Category Archives: empathy

The demons they won’t fight

14 Friday Oct 2016

Posted by in empathy, love, Sin

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When I was fifteen, I met a wonderful, intense, intelligent. creative, amazing, intoxicating group of boys who made me feel so alive. They swore and smoked cigarettes and drank beer and smoked pot out of a Coke can bowl. They were nothing like me. I was a quiet, shy girl who’d never sworn or done anything else good girls aren’t supposed to.

I spent the next three years with them, going on adventures always exciting and sometimes terrifying. They introduced me to William S. Burroughs and Jack Kerouac and E.E. Cummings. To grunge and industrial and Irvine Welsh and surrealist art. We were so intensely alive. In love. All of us.

They also did a lot of drugs during these years. I did not. I started to swear, I’ll admit, but I wasn’t into drugs. I was the permanent designated driver for three years straight. I was into political activism and applying to college and various other positive activities they thought were a waste of time. They started out with just pot and beer. They made fun of stoners and burnouts. Kids who did heroin and crack and too much acid. But by the end of high school, they were the kids doing crack and meth and tripping on shrooms.

One didn’t graduate. Another dropped out of college the third day. Another dropped out a year or two later. They all descended into more and more drugs and alcoholism. I would see the poetry and genius in them every now and then but it became less and less common. I knew they were in there somewhere. Somewhere. Deep inside.

I wanted to help them. Wanted to save them. I tried. They knew they needed to change and they would try every now and then to quit. They would try giving up beer and just drinking liquor. Giving up pot and just drinking. Giving up alcohol and just smoking pot. Giving up cocaine and just taking pills. It never worked.

I felt bad for them. I knew there was a sadness in them so deep and so wide. They were trying to fill it with drugs. I wanted to save them from that darkness. They were capable of so much. I loved them so much. But it wasn’t enough.

I realized one day that they loved drugs more than they loved me. More than they loved each other. Maybe it was the night they let one of their friends die from an overdose rather than dump him at the ER because they were afraid of getting caught and I was the only one who seemed to care. Maybe it was no special day in particular. I looked at them and knew. Knew they loved drugs more and it was time to let them go. As much as I loved them, they didn’t really love me anymore. You can’t save someone who doesn’t want to be saved and all that. It was time to let go.

People criticized me for it. Said I should have helped them more. How could I abandon my poor lost friends like that. And I’ll admit it made me sad at the time. But I never regretted doing it. Never regretted saving myself. Never doubted the fact that they would never change.

A time like this comes to all the relationships we end in life. The day you figure out the person you love, loves something or someone else more than they love you and that’s not all right. You stop asking, do they love me or not? They do, but not enough. They do not love you more than their dysfunction, the demons they won’t fight.

When you let them go and with them your guilt, you are light. You are free. You have fought the good fight and given them your best. And now you are free. For better things.

After 37 years, I did

03 Monday Oct 2016

Posted by in empathy, kids, love

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I feel different today. I feel lighter.
I am 37 years old and have never stood up to my mother. Never spoken back to her. Not once. Not as a child, not as a teenager, not as an adult no matter what she said or did to me. I have never stood up to my sister either. Yesterday, I did. After 37 years, I did.
*
I have worked hard to turn the other cheek, to look for the log in my eye and not the splinter in theirs. I have tried to be empathetic and loving and kind. To not meet their aggression with mine, as you cannot dismantle the master’s house with the master’s tools. But there is a difference between being aggressive and being assertive. I gave up the passivity that defined my role in my dysfunctional family.
*
It was no great scene. Not emotional or dramatic. I simply told my sister I did not want her dirty money (I don’t. She made it off the backs of the poor) and that someone who’d hurt my children like she did, did not get to dictate the terms of our dispute. And then I told her something true that I’m sure cut her to the bone: that she is just like our mother. Because she is.
*
My mother responded by telling me she knew I’d sent “hateful” texts to my sister. I told her the truth. I told her I’d simply told my sister she was just like my mother and my sister apparently considers that hateful. (it’s kind of funny, looking back on it) She said, I suppose I won’t be hearing from you for a while again (referencing the months I’d taken while in therapy a few years ago to work out my wounds from her and what kind of boundaries I needed to establish. During which she was free to see my children whom adore her, but whom she chose not to see). I replied, No, unlike you I don’t write people off for disobeying me. I wouldn’t hurt my children like that.
*
I texted her today to assure her she was still invited to the three children’s birthday parties we have coming up and that the children would be sad if she didn’t come. No reply. I’m not surprised but I am sad for my children.
*
The narrative of what happened will go down in the family history book like this: crazy Libby did something irresponsible again (believe it or not, this whole thing was precipitated by a dog I’d bought impulsively. Don’t ask) and responsible Becky came in to save her and the poor innocent dog (my mother was considerably more concerned about the puppy she’d know for 24 hours during our exchange than her grandson she once referred to as her “soulmate”). Libby responded vindictively and cruelly.
*
I’ve no doubt my sister Becky, who had shut my parents out of her life for the past five years along with me and my children, will now return to the fold. And so my dysfunctional family will go on as it always has. But without me. Not by my choice but by theirs. And my children will be the ones to suffer. First their cousins taken away and now the grandparents they adore.
*
I hope this doesn’t happen. I hope a distant awkward peace can be made enough that they can bring themselves to see my children.
*
I spent my childhood trying to be the good one, trying to earn their love and never be bad. Good grades, never talk back, extracurriculars, stuff your emotions down, don’t ask for help even when you’re in so much pain inside. I was never good enough. I tried.
*
And so in my lightness today, I am using my energy to write letters to my children. To let them know I love them and I’m proud of them. To let them know I only push them so they can be their best and achieve their dreams and purpose in life. I admit to them I am imperfect but I’m sorry for my wrongs. That they don’t deserve the frustration I take out on them at times. I remind them they have a perfect mother in heaven who is always there.
*
Flesh of my flesh, bone of my bone, I seek a new people now. For mine are gone away. They were never there; I just couldn’t see it.

We Liked You Better When You Didn’t Talk So Much: Life After PTSD (a.k.a. after your fasciotomy for compartment syndrome of the soul)

24 Friday Apr 2015

Posted by in doctors, empathy, kids, outrage, PTSD, residency

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Compartment Syndrome with Fasciotomy Procedure

It’s been four months since I recovered from my seven year bout of PTSD. (See previous entries of my blog for real time coverage of the recovery process). My coworkers don’t really know I had PTSD (although I did give a talk on PTSD and tell them the reason I was giving it was because I had it, I think they either weren’t paying attention or blocked it out). They just know that all of a sudden a few months ago I stopped being so quiet and agreeable all the time. At first they thought it was great. I’d blossomed. Developed self-confidence, gotten a backbone. They assumed it to be the result of residency training. But as the months have gone on and I’ve become more and more my true self, they’ve started commenting to me they miss the old quiet me.

I’m a little too opinonated, they say. Talk a little too much now. I’m too hard on the interns. I’m angry, they say. Well folks, what I really am is … me. The real me not suffocating under PTSD. The real me not constantly trying to avoid the bad things I think are coming. The real me who isn’t convinced I’m going to get kicked out of the medical profession if I let on to who I am.

I am indeed angry at times. Unapologetically angry. Righteously angry. Old testament angry. Jesus turning over the money changers table angry. Malcolm X I’m-done-begging-for-crumbs angry. No apologies.

I am hard on the interns. Hard on them like my senior residents were hard on me. I thank God my seniors were so hard on me. Guess what? We’re training them to be doctors. We’re not at the brownie jamboree seeing how many friendship bracelets we can collect. They’re here to learn to be excellent doctors: thorough, hard-working, devoted, compassionate physicians who think things through and can communicate and lead. Some interns need more nurturing than others, but even the most fragile (hi, I had freaking PTSD when I was an intern. I was about as fragile as they come) needs to be held to a high standard. We owe it to them and every patient they will ever treat.

I do talk a lot and have a lot of opinions. It’s not that I have a lot of opinions that bothers them though. I haven’t met many doctors who don’t have a lot of opinions they feel you must be dying to hear all about. What bothers them is that my opinions disagree with theirs. I don’t find their sexist jokes funny or even acceptable. I’m really such a drag, I know. But I’m 36 and I have a daughter and I’m done tolerating that crap.  The male residents are assertive while the female ones are called aggressive and told to tone it down for the same behavior. The male residents really hold the line and don’t take shit while the female residents are told to calm down and lighten up when we do the same thing. To hell with that.

It’s possible I’m a little overly zealous with the assertiveness and rightous anger right now as I delight in my recovery, but can you blame me? PTSD is hell. You’re not dead but you’re only technically alive. I’ve got seven years of pent up thoughts, words, feelings, and actions here.

In my defense, it’s not all anger and thunder bolts around me. I have a lot of joy. I’ve made a lot of progress on forgiveness (entry on that to come). I’m just not PTSD Barbie anymore, putting all my energy into pleasing everyone and always agreeing and going along and not complaining and working myself to exhaustion because I’m afraid everything’s going to fall apart at any moment.

My husband and I met when I was in the thick of the PTSD so he’s had a little bit of a switch-a-roo pulled on him. He always wished I’d be more assertive and talk more, but , as the saying goes, be careful what you wish for.

The thing that’s frustrating about all of this for me is that I’ve been given this amazing gift. PTSD was hell. I can’t tell you how much of the past seven years I had spent wishing I could die. Knowing I couldn’t kill myself because of my kids and asking God why he would put me in that position. The blackness inside of you. The expansive emptiness that feels like it will break you apart. The loneliness you feel like you just can’t bear. And there’s no end in sight. There’s no hope. The fear. Every noise makes your heart race. Do you know how many times your pager goes off a year as a resident? Do you know what it’s like to feel terrifed every time it does just because of the sound it makes? To not be able to trust anyone, not even your husband. To not let yourself open your heart to your kids because you’re expecting them to be gone any minute. To go on psych med after psych med after psych med looking for an answer and all they do is make you tired and remind you you’re crazy.

And I finally escape all that and the people I work with, the physicians I work with, they tell me they like me better the way I was. So, you’ll have to excuse me if I’m unapologetic. If I relish giving them a piece of my mind when it comes to what is right. Silence does not protect us, it fills us with its void until the tensile strength of the matter of us gives out. It’s like compartment syndrome of the soul. You must release the pressure surgically and when you do, sometimes things burst forth and get messy. But it’s the only hope of saving the limb. The real me has come back out and I couldn’t stuff her back in to the old necrotic shell even if I wanted to. And I most definitely do not want to.

Of Angels and Devils

22 Thursday Jan 2015

Posted by in christianity, doctors, empathy, Evil, outrage, PTSD, Rape, Sin

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gelfand

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.

Of Santa Claus and Mama Lions

28 Friday Nov 2014

Posted by in empathy, Evil, kids, love, outrage, parenting, Rape, Sin

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My husband recently informed me my nine year old son no longer believes in Santa. My ten year old with autism still believes. He told me he wants an English policeman costume for Christmas. When I told him that might hard for me to find, he said, don’t worry because Santa can make anything. He said Santa would make it because he doesn’t really believe in elves anymore. I said, so just Santa? He said, well Mrs. Clause too. Obviously. It would be lonely at that cold North Pole without someone to come home to.

My husband and my ex-husband as well don’t really agree with the Santa thing. You shouldn’t lie to your kids, they say. How could they ever trust you once they find out the truth. You lied, you lied! All those years, all those lies! I’ve gotta admit, when they say that my first thought is just, WTF? Are you serious? Then I calm down and formulate a more helpful defense. It’s a little moment of magic we give them for a few years. It’s what childhood is supposed to be. They have the rest of their lives to come to terms with reality. Give them a little piece of magic before the, lets be honest, rather brutal process of growing up begins. They will come across so many lies in their lives told for unkind ends. If we can tell a few to make the brief flash of true childhood a little more magical, I say, do it. I say, it’s not fair for us to impose the world as we see it on them.

There is a truth to Santa. He may not be a man, but he’s the personification of all we feel and hope for them. He is what childhood is. And I hope that’s what we want for them.

I’ve come to realize that protecting childhood is more important to me than almost anything in this world. I don’t mean spoiling kids, I don’t mean coddling them. I mean keeping them safe, giving them room to be themselves, fostering their confidence. When they are young, giving them a time of sweet oblivion from the way of the world. As they get older, leading them into the world as gently and meaningfully as we can. Cradling the fragility of what is true about that childhood innocence intact into the fallen world so they can thrive despite it all and hopefully do some good along the way.

As important as all of this is to me, there is an accompanying … frustration. Yes, we’ll say frustration. We’ll be diplomatic. A frustration with adults who derail this in the less obvious ways. Obviously, there are those who deny kids safety, whether it be sexual, physical, emotional, spiritual. There are those who are not strong enough to let them be themselves. Those who allow their own wounds to keep them from letting them know how wonderfully made they truly are. And frustration is not the word I use for these adults. They are what’s wrong with this world. They are original sin.

The ones I am frustrated with are not the wounded, the evil, the weak. They’re the ones who never really became adults themselves. The ones who do not know the evil this world holds, the suffering, the injustice, the unfairness. Does that sound mean? Bitter? Pessimistic? If so, you may be one of these adults yourself. Before you get all defensive, let’s look at the facts:

1 in 4 girls will be sexually molested in some way
1 in 3 women will be sexually victimized in some way in her life
1 in 4 women will be raped in her lifetime (rape being specifically vaginal or anal penetration)
1 in 6 boys will be sexually molested in some way
That’s in the U.S.

22,000 children die from poverty a day worldwide
28% of children in developing countries are underweight or growth stunted

So, yes, the obliviously priveleged adults of this world frustrate me. They’re safe and warm in their cocoons and the children of the world are outside left on their own. They ignore the safety so many children are denied. They cannot prepare any of the children to make that transition from the innocence of early childhood to the world of trouble and sin we live in. They need to get their asses out here and get to work.

There is a lot of work to do.

I am, above all, a mama lion. For my children and for all the others. Children need milk and play, to learn to fend. They also need a mama willing to rip out the intestines of those who threaten.

Man up, people. Be the mamas they need.

And as I typed the words, I came to believe them

04 Thursday Sep 2014

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I got triggered the other day for the first time in a little while. I refer here to my PTSD. Something happened at work and I had a flashback to what had happened to me in medical school. When one of my fellow students did unspeakable things. And when those higher ups punished me for it instead of helping me. I have never had this happen at work before but there I was. My heart rate was picking up, my throat beginning to gag, the tears welling up. I quietly slipped away from the lecture. I wanted to call my husband but I knew if I spoke, I would begin to cry and wouldn’t be able to stop. So, I texted him instead:

I had a flashback and had to leave. Feeling sad. Please pray.

He couldn’t read the text right away, busy with taking care of baby Princess and our castle. So, I decided to pray with him anyway. I texted him:

God is good. God is good. I knew He is. Christ before me, Christ behind me, Christ on my left, Christ on my right. Christ in the ear of all who hear me, Christ in the tongue of all who speak of me, Christ in the eye of all who see me. We pray for (the Violent Man)’s soul, for (the unethical Higher Up)’s soul. Poor banished children of Eve. May God have mercy on their souls.

And as I typed the words, I came to believe them. And I became calm.

I cannot say I never get angry with the Violent Man or the unethical Higher Up, but I have forgiven them as much as I can as of now. I pray for them and when I do, I forgive them more and more. I forgive because that’s what God tells us to do. Forgive us our trespasses as we forgive those that trespass against us. God has forgiven me, poor wretched sinner that I am. But it’s also true that forgiving them makes me feel better. Brings healing. Loosens the hold it all has over me.

Life is not static. It is not clean. I have my days of mourning and my days of joy. But I have come out of the whole thing better than might be expected. I have forgiven, I have trusted. Because I have to, really. We’re not owed anything in this life. It’s all a gift. There will be trauma. There will be pain. But there is so much more.

My husband got my text soon after I’d sent it. I texted him I was calmed down but asked that he still pray for me. He replied simply:

Yes Love…

My husband loves me. My babies too. God loves me perfectly. Jesus said that it’s easy to love your friends, but that we’re called to love our enemies as well. I used to think that was for the benefit of the enemies, or maybe just a way to keep us all in line. But I think it’s more than that. God really does love all of us more than we can comprehend, yes even child molesting sociopaths. So, yes, it is for our enemy’s sake he tells us to love one another. But he also knows that in striving to love our enemies, we grow closer to him, closer to being good, closer to all that is good. And so in trauma we find God, we find goodness. Our dark days are a gift as much as our joyful. He really does bring beauty from ashes.

The Unspeakable Beauty of Being Broken

04 Thursday Sep 2014

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I accidentally drove to Cranberry this past weekend. I’d meant to drive 2 hours east to Harrisburg but somehow drove 2 hours west to Cranberry instead. I called my husband Poobah and said, “I have to tell you something but you have to promise not to get mad at me.” Not the words he was hoping to hear I am sure. He agreed to the fairly absurd request (one can’t choose to not have at least an initial angry impulse if that’s what’s stirred in them after all) and I told him where I was. He didn’t get angry but he was certainly confused. How is it I had driven for two hours on the Pennsylvania Turnpike the wrong way? Hadn’t I noticed all the signs for the exits that lead to Pittsburgh? I really didn’t know how to explain it and simply told him I’d done it before and that we would try to make the best time we could over to Harrisburg now.

How it happened is not really so complex or mysterious. I’m not on my way to early onset Alzheimer’s or Lewy body dementia. I didn’t have a psychotic break and lose touch with reality. I was just really stressed out with life in general and then climbed into a Honda Civic with three young kids for a three and a half hour drive.

Still, it scared me. It didn’t seem like something a normal person would do. I’d done it before. I’d probably do it again. And it just isn’t normal. Therefore, I’m not normal.

Now, don’t get me wrong. I’ve never been a big fan of normal. I’ve always wanted to be unique, to be myself exactly as I am. I’ve taught my kids the same thing. Truth is, I love my oddball patients the most. I’ve always been a fan of the underdog.

What was scaring me now was the fear that I’m not just unique or special, that I’m somehow… wrong. There lies in me a fear I think we all have to one extent or another: the fear that I’m a fraud. In me, I suspect, it runs deeper and wider than it does in most.

I feel sometimes that my whole life is a house of cards precariously standing by the grace of so many cards all pushing against one another with just the right amount of force, positioned just so for balance. And at any moment, it might just collapse. It all just might fall apart and I will be left with nothing more than a pile of scattered cards. I could just lose it all, just like that, in an instant. I could lose it all because I am not who we all think I am, me included.

It all feels so fragile to me at times. The thing I have to remind myself is that it is. It is fragile. All of it. Everything any of us thinks we have. Anyone’s house of cards could come crashing down. And yes, maybe it would be my fault if it happened. Maybe I would make a mistake and cause it all to fall.

It’s already fallen. The world. Nothing’s owed us. We’re all broken, all imperfect, all sick. Any one of us could knock it all down on any given day. I tend to think that those of us that know how broken we are, are maybe actually the wise ones. I sat in on a drug rehab group recently and listened to a beautiful group of people trying to get their lives back in order after addiction. They laid themselves bare to one another, talking about the wounds of their past, of those who’d loved them and those who hadn’t, of those they’d hurt and betrayed and deceived along the way. Their cards lie scattered and they knew it and they knew it was their own doing. They knew even if they could begin to build again, it would still be a fragile thing and that it very well might fall into chaos again. I hated to leave the group to return to the real world, full of the superficial interactions that make up the day to day of life. I have felt the fragility of it all since I was a little girl and have found so many either don’t know yet, or wish to ignore it or pretend it away. I suppose for many of us, it’s a necessary lie.

Like the woman at Jesus’s feet, cleaning them with her tears and drying them with her hair, breaking open her alabaster jar to anoint him with perfume, we are all but whores at the feet of the Lord. A pile of cards that will one day be made whole again when we leave this broken world for something so much better.