The Unsung Hero

I would write this as a personal letter, but as I thought about it, there are so many of you that might need a "shot in the arm" I decided to dedicate this blog to the performer.  All of you.  Big household names, names on the inside back cover of a CD, those of you slumped over composition books, those panicking tonight about "juries", contest , scholarship auditions, a Friday night gig, that solo that you landed last week for Church that you now dread, and everyone else along the spectrum.

I want to say thank you.

Many who read this blog would be dumbfounded that I would spend more than a sentence or two thanking those of you who over the last week, month and many years have heard thunderous applause, seen endless standing ovations, and endure people taking endless pictures of you. I also want those of you who are still waiting in the wings, those of you that stayed up all night last night rearranging a piece for the 10,000th time because one person couldn't hang on, the person who is back stage frantically changing a broken string with hands shaking, I want you to know how grateful I am for your sacrifice.

I've even watched some of you grow since junior high contests, I've seen the exhilaration of a perfect senior recital.  I've watched you crumble with letters of rejection.  I've heard the criticism directed at you from your colleagues, your teachers, your parents, your spouse and especially - you.  I've seen you running into the corner drug store in a long tail tuxedo.  I've shopped with you as you're trying on another black blouse.

I understand what it takes to do what you love, and when what you love to do takes all you have.  I've seen you miss an entire month of your life preparing, practicing and performing, running frantically from one gig to another.  I know you forgot to eat breakfast, snagged a lukewarm plate from the wedding you just finished and are trying to remember if you even brought the music for your next gig.  I know you are going to fall into bed at 1 or 2 am exhausted and have to be at a church at 9am to do it again.

I know that everyone expects to see you fresh-faced, smiling and excited to play or sing.  I love how you can inject new life into a work created centuries ago.  I love that you love what you do,  it makes us love you more.  I know how you dread a mistake and I marvel at your recovery.

I am a physician. I started down the road you travel every day. What I discovered on a dismal rainy day while soaked, and walking back to my dorm after my 5th hour that week, alone, in a grey practice room was that your road was too hard for me.  Breaking up with my dream was one of the most gut wrenching decisions I ever made.  I called a college back in Ohio, declined a scholarship and chose a path that would lead to healing bodies, instead of souls.

I too, work long hours and have to put on a smile every day, in every room. I spend some weekends and evenings away from my family as well, I've spent endless hours practicing my skills.  I don a white coat, instead of performance black.  I have moments of exhilaration, moments of disgust, panic, and devastation.

Only recently have I dipped my toe in the great ocean in which you all get to swim daily.  And, oddly, not even with the instrument that I had trained in, but the one I dreamt of.  I have had to, as an adult, face some of the obstacles that made me quit music the first time and do this with a new instrument. Interestingly enough, it's made me want to sing again, and I've recently jumped both feet into a venue that I would have never dreamt I would do.

This morning, for the first time in more than 15 years, the black pants came back, and I found myself sight singing, acappella.  I was leaning on instruction from vocal teachers from 30 years ago, the names my director wouldn't know.  The foundation solid as a rock.  On a part of me that I've abandoned for nearly 20 years, that I'm finishing, finally.

To all of you who feed our souls with the beauty of music, applause just isn't enough.  The world can be a very dark place.  This road that you have chosen can be exhausting, yet exhilarating.  I see both anxiety and confidence in your eyes.  I can feel anguish, and then peaceful resolution within minutes while you play.  The color of our lives is given to us by music. I stand in awe of you. You teaching our children ensures that the language of our soul will never be lost.

I took the kids and their friends to a Oklahoma City Philharmonic "Discovery" concert this afternoon. Those musicians were there Friday afternoon, played Friday night, most of them taught lessons all day Saturday and gave another fantastic performance Saturday night, then turned around to play their hearts out today to a bunch of little kids.  Many of them probably came from playing at Church straight to today's venue.

After the show, while talking to my friend, the kids were invited on stage.  She led me to the back and eventually on stage to go collect my crew.  She started talking to me about the Civic Hall, I think.  I was trying to act as though I was present, but I was long gone.  I was at Packard Music Hall, my heart was pounding...

...and I was still in my performance black.  In fact, I just took it off a few minutes ago.

Room 21

Dear patient in room 21,

I know you've dreaded this visit for years.  I see the 6 foot man walking ahead of you, assessing the room, looking for his seat.  He is not nervous.  In fact, he is quite talkative, inquiring about my training, where I came from. How long I've been doing this, and that we have some issues to address. What you don't know is that I have him pegged, and have since he marched into the room. The less I say, the more I can observe.  The nurse comes in, asks you a series of questions answered by him.   She then presents you with a gown and a paper towel and you wait.

What you don't know, dear patient, is that I am outside the door.  I'm listening to you interact when no one is watching because I fear that the family I am about to meet is not the family that you experience.

I enter with an outstretched hand and a warm smile to him.  "He's got her snowed", you think, and I see your shoulders slightly slump in defeat.  I sit down, put my feet up and ask what brings you in, to which he answered "decreased libido, too tired and having a hard time keeping up (with what?), she's cranky and she just doesn't listen very well."

I instantly notice him jump out of his seat to watch me perform a routine breast exam.  I say nothing about the bite marks on your chest. I see the bruises on your forearms, in the exact area you would use to protect your face.  Not bruises around the wrists consistent with creative sexual exploration. He's quick to tell me about your fall last week, except these are fresh bruises.

I ask you to follow my pen. Not because I am concerned about your cranial nerve function, but I need to look in your eyes.  Vacant.  Looking at the floor.  And your husband is quick to tell me that he's just started a church.  You smile right on cue, with a nervous laugh. "Yeah, she has NO idea what kind of man he his...", you think.

What I notice first is your pounding heart, anxious breathing pattern ..."Oh she hates these things!", he exclaims.  I lighten the mood talking about your children and that surely a routine gynecological exam can't be worse than an 8 pound baby, right? "Oh, they weren't  mine," I hear your husband say.

Then, I have him breathing at the back of my neck... Your legs clamp tightly, a barely audible sob fell out completely out of your control.  Your breathing is fast, uncontrolled, and tears roll down your checks.  It's fairly obvious at this point that someone, somewhere, has violated you, emptying you of your dignity and self worth leaving a void now filled with a controlling and  potentially abusive  husband.

"I can't see in there!  Do you see anything?  Does she have anything?"  I smile politely and state that her gynecological exam appears normal.  Except for the fact that he had to mark his territory immediately prior to the visit today, like a tomcat.  What I didn't tell him is that while her pelvic area is perfectly groomed,  her legs have yet to see the 3 minutes of attention they have deserved this month.  I also notice her $700 Coach bag, but 6 month old pedicure.  I see the big bruise on her knee... From the fall "last week" I assume.  I see him aggressively trying to look over my shoulder, and I'm doing my best to preserve what's left of your dignity.  Why won't he leave you alone for 90 minutes for a pedicure?

I continue to engage him, attempting to earn his trust.  Offer to draw labs as a biochemical explanation for your perceived shortcomings.  I believe none of it, but I want to have him think he's got me fooled.  Fooled enough that he will let you come alone next time, so I can really look into the window of your soul and extend my hand as a safe rope .

My student emerges and I ask her what she noticed about you.  "Pretty, thin, quiet and very polite."

"Why is she here today?", I ask.

"Just for an annual. No issues."

"None?", I inquire?
"Tell me about her hands, her forearms.  Did she wear nail polish?  What does she do for a living?
Where was that dysplastic looking mole?"

"Well...I was typing her info. She's v70.0 and 627.2, needs screening Mammogram."

I ask, "What color is her hair?  Tell me something about her husband."

Awkward silence...

And, so now, I spend the next 20 minutes teaching a medical student how to look at her patient, and how to manage controlling husbands, identify signs of abuse, and how to delicately document these observations in a computer medical record that will be eventually accessed by the world at whim.

My patient did come back. He stayed in the lobby on wifi.  She said, "It's not happily ever after, but it's what I signed up, for." I then gently asked if he was always that protective when she went to the doctor. I told her that I knew her bruises were recent and not a result of last week's ice storm. Through tears, she said, "I thought he had you fooled.  He set you up to never believe some of the crazy stuff I could tell you."

I assured her we will check in once a month to address her "hormones".  I also assured her that violence only breeds more violence.   And, that maybe it was time for her 16 year old to come in for a visit as well.

She needed her pap done, but it was about much more than that.  I know that I can't save anyone that doesn't think they are worthy of a better life, but I pray as we build a relationship, she will slowly learn that not only is she worthy of respect, but that her children are learning by their examples how to treat others and what kind of behavior is acceptable.  The cycle of violence and control has to stop, and I will fight it as long as God gives me the grace and the guts to do what it takes so that no one else ever has to experience the gut wrenching anxiety every time they turn the knob at the back door.

I had an attending tell me more than a few times, "God gave you 2 eyes, 2 ears, 2 legs to get to 'em and 2 arms to hold them, you've only got 1 mouth, so listen more, hug more, do more and talk less."  What you give to your patients daily is your vocation, their trust in your care is your salary.

Love is an Iceberg?

Every year I think I'm gonna be less sappy about my son’s Christmas birthday, and it just gets worse by the year.  My children were all conceived with the miracle of in vitro fertilization and I've blogged that already.  (See "The Unplannable Planned Pregnancy" Feb 22, 2013)

The Sunday before Christmas our Priest had announced that a family had lost their son in a tragic car accident while he was retuning from a ski trip. It sounded as if the family was young, and really devastated.  He was asking as many parishioners as possible to go to that Monday mass. My husband and I exchanged looks, saying a whole conversation in a minute.  His dad was killed in a car wreck when Chris was 11. He's never gotten over it, I suppose you never do.  His pain has been so palpable at times, that it can still dissolve him into tears to this day.  Initially, I thought I would try my best and go to this funeral for this family. We had gotten an email about it as well with their name, I didn't know them, I thought to myself, and if I had time I'd go... But we were gonna be at Church Tuesday from 4pm until after midnight all told.  I decided that that was enough.

It was Christmas eve.  My daughter sang at the 5pm mass, and we all came back at midnight to hear my husband play trumpet at the midnight mass.  We came early. Sat in the 2nd or 3rd row closest to the trumpets in the left side of the church. (Most Catholic Churches are in the shape of a cross, use your imagination). Jonah was clearly asleep and not waking anytime soon and Jake and Jordan sat on either side.  I checked my Facebook and thought I'd show Jake my "note" about him and just how much I love and value him and why I get so teary eyed every birthday.  He read it and whispered an exasperated "Oh, Mom!".  The music began.

A family walked in shortly before mass, a fairly big group, with many extended relatives. Then I saw her. They were sitting down directly across from us.  Grieving mothers all walk the same, bent over from the weight of it, holding on to her husband on one arm, and her oldest son in the other, trying to control her sobs. There we were. 10 years from now. The mother and father looked to be in their mid fifties, the oldest looked about 20, the daughter 17-18, and a missing son.  A father, clearly broken and trying to control his emotions so hard he had his hand clamped across his mouth.  The daughter cried audibly while hugging parishioners as she followed closely behind.

The mass begun.  I don't remember a word of it.  I thought of my friend who was trying to make sense of her life after loosing a daughter (my sons age) in the May 20 tornado.  I thought of this mother across from me.  I thought of Mary, the mother of Jesus, and that walk.  I thought of myself. Tears uncontrollably poured down my cheeks.  Jake leaned over to me and said, "That's that family, isn't it, Mom."  I nodded.  He kept watching.  I said quietly in his ear, "That's what grief looks like, Jakey.  That's how much she loves her son." He put his head on my shoulder and covered it in quiet tears.  The daughter across from us had done nearly the same thing.

Now, my daughter pulls my ear down, and says "What's wrong with that family? Mommy, why are you and Jakey crying?" All I could say is, "That is how much your mother loves you. If you were ever taken away, it would destroy us, just like it is them."

"It's that family, Mom."

Nodding, yes.

"So then there were 2 boys and 1..."

Nodding, yes.

She grips my hand super hard, starts crying and doesn't let go.  My mind has now drifted to my husband up there trying to play some pretty difficult material while 1/3 rd of the church is now crying, wondering if he's figured out what we had.  Mass has ended.  It's Christmas.  I have my gift, that woman doesn't.  Jordan takes off across the church making a bee-line for this grieving mother, whom I've never met, and I'm panicked about what could come out of an 8 year old mouth at a time like this.  I left Jonah sleeping with Jake and I tried to catch up to her as she approached this family.

She said, "I don't know you.  My mom doesn't even know you. I'm so so sorry about your son. (At this point, the father takes his hand away from his mouth and strokes her hair.)  We will pray for you so much." And concluded her simple, yet heartfelt sentiment with a great big bear hug to this mom, and the dad joined around them in a group hug. We all cried.  I think I mumbled something to her as well, but she won't remember me.  She will remember that little 8 year old girl who left them and went straight to the feet of Mary, lit a candle and prayed earnestly for them.

I gathered my family. Tight.  I approached my husband tentatively as I had moderate control of myself by now.  He looked at us inquisitively, and Jake threw his arms around his dad and all he could get out is, "It's all so overwhelming."  Fortunately, Chris was oblivious to all of what had occurred in mass.  Jordan told him through tears and we left.

I had all three kids in the van, and trying to lighten the mood, somewhat, had put on some Christmas carols.  I asked the kids what they were hoping to see under the tree when they wake up.  I got various answers and said in an effort to try to connect what they had witnessed earlier, "Tonight you saw a very hard, and painful, dark side of love, tomorrow, you will be surrounded with laughter, surprises, love and friends, and thoughtful gifts given to you by people who love you very very much. You thought you knew what love was, what it felt like, now you now love on a much deeper level."

At which point Jake responded, "I've been reading about icebergs and ships running into them because they didn't know they were there.  Like, you only think you know what an iceberg looks like, but it goes deeper and wider than you think."

"Exactly."

"So, Mom, love is an iceberg."

"Well,  Jake, someday it will be a battlefield, but that's not for about 6 years or so.  But tonight, yes, love is an iceberg."

"Mom, I love you deep and wide and more than you can see. Oh, and hey, what do you want for Christmas?"

Not a single thing.

Stick a Fork in Me (The appropriate use for obstetrical silverware)

There has been a post circulating the Facebook circuit called "Olivia's Law".  This is an article meant to infuriate mothers and initiate a "call to action to end the use of forceps".  I unfortunately have had to grieve with families in the loss of a newborn and it is a pain that is unlike any other.  I can't imagine having a nursery, an embroidered diaper bag and no baby.  Furthermore, I am a mother and like every momma grizzly, I want to protect my children from harm.

However, I am a board certified Ob/Gyn.  I am able to separate my emotions from the facts on this particular subject.  I have found NO Ob's that have offered an opinion on this proposed "law".  I know that this blog is risky business, but I have to speak the truth on this subject.  My job is super fantastically happy, except for when it's not.  Sometimes babies die.  Sometimes we know why, sometimes we don't, but this I know:  I have never killed a baby with the use of forceps. 

The cliff notes regarding this case are as follows: a mother reportedly 4'11'' (and by the pictures provided appears that the father of the baby is a man about 6'0") is post dates.  She reportedly asked her OB for a cesarean section, as she felt the the baby was too big and was denied her request.  She went in for an induction and reportedly pushed for many hours, was horrendously off of her labor curve, forceps were applied.  The couple claims that they heard a cracking noise, that the mother was literally pulled off of the bed with the force he used, that the baby was not able to be delivered vaginally, she was rushed for an emergent cesarean section and that her baby suffered a fractured skull and subsequently was pulled off of life support.  It is also of note, that the doctor they chose has reportedly had his license suspended or revoked (according to some sources) in two states.

This case is not the forceps fault.  They did not jump out of the sterile bag, and into this woman's vagina for the sole purpose of killing her baby.  This case appears (as I have not heard a formal statement from the doctor on this case so what I'm hearing is one sided, thus far) to be a series of bad decisions.

Problem number one: research your doctor.  Know how he or she thinks and how they feel about operative delivery.  Ask questions before you are 42 weeks.

Problem number two: listen to your patient.  If my patient thinks the baby won't fit, I don't argue with them.  They live in that body, not me.  Induce them at 39 weeks in the hopes that a smaller baby has a better chance of fitting while minimizing any prematurity risks.

Problem number three:  Friedman's labor curve.  You are either on it, or you're not.  If you are not, there's usually a darn good reason why.  One you don't want to find out about in an emergency.

Problem number four:  if you apply any method of operative delivery and the fetus does not move, you are done. You don't try to pull the Mom off of the bed with a vacuum or forceps. 

Whether this physician chose forceps or a vacuum, the result would have been the same.  I have seen skull fractures, as brain bleeds, skin trauma and other issues happen with the vacuum.   I have also seen flawless forcep applications with smooth deliveries of healthy pink little babies.  I use both.  And I use them sparingly and when appropriate.  It either fits, or it doesn't.  If it doesn't, put the spoons away and grab a knife and have a safe delivery.

I ask those of you who think that the vacuum is such a "safe alternative" to delivery to do this experiment.  The next time you get in the shower, put some shampoo in your hair, apply a suction cup and try to lift your head.  It will pop off and provide no lift power.  Or better yet, take a toilet plunger and suck it onto your leg and try to lift it.  See how much force it takes over that one spot to lift it.  Now grab a set of large salad tongs, place them around your knee and do it.  The force is evenly distributed and requires much less pulling to achieve the same effect.

On an abrupting baby with a ton of blood pouring out and a head full of hair, those forceps are all that kid has. You don't have the 6-10 minutes it takes to go "to the back" for an emergent c/s.  You can apply a vacuum with a bunch of pop offs and get an impressive hematoma on his head or you can gently apply the forceps around his head and with one gentle pull, save his life.  I've done it.  Medicine is an art.  It is also science.  It is also intuition.  You can't legislate these things.  At least I sure hope not.

Being in the Now, Nowdays

You know, I just wasted about 3 minutes watching a video of people watching their phones.  It was created to make us all feel guilty about the amount of time that we spend online.  And it worked.  But, as I laid in bed, trying to sleep, I felt this blog boiling in me that I will share with you.

I can promise you.  If there is anyone on the planet that hates technology, it is me.  And, I married an engineer.  I suppose if I hadn't, I'd be typing this on a typewriter or word processor and taking it to Kinko's to make copies and pass it around, via the U.S. Postal service.  When digital photography came out, I was mad.  It seemed like cheating, and it a lot of ways it is.  I wanted to preserve the craft of photography for "real photographers".  I've been rethinking that as I wandered my way through this blog in my brain.  Technology has made pretty good photography (to almost anyone with an iphone and a brain) available, and given many the opportunity to explore the art that wouldn't have been able to otherwise.  My kids have no concept of film.  I shot my film camera one day, and my son was behind me taking digital photos with my phone.  And some of his shots were pretty darn good.
He was proud.  (And I have yet to develop that film canister)

I agree that your children and your spouse, when they need you, should have your undivided attention. How often does that happen?  When I started residency, when you were on call (before the wussy work hour restriction rules) you stayed at the hospital.  From 0600 Friday until 1700 Monday.  We couldn't text.  We couldn't remotely check labs, or watch a fetal heart monitor. Most of the residents had  one cell phone per family.  Sometimes it wasn't your lucky day to have one.  So, as long as you could get to a land line (read: pay phone) you could venture out.  Over the course of 4 years, we learned the beauty of an alpha numeric text page, which was heaven.  Being able to remotely check labs, fetal heart monitoring, and communicate with nursing means that when I'm on call, I'm also at ballet, the baseball fields, violin and anywhere else I need to be.  Sometimes that means I'm in the neighbors pool, with my kids.  Do I check for texts? YOU BET.  Are they all nursing or medically related?  Nope. This leads me to my next point.

Texting and widespread cell phone use also means that you can communicate with your long distance family in Ohio, and New York, and Tulsa, from your neighbors pool.  When I was in college, we sent letters.  They took days to get to the destination.  Now, when Jonsey learned to swim, I sent off a little video.  And, I'm not ashamed to say it.  My kids psyche is hardly damaged over this.  It also means that my kids can text Grandmas and Aunts and Uncles with their news of the day.  It also means when my husband is gonna be 2 hrs late getting home, he can shoot me a quick text from the middle of an oilfield.  In the past, I would have been pacing and calling ER's to check and see if he was alive.  It means we can coordinate schedules so that we can all be together.

There is a part of that video where it is inferred that you shut off your phone and take nature in.  How about you video that pleasant beach with the birds chirping and sun setting so you can see it whenever you want?  It does not mean that you are any less there.  I did that last year and posted it on Facebook while I was in Sag Harbor, NY.  It got about 50 hits in a day. It means you can bring others there with you.  Then turn it on vibrate, stick it in your back pocket and enjoy the scenery.

Which leads me to my final point on this subject, connecting with friends on Facebook.  When I opened my Facebook account, I did so because I was visiting family and they all had a Facebook.  At the time, they were living in Kansas City, MO.  We all met many years ago in Warren, Ohio.  I saw people on there I hadn't seen in years.  Why?  It's not because we didn't like each other, there just weren't enough hours to write letters and call to maintain some of those friendships, while making new friends in new cities some 25 years later. It has been a joy and added so much to my life to be able to talk to my childhood friends and share life, as it is now with them.  It's wonderful to see their children (many of whom look scaringly like I remember their parents) and view a slice of their lives.  When we go "home" there is usually 1 week to see both sides of the family and try to contact a few friends.  Now, before I go home this next time, I'm gonna coordinate a way to get together as a small group.  This doesn't make me some kind of social deprivate. I would argue that organizing a get together in a town 1200 miles away while sitting at the chick-fil-a while your kids play makes me quite the social butterfly.  Could I talk to the other Mothers there?  Of course.  And I do make small talk with them, while they are texting their best friend in Idaho.

Technology has expanded my circle, which is both good and bad sometimes.  It is mostly good, however, because of how I manage my time.  And knowing what and who you say/post to.  If I was 43 twenty-five years ago.  I would have about 2 friends, like my mom, and most of her friends that had about 2-3 friends.  That was all you could manage.  Did my Mom like a lot of people, sure, but she wasn't going to send out 200 Birthday cards a year, much less 757 of them.  I still have, as most of us, a trusted few, but there are a lot more people cheering me on than I ever thought possible.  A couple of them I only became friends with because of technology.  I have one friend in particular that I got to know while sharing "pleasantries" while coordinating weekly lessons, "pleasantries" turned into extended texts, then into real conversation, and a friendship.  I have about 750 people that take 10 seconds to wish me "Happy Birthday", congratulate me on my Wedding anniversary, wish me luck at a new job, and check on me through a devistating tornado.  I have found "friends" that I knew in high school that I have more in common with now than I ever did back then, what an unexpected treasure I have found!

Like everything else used in excess, it can be harmful to forming healthy relationships in "real time".  It is implied somehow that taking a "selfie" of you and your best friend having a toast makes you not connected to each other because you are using your phones?  Some of my funniest moments have been captured (actually me and the kids) taking endless "selfies" and unscripted videos.

I am not ashamed to have an online presence, I can do it while I'm with my kids, my bestie, and my husband. And, I have enough functional brain cells left that I can even keep a coherent conversation with an 10 year old while checking on a laboring patient.  Ask him, he'd rather I text than leave the dinner table.  Every. Single. Time.  I won't put "my phone away for the rest of the day" as the video would ask, but I will use it responsibly, carefully and strive to make myself available to my spouse, family and friends in the best way I know how.