in plain sight

It was Holy Week.  The week of Easter. The mother of all weeks in the church. There was preparing, cleaning, cooking, shopping, eating, egg hunting and so much more.  Frankly, as fun as it is, it is exhausting.  So I won’t belabor the point today.

This Easter I cannot let go of the words from Luke 24:5.  “…why do you look for the living amongst the dead?”  I think now, more than ever, we are looking for signs of life. We are flooded with images of death and destruction from our own country and around the world.  Mothers and children in war torn countries, live streaming videos of crime or self harm, the dropping of bombs, all the way down to angry emails and rants on social media.  It’s enough to make you feel withered and dry and near dead.

Where are signs of life?  I think it’s tempting to say that we will find them in our beautiful pictures on social media of our well dressed slightly less well behaving children on Easter or in our waxing on about our job, house, or whatever new or exciting thing has come our way.  I would argue that there isn’t true life found here. Where then, will we find signs of life? For me it’s in those text messages from friends far and near who understand the daily struggle to balance all things work and church and home.  It’s sending a note to remind someone that they are loved and prayed for.  It should be obvious to those of us who have spent most of our lives wandering in and out of the church doors.  If you lose your life you gain it.  We find signs of life when we extend ourselves to another.

I sent a giving key to a fellow pastor’s wife.  One of the tribe.  If you don’t know about giving keys they are necklaces, with a key on them, and a word inscribed in the key. Someone who tak51412342510__07BB8511-CA17-4486-9560-2002B6474851.JPGes the time to remind me to breathe and relax sent me one. The word I sent was “hope.” It was a promise to hold out hope for my friend on the days where it didn’t seem like hope was possible. When the problems in life, the problems in church, the problems in the world seem too much.

So when you find yourself overwhelmed by all the death and deathly news that surrounds you, give away part of yourself. Make a phone call, write a note, sit down for coffee, send a token of care. Find signs of life and share them with those around you.

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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love is more than a sentiment.

Well friends, Advent is in full swing and we are fast approaching Christmas Sunday!  And guess what?  Christmas Sunday is….on CHRISTMAS!  Traditionally we celebrate Christmas Sunday on the Sunday that falls closest to the 25th.  But next week we will celebrate the morning of Christmas.  And I’m excited.  But today is the 4th Sunday of Advent.

We light a candle in celebration of love.

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In the Advent Scripture from Isaiah today we are reminded that God comes to us as Immanuel.  “God with us.”  We have come to that time in Advent when we begin to really anticipate the birth of Christ. Most of you will be familiar with the story.  Mary, the mother of Jesus, is engaged to Joseph. Except then she is pregnant.  And it’s not Joseph’s baby. You can imagine the drama that this would create. It’s a story we want to romanticize.  We like to paint a picture where both Mary and Joseph are overjoyed at the thought of having a baby but I have to believe that they both understood the hard work, the shame, the isolation they would face.  They had enough faith to bravely accept the ways in which God had chosen to use them and follow wherever this path would lead.

The reality is that God comes to us in one of the most uncomfortable stories of all time. Single mother. Unglamorous birth story.  Weird visitors. If it happened in my hospital today people would look the other way or maybe roll their eyes.  But it leads me to believe that maybe God is at His best “Immanuel” in times when we are most uncomfortable. The difficult part is being able to recognize the Immanuel in our own lives. We tend to move away from the uncomfortable spaces, to stay quiet when we see something that isn’t right, to ask how others are doing with the expectation that they should say all is well.

God loved us enough to have Christ come into the most uncomfortable spaces in our lives. If we are to be His people then we must love in the same way.  There is a lot to be uncomfortable with.  Watch the news, read the headlines, get on social media. Aleppo. Violence against women. More gun violence.  Road rage. Sexual assault on our college campuses. Cold and dark days of winter.  But, because Immanuel, we can speak out against violence.  Because Immanuel we can speak out against oppression and injustice. Because Immanuel we can sit with someone in their despair. The Immanuel allows us to sit in anger, bitterness, sadness and frustration with our lives and He doesn’t move away, He moves closer.

If we truly believe that God is with us today as He was way back then, then you must know that God will move with you into the darkest of spaces and that He calls you to move with someone else in the same way. It won’t be easy.  It will feel uncomfortable. It will mean we have to move out of our daily self-centeredness and begin to notice the world around us. And it will be exhausting. Is it worth it?  Honestly, some days I have no idea.  The Pastor and I have spent lots of time in uncomfortable spaces with people. The return on investment is small; sometimes it’s nothing.  But when I am at my most uncomfortable I want nothing more than to share my burden with another and believe in God as Immanuel. Like Mary and Joseph, we are called into the uncomfortable and God goes with us.

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finding peace.

It’s the second Sunday of Advent!  If you aren’t familiar with advent, look here for a little information I posted last week.  My house is decorated for the Christmas season and my kids are excited.  I will be excited too, when the terror of getting everything ready for Christmas is complete.  Pretty sure that will be sometime during the afternoon of December 23rd.cy2o9t-veaa5dyf

But today is about the waiting and preparation of advent.  Today many churches around the world light the advent candle symbolizing peace.

Many times you will hear people praying for peace or telling someone they hope that the person will “find peace.”  I think most people would admit that the world needs more peace.  That we as individuals need more peace in our lives.  But I am not convinced we really understand what we are asking for or what we mean.  Peace is more than just not having nations at war with one another.  It means we find peace with our neighbors, peace with our enemies and our opposites and peace within ourselves.  I think finding peace as a nation might be easier than finding peace with our own enemies and definitely easier than finding peace within.

Here’s the tough news.  Peace just doesn’t happen magically.  It must be practiced by each of us. It is up to us to lay down our weapons and befriend our enemies.  Sounds crazy I know.  You mighscreen-shot-2016-12-02-at-8-17-46-pmt say to yourself, “but I don’t even own a weapon!  I’m just a gynecologist without a gun or knives or anything of the such.”  Friends, we all have weapons.  We have the weapons of mean words and harsh looks.  Weapons of biases, fear of others, anger towards those who have done us harm.  Sarcasm and judgment are great friends of mine and great tools to make enemies of others.  I probably enjoy conflict too much.  Everyone getting along is much too Disney Princess in my book.  I mean, the struggle is real folks.

Truth be told, war will destroy us faster than it can even destroy our enemies.  Our anger, our judgment, our deeply held resentment against another will keep us from having peace in our own heart and mind.  Plus, the world will never find peace if we don’t create it in our homes, in our families, in our communities.  I’m not claiming that I’m going to spend every Sunday afternoon having lunch with my enemy and my opposite, but I am going to claim that we should put less time and energy into being upset with what someone else is doing that we don’t agree with and more time and energy breathing deeply and choosing to be peaceful.  To withhold our hurtful words and frowning faces and extend a hand to help someone we don’t necessarily get along with.  To give someone the benefit of the doubt.  To sit across the table with friends or family and find a moment of peace.

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above all, choose love.

I am, literally, tired of everything.  Anyone else?  I mean, can I get an amen?  And not just in the “I’m gonna go home and take a serious nap after church today” way.  Today I am keenly aware of the huge volume of things in our world to be weary of.

If you haven’t been paying attention, people are upset.  And in the same breath, they are doing perfectly fine.  We are in a season of paradox.  A time when our lives lived out on social media are full of “totes adorable” and “to die for” and our children are well dressed and even better behaved.  At the same time we vilify those who don’t belong to our political party or whose religious beliefs, skin color or patterns of behavior don’t match up screen-shot-2016-05-18-at-12-12-23-amto our own.  We don’t apologize to anyone or for anything because we are certainly right or at least more right than everyone else.  So we sip our lattes and use our best instagram filters and bask in the glow of the number of likes our candidate or our favorite team or our favorite belief systems receives.  And it all comes at once.  And I refuse to believe that I am the only one who is really just over it.

On top of all of this I think our digital age has made us keenly aware of all the wrongdoing that surrounds us.  October is domestic violence awareness month.  An entire month to educate our community on a societal problem that we can’t seem to shake.  This month also contains a day to remember our lost children and the families who mourn them daily.  We are constantly faced with a newsfeed filled will murders of our young men and women, the exclusion of our most vulnerable, the exploitation of women and children in our culture and the corruption of the most powerful.

So what then, are we to do?

My friends, do your best to choose kindness.  It isn’t easy.  Believe me, I am often the first to choose anger and judgement. But when my children are fighting in the back seat I remind them to always choose kindness.  I can think of dozens of time when I regret choosing something other than kindness.  I can’t think of anytime I regretted the opposite choice.  Also, practice empathy.  Take on another person’s perspective.  Make the choice to be open to their thoughts and feelings as valid and important.  When we practice empathy we learn to believe that the hurt of others is as important as our own hurt. (I recommend  Brené Brown’s YouTube video on empathy).

And, above all, love others. What does this look like?  For me, in my faith community, it means being the hands and feet of Jesus like my friends and neighbors were for me this weekend.

While I was at work yesterday my dear friends came to give respite to the Pastor from my two wonderfully rambunctious children so he could rest.  And then my neighbors brought those same loud and crazy kids dinner so they could all rest.  And today my children will be loved and cared for by my own church community so I can rest from a busy night of welcoming babfullsizerenderies into the world.  And while these simple yet profound acts of kindness have and will bring much needed physical rest to our families, more than that these are the tangible expression of a body of people that choose kindness over rightness, vulnerability over social media perfection.  So, friends, today instead of my usual “I don’t look like I’ve only had 3 hours of sleep lipstick and heels” I chose “messy bun, no eyeliner
and stretchy pants” for my church outfit.  And I let my four year old wear her sparkly crown and my 9 year old wear non-matching shoes because, in the end, only these few things matter.

The truth is that our world will continue to saturate us with filtered images of what is good and what is truth, but you and I can choose show grace to those around us by choosing kindness, empathy and love.  And friends, when life makes us tired, we can rest in the assurance of a God who knows us and chooses and His people who are the tangible expression of His love.

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what you say and what you do matters.

On Friday I received an email notifying me that one of my colleagues had suddenly passed away.  He was a fellow OBGYN, a father and a friend.  He was presumably healthy and not elderly. To say that it was devastating is an understatement.  As my phone, my email and my social media sites fill up with questions, comments and memories from colleagues, former coworkers and friends; I was impressed by the themes that ran through this dialogue.  Of course there were stories of his work in our field and the lessons he taught us in obstetrics, but more than that almost everyone mentioned his effort to really know you, know your family and be kind to you.  To ask how you were doing and to listen and to be honest.

I left work that day having both given and received bad news.  I struggled to reconcile all the good in life with the events of the day.  That evening was my 20 year high school reunion.  Pastor Jason and I met there and I saw faces and heard voices that brought back lots of wonderful memories.  Someone who was very dear to me mentioned that she was proud of all I had accomplished and another friend asked me about the meaningfulness of my work.  Those words were especially important to me at the moment.

You see, what we do and what we say matters.  And I don’t mean in the sense of what our job title is or how many important decisions we get to make.  I think it’s more about how we speak and listen to those around us.  At work, at home, at church, at the grocery store.  Our actions towards our spouse, our children, our friends, our enemies and the least of these among us.  Those of you who know me well, or know me at all, understand that I am almost NEVER at a loss for words.  I am full of stories I think are charming, opinions I think are correct and ideas I’m sure are fantastic.  But over the last few weeks I have felt the spirit move me to really consider what I say and what I do.  No gynecology today.  Just my own breed of the theology learned being married to the pastor for 15 years now.  And here are my thoughts…

  1.  Say “thank you” instead of “sorry to bother.”  And mean it.  We have become a culture that doesn’t say thank you enough.  If we need something that inconveniences another we say “I hate to bother you but…” instead of saying “thank you.”  If you say “I’m sorry to bother you” then the other is obligated to say “oh that’s ok” even when it’s not.  If you say “thank you so much” to those who take the time to help with your need, you have expressed what you feel and the other owes you nothing in return.  Thank you.  These two words can change you.  They can change people around you.  So the next time you need something from someone and they oblige you, don’t apologize for the need, thank the other for the response.
  2. Tell people you are proud of them.  At my reunion my friend Julie looked me square in the eye and said she was proud of me.  It was the best moment of the week.  It reminded me that my kids need to hear it, Pastor Jason needs to hear it, my friends needs to hear it and I needed to hear it.  I am all too guilty of saying “good job” to the residents and students I work with.  A job well done is fine but to know that someone is proud of you is not just about the work you have done but the person you have become.  Replace as many of your “good jobs” as you can with expressions of pride for those around you.
  3. Sacrifice for others.  Be the kind of person who can be counted on.  Whether you tell someone you will pray for them or you ask what someone needs from you, make sure they know you can be counted on.  I told one of the church girls that I think when people say “what do you need?” or “how can I help?” we always say “oh nothing” because we assume our need won’t be met.  Be the person that meets someone else’s need.  The saints in my life are the friends and coworkers who can help out in a pinch; they will make an extra trip to grab something to feed my kid when I’m running behind, they will change their schedule to help me out at work or answer their phone with a willing yes.  And if a friend tells you they don’t need anything during a difficult time, don’t believe them.  Do something anyway.  Show up, bring coffee, watch their kids, feed the dog or just sit and listen.  Next time you ask they will be honest with you and grateful you showed up.
  4. Ask more questions than you give answers.  I learned this from the Pastor.  When you have a meal with him be prepared not to eat.  He will come at you fast and furious with questions.  About your work, your kids, your background, your hobbies.  You will walk away with value and having shared what is most important to you.  It is easy to get caught up in our own daily struggles and achievements that we forget to ask about what is happening in the lives of those around us.
  5. Care deeply.  One of my favorite things to say is “remember the un-squeaky wheel.”  Just because someone doesn’t need to be taken care of doesn’t mean they don’t need to be cared for.  This is one of my go to soap boxes.  But I won’t belabor this one as you can read my previous post on caring deeply here.IMG_4136
  6. And maybe, most importantly, as Mr Rogers said, love others.  Try to drown out the criticism and the anger, the violence and the sadness by loving those around you.  It sounds silly I know, but people who are really loved will be people who say thank you, who tell others how proud they are of them, who sacrifice and ask questions and care deeply.  Your family, your community, your world will be better for it.

For those who had the opportunity to know my colleague who just passed and the fellow OBGYN we lost to cancer last year, they will tell you that as much medicine and surgery as we learned from these two men, they were people who knew what they said and what they did mattered.  And all of us were better for knowing them.