Monthly Archives: January 2015

The Scarlet S on my White Coat

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From January 2015:

His name is Rohit Agrawal and he’s the Secretary of the State Board of Osteopathic Medicine. I didn’t remember his name all these years but I looked him up recently. He’s one of the people who punished me for stopping a sociopathic child rapist. He’s one of the physicians who punished me for stopping a sociopathic child rapist.

Today, it’s his job to handle cases of physicians in Pennsylvania who have had ethical breeches. I’d call it ironic or ridiculous if it weren’t so disturbing and very serious.

In August 2008 he came to my medical school campus, the Lake Erie College of Osteopathic Medicine, and gave the student body a talk about sex and how it could get you in trouble as a physician. That may sound like an odd thing to you, a state physician licensing official coming to muggy Erie Pennsylvania to give a lecture on keeping your knees together to a group of student doctors. But this was no ordinary August day.

You see, two days earlier one of the medical students at my school had been arrested by the FBI for possession and transport of child pornography and obscenity. They had come to his door the morning of a big exam and come into his house with guns drawn and arrested him.

They’d seized his computers and found that he’d been looking at violent graphic pictures of little girls just an hour earlier. Little girls bound and gagged by duct tape with their legs over their shoulders.

When this physician came to speak to us, this leader, this pillar of physician ethics, I assumed he would talk about that child rapist. He started talking to us about a fellow medical student. He didn’t give the student’s name but I assumed it must be this student.

I was naive.

He said this student was sexually immoral. He said this student wasn’t fit to be a physician. He said this student really ought to leave med school now before she got into more debt. Because she wasn’t fit to be a physician. Because she never would be a physician. Let her be a warning to you. Don’t be sexually immoral like her.

I don’t remember the exact moment I realized he was talking about me and not Jeremy, the child rapist. I don’t remember what exact phrase he used that made me realize it. I do remember how it felt. I remember my stomach dropping and my heart racing and the tears welling up in my eyes. I remember the fear and humiliation and anger and confusion and despair. I remember that well.

I didn’t remember his name afterwards. I was so filled with shame after going through my several months long ordeal of rape, torture and humiliation at the hands of Jeremy, that I just wanted to try to forget all of it. Including what Dr. Agrawal did to me.

And so I forgot his name. Because I could. And any crumb of it I could forget was a relief I welcomed.

I couldn’t forget his words, though. Or the shame and betrayal I felt because of them. I couldn’t forget his face.

Years passed. I needed to finish medical school. I had children to raise. I met my new husband and married him. Eric and I spent our first Valentines Day together as a couple in federal court at Jeremy’s trial.

After med school there was residency to tackle. Our sweet baby came along.

The PTSD was with me through all of this. On top of me. Like Jeremy had been. Choking me. Like Jeremy had.

I finally gathered the courage to look up Rohit Agrawal’s name on November 15, 2014. Six years and 3 months after his talk. Six years and 3 months after his assault. That scarlet S he’d pinned to my white coat.

There he was. Still on the state medical board. The secretary now, actually. He’s an emergency medicine physician according to the Google. He’s trained to collect rape kits when victims come into the emergency room then.

I wrote his name down. I typed into a memo on my phone. I did not memorize it. I had to copy and paste it tonight for this piece.

A physician charged with leading the physicians of this state actively participated in publicly punishing a student doctor who’d stopped a child rapist student doctor at the risk of losing her life. He very actively, explicitly, and personally sent a message to hundreds of future physicians that if they chose to do the same they would be punished too.

That. Is. Dangerous.

It is immoral, unethical, and unacceptable.

His name is Dr. Rohit Agrawal and he punished me for stopping a child predator.

Of Angels and Devils

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From January 2015:

Dr. Steven Gelfand died on January 18th after a brief battle with cancer. He was 66 years old. He was also amazing.

I’m going to tell you about him. And just from reading about it, you’ll be better off for having known what little I can tell you here.

I met Dr. Gelfand July of 2009. He was the attending of my very first clinical rotation as a medical student. The first two years of med school are spent in the classroom and the last two years are spent on rotation. You get to leave the classroom and spend time actually doing medicine.

I’d had PTSD for about a year at this point. My perpetrator, a fellow medical student, had been arrested in August 2008. My trauma officially ended with his arrest I suppose, and then came the PTSD.

After he was arrested, my medical school became upset with me. You see, the FBI released my name (even though they didn’t need to) and implied a lot of things about my personal life, sex life, and mental health in the affidavit they used to arrest the sociopathic child molestor I’d turned in. Some of what they wrote about me was accurate and some of it wasn’t. Two things made very clear by this affidavit were:
1. He was a dangerous sadistic pedophile
2. I had risked my life and the lives of my children to turn him in.

I’d like to think a medical school, an institution charged with shaping the physicians we place our trust in and rely on for our lives and health, would be appreciative of a future doctor risking her life and the lives of her children to stop a fellow future doctor who is a sadistic pedophile from hurting any more women or children. But that’s not how it went.

Quite the opposite.

My school chose to punish me instead. They placed me on probation for having morals below the standards of the community (in reference to the affidavit’s inference that I had engaged in consensual, kinky sex with the perpetrator before The Ordeal began). More than this, they waged psychological warfare on me. They brought in a speaker from the state board of medicine (and an alum of the school) who spoke in front of the entire student body about me, saying I really should leave med school now because I wasn’t fit to be a doctor. Warning them not to be like me. A sexually immoral person. The head of my school told me I would never be a doctor. She said no doctor would take someone like me on for clinical rotations and that even if I somehow managed to become a doctor, I would never have patients because I was so disgusting, they wouldn’t want me touching them.

Such cruel words coming from the head of your medical school, coming to you in an acute post-traumatic state, has such an impact. I didn’t even realize at the time how much I believed her.

I was able to get a lawyer and, after a legal battle, get her off my back (but not before suffering the utter humiliation of being forced to apologize for my behavior to the faculty of my school.) But she had gotten inside of my post-traumatic soul and planted herself there.

Fast forward a year to my first day of clinical rotations. The day she said would never come.

The PTSD had obliterated my self-confidence. Deep inside I was afraid she was right, that I wasn’t going to make it and I should have cut my losses when I had the chance.

I know there is a God because it cannot be chance that I wound up on Dr. Gelfand’s doorstep. By the end of my first day with him he’d shared with me that he had no respect for the head of my school. In fact, he told me, he’d once told her to go f*** herself. He was a Jewish, cursing, bold as all hell, certified angel.

He told me she had once punished a medical student he had rotating with him after he gave the student time off to spend with her mother who was dying of cancer. He responded by sharing his feelings as above.

I ended up telling him what had happened to me. The brave deed I’d done and the evil she’d paid me with. He told me I’d done a courageous thing, the right thing. And he told me not to tell any other doctors like I’d just told him. It could ruin my medical career.

Over the next two years, he became my two special needs sons’ neuropsychiatrist. He was, by far, the best doctor they’ve ever had. He became a mentor for me too. He told me I was going to be a great doctor. And part of me actually believed him somehow.

He was a tough attending. He let you know every single detail you got wrong. But he also let you know when you got something right. And when he did, it really meant something.

He went into medicine for the right reason. He cared about his patients and worked for and advocated for them fiercely. He was good and he knew it, and he earned it.

Dr. Gelfand was right that I shouldn’t tell the other doctors I would be rotating with what she’d done to me. It wasn’t the time for it. She still had the power to end my career. I wasn’t emotionally ready to speak publicly about it yet either.

But I have been healed of my PTSD after seven long years. I am getting ready to graduate from a wonderful, supportive residency. And I’ve never been one to keep quiet.

It was Martin Luther King day on Monday so we talked to our kids about the civil rights movement. We talked about the turning points like Rosa Parks and how those were just moments that sparked off a movement that ha been building for a long time. My son asked me why those particular events set things in motion and I told him no one could say for sure.

The passing of this amazing man has changed things for me. Something has been brewing within me that would inevitably, eventually come out. I didn’t know when.

The silence ends now.

Jeremy Noyes raped me, tortured me, threatened to kill me and my babies. My medical school punished me for risking all of that to do what is right as a physician and as a person. He is now serving 45 years in federal prison. What my school did was wrong and dangerous. They sent a clear message to that school full of future doctors that turning in a child predator could cost you your career. It was unethical, immoral, and unacceptable.

Your seven years is up, LECOM. Let’s talk.

Better Living Through Science

21 Wednesday Jan 2015

Posted by in autism, doctors, empathy, kids, medicine, parenting, Sin, special needs

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I’ll admit I spend a good amount of time on Facebook. I like to see what politcal/social justice type things my friends from college are up to. I like to post pictures of my kids for distant friends to see. Sometimes I’ll take one of those quizzes: Which Golden Girl are you? (I got Rose, in case you’re wondering. I was really hoping for Dorothy but I guess I haven’t matured to her level of sass and pith quite yet). One thing that dominates my feed is posting from my fellow doctors and nurses bashing parents who don’t vaccinate their kids. And yes, I mean bashing. I don’t mean expressing concern for their children. I don’t mean seeking to find ways to turn the tide of increasing numbers of people not vaccinating their kids. I mean, bitching about them and how they’re screwing up herd immunity for the rest of us because they are bad people who ignore science.

I have issues with this.

Ironically, these people of science are not being scientific at all. The whole argument is that these crazed non-vaccinators are ignoring science. They’re irrational. They’re backwards. They’re stupid. They’re ignorant. The problem with this argument is that the accusers here are ignoring the fact that *they* themselves are not being scientific. Let’s look at the facts:

-By and large, non-vaccinating parents are highly educated with average to above average intelligence. That’s what the research shows us. Most of them have read everything their doctors have read and come to the decision that it’s not compelling evidence to them for one reason or another. So, calling them stupid or irrational simply isn’t accurate.

-Most parents who do not initially vaccinate will vaccinate their children within a few years. The vast majority of patients questioning vaccination cite their doctor as their most trusted source of information. But here’s the rub: the research shows that if their doctor comes at them with the attitude most doctors hold, these parents actually become *more* likey to not vaccinate. What has been shown to work, scientifically, is for physicians to engage in respectful, open minded dialogue with them and not engage in scare tactics etc.

We have an obligation as physcians to pediatric patients of these parents and also to the greater community and society. We’re tossing aside evidence based medicine and compromising both with our attitudes towards these parents.

Why? Basically because this topic makes most doctors really really mad. And we allow really really mad to get in the way of our obligation to these kids. We find it emotionally comfortable to get angry and make it into a moral failing in these parents. Some of it is righteous anger in defense of community health. Some of it is control issues. We don’t like it when patients don’t do what we say. We got into medicine to help people and now they’re not letting us help them. Maybe it makes us sad to see them hurting themselves. Maybe it pisses us off they’re messing up our plan.

I was discussing a law recently with some fellow residents that I read about going into effect recently in a southern state. They were starting to arrest mothers who did illegal drugs while pregnant once the babies were born. Two of us thought it was a terrible law because addiction is a disease and criminalizaing it really wasn’t the answer. Putting a baby’s mother in jail soon after birth is incredibly obviously not good for a baby. Knowing she’ll go to jail if she delivers her addicted baby in the hospital will inevitably lead to some of these mothers delivering their babies at home and not getting proper medical care. They’re certainly going to be more likely to lie to their physicians about what drugs they’ve been doing. The resident in favor of the law was adament that these women must be punished. They’ve harmed their child and they must be punished. The fact that this law was only going to hurt these babies further was not the issue here. Addiction was not a disease, it was a moral failing.

The truth of it is, it is simply easier and more satisfying to write these non-vaccinating parents off as kooks and lost causes. But if you truly believe not vaccinating their children (your patient) puts them at risk, you have a moral obligation to not write them off as a lost cause. You are that child’s advocate. You are a physician practicing evidence based medicine. So act like it.

Parents who are simply questioning vaccinating may or may not know much about it. So, guage how much they know and offer them education in a respectful way. Talk when appropriate and listen when appropriate. Don’t engage in scare tactics. Show them some compassion. This will maximize the chances they will vaccinate today or soon therafter. In case we’re not clear on this: making them sign a release recognizing they’re placing their child’s life at risk by not vaccinating is not productive in this regard.

Some parents are at the point where they are refusing to vaccinate and have probably read up on a lot of what you have to tell them about vaccine safety and efficacy. If you can tell they’re already familiar with the information you have to offer, it’s time for you to sit and listen. Ask them why they don’t want to vaccinate and listen respectfully and compassionately. If they’re open to your responding, then go ahead and respond. If they’re not, then thank them for sharing with you and let them know you truly believe vaccination is the best thing for their child and that you hope the dialogue can be kept open at future visits.

If the above approach chafes your chaps, if it seems just plain wrong, that’s a perfectly valid feeling you’re having; but it certainly isn’t scientific.

Instead of reading self-congratulary after self-congratulatory article on how awful these non-vaccinators are, you’d be better served to read up on why parents make that choice. Better yet, try talking to a few of them. As a mom of a child with autism, I can tell you there are plenty of parents in that community who would be more than willing to talk to you about it. Step back from the moralistc thinking and consider all the psychological and social reasons parents might have to make this socially unpopular choice. What life experiences have they had that have led them down this path?

One thing I try to stress to my interns starting out in residency is that there’s a place for book knowledge but most of what you need to know about being a good doctor comes from experience. Your experience as you go along and learning from the experiences of the doctors teaching you who’ve been at it so much longer than you. If you’ve seen a child suffering from a vaccine preventable disease, you’re most likely eager to share that with your patients. But, you’re better off trying to find out about their experiences affecting this decision. Scientifically speaking.

One common misconception amongst the American public that upsets physicians is the idea that vaccines cause autism. How can so many people believe this stil?! It’s been scientifically disproven! Heck, it’s even been anecdotally disproven in the case of thimerosol. Let’s get rid of the exclamation points and ask that question for real. Why is it that people still believe all vaccines or MMR or vaccines containing thimerosol cause autism? Is it all due to that villain Dr. Wakefiled who published that now discredited study in the Lancet? Has he mesmerized these foolish parents? Or could there be a more logical explanation. Perhaps one explained by medicine?

Let’s set aside the vaccine facts for a minute here and consider some facts that are at the core of every family’s life who has a child on the autism spectrum:

1. Doctors do not know what causes autism
2. They’re pretty sure it’s a genetic predisposition that gets triggered but they don’t know what’s triggering it
3. But they’re pretty sure it must be mulptiple things because they can’t really find any one thing these kids have in common
4. Doctors have no cure for autism
5. Doctors don’t even have a very good treatment for it
6. Most PCP’s don’t know nearly as much about autism as an informed parent. As PCP’s, we’re generalists and it’s not something stressed in med school
7. The rate of autism keeps climbing and the truth of it is, scientifically speaking, we don’t really know why

Can you honestly tell me a parent in this situation would be irrational to question things that are dogma to modern medicine such as vaccines? Modern medicine has failed them. What they need from you is not a lecture or an anecdote of what can happen to unvaccinated kids. Assurance of the rarity of adverse events from vaccines (and yes, there are rare but quite serious effects at times) will not comfort them. They need their trust in medicine restored. And that begins with you, the PCP. I say begins because it is a process that can’t be rushed. You have to sit with them, sit with the uncertainty and anger and helplessness that comes with special needs parenting. You need to show them their child is your patient who you care about. That you see the challenges and the joys of their life. To show them that this isn’t about a battle for control. That you want what’s best for their child. And that you’re open to learning from them. That it really is a dialogue and not a lecture.

Only 1% of parents in Pennsylvania choose not to vaccinate their child, but the lessons we can learn from this issue will make us better doctors in a lot of ways. And better people for that matter.

Listen. Empathize. Validate. Assert. Repeat.

I often tell my kids: it’s okay to get angry. It’s not bad to feel angry. But when we get angry, we have to make good choices of what to do with that anger. I think we could all stand to hear that on a regular basis. So, my fellow physicians: it’s okay to get angry about vaccination. It’s not bad to feel angry. But you need to make good choices.

You’re a physician practicing evidence based medicine. So act like it.

New Year New You! (How Ima Got Her Groove Back)

10 Saturday Jan 2015

Posted by in empathy, kids, love, medicine, my awesome husband, parenting, PTSD, Rape

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I found this idea on Pinterest for keeping a jar where you write down happy/funny things that happen throughout the year and put them in this jar. I believe it advised a big jar (with the assumption being you’ll have lots of good things happening I suppose). You open the jar up at the end of the year and read over all the little happy moments you otherwise might have forgotten. The woman who’d pinned it had written it was a “super cute idea !!!!” and that she was definitely going to try it.

I pitched the idea to Poobah and he liked it (although he didn’t call it super cute or exclaim). So I took the large clear plastic teddy bear shaped animal cracker jar and dumped the animal crackers out into a bag (they’ve been sitting uneaten in the jar for 3 months so why not keep them uneaten in a different container a little longer) and wrote 2015 on the bear’s tummy with a Sharpy.

As I did so, I thought, why only write down the happy times? Why not the bad times too? It was January first and I was heading to work soon. I wasn’t very cheery.

But it wasn’t just working on a holiday that made me think that. I’d been bogged down in PTSD and working crazy hours and stress and financial problems and family discord. Bogged down for a while.

I felt like there wouldn’t be much to put in the jar.

I said goodbye to my husband and kids and headed to the hospital. Holidays can be slow because people put off going to the hospital on a holiday if they can, but it’s been a particularly busy year for hospital medicine because of all the influenza. I expected I’d be fairly busy and hoped it wouldn’t be any worse than that. I hoped no patients crashed. I hoped for some time to think.

Earlier in the day, Poobah and the kids and I had gathered in the living room around our old school fake Christmas tree (the kind that really do look fake and aren’t “pre-lit” and don’t have green concentrated pine scent aroma sticks discretely hung on a strategically chosen back branch) to continue a tradition my sister Nicci and I had started when I was still in high school. Every New Years we make predictions for the upcoming year and then the following year we read over them and see who got the most right. We also talk about things that happened over the past year that were unexpected.

We’d each made three predictions but I wanted some time before I went and started the admissions to write down a few more and think about the year ahead.

I started writing and this is what came out:
I need to move forward. But these next 6 months are going to be exhausting. I’m not sure what to do. I wish it were a simpler tale. I wish I could figure it out.
Where did it begin? Before I was born? If it did, then what?

We all seek to be an individual with self-esteem
There are those who stand in the way
And so we assert to be ourselves in maladaptive ways
Because of the innate drive towards maturity

Malcolm has something special in him. Malcolm could change the world.
He said he wants to be an astronaut so he can change the world.

Mies has this amazingly unique combination of traits.

They’re extraordinary.

Maybe I am too.

And with those four little words, I got my groove back. I didn’t just get my groove back from before Jeremy Noyes traumatized me seven years ago or before my medical school rubbed salt in the spiritual wound and made it stick. I mean I got my groove back from Way back.

It’s a process, of course, but it is set in motion. It is inevitable. The rate limiting step of the reaction has been overcome and the chemical cascade is in full swing.

I’ve spent most of my precious little free time since then wading through shame and heartache, cleaning out every dark corner of the past 35 years. It’s amazing all the things I’ve been ashamed of over the years. It’s amazing how ashamed I still felt now, decades later, simply writing out the words different people have said to me. I’ve done that sort of thing before, sitting and trying to process bad memories. But the difference this time is that I finally believed that I didn’t deserve any of it. I finally believed I’m extraordinary and so deserving of love and safety and joy, it’s ridiculous.

The words lost their power over me. Those people lost their power over me.

There are things I’ve done in my life I’m ashamed of and I sat with those too. Some of them I reminded myself I had no control over (feeling ashamed I “let” myself be raped, for instance), some I decided are just inevitable mistakes of youth, and some I had to forgive myself for. I regret very little as a general rule, but the things I’ve done that have hurt people, really hurt them, I do regret, and I had to forgive myself and let go of the shame.

Another inevitable piece of it is that I am losing the extra weight I have clung to for many years. It’s time to let it go and so I am. I feel hungry but it doesn’t distress me because it’s what’s supposed to be.

I’ve recovered from political amnesia and am reading feminists and progressives and anarachists again. I’m engaging with people about things that matter. I’m throwing a hundred evolving ideas out to my husband on everything our future holds after we graduate this June.

It’s not that I’m becoming a whole new person. It’s that I’m returning to being myself. I’m doing what we are all made to do: becoming more myself and finding what it is I am supposed to be doing to make the world a better place.

I look at my two year old daughter and see she’s there. She’s got her groove on. She knows what she thinks and wants and feels and she lets you know it. She’s engaged with everything and everyone she comes in contact with. She’s alive. She’s in the flow.

I want to do everything I can to keep her there as much as possible. I want to help all my kids find their flow. And anyone else I can. Because that’s what life is. But I see now, it’s not selfish to enjoy having my own groove on. Quite the opposite. Flow begets flow.

And so, the other day, I took a little green slip of paper next to the empty animal cracker jar and I wrote the first memory of 2015: January 1st Ima got her groove back. (our kids call me Ima. I’ll tell you about it some time)

This is for my husband now: My name is Elizabeth Spaar and 2015 is the year I got my groove back

The surprising mathematics of shame

05 Monday Jan 2015

Posted by in christianity, empathy, kids, love, medicine, parenting, PTSD, Rape

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I came home from working a 24 hour shift and thought, I should relax and watch something funny before I head for my nap. I have a tendency not to follow through on such intentions very well. I tend to wind up watching a documentary about something heavy instead. My therapist Dr. O said my main hobby in life seems to be thinking and that has its benefits and its drawbacks. One of the drawbacks being my insomnia largely caused by my unending pondering. So I knew logically that I really should put on something lighthearted to unwind and then go take my nap, but logic rarely dictates what we do in this world and I am no exception.

In my defense, I did go to the Search area of Netflix and begin to type in “Sex and the City.” I can’t be blamed for Netflix suggesting I might enjoy the TED talks on the topic of sex and love.

The first talk was “eh.” It was about parenting taboos I didn’t exactly find earth shaking. Maybe because I entered parenting via the special needs route. I was doing calculus when the parents giving the talk were still learning to count. Not to say their talk didn’t have value. Sesame Street has a lot of value, for instance. But I digress….

The second talk was different. It was by Brene’ Brown, a PhD in social work, and it was titled “The Power of Vulnerability.” She talked about the most basic human need being connection. She said it was the meaning of life. She talked about the thing that keeps us from it too: shame.

She described shame as the fear of being disconnected. Our fear that if people really knew us, they would reject us.

She said something else too: the less you talk about shame, the more you have.

She said the key to happiness in life was vulnerability. Being willing to sit with uncertainty, taking risks worth taking.

She said that the difference between people who feel loved and connected in this life and those who don’t is whether or not you feel worthy of being loved and connected.

She said we numb vulnerability with food and buying stuff and drinking and medication but when we do, we also numb joy and happiness and make ourselves more and more miserable.

She said more in 15 minutes that is worthwhile than I learned in four years of medical school. My husband says I’m exagerating a bit when I say that. I’m prone to exageration, so I guess I’ll rephrase: what she said launched an epiphany for me that will make me a better doctor and a better person.

You see, PTSD is about disconnection and not being able to be vulnerable and numbing and shame. And shame. I’ve been trying to figure a way out of the disconnection and numbing and avoiding vulnerability piece. It didn’t occur to me that the key could be shame. And it didn’t occur to me there might be a simple mathematical solution:

Talk about the shame –> less shame

I always thought it was the other way around. Maybe that’s why therapy hasn’t done a lot for me over the years. Maybe.

So I’m on a mission to talk about my shame. Every last bit of it. Everyone has it except for psychopaths, so there’s no shame in admitting you feel ashamed.

I had a grrl band when I was in college called Dum(b). Don’t ask about the parentheses. I named the band Dumb because we were a grrl band giving voice to women’s and girls voices (dumb used to mean mute in addition to meaning stupid FYI). I used to be an oral historian trying to give voice to marginalized people (thank you Howard Zinn, God rest his soul). But it’s time to look at myself now.

I need to talk about the things I’ve kept silent so long. The things I have tried to stuff down with food, to forget in the rush of infatuation, have tried to bury under a pile of things bought with credit cards. The things that have kept me from being fully present, that have made me afraid to be vulnerable.

These things that keep you from being alive. The opposite of life.

When I look at my children it is so easy to see that they are extraordinary just as they are. So easy to know in my bones they don’t deserve to feel shame. What I have come to realize is that I need to feel that way about myself.

I have spent the past seven years surviving. Surviving for them, because I had to. But survival isn’t life. It’s a holding pattern. I need to live and not just for them. I need to be fully alive again for me too. Because I deserve to be alive and joyful and self-confident and full of plans and hope and possibility.

Possibilty. It’s been so long since life seemed to hold real possibility.

I went to sleep for a few hours last night during a lull in admissions for the first time in so long. I prayed and thanked God for what the Holy Spirit has revealed to me through a TED talk. And then I stopped thinking and went to sleep. Because I deserve it.