deeply rooted pain.

Most gynecologists will tell you that one of the most difficult patient encounters they will have in their clinic is someone with pelvic pain.   Pain comes in many forms and is different for every individual.  Sometimes pain is straightforward.  If I were to give you a generous throat punch (a hollow threat I often use) you will be able to precisely locate your pain and know its cause.  Some painful events are less straightforward.  Let’s say your img_4091appendix has decided to become inflamed, infected and will try to  rupture in an attempt to ruin your life.  That pain will usually start around your belly button before it moves to the lower right side of your belly which is home to the offending organ.  Pelvic pain is often like the latter.  It is difficult to find the cause and can present in a variety of different ways.

About 15% of women will experience chronic pelvic pain at least once in their lifetime.  Chronic pelvic pain is pain that lasts 6 months or more in duration.  It could be daily or constant pain or it could come and go inconsistently.  About 5 to 8% of women will struggle with chronic pelvic pain for a large portion of their life.  When I see patients who have pain in my clinic I remind them that I can list probably a dozen things that might be causing their pain.  Usually we can narrow down what we call the differential diagnosis (list of potential causes) to a few most likely causes or maybe even the exact reason for the pain.  In other circumstances we have no answer.  Nothing.  A list of maybes, a list of treatments, but no name, no diagnosis for the face that sits in front of us.

Most women with pelvic pain have endometriosis.  Endometriosis occurs in less than 10% of women but is the diagnosis for at least 70% of patients who present with pelvic pain. The American College of Obstetricians and Gynecologists state in their practice bulletin on the topic that “the clinical manifestations of endometriosis are variable and unpredictable in both presentation and course.”  No sentence could be more true.  Endometriosis is, to put it too simply, when the lining of the uterus is implanted inside the body, usually in the pelvis.  When visualized during surgery it can appear red, black, white, clear or even be difficult to see.  Harder than finding it is getting rid of it.  Many women with endometriosis have infertility from their disease.  We have few medications and surgery is often not curative.

Some other women with chronic pelvic pain have muscle spasms that are often long-standing and difficult to reverse. These women often have a difficult time being diagnosed and once they are, the road back to health is quite long.  Still others have gastrointestinal disease, inflammation of their bladder, scarring from previous surgery or pain caused by previous trauma or abuse.  Even depression and anxiety are known to cause pelvic pain. Can you have pain without a cause?  Sure.  Just like you can be sad and not know why or be upset and not exactly know what you are upset about.

If you know someone with pelvic pain, know their pain is real.  If you are someone who has been diagnosed with chronic pelvic pain, please know that your doctor wants to help you get better.  My best advice for you is to find a provider you trust; to know the road will be long and will require patience and strength; and to find someone who will support you on the journey back to health.

 

the worst part.

I got my flu shot on Friday.  The worst part?  My office nurse made me weigh and take my blood pressure before she would give me the vaccination.  Talk about ouch!

“Should I get my flu shot?” is one of the most frequently encountered questions I answer between the months of October and February.  My answer; almost always a resounding “yes.”  Why?  Not only because the flu is terrible to have, it kills people.  And I’m not talking about the “my husband has the flu and now he acts like he’s dying but I might kill him instead” kills people.  Like it really kills people.  While the current reporting systems don’t allow us to know exactly how many people die from the flu in the US annually it is likely to be somewhere around 20,000 people including about 150 children.  The young, the old, the pregnant and the immunocompromised are the most at risk.

So why would anyone question getting their flu vaccine?  Oh, let me count the ways.

Many of my patients think the influenza vaccine can give them the flu.  Wrong.  It does create an immune reaction and you develop antibodies in about 2 weeks that should be protective against the flu.  Most patients receive either the trivalent (traditional) or quadrivalent flu vaccine. Trivalent vaccines protect against an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. The quadrivalent vaccine (what my nurse was giving me in the above photo) has protection against an additional B virus.  These are inactivated or recombinant immunizations which means, in short, they won’t give you the flu.  And remember, it takes 2 weeks to be immune, so if you get the flu 2 days after you get your shot don’t blame the vaccine.  Blame the person who exposed you to the flu virus before you were protected.

Some patients just don’t think they need the vaccine.  Maybe they have never had the flu.  Well, trust me that it only takes one week of feeling incredibly ill with the flu to convince most people they never want to skip out on vaccination again.  I also tell my patients that even worse than getting the flu is giving it to someone else.  If you have a child, a pregnant woman or a person over the age of 65 you care about then the influenza vaccine is for you.  If you have friends or a family member who has cancer, asthma, diabetes or another immune disease then the flu vaccine is for you.  Giving the flu to someone who is at high risk of hospitalization or death is not nice.  Pregnant?  Pregnant women who get the flu are more likely to have severe illness, be hospitalized or die from the flu.  Scary much?  Trust me, I repeat that line on a weekly basis.  Plus, the infants of pregnant women who are vaccinated for influenza in pregnancy have protection that can last up to 6 months.

So what do I say when asked by someone if they should get the flu shot?

Yes.  You’re pregnant and I don’t want to risk seeing you in the ICU with the flu.  Plus your baby can’t receive a flu vaccine until 6 months of age and you want to protect your infant until they can protect themselves.  You can be vaccinated in any trimester so trust me when I say if you don’t do it today I will ask you again at your next visit.

Yes.  Immunizations carry much less risk than the diseases they protect you from.  Does the flu vaccine guarantee that you will not get the flu?  No.  But it does significantly reduce your risk.  You still need to wash your hands, avoid sick people, cover your mouth when you cough and all those good things your grandma has been telling you since you were small.

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Yes.  Getting a flu vaccine is more than just about protecting you.  It’s about avoiding the flu so you don’t spread a virus to someone who can’t get vaccinated.  Or spreading the illness to someone who could get very sick and hasn’t had time for their vaccine to be fully protected.  Or your wife.  Husbands, get your flu shot.  If you give the flu to your wife no one will be happy.  The Pastor had the flu last year and I literally locked him in one room of the house until he was no longer contagious.

Yes.  Because you care about your kids and your family.  My kids will be disappointed to learn the nasal spray isn’t recommended this year.  The needle stick will be the worst part for them.  But the good news is this…first, they get excited when they get on the scale at Dr. Melissa’s office (unlike me!) Second, they think doctors and nurses are awesome and trust that they will be protected.  Finally, there are stickers…and probably treats on the way home.

So go get vaccinated.  There are about 150 million doses available so I’m sure you can find one.  Some more news for those of you still skeptical.  Now you can be vaccinated if you are allergic to eggs.  There is even an intradermal version: which means the needle is about 90% smaller for those adults in the group who are afraid of sharp things seen above.   No matter if the weight or the blood pressure measurement or the waiting in line to get it done or the actual needle stick is the worst part.  This gynecologist and pastor’s wife thinks it will be worth it.

(photo credit my arm, Heather’s hands and Erika for being the photog.)

 

red hair…don’t care.

I got the “red hair…don’t care” award from my residents a couple years ago.  I loved it.  They decided this award was best for me because I shoot pretty straight on most things; especially when it comes to the residents and medical students I work with.  I say things like “here’s a great way NOT to impress your attending.”  Or  “how about we try not to say that in front of the patient.”   I also have a thousand funny memes and sayings and have been known to let loose with my sarcasm at times.

In the spirit of all things “don’t care” I thought I would share with you what myself and my fellow OBGYN’s don’t care about that our patients seem to be all worked up over.

That your legs are not shaved.  No seriously.  I’m not giving you a leg massage.  It really doesn’t bother us.  We usually don’t even notice unless you bring it up.  Confession: our legs probably aren’t freshly shaved either since most of us prefer to use that extra few minutes for sleep instead of time in the shower.

That you are on your period.  I’m sure you hate it but we signed up to deal with it.  Like every day.  Remember we deliver babies and perform surgeries and see hundreds of women who are bleeding.  We got this.  Thanks for worrying about us but we will be fine.

That your socks don’t match or your toes aren’t manicured or you aren’t wearing your cutest undies.  For the most part we get dressed in the dark.  We come into the hospital in the middle of the night.  Our socks might not match.  Wearing underwear is considered enough.  Please do wear it.  You don’t have to wad it up and hide it from us under your other clothes, we don’t care what it looks like.

That you might see me in public.  One time I saw someone bolting down the aisle at Target to avoid me.  It’s OK if you see us at the grocery store or the gym or the PTO meeting (who am I kidding we are always at work during the PTO meetings) we will do our best to remember your name correctly and say hello but it won’t be awkward for us because we take very seriously protecting your privacy and honestly we don’t remember every detail from every patient…that’s why we take good notes!

That you have a ‘weird’ question.  Trust me.  Patients often say “I have a weird question” followed by something that is totally normal/common/not weird at all.  There is not much we haven’t seen or heard.  Not much we haven’t dealt with, walked patients through or bailed someone out of.  What might seem weird to you is probably routine for us.  So hit us up with your ‘weird’ questions.

What the internet (or your bestie) told you.  If you come to the doctor with a plan in place for yourself then it makes our job harder.  Instead of focusing on listening to your problem and making decisions on the best available evidence we spend time re-educating you about what you have read or heard.  We are happy to provide you with that information but we really want to spend our time helping you get better.

So, here’s what we DO care about.

That you are honest with us.  We can’t take care of you if we don’t know what is really going on.  While most OBGYN’s are friendly and inquisitive by nature, we ask about who you are sleeping with and what medications you are taking because we want you to be safe and healthy, not just because we are nosy.

That you know we want what’s best for you.  If you are honest with us we will listen, we will empathize and we will be honest with you.  Sometimes that means we might tell you something that is hard to hear.  Or give you bad news.  But through it all we are doing are best to do what is best….for you.  For your health and for your family.  Try to remember that when the answer we give you isn’t necessarily what you wanted to hear or involves hard work.  We want you to be safe so we are going to ask about any history of violence or dangerous behavior.  We want you to be healthy so we are going to ask you about your diet and exercise habits.  We don’t want to harm you so we might not be able to give you a medication you want or perform a procedure you would like to have.

That you know we are doing our best.   Sometimes we run behind, we get stuck at the hospital or are dealing with a difficult situation.  I can’t promise you won’t have to wait in our waiting rooms or that your surgery won’t be delayed or even that everything will turn out perfect, but know that we are doing our best to make sure you are taken care of as best we can.  We are mothers, fathers, husbands, wives and most importantly, human beings.

screen-shot-2016-09-25-at-6-38-08-pmSo there you have it.  The truth from blonde covering gray hair who don’t care and will tell you how it is.  Go ahead, don’t shave your legs. (Please note that my obgyn friends do ask that you please have clean feet when you arrive.)  Ask the embarrassing question without even saying it’s ‘weird’.  Say hello when you see us at the grocery store with our screaming children and sweat pants. And come to your physician with honesty and an open mind.  Grace and peace, friends!

 

fearless.

What is your biggest fear?  What are you most afraid of?

That was the question of the night when the church girls and I went on a weekend trip this summer.  It’s a question I would have never thought about asking.  But, if I’m honest, there are a lot of things I am afraid of.  Like spiders.  Those guys are creepy and fast.  And most other bugs.  “Blood and guts” as my girls say, are fine but bugs are gross.  My friends all had different fears.  Losing the people they love, dying, rejection.  All super legitimate.  I don’t know that any of us are fearless.  And maybe that’s a good thing.  We should be wary of wandering out into the street, feeding wild animals, playing with matches and all the other things your mother told you not to do.  Fear and worry sometimes work to my advantage.  In my line of work you prepare for the worst case scenario.  You think of all the things that could possibly go wrong and then work to avoid them and then figure out how to fix them if they occur.

But, in general, I’m not sure fear does us a whole lot of good.  When we are afraid we move away.  We walk to the other side of the street, we go to the end of the line, we don’t raise our hand.  We miss out.  One of my best girls painted a canvas for my youngest when she was born.  Her life verse.

Psalm 46.

“God is our refuge and strength.  A very present help in trouble.  Therefore, we will not fear.”

Say whaaat?  I will not fear. Um, I’m not so sure.  I will not fear…except for when I face something new or unexpected.  And maybe when things are tough.  Oh and spiders…still fearing spiders over here Jesus.  But what do I fear most?  What seems impossible when it comes to “I will not fear?”  Suffering.  Loneliness.  Failure.  You see I’m not afraid of deathScreen Shot 2016-09-11 at 7.51.48 AM.png but I am afraid of suffering prior to dying, getting defeated by illness, and then no one showing up to my funeral.  Funny how fear works.  It seems to find the things deep inside you where you are most vulnerable and remind you of why you put them there.

Today pastor Jason and I went on an adventure course.  We did a 75 foot high tower ropes course, a vertical drop, zip line, fun slides and a rapid rafting course.  I was afraid and thrilled all at the same time.  I’m wearing a harness and watching other people older and less agile than me do all this stuff and manage to not die…but still.  There’s a part of your brain that just can’t quite shake the feeling that flying 80 feet in the air over a river and then back is not that safe of an idea.  That place deep inside begins to creep up and tell you to be afraid.  But then you do it.  Mostly because the old guy in front of you managed to be courageous enough to do it. Partly because your dad has done it and you can’t chicken out on something your dad has conquered.  And it’s amazing.  You realize what you would have missed out on had you not stepped off that ledge.  And you’d take the step a dozen more times.  The fear doesn’t disappear but knowing what is on the other side makes it seem so much smaller.

I think fear keeps us from taking that first step in so many places in our lives.  When I am afraid of suffering I will never move out of my comfort zone.  When I am afraid of loneliness I miss out on those quiet spaces of rest and refuge.  When I am afraid to fail I miss out on all the good things that come with doing something hard, something new. When fear controls us we are powerless to change.  Will I be killing all the spiders at our house from now on?  Nope.  But the next time fear creeps in I’ll try and remember what it felt like to take that step off the ledge and into the air today.

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(photo credit ultimate selfie at Riversport adventure in okc)

control. period.

A tough thing to come to terms with as an adult is how little control we have over life.  Growing up we can’t wait to be in charge of our lives.  Then you become an adult and realize that there is very little you can control.  Today’s blog is about taking control back from your uterus…and your ovaries for that matter.   Hang on kids, this one’s not for the faint of heart.

I have control issues.  The more things I think I’m in charge of the better I feel.  Seriously.  I blame my parents.  (Just kidding mom and dad!)  I’ve been this way since I was small.  Trying to be in control of what I wore, what my older brother did, where we went when…sounds amazingly wonderful for my parents right?  This is why I was the LAST child.  Well one of my favorite things about my job is giving women control over their lives and their bodies.  If you haven’t heard the news ladies, your reproductive system is working hard most of your life just to do that…reproduce.  And that means a wonderfully complex rollercoaster of hormonal shifts resulting in either pregnancy or a menstrual bleed.  Really?  These are my options.  Awesome.

Humans have been trying to prevent pregnancy since at least the 1500’s.  I won’t drag you through the remote history of attempts at contraception but just know that it involves the use of alligator dung, fish bladders, mercury ingestion and more.  The first commercially available oral contraceptive was available around 1960.  In the 50 years since it has become illegal to advertise or have any public information distributed regarding contraception.   It was available to married couples only.  In fact, it wasn’t until 1972 that birth control became legal for everyone in the US.  Contraception as we know it, with many safe and reliable choices, is a reality that only came into existence in the 1980’s.  To recount all this is fascinating to me.  I have a dozen handouts and booklets on contraceptive options for my patients.  It is difficult if not impossible for me to imagine a reality where I wouldn’t have a choice in, if and when I wanted to become pregnant.  Not to mention no control overScreen Shot 2016-08-25 at 10.08.42 PM my own menstrual cycle or the multiple medical conditions that hormonal contraception is used to control and improve.  A world without hormonal contraceptive options for me is like a world without the internet on a handheld device for the pastor.  Disastrous.

When the pill first became publicly available most women requested it for menstrual regularity.  In fact, many packages had a warning label about the medications “contraceptive side effects.”  But a woman could go to her doctor and ask for the pill for these reasons and then use the medication to safely and appropriately space her family.  Using a hormonal contraceptive for a non-contraceptive indication is quite common these days.  In other words, a lot of my patients come wanting relief from their pain or anemia associated with monthly menses, improvement in their skin from excess androgens and relief from symptoms of things like endometriosis, polycystic ovarian syndrome and others.  Do some of these women use hormonal contraception to prevent pregnancy?  Yes. But some simply use it for these other reasons.  To take control away from their uterus and back into their own hands so to speak.

What most people don’t realize is that you can use the birth control pill and other hormonal methods to completely suppress their period.  No seriously, you can.  And guess what?  It’s safe to do so.  If you ask a room full of female gynecologists who aren’t actively trying to get pregnant if any of them are having regular cycles know what you’ll get?  Crickets.  We avoid periods like the plague.  Why?  Because they are disruptive.  And annoying.  And messy.  Do hormonal contraceptives have risks?  Yes, but these are small compared to the risks of having a baby.  Is hormonal contraception right for everyone? No.  But multiple studies and multiple systematic reviews of those studies have shown extended use of contraception to suppress the menstrual cycle to be no more risky than the usual use of the pill.  Oh yes, and they found that patients were happier not having their period come every month.  Shocking, I know.  When the pill was created it was supposed to mimic a regular cycle so that no one would know you were on the pill.  Sneaky, huh?  Well now every magazine you pick up contains some advertisement for birth control or tampons or something associated with your reproductive organs.  And while we still live in a culture where we raise a fuss about who is having sex with whom (well except for our own kids who would never do such a thing), we have come to terms a bit more with discussing issues surrounding reproduction.  We still have to fight battles for access to affordable and reliable contraception in a country where almost half of pregnancies are unintended.  Sex education in our culture is informal and erroneous at best which propigates most of those unintended pregnancies in both the young and the not so young. But thanks to those who have gone before and paved the way for us to make choices about our own body.  Seriously people.  Someone had to protest for me to gain control over my reproductive organs.  This is the world we live in.

So there you have it.  There are lots of things you can’t control.  What time the baby will deliver.  If your kids will behave in the restaurant.  My work schedule.  How many people will need to talk with Pastor Jason after church.  But fear not.  The menstrual cycle can be controlled.  Don’t want to have a period?   Don’t have to.  Don’t want another baby?  Don’t have to.  Don’t want to be bothered by anovulation or cramps or worsening of some other problem…don’t have to.  You can control at least one part of your life.  period.

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the struggle to stand tall.

I have bad posture.  I am getting better at standing up straight but it has taken me quite a while to get in the habit.  My biggest motivation has been seeing myself in pictures hunched over.   My sister in law, who also happens to be editor in law of this blog, has great posture.  Always standing up straight in photos.  So does her mom.  So a family photo op including me hunched over is uber flattering as you can imagine.

I think having kids makes your posture worse.  Your back does all sorts of shifting around during pregnancy and then you spend the first several years of their life scrunching over to breastfeed, change diapers, pick them up out of their cribs, pick them up off the floor, pick up the toys they left on the floor and finally sitting hunkered down on the floor to create whatever craft it is that is due in the morning for school that you forgot about until the last minute.  In fact, a certain blogger and gynecologist you know might be snuggling up with her heating pad after just finishing a school project and picking up after two children.

If you churched with me today you heard a sermon out of Luke 13 where Jesus heals the bent over woman.  She has had a spine deformity for 18 years.  Most biblical commentaries relate this to osteoporosis.  Osteoporosis affects women more often than men and can result in a fracture of the spine, hip, wrist or another bone.  In the US almost 8 million women are affected with osteoporosis.  Over half of women over age 50 will break a bone due to the disease.  A broken bone might not seem like a big deal but many of these women will require hospitalization, rehabilitation, and some will even have life threatening complications.  And guess what?  I have already passed my prime when it comes to bone health.  Peak bone mass is reached in young adulthood.  This 38 year old can do nothing but keep her bones as healthy as possible.  That’s why it’s important to make sure your kids do things like eat food rich in calcium, exercise daily and get enough vitamin D.  And for you, who like me, have already reached peak bone mass, we need to keep our bones healthy by continuing with calcium and vitamin D intake, strengthening our bones and muscles with weight bearing exercise and avoiding falls by improving our balance.

But what I found most interesting from today’s sermon was not the shout out to osteoporosis but the revelation that this woman not only strugglScreen Shot 2016-08-21 at 11.00.07 PMed to stand tall because of her physical disease but because of the shame heaped on her by her own community of faith.   You see, this was a woman who had a disfiguring physical ailment.  She was labeled as the outcast and treated as such.  What Jesus does in this passage is three-fold, with the miracle of healing coming last and maybe leaving less of an impression with me than the first two.

First, He speaks to her.  While her community of faith had worked to suppress her into a folded bundle as close to the ground as possible, Jesus seeks her out and calls to her.

Second, He touches her.  Not only is she a woman but an untouchable broken diseased woman.  And He just reaches out and grabs her hand.

We are all surrounded by people who have been bent over and crippled with shame by our culture.   Can you imagine if we called them by name and reached out to take them by the hand?  Whether or not you believe in Christ and the miracles found in scripture, you can imagine what kind of world we would create by loosing the bonds created through the oppressive nature of the systems in which we live and work.  If each one of us took a moment to call out to the woman shamed by her past or treated by her society like she doesn’t matter as much as the man sitting next to her…if we reached out to grab the hand of someone who suffers from physical or mental illness…if we dare to move beyond the labels we have given to others, we just might create the change we all are longing to see in our world.

There are lots of things I love about this Jesus character.  But one of the best is the way He is so practiced in His hospitality toward the shamed, the marginalized, the outcast.  Like He’s been doing it His whole life…because He has.  So just like your kids need their milk and yogurt and exercise now when their bones are growing, our kids need to practice calling out and reaching out to the broken, shamed and marginalized among us.  They will strengthen their bones of hospitality and mercy so that when they are old and tired and picking up after small people they remember to speak names and grab hands of those left out by society.  And for those of us who have already reached our “peak bone mass” so to speak; we can still practice finding the suffering and shamed among us, bent over and crippled by the weight of all we have put on them through the years.  We can still strengthen ourselves to become a person whose posture mimics that of a man who had the audacity to call out to and grab the hand of the crippled woman in the back of the room.

And by the way, someday we will all find ourselves crippled and bent down low, waiting for someone to call to us and grab us by the hand and bring healing into our lives.  May we be surrounded by a community that has been practiced in such hospitality.

(photo credit: the internet and @okcfirst on Instagram)

the least of these.

If you don’t know, the healthcare system in our state and in our country isn’t perfect.  I know, shocker. We have problems in the system like limited access to healthcare, concentrated health care resources, lack of appropriate funding and lack of educational resources.

You also may realize that Oklahoma does not rank well when it comes to being a healthy state.  A review of our state health department’s state health report will reveal that as of 2014 we received an F in overall mortality with the highest rate for death in heart disease, stroke and are near the top in death from diabetes and near the top in obesity rates.  Almost 20% of our state’s residents don’t have insurance coverage and about 1 in 6 Oklahomans live in poverty.  Most of those living in poverty and many of those without insurance are our state’s women and young adults.

We know that individuals without medical insurance have poorer access to healthcare and overall worse health in general.  They visit the ER more often as uninsured individuals don’t have the ability to access preventative health or have a primary care physician they can see when they have a minor illness or need an urgent visit.  The uninsured with disease are more likely to have it diagnosed at a later stage and develop complications that result in long term harm or death due to their lack of healthcare.

The debate about what to do with our large uninsured population has been going on for over 2 decades.  Not many are willing to claim it isn’t alarming.  But most of us can’t agree  on what to do about it.  Our state has failed to pass a tobacco tax and a plan to expand medicaid; we have not found a reliable way to allow small businesses to provide insurance to their employees and we have left undone the poor, the widow and the orphan in our state.  The Affordable Care Act has helped some in Oklahoma but certainly is not the perfect solution to this broken system.  The reality is that healthcare is expensive.  Layers of administration and bureaucracy contribute to this.  A culture that says we must have the best drug or test and we must get it right away contributes to this.  We don’t have good programs to promote health and wellness, physically or mentally.  As our state gets more sick, the cost to care for our state goes up.  But just because we don’t have the perfect solution doesn’t mean we can check out and ignore this huge problem.

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Last week I had the privilege of staffing the Variety OB clinic, our Federally Qualified Health Center (FQHC) here in OKC.  I always leave these days with the distinct feeling that although my life is radically different in economics and culture than almost every patient I encounter there, I have shared experiences with them having been pregnant and being a mom.  In the end, we are all bound by the common denominator of the shared experiences of our health.  It is almost overwhelming to think about the disparities I encounter when I walk into each room.  My friend and former partner in practice Lydia is the director of women’s health at Variety Care.  They are a safety net clinic.  The clinic provides healthcare to those who cannot afford to go elsewhere.  She is working hard to make affordable and accessible healthcare a dream come true for our state.  Every week she sees this problem lived out.  She sees patients choosing between picking up their antibiotics for their infection or buying groceries for their families.  She sees women with advanced stage breast and gynecologic cancers that are no longer curable due to a lack of access to care.  These women, with proper access to care would have had a great chance for cure.  When her patients don’t show up for appointments she knows that it’s probably not because they don’t care but because they have limited access to transportation or childcare, or they work in a job with no paid time off.

So what are we to do about this enormous problem?  I think the first step is to understand that if you have access to good healthcare resources that there are literally thousands of men, women and children who are desperate for that access. If we only care about spiritual health and ignore the physical health of the community around us we are missing the point.  When you visit your healthcare provider know that you and I are among the privileged and recognize that this problem is a problem that belongs to all of us.  Not just if you are an Oklahoman like me; but no matter where you live.  The next step is to begin to advocate for the community around you.   Ignore the voice in your head that says something is good or bad based on the political party that endorses it.  Be a voice for those without a voice in the system.  Donate to your local community health clinic, speak to your legislator, vote with a heart that believes you should decrease so that those around you may increase.  Have eyes that see the hurting, the hungry and the sick around you.

And let the image that your eyes see move your heart to speak up and show up for the least of these.

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.

Schooled.

Last Friday I had the privilege of leading our resident education session.  We spent 2 hours together learning how to become better educators.  I say ‘we’ because, despite being in medical education for the last 12 years, I still have a lot to learn about teaching.

I think for a long time I bought into the myth that anyone can teach.  And that anyone can be an excellent teacher.  Like once you have mastered a subject, let’s say addition, that you will be great at teaching addition.  Well, you’re not.  Or at least I’m not.  I can distinctly remember my oldest child attending preschool and being sent home with a packet of sight words.  Until that time I had no idea how children would get from having a cry or smile as the only method of communication to speaking, reading and writing complex words.  Thankfully my child’s teacher knew the path.  In fact, her 2nd and 3rd grade teachers have more experience teaching than I have in being alive.  They knew where she had been and where she was headed in her educational journey.  And her 4th grade teacher will as well.

I teach adult learners.  Medical students and residents.  Medical Education is wonderful and also amazingly challenging.  When a new 3rd year medical student begins with us they have literally spent about 25 hours per week in the classroom in addition to the dozens of hours a week they spend studying in the library.  They soak up all the knowledge you give them.  They are early in their journey toward their final career goals and eager to learn all that medicine has to offer.  They want to know their patients and help create tangible positive outcomes for them.  My residents spend even more hours at work and in the learning environment than the medical students.  They are responsible for patient care as well as a huge chunk of the medical student education as well as making sure they learn all they can before leaving the training environment.  It’s a lot to accomplish.

What I have learned in medical education is that being a teacher is a huge responsibility.  It isn’t enough for me to have passion for the subject matter.  I have to translate that passion into meaningful experiences and into a format they can understand and retain.  It means more than just making sure the medical students know the basics about caring for women; it means that we have taught them how to have respect for their patients, to care deeply for the broken and hurting around them and to find a way to always have compassion.  The challenges come when you are consumed with your own work and you find it hard to stop and teach someone else.

I think this is a challenge for everyone in education.  Teaching is hard.  Being an excellent teacher is even harder.  For me, I stay in the Medical Education environment through the struggles because I remember the faces of the teachers that taught me empathy and compassion, because I still have a lot to learn and those medical students and residents challenge me daily to be better than my best, and because I hope that my community and my state are healthier and better cared for through the work we do in our teaching institution.

Hug a teacher you know. Hug all the teachers you know.  Or bring them a snack or send them a note of encouragement.  They leave each day having given all they can to some who will receive and some who might not.  They are not only teaching subject IMG_2943matter they are often teaching the life lessons of respect, empathy, compassion and kindness even when their own runs low.  They are the feet with which He is to go about doing good.  They are caring in places many of us would not dare to invest.

And if you know a medical student or a resident physician, give them a hug too.  Or maybe a cup of coffee.  They are always being challenged to learn more and do better. They spend themselves each day to do their best for others, using their hands and their heads and their hearts to care.    They teach me something every day and for that I am grateful.

 

the problem of prematurity.

If you know me at all, you know I love completing a to-do list.  I am task oriented.  Sometimes I will make a to do list at the end of the day just to cross off everything I have completed already.  You’d think I’d be embarrassed about that…but nope.  But sometimes your to do list gets interrupted by meaningful conversations with friends.  That happened to me this week with my friend Jenny.  Jenny is a labor nurse, a mother, an entrepreneur and a friend.  Jenny is also one of the 10% of women in my state who has given birth prematurely.  She is the inspiration for this post which is a mix of medicine and miracles of God.

(please note that Jenny is not my patient and has seen and approved of this blog.  Here at gynecologyandtheology we like to remain accurate as well as HIPAA complaint.)

You see, each year in our country about 10% of babies are born premature (preterm) or before 37 weeks of gestation.  These babies fight for survival and then many of them face a myriad of health problems that can be life-long.  The problem of premature birth costs our nation about 26 billion dollars per year. Parents of these babies carry a huge emotional and financial burden.  In many cases we don’t know the cause of preterm birth and have few interventions to stop it from happening.  Age, pregnancy spacing, smoking, health complications and many other factors contribute to preterm birth.  For some of these problems we can help our mothers with education, contraception to appropriately space pregnancies and interventions to improve their health prior to and between pregnancies.  In some cases we don’t have any prevention methods such as preterm birth in twins or other multiple gestation pregnancies.

For my friend Jenny, her preterm birth story is particularly devastating.  You see Jenny’s first born daughter was born so extremely premature that she was too young to survive.  Jenny has a condition called cervical insufficiency; one of the many causes of premature birth.  Payton Marie was delivered in September of 2011 at 23 weeks gestation.  She was too young and too small for any interventions that would be life saving.  By the miracles of medicine and Jesus she now has two more beautiful healthy children.  Her story is filled with pain, suffering, the “what ifs” and more.  She had very few, if any, risk factors for preterm birth.

So what can be done?  First, be informed.  For those of you who are planning their first or next pregnancy, know the risk factors as well as signs and symptoms of preterm birth.  But for those of us who don’t plan to gestate anyone else in the future, we still need to be educated.  The problem of prematurity affects each of our communities.  You can find your state’s report card on preterm birth as well as a whole lot of other great information about prematurity from the March of Dimes.  The website has information about risk factors and symptoms of preterm birth as well as information about the problem of prematurity around the world.  And speaking of the March of Dimes, you can get involved.  I had the privilege of walking in an annual march for babies campaign to honor the friends and coworkers around me who have had a premature birth.  So get out and walk, mail that envelope back in with a donation, or become an advocate.  My state’s grade on preterm birth is a “C” so we have some work to do people!  I bet each of us know someone who has had a preterm birth.  Remember these families.  I know prematurity was probably not on your radar of problems to work on to make our world a healthier place to live…but it is a super important one!

As for Jenny, she is her own miracle.  I think my best evidence for God is that we can suffer unimaginable loss and pain and walk out the other side with continued love and compassion for those around us.  Why did Jenny have to lose her first born?  I can’t answer this.  It’s the problem of systemic evil and I will leave that one to Pastor Jason.  Jenny will Screen Shot 2016-07-17 at 7.58.47 AMprobably tell you that her two other children will never “replace” her firstborn.  She will always have 3 kids; one of them just didn’t come home with her.

I have been listening to a beautiful version of “It is Well” by Bethel Music and Kristene DiMarco.  Ironically I hated the song growing up.  People would always sing it at funerals and I just thought it was crap.  People were sad someone died.  I was sad someone died.  I really didn’t feel like it was well with anyone’s soul, nor should I feel like I was obligated for it to be well with my soul.  But I listen to this version with a renewed sense of hope.  It speaks of the power of Christ to move with us through incredible grief and pain and emerge on the other side knowing that He who suffers with us is working with us to make all things well.  This is Jenny and so many others close to me who have suffered incredible loss and heartbreak.  I think they would tell you that their friends, their families, their faith communities were the hands and feet of Jesus.  They were the grace, mercy, hope and love they needed.  That although it will never be OK, It is Well.