Category Archives: empathy

40 Days and 40 Nights (or, what doesn’t kill you also makes you more grateful (if you let it).

03 Sunday May 2020

Posted by in Catholicism, christianity, doctors, empathy, kids, love, medicine, parenting, PTSD, Rape, residency, Uncategorized

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We have now had a fever for 42 days. Off and on. Mine had gone away yesterday and I thought, maybe this is it. Maybe this was a fever that lasted 40 days and 40 nights, that started two days before I stopped being 40 years old. And maybe if that’s true, there is a deeper spiritual meaning to it. So, I researched the number 40.

They say 40 in the Bible essentially means, a really long time. It rained for 40 days and 40 nights when Noah was out on the ark. The Israelites wandered in the desert for 40 years. Moses’s life is divided into three 40 year phases. Jesus was tempted by Satan for 40 days. He stayed with the disciples 40 days before ascending to Heaven where he is seated at the right hand of the Father.

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They also say 40 represents a new beginning. It has to do with it being a factor of 5 and 8, and 4 and 10. I will skip over those details. After 40 days, the flood receded and it was a new world. After 40 years the Hebrews were considered to have paid the price for their disobedience and given a new life in the promised land. After 40 days, the Holy Spirit anointed the disciples and they were reborn. In Judaism, the embryo is considered to be formed at 40 days gestation. And a pregnancy lasts 40 weeks.

It also represents water, baptism, mikvah. There is the great flood. In traditional Judaism a woman goes to the mikvah ritual bath for purification 40 days after having a son, 80 days after a daughter. The mikvah is filled with 40 seah of water.

According to the Jewish Talmud, at 40 years old you gain the gift of understanding. You come to begin to fully understand all you’ve been taught.

I have been feeling exhausted lately, burdened. And feeling like I will forever be wandering in the wilderness, the promised land always just slightly out of reach. Time and again telling myself, you just need to get through this phase and then things will get easier. At what point do I admit to myself it’s a lie, that this is as good as it gets? In other words, I have been hopeless and have lost that sense of possibility I’d been so grateful to regain back in 2015 when my PTSD was healed.

My life is better than a lot of people’s and I know this in my head and I know this in my heart. But their suffering did not seem to alleviate mine. I kept telling myself to get over it, but I just couldn’t.

Perhaps it’s the nature of this fever. You feel good for a day or two or three. Really good. And you’re so grateful. You have energy and joy and you can run and get things done and enjoy life. And you think this is it, I’m better. I can get on with my life. And then it comes back.

Perhaps it’s this quarantine grinding us all down. Or the fact I had three people close to me in my life a year ago and now I have none. And I’m in isolation and can’t replace them. I cannot picture my future because none of us can. We do not know what will happen with the economy, with the pandemic, with the election, with the way things are done and the way we relate to one another. And so, how do we have a sense of possibility? There are infinite possibilities and none at all.

And so I looked to the number 40 for hope. If my fever lasted 40 days then maybe there was a divine reason God had allowed it to go on so long. Maybe God had a plan for me. Maybe beyond 40 years and 40 days and nights I would emerge from the wilderness and finally enter the promised land. Purified and born again.

But here I sit on day 42. Maybe sometimes a fever of unknown origin is just a fever of unknown origin.

I had the energy to play with my daughter today. She couldn’t believe it. We ran shuttle runs and played charades and had a jumping competition. I felt great. For now, I’ll take that and be grateful. We’re not promised a damn thing in this life. If I ever return to good physical health and energy I will be grateful in a way I couldn’t have been before. When we emerge from this quarantine and I can be with my patients in my office again, I will be grateful in a way I couldn’t have been before. And when the second forty years of my life are easier than the first (and they will be. I know this much is true), I will be grateful in a way I couldn’t have before.

I hate the saying what doesn’t kill you makes you stronger, even though it’s true. I mean, what a crappy gift: the knowledge now you can make it through something even more awful. But this truth has saved my butt more than once and I put faith in it that my children’s difficulties have done that for them. Because life is hard and the best thing we can do for our kids is prepare them to face whatever it throws at them without falling apart. But what doesn’t kill you also makes you more grateful (if you let it).

I’m grateful for my kids’ fever because at one time their immune systems were so dysregulated, their bodies couldn’t mount a fever response to invading pathogens. I’m grateful every time my 14 year old acts like a jerky teenager because he gets to a live a relatively normal teenage life now instead of being in PANDAS hell. I’m grateful every time I eat a meal without an abusive husband there criticizing what I’m eating or not eating because that was not always the case. I’m grateful to be a doctor, the good and the bad, because it was almost taken from me and I gave literal blood, tears and a piece of my soul (and my cervix) to get through my training. I’m grateful for the sense of possibility because for so many years in PTSD, it wasn’t there as I dwelled in that place between life and death.

So maybe that’s what the promised land really is: gratitude. If we never wandered through the desert for forty years, how could we even know we were in the promised land? Maybe it is not a static place, this promised land. Maybe it can’t be. Maybe it’s an oasis where we replenish ourselves and get a rest before heading out again. We never know how far into the wilderness we will go and for how long, but we know the promised land is always there. Until we reach the end of this life and enter the world without end and find that possibility we have been been seeking once and for all.

Lassoing the Beast

24 Friday Apr 2020

Posted by in christianity, empathy, Evil, kids, love, marriage, medicine, my awesome husband, narcissism, PTSD, Rape, Sin, Uncategorized

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I do not think that I have ever seen a case where the sentencing goal of protection of the public figured more predominantly. Anyone who sat through this trial would realize that this defendant is the worst nightmare of every child’s parent. The entirely credible and overwhelming evidence demonstrated that the defendant is a dangerous predatory sadist…
Hon Sean McLaughlin, sentencing of Jeremy Noyes

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A package arrived today. A hoody. Oh, how I love a good hoody. Is there anything better? Cozy and comfy and flattering on people of all shapes and sizes. Maybe it’s because I grew up crushing on boys with long hair in hoodies and Vans, but hoodies hold a special place in my heart. Back to present day: the hoody that arrived was blazoned with Beast on the Bay. Because I have decided to run the Beast on the Bay again this year.

Regular readers may recall that in 2018, I ran the Beast as part of my ten year anniversary of my trauma. It inspired me to get into shape and do something that felt impossible. It also happened to be in Erie, where my trauma occurred and is sponsored by my old med school, who made the trauma significantly worse. I was not able to run the race in 2019 because the previous summer, in the best shape of my life, I had suddenly developed a mysterious autoimmune neurologic disorder a week before I was to run a different obstacle course race, the Spartan. Now, within this surreal time of quarantine, I’ve decided to do it again this September (if it’s not cancelled).

I had come to some new revelations on Easter Sunday. Not regarding God or Armageddon or resurrection. Regarding my immune system.

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In order for me to explain, let’s rewind to June 2019.

I’d been in training for 14 months and was in peak form. My body fat percentage was its lowest ever. I could run a 9 minute mile. I was pumping out burpees like a champ. I felt amazing. On Sunday, my husband I went to a local Crossfit gym to do a class and practice rope climbing. I’d never climbed a rope in my life. I never even tried in gym class as a kid because I was convinced I couldn’t do it and would just embarrass myself. I knew I needed to climb one for the race coming up the following Saturday so we went and the owners gave me some tips and I did it! I was so damn proud of myself.

The next morning I woke up and felt sick: I was exhausted, my muscles ached and felt weak. It wasn’t the way I felt after a really brutal workout. It was the way I felt when I had the flu. I decided I better give into it and rest as much as possible but I’d been planning on working out leading up until a couple days before the race. I needed to get better quick, though , so I cancelled the workouts. By the time Friday came, I was still exhausted and I knew I needed to cancel the race. I was heartbroken. I’d worked so hard and it meant a lot to me. It was odd I was still feeling just as bad six days in, so on Saturday instead of going to the race, I went to Quest to get some bloodwork drawn.

Over the next few months I saw neurologists and rheumatologists. I had bloodwork, MRIs, EMGs, and EEGs. I began to piece together symptoms I’d been having in the months leading up to my exhaustion. Blistering on my lips I’d assumed were cold sores (they weren’t). Neuropathy in my arms and legs after showering. A tightening of my rib muscles during a run. At one point, my calves swelled and hardened during a run, forcing me to stop. My fine motor skills were off and I was having more of the involuntary muscle movements I’d gotten for years. I was losing my balance more often too.

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None of the doctors ever arrived at a diagnosis and I was told to deal with it and be grateful it wasn’t something bad. I wasn’t. How could we know if it would get really bad or not if we didn’t know what it was? I had plenty of patients in the same boat. Vague autoimmune symptoms and slightly off labs but no clear clinical picture of a known disorder. They often found their way to my doorstep looking for help from medical marijuana (Which is smart because it helps both the symptoms and has immune modulating effect which can help longterm outcomes). I was now one of them.

I tried changing to a plant based ketogenic diet but it only seemed to make it worse (and was unpleasant as hell to eat). I tried forcing myself to exercise but it made it worse too. I would have a few days where I felt pretty good, but the symptoms always returned. That is, until November.

In late November, my husband moved out. Our marriage ended. And so did my symptoms. I hadn’t been expecting such a dramatic reaction on the part of my body, but there it was. Fatigue, pain, weakness, skin blistering, muscle jerking, neuropathy. Gone. My toxic marriage had been killing me. My body was sending me one last desperate message before it gave up the fight. And it worked.

What can make you more grateful for the movement of your body than losing it?

There has been a lot going on in my life since then. Divorce, buying a new house and moving in less than two weeks before Christmas, and the in and out of court of a high conflict divorce and custody battle. Finally as February came to a close I felt like things had settled down and I was ready to start working out again and go on a diet to shed the weight I’d gained since June. It went well for a couple weeks and then buh buh buh, quarantine! And it all went to pot. Like it did for all of you.

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No more daycare. No more school. Time to homeschool 3 kids and take care of a preschooler. And now you have to take your medical practice and completely restructure it because you can’t do office visits anymore. And no one can help you because it’s a freaking quarantine. And did I mention the high conflict divorce I’m in? Yeah, those don’t improve with quarantine either.

And then we got sick. March 22nd, my four year old and I woke up with a fever, sore throat and cough. Exhausted, body aches, chills, no appetite. Then the other three kids got it. We didn’t qualify for COVID testing so I put us into complete isolation (actually considerably worse than regular quarantine life, believe it or not) and waited for it to pass. But it didn’t. The fever would sometimes for 24 or even 72 hours, but it always came back. We’re now on Day 33. I eventually coerced an urgent care into giving me a test despite not meeting criteria on Day 24 when our fevers went up higher than ever. The test came back negative but they told me false negatives were common and I should consider getting tested again. I consulted with my mentor, the best doctor I know. He said he thought it was COVID and a false negative. I agreed.

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If you consider the other things in the differential diagnosis (cancer, rheumatoid arthritis, Epstein Barr virus, CMV, Lyme disease), none of them made as much sense as COVID.

And so, here we sit in isolation. Now, back to the Beast. I was in a lull of symptoms two weeks ago on Easter Sunday. I was sitting watching a local church service on my big screen TV while my kids ate their candy and watched their iPads, and a verse struck me.

A good man brings good things out of the good stored up in his heart, and an evil man brings evil things out of the evil stored up in his heart. For out of the abundance of the heart the mouth speaks.

And I realized my husband had ruined my relationship with God. Because that’s what abusive people do. They isolate you. From friends and family and, sometimes, if they’re really good at it, God. I realized how far from God I’d gotten, and how I couldn’t separate God from my husband and the harm he does. And I realized it was now time to stop. And I said hello to God again.

I realized something else that night as I stayed up late journaling about all my newfound epiphanies. I was ready to get in shape and lose weight again. But I needed something to focus on, a race. I thought of the Beast. But when I thought of it, my stomach dropped. I realized the thought of running it alone, without my husband, scared me. That I felt like his ghost would be haunting me the entire time. And most things that scare you, are the things most worth doing. And then it occurred to me. The timing of the onset of my autoimmune issues. I’ve always noted the cruel irony of it beginning right as I was to run an obstacle course race even harder than the Beast, that I’d trained for for so long. Right at my physical peak. My husband was going to run the Spartan with me just like he’d run the Beast with me. He jumped on the Beast wagontrain late in the game. He said he didn’t think I’d actually train and go through with it so he waited. Like it was such a big freaking honor to have him run it. He took something that was mine and made it his. He was jealous. And he was going to take the Spartan from me too. He had spent years complaining I was fat and had a flat butt but when I got in shape, he was so damn jealous, he did everything he could to undermine me. And he couldn’t let me have the Beast, my moment. I didn’t finish high in the Beast, mind you. I couldn’t do about a third of the obstacles. But I finished. And I was so damn proud. He acted proud too: proud of us, proud of his wife, of himself. His wife, not me. His possession that reflects on him. That was what he showed the world. A few weeks after we finished it, I put a “I Beat the Beast” bumper sticker on my car and he looked at it and said “You didn’t beat the beast. You didn’t finish all the obstacles.” And that, ladies and gentlemen, is what he shows his family. For out the abundance of the heart the mouth speaks. I stood up to him and told him I had finished and tried all the obstacles and that was a big accomplishment for me. He gave me a shitty look and walked off.

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He took the Beast from me and my body wasn’t going to let him take the Spartan. Maybe that’s why it shut down. Maybe my heart called up my immune system and said, if he does it to her one more time I’m going to break. And my immune system said, ok, time for the Hail Mary. We will throw the switch and shut the whole plant down and give her some time to sit and think. And if she won’t walk away, we’ll leave her there sitting. And if she does, she’ll run it for her. And my heart blew my immune system a kiss and my immune system blushed. Maybe. Maybe it was a gift from my body.

So, I signed up for the Beast. And ordered a hoody. And the next day fruits and vegetable and water became a thing again at our house. Planning and cooking dinners because a nightly thing. And working out resumed for me and my kids too. Life was good. I was triumphant!

But then life happened. Our fever has taken up residence and work and homeschooling are getting harder instead of easier. Yada yada yada. I’m back down for the count. But I’m not cancelling the Beast. I am running it, come hell or high water or fever or economic collapse. Even if it takes me ten hours, I’m running it.

I cried a good bit during the Beast the last time I ran it. Cried for what Jeremy did to me, for what my school did to me, for what their mom having PTSD took from my kids, for all the other survivors I know who will never see justice like I did. I imagine I will cry this time too, for a whole other set of reasons.

My high conflict divorce has been nastier than ever this past week. We may soon go before the judge via teleconference (ya know, quarantine) and I am scared my husband will convince the judge he’s the guy out there bragging about his wife running the Beast, instead of who he really is, the guy denigrating his wife when she dared to be proud of herself. But this is not my first rodeo, dear reader. I have sat in court with a man who accused me of lies before and I have spoken the truth and justice prevailed. I will lasso the Beast again this time. And I will put on my hoody and take a run and thank my heart for being so damn good to me.

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America we’ve given you all and that’s not nothing (or Narcissus needs a drink)

11 Wednesday Mar 2020

Posted by in empathy, Evil, love, medicine, narcissism, Uncategorized

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America
I’m addressing you.
Are you going to let your emotional life be run by Time Magazine?
I’m obsessed by Time Magazine.
I read it every week.
Its cover stares at me every time I slink past the corner candystore.
I read it in the basement of the Berkeley Public Library.
It’s always telling me about responsibility. Businessmen are serious. Movie producers are serious. Everybody’s serious but me.
It occurs to me that I am America.
I am talking to myself again.
*
*
*

I have spent a lot of time reading about narcissism lately. I have my reasons I won’t go into here. An unexpected outcome of this research is the realization almost every politician in the Democratic primary is above average on the naricissim spectrum, some just as high as Trump. One in particular. The one who had to drop his bid in 1988 because he was exposed as a pathological liar and plagiarist. The one whose toxic masculinity led him to challenge someone to a fist fight recently. The one who has assured the billionaires “nothing will change.” And a relationship with a narcissist, my dear reader, only ends one of two ways: you wake up and leave or they suck the life out of you. The Democratic electorate has chosen the latter. It is narcissist versus narcissist in 2020 (it has been before, to be fair) . We will all lose no matter which one wins. If Biden wins, we are left with an America still under the conditions that created Trump and we will either get another Trump or …. Trump. Do you really think leaving the White House will make Trump go away? He has created a movement and they will follow him where he leads. The presidency,  my dear reader, may become significantly less relevant. The question is, will the movement Bernie is driving remain intact to counter it?

 

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I think of the people most affected by all this and I cry. My addiction patients in rural Pennsylvania, their children. They don’t even realize just how different much of America is living. And most of America doesn’t realize how they’re living. If they did, I’d like to think things would be different. But narcissists are very good at gaslighting and projecting and lying. Lying especially. Lots of lying. And if you’re a decent, feeling, empathetic human being, it is hard to resist. It is hard for for you to conceive that such a person could exist. Someone with no empathy and no remorse. Entirely self serving with nothing to limit what they’ll do to get it. Try to imagine. It should scare you. Terrify you.

I believe most Americans are decent people trying to get by in the face of a lot of hardship. I see it in my office everyday. Not just my most vulnerable patients, my middle class medical marijuana patients too. The cop with PTSD who had to retire because of it and now has no insurance or income to pay for the therapy he so badly needs. The single mom of an adult son with autism, trying to get services that aren’t there, trapped in her house. Chronic pain patients that were abruptly kicked off their pain meds once doctors started facing consequences for over-prescribing, not offered any help for withdrawal or to manage their pain. And I see the upper middle class patients who benefit from the system but have so much anxiety and depression, the money does them no good. And still they hold onto it tightly, unwilling to see letting some of it go would not only save so many struggling; it would save them too.

Greed is an illness. An ugly dark emptiness that cannot be filled and will not stop making you hunger for more. Like any addiction. Are the heads of the pharmaceutical companieds just projecting then? Turning so many into addicts so they can see themselves? And Trump, who will never have enough cheering angry supporters or enough money. He pulls the worst from us, feeding off negative emotions and chaos as narcissists do. Projecting onto America the darkness inside of him.

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I do not mean for this post to sadden you or leave you feeling hopeless. Indeed, that is exactly what a narcissist wants. I want you to see that once you know you’re dealing with a narcissist, you begin your steps towards recovery. Leaving is not easy. They will try to suck you back in. They will love bomb you, bring you flowers and tell you how wonderful you are. But if you stay strong, it gets easier in time. And the best part? The thing narcissists hate most is someone who heals and is happy and strong. Our revenge would be a healthcare system that takes care of us, universal childcare, a Green New Deal, a living wage, an end to mass incarceration. Our revenge would be joy. Like an army of Care Bears shooting out beams of love and kindness and hope from our chests. They would keep trying, but with no one to reflect their image back to them, narcissists wither. Like Narcissist himself, when the reflecting pool they’re so addicted to dries up, so do they. And we, America, will have won.

***

America, by Allen Ginsburg

America I’ve given you all and now I’m nothing.
America two dollars and twentyseven cents January 17, 1956.
I can’t stand my own mind.
America when will we end the human war?
Go fuck yourself with your atom bomb.
I don’t feel good don’t bother me.
I won’t write my poem till I’m in my right mind.
America when will you be angelic?
When will you take off your clothes?
When will you look at yourself through the grave?
When will you be worthy of your million Trotskyites?
America why are your libraries full of tears?
America when will you send your eggs to India?
I’m sick of your insane demands.
When can I go into the supermarket and buy what I need with my good looks?
America after all it is you and I who are perfect not the next world.
Your machinery is too much for me.
You made me want to be a saint.
There must be some other way to settle this argument.
Burroughs is in Tangiers I don’t think he’ll come back it’s sinister.
Are you being sinister or is this some form of practical joke?
I’m trying to come to the point.
I refuse to give up my obsession.
America stop pushing I know what I’m doing.
America the plum blossoms are falling.
I haven’t read the newspapers for months, everyday somebody goes on trial for murder.
America I feel sentimental about the Wobblies.
America I used to be a communist when I was a kid I’m not sorry.
I smoke marijuana every chance I get.
I sit in my house for days on end and stare at the roses in the closet.
When I go to Chinatown I get drunk and never get laid.
My mind is made up there’s going to be trouble.
You should have seen me reading Marx.
My psychoanalyst thinks I’m perfectly right.
I won’t say the Lord’s Prayer.
I have mystical visions and cosmic vibrations.
America I still haven’t told you what you did to Uncle Max after he came over from Russia.
I’m addressing you.
Are you going to let your emotional life be run by Time Magazine?
I’m obsessed by Time Magazine.
I read it every week.
Its cover stares at me every time I slink past the corner candystore.
I read it in the basement of the Berkeley Public Library.
It’s always telling me about responsibility. Businessmen are serious. Movie producers are serious. Everybody’s serious but me.
It occurs to me that I am America.
I am talking to myself again.
Asia is rising against me.
I haven’t got a chinaman’s chance.
I’d better consider my national resources.
My national resources consist of two joints of marijuana millions of genitals an unpublishable private literature that jetplanes 1400 miles an hour and twentyfive-thousand mental institutions.
I say nothing about my prisons nor the millions of underprivileged who live in my flowerpots under the light of five hundred suns.
I have abolished the whorehouses of France, Tangiers is the next to go.
My ambition is to be President despite the fact that I’m a Catholic.
America how can I write a holy litany in your silly mood?
I will continue like Henry Ford my strophes are as individual as his automobiles more so they’re all different sexes.
America I will sell you strophes $2500 apiece $500 down on your old strophe
America free Tom Mooney
America save the Spanish Loyalists
America Sacco & Vanzetti must not die
America I am the Scottsboro boys.
America when I was seven momma took me to Communist Cell meetings they sold us garbanzos a handful per ticket a ticket costs a nickel and the speeches were free everybody was angelic and sentimental about the workers it was all so sincere you have no idea what a good thing the party was in 1835 Scott Nearing was a grand old man a real mensch Mother Bloor the Silk-strikers’ Ewig-Weibliche made me cry I once saw the Yiddish orator Israel Amter plain. Everybody must have been a spy.
America you don’t really want to go to war.
America its them bad Russians.
Them Russians them Russians and them Chinamen. And them Russians.
The Russia wants to eat us alive. The Russia’s power mad. She wants to take our cars from out our garages.
Her wants to grab Chicago. Her needs a Red Reader’s Digest. Her wants our auto plants in Siberia. Him big bureaucracy running our fillingstations.
That no good. Ugh. Him make Indians learn read. Him need big black niggers. Hah. Her make us all work sixteen hours a day. Help.
America this is quite serious.
America this is the impression I get from looking in the television set.
America is this correct?
I’d better get right down to the job.
It’s true I don’t want to join the Army or turn lathes in precision parts factories, I’m nearsighted and psychopathic anyway.
America I’m putting my queer shoulder to the wheel.
Berkeley, January 17, 1956

That’s me in the corner, that’s me in the spotlight (or, the fault in our star)

03 Tuesday Mar 2020

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losing my religion:  southern term for losing one’s temper, “flying off the handle,” going insane  etc. Note that the R.E.M. song of this title has nothing to do with religion, despite the common misinterpretation of the phrase.

Oh, life is bigger
It’s bigger
Than you and you are not me
The lengths that I will go to
The distance in your eyes
Oh no, I’ve said too much
I set it up

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I don’t remember which one became my patient first. I think it was Him. But it could have been Her. He was initially more memorable. He liked to show me pictures. Of his woodworking and antiques he’d restored. Of his boys. Of the squirrels they’d killed that year. I asked him not to show me the squirrels but he did anyway. She was quiet. Told me about the jewelry she made and the things she grew in her garden and foraged for in the forest. I do remember the day I realized they were a couple. That he was the he she talked about and she was the she he talked about. The “Ohhhhh” moment. The “oh wait, she’s *that* She and he’s *that* He!” It happens a lot in my rural practice. Six degrees of separation is not a thing in rural northwest Pennsylvania. It’s more like two.
*
They started coming to their appointments together eventually. They would tell me about their garden and their yard and the retaining wall they were battling to put up. And they would tell me about things addiction patients in rural northwest Pennsylvania tell you about. Meth and heroin and jail and stealing from the people you love and five year old kids calling 911 when their mom overdoses. They’d both been clean a long time, but everyone had relatives and friends still lost in it. They were no exception.
*
They gave me things. A piece of amethyst they’d hunted and extracted themselves. A small glass vase with a flower from her garden. She gave me gardening tips, foraging tips, taught me some herbalism.
*
They were always late. Always. That was a given. And that was okay. As long as they came. Sometimes they mixed up their days and we’d get a call a couple days later and fit them in the schedule for another day. I always held my breath until they called. Because you never know. You never really know if something didn’t happen and if they’re really all right.
*
And so it happened that they came in a week or so after their appointment in early February. I wasn’t at my office in northwest PA so they came to my office in Verona. Sam got to meet them for the first time. They got to see my other office, which is fairy tale themed. I knew she’d like it.
*
She wasn’t herself that day, though. She was sad. So damn sad. He had to talk for her for most of the appointment because she couldn’t stop crying. She’d been depressed. But it was more than that. She’d been having pain in her side a while now and it was getting worse. She’d gone to the ER and they’d drawn blood work which came back with an abnormality but when they tried to get an IV in so they could run some imaging tests, the nurse couldn’t get it. They kept poking her over and over and she ended up leaving the ER.
*
I asked her some questions to see if I thought she needed to go to the ER right now (it had been a couple days since leaving the ER and she hadn’t gone back yet). Based on her answers I told her I didn’t think it was an emergency but she needed to go back and get the test done. I said maybe she could try going to a different ER where the nurses were better. We talked about her depression and I started her on an antidepressant and told her to email me in a couple weeks to let me know if it seemed to be helping at all so we could work on the dosing.
*
I had a crystal sitting there. Malachite. A pretty dark green stone. I’d been feeling for a couple of days I was supposed to do something with it. An odd feeling kind of hard to describe. Like, restlessness. But with a stone. And before she left I took it and said, here, I want you to have this. And she told me she had something for me too. It was a necklace she’d made but she’d felt timid about giving it to me. But when I gave her the crystal, she said, she felt okay to give me the necklace.
*
He said, (or maybe she said?) that it was fitting because it had a star on it and pointed to my walls. The room we were in has a Sleeping Beauty theme and is covered in stars. (It is based off something I wrote about kids with PANDAS battling the disorder and emerging from it, like sleeping beauties waking up). I took it and told her I loved it. And I did. When I went to put it on, the chain broke, so I put it in my pocket. My back jeans pocket. And we walked out together and said our goodbyes. And Sam said they were sweet and I said I was worried about her. And I was.
*
Somewhere between there and my kitchen, I lost it. The necklace, that is. I realized it later that night and told myself, it’s here somewhere. It’s not gone. It hasn’t fallen off planet Earth. You’ll find it (this is the same thing I say to my children when they are panicking over something they’ve lost. I find it is helpful to give myself the same talks I give them pretty often). I looked a couple places I thought it must be (the cubby over my coat hook by the front door, the back pocket of those jeans I’d since thrown in the hamper) but it wasn’t. Over the next few days I looked a few other places and it wasn’t there either. I tried to remain calm.
*
Then a week later I found it. I was trying to dig a quarter out of my left coat pocket for a cashier, in line ahead of a grumpy resentful old man in the Giant Eagle “12 Items or Fewer” lane and I pulled it out instead. I was relieved. He didn’t care. At all.
*
I went to coffee with a friend that morning (please note: this is a rare occurrence) and stopped in at the crystal shop across the street (please note: this is not a rare occurrence). It had been quite a while since I’d received that amethyst. A lot had changed. And I now frequented the local crystal shop (thus, the malachite). I was browsing on this particular day and saw a necklace with a stone in it that looked like the one my patient had given me. I excitedly drew the necklace from my left pocket and held it up side by side to the other and they were an exact match. I told the women in the shop the story of the necklace and asked what the crystal was. They told me and I asked if I could take the little card that had the name of it and its meaning and they said yes. And they said how sweet it was my patient had made me a necklace. And I said, yes she’s very sweet.
*
The next day I was answering the phone (Sam was out of town and I was like a dad on a laundry detergent commercial, drowning in ineptness with a lost look on my face, trying to perform basic office functions). I was relieved when a familiar voice spoke back to me. It was him. And then it happened. One of those moments. One of those moments that create a Before and After in your life. He told me she had cancer. One of the really bad ones. There’s no such thing as a good cancer. But there are such things as really bad ones. That’s what she had. I stopped breathing for a few seconds. Parastalsis slowed. I got goosebumps (the medical term for that is piloerection. It’s the same thing that makes a porcupine’s quills stand up when it sees a predator. It’s supposed to make us look bigger and scarier, in theory. It does not, in practice). In my head I thought, “Fuuuuuuuuccccckkkkk.” I did not say this to him. I asked how she was. I asked him a series of questions trying to get more medical type details. I tried to get him to say something that would make me realize he’d gotten it wrong and it wasn’t actually cancer. It didn’t work. He said she was resting but I should call her later. I said I would. Even though I was scared to. Because there’s nothing really great you can say. Because you’re a doctor and you’re supposed to fix people and this is not something you can fix.
*
Her palliative care doctor called a little while later while I was on the other line with someone considering making a medical marijuana appointment for anxiety. They had a hundred questions and, in the end, said they’d call back once they decided what to do. I listened to his voicemail and frantically wrote down his number and called him right back. He was nice. God help me, he was a genuinely nice, caring doctor. If you knew doctors like I know doctors, the way they actually talk when there aren’t patients around, you’d know how rare a thing that is. He hadn’t seen her yet (the appointment was for the next day) but he wanted to touch base with me since I prescribe her a controlled substance and his role was pain management (also prescribed substances).
*
When I talked to her that night (well, to her voicemail), I let her know the pain doc was good people and would take good care of her. And he did. We have texted and talked since then, each step along the way, She and I. He and I. And even the palliative doc and I. There is more to it than this, various details you might not expect. But the heart of it is this: a really beautiful human being is sick with something she likely won’t survive. She is in a lot of pain. And the man who loves her is doing an amazing job supporting her through it. He is an unlikely romantic hero. Not a sappy, trite one. A genuine romantic hero. And she is a warrior. Strong and smart and intuitive and kind and creative and honest. And she is so damn young. Too damn young for this shit.
*
And so it was that I came to wear a star necklace everyday (I ordered a new chain for it the day he called with the news. I kept it in my pocket until the chain arrived). And so it was that I came to wear that necklace the night I ran into a good Christian I know.
*
The Good Christian looked at it in horror. Genuine fear in his eyes. And he said, “Have you lost Jesus?” He was distressed. I looked at him and said, “What?” And he pointed to my necklace and said it was a witch’s necklace, a Wiccan necklace. I said, it’s a star. A patient made it for me. That doesn’t mean I’ve lost Jesus. He looked… freaked the hell out.
*
And I thought of the word the palliative care doctor had used when he told me about her CT scan. Innumerable mets. Meaning, the cancer had spread to so many spots, the radiologist gave up counting. I remember when he told me that I wondered, at what point do they stop counting? 10, 20, 100? Maybe that particular radiologist was lazy and she really only has 3. But that’s not likely. When he used that word, innumerable, the hope I’d held out faded away. And I began to focus on how we could all support her in finding peace and being comfortable and doing the things with her last months she’d like to do. Because, lets be honest, doctors very rarely actually fix patients anyway. So maybe this very nice palliative care doctor and I could help her with these things. Hopefully I could be of use.
*
I thought of that word, innumerable. And I thought of the cancer growing inside her. And about how brave she is. And how sweet her he is. And I looked at this Good Christian and saw something in him. A different kind of cancer. One with innumerable mets to the soul. Dark and sticky. Inoperable. Incurable.
*
And I thought, this patient knows more about Jesus than you ever will. Because Jesus is love. And she is full of love. And she has brought joy and love to so many people. And she will keep doing that. Despite it all. She will keep inspiring other people to love. And she knows that I love her. And she lets me love her. And loves me back.
*
And that, dear reader, is not something the Good Christian is capable of. Not something he even understands. And that is why a necklace can inspire a look of dread and disgust in him. A star. An innocent little star.
*
I told my kids a bedtime story tonight. The boy in the story was looking up at the night sky when a shooting star appeared. My daughter got so excited and was urgently shouting “make a wish quick! Before it’s gone!” She was nervous the boy in the story would miss it. Because everyone knows if you make a wish on a shooting star, it comes true. Because that is what stars are for. To wish upon, to make our dreams come true as we sleep beneath their lovely glow. They’re magical. And shooting stars? They’re actually little burning meteors,  magical, glowing rocks. Kind of like amethyst or malachite.
*
If taking comfort in that means I’ve lost Jesus, dear reader, then consider me lost. Because not every sleeping beauty wakes back up at the end of the story. Sometimes her true love kisses her goodnight one last time. And releases her to shine down on us and remind us of who we are, innumerable stars in an endless universe connected to one another always.

 

***

Oh, life is bigger
It’s bigger
Than you and you are not me
The lengths that I will go to
The distance in your eyes
Oh no, I’ve said too much
I set it up
That’s me in the corner
That’s me in the spotlight
Losing my religion
Trying to keep up with you
And I don’t know if I can do it
Oh no, I’ve said too much
I haven’t said enough
I thought that I heard you laughing
I thought that I heard you sing
I think I thought I saw you try
Every whisper
Of every waking hour
I’m choosing my confessions
Trying to keep an eye on you
Like a hurt lost and blinded fool, fool
Oh no, I’ve said too much
I set it up
Consider this
Consider this
The hint of the century
Consider this
The slip that brought me
To my knees failed
What if all these fantasies
Come flailing around
Now I’ve said too much
I thought that I heard you laughing
I thought that I heard you sing
I think I thought I saw you try
But that was just a dream
That was just a dream
That’s me in the corner
That’s me in the spotlight
Losing my religion
Trying to keep up with you
And I don’t know if I can do it
Oh no, I’ve said too much
I haven’t said enough
I thought that I heard you laughing
I thought that I heard you sing
I think I thought I saw you try
But that was just a dream
Try, cry
Why try?
That was just a dream, just a dream, just a dream
Dream

Good Friends Are Hard to Find (or, My Brother from Another Mother) (or, Tacos Fall Apart Sometimes and We Still Love Them)

01 Sunday Mar 2020

Posted by in empathy, love, Uncategorized

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IMG_0267

 

It’s the Kalenda of March today. You may have heard of the Ides of March (especially if you took Latin at Indiana Senior High like I did) but probably not the Kalends of March. It is the first day of the month. It comes from the same roots as the word calendar (thank you, Latin class. You rock) and was part of the newly formed Roman calendar which was no longer lunar like all those before it (see, for instance, the Hebrew calendar which leads to holidays falling on different days each year). The lunar year is made up of equal months that follow the waxing and waning moon. The Roman calendar had to make up the idea of a Leap Year to reconcile its imperfection.

And so here we are on the Kalends of March, the day after February 29th. That pesky day that tries to make up for the illogic of the Roman calendar. The moon and it’s cycles have always been linked to the Divine Feminine and Nature, so it is no surprise the Romans wanted it squashed. 

March is my birthday month. I will be 41 on the 24th, a few days after the spring solstice. My 40th year has been intense, to say the least.

Some good, some bad, most of it both. 

With me through all the ups and downs have been a few people I managed to stay close to despite the relative isolation I found myself in in recent years. One is a wonderful fellow PANDAS mom, one a good friend from college who was with me through the Jeremy ordeal, and one is my friend and coworker, Sam (he says I can tell you his name. I always get consent, dear reader).

Sam came to my practice at the suggestion of my husband. He recruited him. And for that I am eternally grateful. Sam is warm and sunny and kind and just fills you with positive energy from the second you meet him, whether by person or over the phone as many of our patients do. I cannot tell you how many patients pause in their appointments and say, I have to tell you Sam is wonderful. I say, oh I know! And they look at me very seriously and say, No, I mean it. Truly wonderful, (as though I’m not convinced) I was so nervous when I called here and he made me feel so comfortable and so much better. Never let that one go! I’ve even had patients try to hire him away from me (no joke). They send him chocolate covered strawberries and give him birthday gifts. When I told our grove city patients, who have only talked to Sam on the phone since he doesn’t come up to the grove city office with me, that he was coming up in March, it was like I’d told them a celebrity was coming. The excitement was palpable and real. 

Sam was with me through a lot this year and always there however I needed him to be. He never tried to tell me what to do as I tortured over some big decisions. He listened. He heard me and allowed me to talk it out to figure out the answers I already knew deep inside. He laughed with me. He sat with me as I cried. We drank champagne sometimes; other times we talked about how damn unfair some of our patients lives are and how we wish we could do more. 

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More than once he has run something badly needed to my house at 10 at night (not sure what my neighbors thought he was putting in my mailbox but I can assure you it was all perfectly legal). More than once he has either run my son Mies to school when he missed his van, run my office with me completely unavailable tied up in court, run inconvenient errands for me or ordered me rose water pistachio ice cream (vegan if course) when I really really needed it (and run it over to my house of course. The man runs). 

Sometimes we bitch about men together, even though Sam is a man. Sometimes he lets me bitch about women to him, even though I am myself in fact a woman. I know there’s nothing I can say to Sam that will make him judge me or love me any less. (Well maybe there’s something but it would have to be pretty extreme). 

Sam has reminded me I am a good person. That there are parts of myself I’ve pushed down so many years that deserved to rise back to the surface. That it’s okay to be a contradiction. That it’s okay to not be okay. Because everything is going to be okay. And it is. 

So it is not just female friendship I am reveling in now. The Divine Masculine and Divine Feminine are in us all. We must embrace both. Sam does that beautifully. He is a fabulous moon, orbiting with me. I no longer orbit any person. But I make my way through space , through the cycles, pulling the tide in and out, with some wonderful fellow celestial bodies. You can keep your Leap Day. We will take the solstice and the mother moon (and some champagne lunches from time to time).

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.