouds and I knew what I was destined to do. But there was no transformative moment or ray of light.

The truth is I wasn’t great at that many things. I was good at school, a below average athlete, well below average on the cuteness and popularity scale.  I was good at organizing and prioritizing which, if you didn’t know, aren’t skills widely praised in the high school arena. I think mostly what I was looking for when people asked me about my future was to give them an answer that would seem like something great.  Turns out, I said it enough that I really believed it, and, well, here I am today.

I was reminded this week of the things that linger from when we are young.  I think most days I can still feel the shadow of those thoughts that I might never measure up to those around me. For most of us, we have these small things that are difficult to grow out of. I can recall the moments in my past that are the reasons I still don’t like to be teased in public or get the feeling I am being left out. I spent time with a friend this week who remembers the feeling of never really having enough; the feeling lingers in his life today despite proof of the opposite. How do we move beyond the insecurities of our youth? How do we get past those things that always seem to linger?

I’m not sure letting them completely go is the answer. There’s no shame in wanting to do something great. What I had to do is convince myself that being great wasn’t about gaining approval from some person who I was sure didn’t think I measured up. Doing great things was about pushing myself beyond what I initially thought I was capable of doing or accomplishing. I’m fairly convinced that I push myself to write another research proposal or figure out how to improve our educational curriculum because I don’t ever want that lingering feeling that “I can’t” to take hold of me.  I believe that small voice that continues to whisper that you might be left out is pushed further into the background every time you practice inclusion. When you live a life of generosity with others you squelch the fears of scarcity just a bit more.  In a few months I will turn 39. Last summer one of my best church girls told me that my 38th year could be one of my best. And it has. I think this year, more than any other, I have discovered what it means to consciously shake the insecurities that bind me and learn what it means to find the joy that is discovering true friendship and fellowship with others.  And I’ve only figured out how to do it about half the time.

In the evenings I am reading Richard Rohr’s book “Falling Upward.” It’s about the second half of life. Fr. Rohr reminds us that if we never move beyond the first half of life we risk missing out on the best that God has to offer us.  I am reminded each night that although there was no transformative moment marking my decision to become a physician that daily I am transformed into a physician, and a person, who uses those lingering things from the first half of my life to liberate myself as well as others.

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May each of us, friends, shed the insecurities and disappointments of our youth just enough to move forward, but not so much that we can’t use them to transform our own lives as well as the lives of those around us in meaningful ways.

 

despair and disparities.

“Lord I have seen your goodness and I know the way You are.  Give me eyes to see you in the dark.” – Christy Nockels, Revive Me.

Those words have haunted me today.

About 1/3 of women in this country are a member of a racial or ethnic minority group. Healthcare providers have become increasingly aware of disparities in access to care as well as health care outcomes for women who belong to these minority groups. Our job as care providers is two fold.  One, we should appropriately document a patient’s race/ethnicity so that information collected on healthcare issues for these women is accurate.  Second, we should attempt, collectively, to identify and address factors that contribute to these differences.  We cannot fix what we fail to recognize.   Black women have an increased risk of stillbirth and preterm birth. Native American women are less likely to receive prenatal care in the first trimester.  Despite having an equal or lower rate of breast cancer, black women are more likely to die from their disease. Minority women are more likely to report their health as poor and less likely to have health insurance coverage.  These women are less likely to get their mammogram or Pap test at the recommended interval and a quarter report having no personal physician.

Disparities in health vary among each state. However, in those states where there are fewer disparities it is most likely because both white AND minority women are in poor health and have less access to healthcare resources.  We must recognize that there are many barriers to good health for minorities, especially women of color. Poverty, lack of education, gender wage gap and single parent households all contribute to poor health. Health disparities are not simple problems to solve and they are not simple to correct. And the truth is there is not a set of winners and losers in healthcare.  When we fail to correct these healthcare disparities, healthcare costs for all increase and our overall health as a community suffers. More than those reasons above I think we should all be concerned when the most vulnerable among us aren’t being made whole.  If you have worked in healthcare long enough you will encounter the despair in these disparities.  You will feel the despair when one of your patients, who happens to be a woman of color, dies from her cancer.  You will ache with despair when a minority woman presents to your office after the death of her infant.  You will notice the ones that don’t come for many of their doctors visits.

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In the light we see all the good that screening programs and medications and preventative services do. In the light we see all our good outcomes and lives saved and people helped. But in the dark spaces are where the disparities hide. In the dark is where, unless we look closely and carefully and with serious intent, we will miss the most vulnerable among us. We will fail to recognize the despair that awaits if we continue to ignore the women of color that are daughters, sisters, mother and patients just like we are. In the dark is where we need eyes to see, ears to hear and feet to move towards better health for all individuals regardless of race, ethnicity, gender or socioeconomic status. Give us eyes to see.