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.

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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stay in your own lane people.

We’ve all done it, right?  Veered into another lane of traffic.  Oh, you haven’t?  Yeah right. Anyhoo, moving into another lane of traffic can be no big deal or a giant disaster.  And while I hope we all can agree that we should put down our phones and ignore our children in the backseat and pay attention to the road I’m not really here to discuss actual driving habits.  To stay in your own lane is to stick to what you know.

For the past 3 Sundays I have awoken to the desperate need for a cinnamon roll.  Not the kind you can get at a donut shop on a Sunday morning but a warm iced homemade cinnamon roll.  Guess how many weeks I happened upon said delicious breakfast treat?  ZERO.  So this weekend I decided I would make my own cinnamon rolls.  That’s right. I can perform surgery so certainly I should be able to follow a recipe and make these rolls. With great pride I proceeded to gather all my ingredients from the grocery store along with three other food projects I decided to create for our Super Bowl party.  Yes, you read that correctly.  Not only did I decide to make cinnamon rolls from scratch I figured adding a few img_7732other new recipes in the kitchen certainly wouldn’t add to my angst.  Um, oops.  Moving on, I made those cinnamon rolls.  I mixed up the dough and let it rise and put it in the fridge ready to complete my creation.  It was only then that I noticed the recipe I was using said clearly at the top: “Makes 40-50 Cinnamon Rolls.”  You have got to be kidding me. What am I going to do with 50 cinnamon rolls?  At this point I panicked and frantically phoned one of my best church girls who also happens to whip up homemade cakes and pies and other fancies in her kitchen on a daily basis.  My exact text: “WHAT HAVE I GOTTEN MYSELF IN TO?”  Clearly I had veered from my own lane. Fortunately for me cinnamon rolls can be made ahead of time, they can be frozen and they can be shared with those you are lucky enough to attend Sunday School with.

In this case moving out of my comfort zone, my lane, didn’t turn out so bad. It could have turned out worse.  Sometimes we decide to swiftly move into territory in which we have no education or experience. This has the potential to be disastrous. I won’t be trying my hand at teaching kindergarten, flying a plane or operating any heavy machinery.  Our culture too often tells us we know as much as the experts. And why not? We have access to all sorts of information through the power of the internet. Exactly.  All sorts of information.  The good, the bad, the ugly.  It’s too much. In my arena we use what we call “evidence based medicine” as best we can to direct patient care and research efforts.  We are taught to examine the evidence and decide what the full body of research has concluded, if anything, on a subject. And while I have a good deal of experience reviewing medical literature it doesn’t mean I can easily read the law, interpret scripture or solve complex math problems. At other times knowledge in one area transfers easily to another. Take surgery, for example. When we plan for a gynecologic surgery our team anticipates possible deviations from the norm we might encounter based on the patient’s problem, their medical and surgical history and the procedure being performed.  We create a plan to minimize risk and maximize benefit to the patient.  Does being a gynecologic surgeon mean I should volunteer to operate on your brain or in your nose?  Well, first of all, gross. Secondly, while some principles of surgery carry over from one specialty to another like sterile technique or attempting to minimize blood loss and restore normal anatomy, a gyn surgeon does not have the expert knowledge and experience a neurosurgeon might have. If you ask me the best treatment for say, your eye disease, I’m going to tell you to go to your ophthalmologist, ask some questions about the risks and benefits of each treatment and some others on success rates, etc and then make an informed choice on what to do with the help of your physician.  On the other hand, many more of the techniques used in general surgery would apply in gynecology and vice versa.  So, should natural disaster strike, general surgeons and gynecologists would operate side by side to save life and limb.  But let’s hope it doesn’t come to that.  There are lots of other examples.  Have kids in school?  Swerve into the other lane because you must know how education works!  Voted? Swerve into the other lane because you can run the government.  Been going to church awhile?  You probably know the Bible better than most. The truth is we are all stakeholders in these issues: whether it’s our own health, education, the government or theology.

So what is the best way to change lanes?  Well, we check our blind spot, we put on our signal and then deliberately move over.  Life should be much the same. How do we improve education?  We find our best educators and the best available evidence on education and then create your best practices.  I know exactly who I would approach if I want to figure out how to make low income kids succeed in the classroom.  How about government?  Well, until about 4 months ago I didn’t actually know how the electoral college works.  Or really much else about government.  Who knew those things would matter when I was ignoring them to focus on my science and math classes way back when? So I find those whom I trust who have done their homework and who will, more importantly, discuss all sides of the issue with me. And when it comes to theology, well, I’ve been learning from the Pastor for almost 16 years.  And trust me when I say he knows what he is doing people.  So let’s check our blind spots.  Let’s figure out where we have assumed we know best and admit that we don’t know best.

Here’s another “if you know me” moment.  If you know me, you know I love being right. But I’ve learned that being loud and persistent doesn’t mean you’re right.  So now I’m learning to signal to the people around me and learn about what they have to offer.  So join me in checking our blind spots. Let’s figure out where we have assumed we know best and admit we don’t know best. Otherwise we should just stay in our own lane people.

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the measure of success.

How do we measure success?

The Pastor and I were discussing the events of the last few months and upcoming events. Elections, the national title game, the end of the church year, the end of the calendar year, the NFL playoffs, the Super Bowl, the upcoming year.  Each of these events has many ways in which those involved can measure success.  For some, success is equal to winning.  For others, success is equal to just being present in something greater than yourself. Success can be measured on a personal level, a team level, a national level.  And not all those measurements will come up with the same answer in the same situation.  Let’s take employment, for example.  If the unemployment rate goes down then, on the national level, it will be counted as a success.  But, if you lost your job in that same timeframe and are yet to find new employment I am guessing you would not agree that there was major success in reducing unemployment.

 

In medicine we measure success in many ways. One of the most common ways is morbidity and mortality.  Morbidity refers to disease or worsening health and mortality refers to death.  We view morbidity as complications or poor outcomes related to disease or surgical or medical interventions. Mortality is easy to measure.  Did the patient live or die?

How does our own nation do?  When we look at comparable countries (those with total and per capital GDP rates above average in the last 10 years) we find that we have worse mortality rates for almost all diseases than in those other countries.  The US spends more on healthcare than any of these nations.  Why the difference? Some of it falls on the healthcare system itself.  We have issues that lead to difficulty in accessing healthcare; we have a complex system that contributes to cost, and for many Americans a significant portion of that cost will be spent in their last year of life.  But there are also social determinants that impact our health.  We have more obesity, a more sedentary lifestyle, and more disease caused by environmental factors.  When we evaluate morbidity, or disease burden, we see that despite having a lower rate of smoking and alcohol consumption, we have higher rates of lung cancer, alcoholic abuse and alcohol related liver disease than comparable countries.

Now those are all national statistics.  Measuring outcomes in a large scale view.  It is not the only way to measure success.  A patient might measure the success of their surgery based on when they are able to get back to their yoga class or weekly run and their surgeon might be measuring success based on the time it took to complete the surgery, or by minimizing blood loss or the patient’s hospital stay. Your primary care doctor may img_5778measure success by looking at vaccination rates, patient satisfaction, personal job satisfaction or seeing that long time patient achieve their weight loss goals or quit smoking.  Your OB might measure success by lowering their c-section rate, improving quality of life in the women they care for or when that patient who has long-suffered with infertility or pregnancy loss finally gives birth.

How will you measure success in 2017? Maybe you will set a personal goal for your health, your business, your family.  Maybe you will look at national data like the unemployment rate or what the Dow Jones does.  Maybe you will measure success by what your own state does for its own citizens.  Hopefully many of us will measure success in ways that are much less “measurable” but in ways that have much more meaning.  May we measure success by how we treat our neighbors, how much our children know that they are loved, by how the widow and orphan are cared for and by how we have given away from ourselves in 2017.

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women on lockdown.

In 2013 the Center for American Progress rated Oklahoma as one of the worst places to live for women. Why?  Well, in addition to our above average gender pay gap, ranking near the bottom for women in poverty, and the huge number of uninsured women, Oklahoma has more women in prison than any other state in America.

As a background, the United States imprisons more of its population than any other nation in the world.  In the last 20 years, the percent growth of female inmates was twice as much as male inmates.  So, as a country we have a trend.  When you look at my own state, Oklahoma, we have experienced exponential growth in female incarceration not screen-shot-2016-12-26-at-9-09-16-pmseen in any other state.  As of 2015, Oklahoma puts 127 of every 100,000 women behind bars.  Compare that to 63 of 100,000 as the national average.  From 2015 to 2016, the number of incarcerated women in Oklahoma increased by 9.5% while the number of incarcerated men decreased by 1%. This begs two questions from me: Why do we have so many women in prison? And then, are we any safer or better off with all these women behind bars?

First, at least 2/3 of the women in Oklahoma who are in prison have committed non-violent crimes. Many are incarcerated due to drug offenses, which up until recently carried serious jail or prison time due to Oklahoma laws.  There is no compelling evidence that we are any safer with a high female incarceration rate.  According to the our state Bureau of Investigation, violent crime in Oklahoma was up about 3.5% from 2013 to 2015, and non-violent crime was down by about 4.5% in that same time frame.  The overall violent crime rate in Oklahoma has decreased 7.3% in the last 10 years, while the rate of female incarceration doubled in the same time frame.

For the last couple of years I have given a lecture to our second year medical students on the state of women’s health in Oklahoma.  The good, the bad, the ugly.  I always touch on our incarceration rate.   Why?  Because our other state health indicators are major reasons why we incarcerate so many women.  1 in 25 women enters prison pregnant.  Over 2/3 of incarcerated women have a minor child. The consequences for these children are devastating.  Also, more than half of incarcerated women in our state have experienced domestic violence in adulthood and/or abuse in the home as a child. About 70% have been diagnosed with a mental health disorder.  Why does this matter? Because in 2013, our state ranked 46th (where 1st is best) in mental health expenditures per capita that were state funded.  picture1Most women in our state who enter prison live in poverty and have a lack of education. Again, we rate 40th out of 50 for number of women in poverty.  When women in Oklahoma are marginalized in health and economics, they are disproportionately more likely to end up in prison.  But is the news all bad? Fortunately, no.  In 2015, our state passed 2 bills that allowed reduced sentences for drug offenses and judges to deviate from mandatory minimum sentences.  Then, in 2016, the people of Oklahoma passed a state question that made certain drug and theft related offenses misdemeanors instead of felonies.  The money saved from the reclassification of these crimes will be used for rehabilitation programs, thanks to another state question supported by the voters in my state.  Tulsa County, along with the George Kaiser Family Foundation, have established a Women in Recovery program.  Since 2009, they have helped 475 women and over 1,000 children.  But we still have a long way to go.

Why should you care?  What can you do?  I think, no matter what state you live in, the rate and growth of female incarceration in our country should alarm you.  As a gynecologist I’m probably biased but I think we can measure the success of our nation by the success of its women.  If we can keep women out of prison their children are more likely to succeed in school and avoid drug abuse and addiction.  We should be advocating for increased mental health services in our states and in our nation; for reduction in the gender pay gap and other measures to reduce the number of women and families in poverty.  We should find ways to reduce domestic violence in our nation.  We should support efforts like the Women in Recovery program, and drug and mental health courts that focus on rehabilitation services.  No one knows this better than my sister-in-law, who also happens to be editor-in-chief of this blog.  She works in the drug court system.  She sees women as offenders every day in her home state of Missouri.  She knows it takes, sometimes, half a dozen times or more for offenders to find recovery.  She will be the first to tell you there are no easy fixes and no simple answers.  But I believe if we begin to change the idea that prison is the solution, then we can begin to create a culture where we focus on restoration and rehabilitation for our women.  I think we will all benefit. We have a shared brokenness.  We should share in the efforts of recovery.

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a voice in the wilderness.

It has been quite a week.  Pastor Jason was involved in all the church Sacrements last weekend.  A funeral, a wedding, a baptism, a dedication and communion.  Which means it was a very. busy. weekend.  So I didn’t get my blog post done on Sunday.  I was a bit disappointed in myself but I just didn’t have peace about the final version.  Well, it got scrapped so here I am with version number 2.  Same title, different content direction.

My first version of this post told a story about Nancy and Mac, who we sat next to at the rehearsal dinner and who were a voice in the wilderness for us.  They spoke into our lives and reminded us that what we do each day has meaning and purpose, that our hard work is not thankless and that there is hope in the future.  And then Monday happened.  Work was work and people were acting a fool.  So the blog post sat.

But today my disappointment for not being done with the blog post “on time” was wiped away by renewed inspiration to be a voice in the wilderness.  If you didn’t know, I live in Oklahoma.  Today, our state passed a bill that makes it a crime for any physician to perform an abortion in our state, except for in the case of the life of the mother.  You must be thinking as a person of faith and a pastor’s wife that I would think this is great news, right?…wrong.  Fasten your seat belts kids, this Jesus loving gynecologist is going to try to explain to you why this is a terrible idea.  It’s going to take a minute, so bear with me.

First, I don’t think we can consider ourselves “pro life” unless we are really going to work to help make a life for those around us.  That means a living wage for all people, enough food for families to eat, prison reform, quality education for all and support for those women who find themselves raising a family alone…not to mention standing up against domestic violence and sexual assault.  And to be pro-life means you support planned and appropriately spaced pregnancies so that they are more likely to have healthy babies and take care of them in the ways we would all like.  It means you believe in access to affordable and reliable contraception for everyone.   Because even if you intend to be abstinent you might find yourself among the 1 in 5 women who is a victim of sexual assault..see previous blog post…needing emergency contraception.  Which, by the way, prevents ovulation…which happens PRIOR to conception, therefore not ending pregnancies, just preventing them.  And if we as the culture, the church or the community are really going to say we are pro-life…then we need to have the guts that two of my close friends did and invite a child from the over-flowing foster care system into your home.

Second, laws like this do not deter women from getting an abortion.  Electively terminating an pregnancy in my state is not easy to do.  Women must have money, transportation, time off of work, family or community support, not to mention navigation of the multiple laws.  So I don’t think adding this one will make a huge impact.  What makes abortion rates go down?  Access to affordable and reliable contraception.  In Western Europe abortion rates are very low, even though it would be easier to have an elective termination of pregnancy there compared to most places in the US.  Why?  They have a high rate of contraception use and a low unintended pregnancy rate.  Furthermore, I disagree with the legislation of reproductive rights.   What would happen if someone made a bill that said I couldn’t have fertility treatments to have my second child? What about a law that says no one can have more or less than 3 kids?  Uh, no thanks.  We think that these laws restricting or outlawing abortion are “good” because abortion is “bad,” but legislating reproductive rights in any way is never good. You just might not see it that way until you are on the receiving end of the law and it doesn’t fit your belief system.

Lastly, physicians don’t practice good medicine when we practice in fear.  In my job and within my belief system I would only be involved in a termination of pregnancy if the life of the mother is in danger.  I make these decisions based on clinical experience, medical evidence and science and standards of care if they exist.  Except…now that I might go to jail if I make the wrong decision will I second guess just what does “exceptions for the life of the mother” mean?  Can I remove the ectopic pregnancy, and therefore terminate the pregnancy, before it ruptures and tries to kill the mother?  Do we deliver the woman with very early and very severe preeclampsia knowing her baby will almost surely die from prematurity before she has a stroke or a seizure or is her life only in danger if one of those happens.  These seem like silly questions but when providers are asked to make decisions with a law hanging over their shoulder threatening to make a criminal out of them it just might impact judgment and decisions.  And that will certainly negatively impact the lives of women in our state.

So what do we do?  Well, it is my hope and prayer that no woman would need to undergo an elective or medically necessary termination of pregnancy (i,e, abortion).  I hope that I will be around to see that world.  But it won’t happen if I don’t do my part.  My solution, for today, was to be a voice in the wilderness.  Mostly, I try not to get myself or the pastor in too much trouble with my tendency to say whatever I am thinking and ask whatever is on my mind.  I will certainly have friends in my church, my Christian community and others around me strongly disagree with this post.  But as Pastor Jon and Jason say, we must find a way to disagree Christianly.  Nancy and Mac, from the rehearsal dinner, were a voice in the wilderness for me.  They weren’t afraid to say what they thought, to listen to us and to tell us that our voices matter.  Today I am a voice in the wilderness for the women and their children in my state.  My state that has no solution for a 25% reduction in state funded healthcare that will leave thousands without access to medical care, a state where the district I live in has a 3.6 million dollar deficit to make up for in education despite having some of the lowest paid teachers in the nation and no art program.  A state where we put more women in prison that almost anywhere else, where we have significant problems with tobacco abuse, obesity, cancer prevention and other community health needs.

Isaiah is one of my favorite books of the Bible.  It is the inspiration for this blog post.   I love Isaiah 40.

Comfort, O comfort my people,
says your God.
2 Speak tenderly to Jerusalem,
and cry to her
that she has served her term,
that her penalty is paid,
that she has received from the Lord’s hand
double for all her sins.
3 A voice cries out:
“In the wilderness prepare the way of the Lord,
make straight in the desert a highway for our God.
4 Every valley shall be lifted up,
and every mountain and hill be made low;
the uneven ground shall become level,
and the rough places a plain.
5 Then the glory of the Lord shall be revealed,
and all people shall see it together,
for the mouth of the Lord has spoken.”

Be a voice in the wilderness today.  I challenge you to think about what it means to be “pro-life” to everyone around you, whether you think like them or not.  The truth is they are loved by God just like you.  Maybe, together, our voices can improve the systems we live and work in so that the valleys can be lifted up, the ground will be leveled and the glory of the Lord will be revealed to the least of these that surround us.  Thanks for enduring with me on this one.

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