your grandma ain’t my grandma.

If you recognize this line from Chance the Rapper’s song “Sunday Candy”….bravo and let’s hang out.

I’m on the return leg of a few days away from work with the Pastor. We enjoyed a good bit of rest and reprieve, but I couldn’t help to notice that people are people no matter where you go.  I saw a man spend 10 minutes complaining to the pregnant hostess at a restaurant because his waiter didn’t stay at the table long enough after bringing out their meal.  I watched a woman tell other patrons at a breakfast place that her waiter just couldn’t understand that she wanted “CRISPY bacon!” and how this was completely unacceptable. People were anxious to be the first in line to get off the plane just to stand around waiting for luggage with the rest of us.


At work I often refer to myself as “grandma.”  While I’m not the oldest member of the faculty, each year I find new situations where a resident or medical student will ask me about how a technology or medication was used during my training to which I will reply, “um, well, that didn’t exist when I was in training.”  Then comes the look.  The one with the big eyes and the raised eyebrows indicating that my learner just realized that their attending came “before.”  Before topical hemostatic agents were commonly used or available.  Before targeted cancer therapies.  During my training the HPV vaccine was introduced and we added sub-dermal contraception to our regimen of just 2 other long acting reversible agents.  Now we have an even better HPV vaccine and our patients have more reliable contraceptive options than ever before.  Residents are now trained in robotic surgery. In the last dozen years since I started residency the number of female physicians has grown by 40%. We’ve come a long way.

Certainly being a grandma isn’t all bad.  You have the benefits of time and experience on your side. One thing I learned from my grandma is that as much as things change…things also stay the same.  Narrow the differential diagnosis. The basic principles of surgery such as sterile technique and proper tissue handling are always going to be important.  People are still people from generation to generation. No amount of technology or scientific advancements will replace careful listening to your patient’s history and learning to do a detailed physical exam.  Nothing will replace what you accomplish when you put patients first.

I was fortunate enough to know both of my grandmothers.  They cooked whatever food their grandchildren had in mind for that day or that meal. (Seriously- potatoes and chicken for me, spaghetti for my brother.  Two entirely different meals!) But more than that they were generous with their words, their love and their lives.  They put others before themselves.  They made sure those around them were cared for and had their needs met. Above all, they treated others with kindness.

Maybe if we focused a little less on “me first” we could help eliminate a lot of the “me too” and the “not for you” we see across our screens on an hourly basis.  If we could eat less crispy bacon, be a little more patient, move to the back of the line or give up our seat we just might notice our neighbors in need of help or our friends who are suffering.  The world just might change.  While we excitedly embrace new technology and advances in the world around us, may we also embrace the helpful lessons from our grandmas, like always choosing kindness and putting others first.  In those ways, may we all strive to be the “grandmas” of our professions.

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what comes next.

Near the end of the summer the Pastor and I went to Chicago to see Hamilton© the musical.  The Pastor had listened to all the songs, knew the story, listened to podcasts about Lin-Manuel Miranda and just about everything you can do to prep for seeing the musical.  Then there was me.  Did I remember that Aaron Burr shot someone?  Yes.  Did I remember it was Alexander Hamilton? Maybe.  Did I have any idea what role Hamilton played in history or who he was at all?  Nope.  So I went in blind.

The other thing you should know is that the Pastor has been known to overhype things.  Cajun restaurants, songs, TV shows, people.  Occasionally he will find something he enjoys so much he is just sure it’s going to be life transforming for me as well.  So, you can imagine that while I was thrilled to take him to see the show I wasn’t so sure that this would be the wonder that he had prepared me for.


Score one for the Pastor.  Hamilton© is genius.  Amazing, incredible, moving.  It would be impossible to over hype this thing.  Impossible.  It is massively creative, funny, tragic, thoughtful and uses the word “afterbirth.”  What more could you ask for?


Near the middle of the show there is a song called “What comes next?”  It’s about what will happen after the colonies have gained independence.  You’ve worked so hard and sacrificed almost everything to get where you wanted to be…and now what?  As I have (repeatedly) listened to this soundtrack these words have resonated with me.  It’s the beginning of a new year.   What now?  Where do we go from here?

What comes next?

It holds both prospect and peril.  What awaits us on the other side of an accomplishment, an anniversary, a new dream or a new year?  Some of us are holding our breath hoping this year will be nothing like the last.  Waiting for the new year to break in and disrupt the disappointments and distress of the last. Time will only tell.  How do we embrace the hope of possibility and push away the anxiety of the unknown?  Will our efforts in the new year be enough? We will have enough? Will life be different this year? One of my favorite strategies is something I think Hamilton himself employed when he thought about the future: Never. Stop. Moving.  [the man was non-stop].  I am more than uncomfortable sitting still.  And I’ve convinced myself that if I move fast enough and never stop working, reading, thinking, doing, writing, running and more working (whew)…there will be no time to worry about what lies on the other side of the horizon.  The problem with this only comes when either you are forced to slow down or you simply run out of gas.

As we emerge over the horizon into 2018, this year holds much promise.  A year for us to eliminate some of the hate, discrimination and harassment in our world.  A year for collaboration, cooperation and tolerance. For equality and equity. A year in which we will certainly have mis-steps and failures alongside of our triumphs and treasured moments.

Maybe there is a better way.  Maybe there is a way that we; you and I, find the balance between “non-stop” and “being enough.”

In my last post I wrote about finding hope in the midst of hopelessness, peace in the midst of anxiety.  In the same sentiment, the Pastor preached last Sunday about the journey of life we are all on together.  He spoke of those moments where we carry each other when we simply cannot carry ourselves.  If we live our lives in “non-stop” mode we will move too quickly to notice those around us who need help along the journey. In the same way, when we learn to “be enough” we allow others on the journey the joy to carry us during the moments we simply cannot make it alone.

Maybe this year we can slow down, learn to be enough, and share life with one another.

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You can make all sorts of arguments about whether or not the world is getting worse. When you look back at events like the Holocaust and periods of history like slavery and segregation you could make the case that we are not more violent and worse off than in the past.  And then, Charlottesville.  It’s tragic and shameful.  It’s almost hard to believe it really happens.  Almost.  Except, it happens every day. This might be the worst we’ve seen, but every day people would rather take for themselves than give to someone else. People chose to fear the other and decide that a message of hate is going to save them.

First, may we all condemn white supremacy and the events from Saturday.  Secondly, let’s admit that violence and hatred and suppression happens every day.  It happens in big huge giant ways and in the smallest of small ways. It happens every time there is an incident of domestic violence. It happens every time we refuse to condemn amisogynistic statement or a racist joke. It happens every time we tolerate a gender pay gap and a minimum wage that leaves families below the poverty line.  It happens every time we give in to the fear that someone will come and take away the life we have ‘built’ or our security. In both big and small ways we are guilty of putting our own well being above all else and deciding that someone else’s life matters less than our own.

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What then, must we do?

Open our mouths.  Dare to say something when your friend, your neighbor, your fellow church member or even someone in your family privately or publicly says something that is oppressive, racist, supports gender bias or invites hatred. We must say something. It won’t be easy, it probably won’t be popular, but it will be right.  But it must go beyond just our voices.  If we really want to be agents of change in our society we can’t just use our voices but must embody justice, equality and peace with our whole selves.

For those in my tribe called Christian and especially Nazarene, IMG_0635it means putting your money where your mouth is and then making sure your hands and feet follow your money.  That’s right.  It’s not enough just to send your money to the after school program or the food pantry or the non-profit.  Giving your money is necessary and sacrificial but not necessarily transformational. To be transformed means you take an afternoon off from the comfort of your office where you are paid more than you probably ever need and find yourself  sitting next to a child that looks remarkably different than your own and help them learn to read or finish their homework.  To be transformed means to bring your kids with you to serve a meal to someone for whom life has not given many opportunities and forge a friendship.  Not only will it transform you but your kids will grow to understand they aren’t the only people who matter. Transformation is to remove the “us” and “them,” to eliminate the fear of someone who believes differently or looks differently or behaves differently than you.

Today, if you find yourself saying “I haven’t done anything terrible” think about those first 4 words.  Have you done anything at all? Be generous.  With your time, your money, your life. Put the needs of someone else above your own. Condemn anything that represents hate of the other, fear of those who look differently than you or closing doors and windows to the poor, the widow and the orphan. Instead, may our lives reflect a God who would rather arm his people with food, with health and with life than with weapons. A God who looked beyond gender, race, age or anything else when He came to offer healing and hope.

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we hold these truths.

The Pastor and I don’t have many absolutes in our lives.  At our house you can count on things never being the same.  Our schedules are always changing.  One of us is likely to get called away in the middle of an event or have to rush off to work.  But there is one thing you can count on.  One thing that always remains the same. We cannot, I mean CANNOT, watch America’s Got Talent without both ending up in tears. EVERY. SINGLE. TIME. I mean, there is the kid that used to be blind; the girl who lost her hearing; the 9 year old who is getting a little sister and for goodness sake a sweet girl from my home state and her puppet.  On stage stands someone who is probably in one of the most vulnerable moments of their lives.  Sitting across from them are those whose job it is to pass judgement. These people muster up all the guts they can find in their body and get on stage and hope and pray that they will find success.  And then, when they are finished, the most wonderful thing happens.  The words are spoken.

If you’ve seen the show you know what I’m talking about.   It’s more than just telling these performers they were excellent.  The power of the words they speak is life changing. Because of the enormous weight with which they are delivered, the words “you are a winner” or “you have a gift” or even “you are beautiful” seem to penetrate into the very heart and soul of those on stage. You can see it in their eyes. It’s as if all the sudden they believe in the person they have always been.

And cue the tears.

Over the past few weeks the Pastor has been teaching our girls about the Sh’ma. It’s an Old Testament Scripture or prayer that contains the Greatest Commandment.  And then goes on to remind God’s people to bind the words onto their hands, their foreheads, their hearts.  To recite it morning and night. To never forget those important words.

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It is not lost on me that the lesson in all of this is that words matter. And as someone who likes to blog and helps keep both the post office and her local Hallmark® store in business, I am a big believer in the power of the written word. But a spoken word is different.  It seems to be more weighty, more full.

I hope someday I have the opportunity to speak the truth into someone’s life and change them for the better.  Even more I hope someone does the same for both my girls.   And I hope they learn the Sh’ma and I hope they know their own words matter. That in a digital world full of memes and gifs and over the top OMGs, that you and I and even they, will have the opportunity to look someone in the eye and tell them how incredible they are and how much they are loved.  I hope none of us miss the opportunity.

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.




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.