stop apologizing.

The Pastor and I both get to work alongside some all-stars. We can debate about who has better co-workers (me) but today I’m going to tell you about one of his coworkers. Pastor Brit.  She is a unique spirit to say the least.  Brit has chickens; not for food but for pets because she doesn’t eat meat.  Not even bacon.  The chickens all have names and she can tell them apart.  I’m not making this up. She recycles everything, (EVERYTHING!), probably doesn’t own a pair of heels and doesn’t need fancy expensive lattes, just coffee from her thermos.  Sometimes it’s enough to make me roll my eyes.  But the craziest thing about Brit is that she will gladly give me the bacon that came on her salad, she will tell me I look great in my shiny high heels and she doesn’t make evil eyes at me each week when I walk into church with my non-recycled coffee cup with an expensive latte inside that probably is harming the planet…at least not to my face.  Why? Because Brit doesn’t expect anyone to apologize for where they are in life, good or bad.  She has the true gift of opening her arms and welcoming whomever shall find themselves within her reach. In her current role she ministers to our college students and young pastors around the country and I am CERTAIN that she has, and will continue to, save lives by loving and accepting young people exactly where they are at the moment she meets them.

Honestly this is a tough one for me.  One of my most over repeated mantras in life is that “That’s just the way I am” doesn’t fly with me. “We don’t let bank robbers or kidnappers get away with saying it so why should we let you continue to (insert some poor effort or unkind behavior).”  I have spent thousands of hours of my life reviewing my shortcomings and working towards becoming a better physician.  I probably should spend more time working to become a better person but that’s another story altogether.  Accepting you where you are now? Difficult.

But then I started reflecting on some conversations I have had in the last few months.  I found myself at the receiving end of several apologies.  These apologies weren’t for things like accidentally hurting me or even saying something unkind.  These dear friends were apologizing for their mental and emotional burnout.  Apologizing that they weren’t OK.  Apologizing for needing help or prayer or both.

I found myself saying more than once “stop apologizing.  it’s ok not to be ok.”

You see, no one apologizes for having diabetes…or high blood pressure. (Although when it happens to me I’m sorry I ate all those peanut butter M&Ms and bacon.) So why do we expect someone to apologize for their emotions? Sometimes life is hard and you have nothing to give.  It’s ok just to receive.  Some of you, my friends, have experienced unimaginable loss or abuse. It’s ok not to package up neatly your grief, your burnout, your depression or whatever else is going on in your heart and mind like it’s a 30 minute sitcom that needs to end on time so we can all watch the news. (Pro tip: stop watching the news.)

Take your time.  Move through your grief and do your work at your own pace.  May we come alongside you and accept you in wherever that place is you are staying. To love you at that moment more than you love yourself.  Until you are ready to move on. Then, when you are ready, please give away compassion and kindness and mercy like it’s your job.  Shoot, it probably is our job. Give as strongly as you received.  Remember that you were welcomed with open arms and recount the mercy given to you and return the favor.

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If you don’t listen to Lauren Daigle you are missing out on one of the true wonders of life.  She has a song called “Rescue” that summarizes what every human needs to hear on their worst day, and maybe even on their best day.

I will leave you with just a few lines from this remarkable anthem.

“I hear you whisper you have nothing left….I will never stop marching to reach you in the middle of the hardest fight it’s true…I will rescue you”

grace and peace my friends.

 

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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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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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.

 

you’ve got a friend (in me).

As many of you know from the rest of my social media presence, my youngest graduated from PreK this week.  It was all the gloriousness you would imagine.  There were caps and gowns, diplomas, pictures, refreshments.  For part of the program her class sang the song “You’ve got a friend in me” from the movie Toy Story®.  It was, as you can imagine, adorable.  And then the big one had her first acting gig in the church musical.  She nailed it. And back to the little’s ballet recital.  Killed it.  And now we ready ourselves for the last week of school. Of course, you can’t go through this time of year, full of its transitions, without some reflection on the months that have passed.

It was a little over a year ago.  I was listening to some music on a run and for some reason I started thinking about what it meant to be merciful. I was quick to realize that I didn’t really have any idea how to describe or understand or even think about mercy. This, of course, was disconcerting to me having been married to the Pastor for almost 15 years at that point. I was at a loss.  So I decided I would spend some time trying to figure out what mercy was, where it was present, how it happened.  And turns out, mercy showed up in all sorts of places. What I discovered is that mercy might be hard to understand because it is that sneaky thing that is always around but not obvious.  But when you start looking for it, when you take the time to seek it out, you will find it’s all around. In the last year I have been enveloped in mercy.

Mercy is your best friend from long ago and also today getting up before the sun does to go to the YMCA with you.  Even though she could go later…because you can’t.  It is a new friend who came along just at the right time and always tells the truth even when it’s not nice.  And reminds you they are there to stick through the best of times and the worst of times. You can feel it when you sit for coffee with someone who has been in your shoes and nods their head in understanding.  You feel it when that call or text arrives at the exact perfect moment from someone you don’t often get to see but the friendship remains none the less.

Mercy shows up in a big blue van driven by a teensy twenty something year old who picks up kids, who look nothing like mine, after school and nourishes them with food, education and love four days a week.  It’s there when those same kids are on stage at your church next to your own reciting lines in the cheesy kids musical that makes you tear up because you know that this demonstration of inclusion and unity is what God intended. And soon those kids aren’t those kids at all.  They are just kids like mine and yours, showing up every week.

Mercy happens when that person who thought she’d never have a baby sees that face on the ultrasound, or even better, holds that person in their arms. But it is also there when you hold someone’s hand as you give them bad news or grieve with them in the losses great and small.

Mercy happens when the Pastor does a funeral for what can only be described as a tragedy and reminds us that the gospel is an unconventional story and we have an unconventional Savior.  And so is mercy.  It’s there in the loud and in the quiet.  In the wins and in the losses.  It’s wherever we show up and remind each other that there’s mercy enough for each of us.

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i’m not making this up.

A few months ago I was at dinner with friends, one of whom is pregnant. The topic of drinking in pregnancy came up and someone said to me “you just tell people not to drink because you have to, not because it’s really harmful right?” Um…I made that face. That face.  You know. The one where  you couldn’t possibly believe what you heard but, then again, you heard it.  The one where your eyes are big and your mouth is open.  After a pregnant pause I explained that national and now international guidelines recommend against any alcohol consumption in pregnancy.

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We all know that you are never going to get more unsolicited advice than when you are pregnant.  What you can and can’t do including raising your hands above your head or eating peanut butter in the bathtub along with what your baby should eat, how it should sleep, what it should wear and where it should go to college.  Whether or not you should consume alcohol in pregnancy is among that advice.  However, drinking during pregnancy is the most common cause of birth defects in the United States. And while these birth defects are most common among women who drink heavily, there is no safe amount of alcohol consumption for a pregnant woman.  Alcohol use in pregnancy is associated with low birth weight, preterm birth, birth defects and developmental disabilities.  Health care providers are encouraged to discuss discontinuation of alcohol for women who are pregnant and those actively trying to get pregnant.

April is alcohol awareness month. It was established to reduce the stigma associated with alcoholism and increase awareness about alcohol abuse, treatment and recovery.  Excess alcohol use costs the United States about 250 billion dollars per year.  About 5 billion of that is related to alcohol use in pregnancy.  So no, as gynecologists we don’t just say these things because “we have to.”  We say them because we truly want the best outcome for you and your baby.  So if you should find yourself with two lines on that pregnancy test, congrats!  It’s time to take a break from alcohol.  If you are already pregnant and haven’t stopped drinking I would urge you to do so now.  You can tell your grandmother, your best friend, the lady at the grocery store and the dude at the gas station that you are doing everything you can to take care of yourself and your baby.  Really.  We’re not making this up.