Unmade in America

jewish_refugees_aboard_the_ss_st_louis_in_cubaMy 10th great grandfather and his family boarded a ship in Mannheim, Germany in 1663 bound for America.  They came to Germany by way of Amsterdam and before that France, seeking refuge from religious persecution.  Each new home offered only temporary asylum.  During this time, and for reasons that are not entirely clear to me, the Catholics were persecuting the French Huguenots, murdering and torturing them, causing them to flee to the corners of the world.

David and his wife Marie were among these French Huguenots fleeing certain death toward a new world.  They were refugees.

I have been researching my family lineage.  My mother’s father’s side is rich with history like the story of David and Marie.  David’s offspring fought in the American Revolution, the War of 1812, the Korean War, World War’s I and II, Vietnam, and Desert Storm.  It is fascinating to imagine how my family were some of the first settlers in this new world, shaping the story of American history, living the ideals of freedom, worshiping their God, fighting for their country, and building a future that includes me and my children.

My family included farmers, factory workers, musicians, soldiers, carpenters, seamstresses.  I haven’t found any doctors.  It seems I’m the only one, an anomaly.

My father’s side has been more difficult to research and I’m actually a little nervous to dig too deep.  You see, his mother’s side were white southern farmers.  If I dig too deep, I might find something more sinister, like the vile stench of slavery on the family name.

My father’s father’s side came from Hungary.  I have acquired the death certificates of my great grandparents which lists their parents’ names, but that’s where the trail ends.  My great grandfather’s death certificate does not list his mother, only his father’s name.  Did she come to America with him from Hungary when he was a child?  Or was it just him and his dad?  Were they fleeing persecution?  War?  Certain death?  Did she die trying to escape?

All of these stories led to me, sitting here today, pecking at these keys, occasionally staring out the window, trying to find the right words to convey the emotions that I feel so that you can feel them, too.

David and Marie boarded a ship, knowing full well that it may never make it to shore, it could end up at the bottom of the ocean.  They still got on, fully aware of the dangers that they would face traveling to their new home.  They knew that once they got to America their troubles would not be over.   They needed to find shelter, food, a community that accepted them.

The spirit within them still stirred, compelling them onward despite the dangers, promising them a future even when it looked like there could be none.  They got on the ship.  They leapt into the unknown.  The took a chance with their lives.  The horror that they were fleeing was so overwhelming that escape was the only option no matter what new dangers lie ahead, like jumping out of the window of a burning building 10 floors above the ground.

There are places in this world that are worth escape even if death is the destination.  There are people who still make the journey no matter the cost.  They would die to live the American dream, to be free.  I see the death of the American dream before me.  If there is no promise of freedom for those that seek it, then there is no America.  America has closed it’s doors, shackled it’s heart, barb-wired it’s soul, and stepped on the necks of the oppressed.

David and Marie made the journey for the chance at the American dream.  The pay off, 400 years later, is that I sit here understanding why someone would make the journey.  To be an American, worshipping my God, expressing my opinion, loving who I love, standing up for those who can not speak for themselves, helping others by being their doctor, supporting causes that help the less fortunate, speaking out against hate, calling out hypocrisy, calling out the lies -this is why David and Marie crossed the ocean.

They made me an American.  Because of their sacrifice, I am deeply rooted in the American dream, to never let the quest for individual freedom die, no matter the cost.

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Suicide Dissolution

Trigger warning:  This post discusses suicide, if it is a subject that triggers you, please do not read this post.  If you are suffering from depression, having thoughts of suicide, please seek help by calling the Suicide Prevention Hotline 1-800-273-8255


imagesI only know one person that committed suicide.  He was a patient of mine.  There were plenty of patients over the years that had tried, but all of them were unsuccessful.  Except for him.  Over the years, whenever suicide becomes big news, my mind often goes back to him.  I search all of my recollections of meeting him in the office, talking about his job, his family, his military experience, and I never once suspected that he would take his own life.  Never.  Once.  He never seemed depressed, never admitted to being depressed, never expressed any feelings of desperation, isolation, loneliness, sadness, or rejection.  He was pleasant, likable, even a bit jovial.

Someone in the office saw the headlines in the local paper and told me that he had died.  I couldn’t believe it, I had to see for myself, the article read:  Suicide.  I instantly called his wife.  She was inconsolable, she could barely speak.  I knew there were no words, but I wanted her to know that I was there for her.

I think about him then and now and wonder, was there anything that I could have done to save him?  I knew him well, I was his doctor, and I never once considered the possibility.  There were no clues.  None.  He was the last person in the world that could have done such a thing, but he did it and there was nothing that I could have done to stop it.

I wish there was because I feel like I failed him.

My sweet lovely husband and I have been talking about suicide a lot lately since the recent slew of celebrity deaths.  My husband’s gentle demeanor and upbeat personality can not fathom the spiritual and emotional black hole that sucks the life out of a human being.  He had a lovely childhood, with lovely parents, a warm bed, clean clothes, church 2-3 times a week.  He knew kindness, community, a higher power, gentleness, and comfort.  Not everyone is so lucky.  Not everyone experiences life in these terms.

Life can be hard.  Not just hard, but downright cruel, wrought with evil.  Life can take you to places that undermine your sanity, leave you reeling, wondering, what is this all for?  It can feel like a Godless place, full of despair.  The people that know you, share this life with you, may never even know what you are going through.  That is the saddest part, really.  People that know you, love you, need you, can be kept from the truth.  They can be kept from the chance of saving you. It’s not fair.  Suicide is unfair.

If someone comes into the ER with chest pain, at least I have the chance of saving them.

The only chance we have is to be kind.  To everyone.  All the time.  We have to change the  societal discourse that is willing to encourage the killing of strangers with guns, remove children from foreigners seeking asylum, throw insults anonymously over social media, allow children to go without food or medicine, hate people that don’t think like us, love like us, look like us.

We have to care about each other, the planet, and above all, we have to value life.

 

 

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For the love of nurses

nurses-uniformI passed the boards, in case you were wondering.  It’s a relief.  I don’t have to think about that again for 10 years.  Who knows, by then I may be retired.  Or a famous writer.  Or still doing the same thing I’m doing now, the job I love.  I have found a new delightful rhythm in my work.  It feels refreshing instead of draining.  I am on the other side of something sinister.  My steps feel lighter, my laugh less restrained, my love for this work blossoming.  I have my favorite nurse back in a new place and it makes all the difference.

My husband recently said something genius, “you are only as good as your worst nurse,” and he’s so right.  Physicians often feel very alone and isolated, our life and death decisions are made in our own heads, the consequences resting on our shoulders, the burdens felt in our hearts, any bad outcomes solely for our conscience, but I’m never truly alone in my work.  There are so many people that I depend on and need to help me do the best job possible for the patient.  I can’t do it alone.  Being alone is exhausting.  When the people that I need to help me do my job instead work against me, it’s a perfect storm for burnout.

A lot of the time, I get all the credit.  The relationship is built predominately between me and the patient, I am the one they want to talk to on the phone, the one that gets all the accolades when things go right, the one that gets the baked cakes and Christmas cards.  Like my husband said, I’m only as good as my worst nurse, and I have the best nurse, she makes me look good.  She makes me a better doctor.

There have been times that I haven’t given nurses enough credit.  Sure, sometimes they can be annoying, offering their own advise to patients that may not be exactly what I’d say, taking it upon themselves to diagnose an illness (thus taking away my thunder), forming their own special relationships with the patients, offering advise on tests to order, pointing out medication errors, and just plain doing a good job for the patient.  For a doctor, trying to navigate a strange field where our degrees and our licenses allot us great responsibility and great rewards, but come with great sacrifices and great burdens, sometimes it is difficult to allow a nurse to have his/her say.  It is hard to give them the credit that they deserve, to admit how much we need them, or to recognize the depth of knowledge, wisdom, and experience that they possess.

I have the best nurse.  I know this for so many reasons, but recently it was because she showed me she cares for these patients as much as I do.  When one of our patients recently passed away, we both got tears in our eyes and reminisced about him.  He was just as much her patient as mine.  He touched her heart and I discovered that I’m not the only one who carries the burdens of this job.

I trust her implicitly.  She has the best interests of the patient at heart and therefore, my best interests.  She’s my right hand.  Nurses are life saving, not only for the patients, but for the doctors too.  My nurse is the best.  I am so grateful to work with her.

 

 

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Be Kind, Unwind

Unknown-1The unwind.  That’s where I find myself right now.  It’s this strange process, like a colon cleanse or some such shit, whereby I untangle myself from the trappings of my job, just briefly, while on vacation.  This unwind doesn’t last. It really never processes to completion, anyway.  In fact, it’s kind of a tease.  I can never truly unwind myself from this work.

On the agenda today, the one and only house cat museum in America and the train wreckage from the movie, The Fugitive.  Both happen to be located in Sylva, NC, about a 2 hour drive from our home.  I’ll drive, the kids will be in the back of the minivan, arguing about movie choices and snacking, contributing to the layers of crumbs that have accumulated on the floorboards.  Which reminds me, I need to find time to vacuum the minivan before I go back to work next week.

Tomorrow, a cat cafe in Charlotte and a train museum in South Carolina.  Do you sense a trend, yet?  Cats and Trains.  This is how I will unwind.  Not because these are my choices, but my kids’.  The youngest likes cats, the oldest likes trains, so I oblige.  They are off for Spring Break and I took the same week off from work so that we could go on adventures together.  If it were up to me, we’d be in Bath, Beaufort, and Ocracoke following the path of the pirate, Blackbeard, as he traipsed through NC, but my kids nixed that idea.  They said it was too scary, so we stayed home taking day trips about cats and trains.  I accidentally mentioned a ghost tour in Beaufort and that was it for them.  Nope.  Don’t want to go.  I wouldn’t have made them do the ghost tour, anyway.  Little turds.

I have already been in my work computer this morning to make sure there weren’t any pressing messages.  So much for the unwind.  12 messages, 15 med refills, 10 lab results, 1 patient email.  Don’t they know I’m on vacation?  It really never ends.  Maybe that will be the worst of it.  Mondays are usually insane, it can only get better from here.

I plan to check my computer every other day, but this part of me, the part wound the tightest can’t rest until I know there is nothing “bad” waiting for me.  I just need to know. I just need to fix it before someone gets hurt.

I know I’m being a bit over dramatic. It’s part of the unwind.  It resists.

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Wrinkles of Time

51NL8VCyZqL._AC_UL320_SR210,320_My favorite childhood book was A Wrinkle in Time.  I don’t think it was because the story was anything special, but because my favorite person in the world told me it was her favorite story.  She lowered herself to my level, looked me directly in the eyes, the eyes of a 10 year old who didn’t know anyone really even saw her and said, this is my favorite story ever, and I want you to read it.  

She handed me the book, her copy, worn and tattered, dog-eared with the binding bearing the grooved lines of having been open and shut numerous times, lying face down on a night stand awaiting the reader to return at daybreak.

I read the book, the first book I had read all by myself.  I read it in secret, not because my parents wouldn’t approve, but because they really weren’t paying much attention to me anyway.

I loved the story because I loved my teacher who lent me her own personal copy.  She was so integral in my life at that time.  My home life was not particularly calm.  In fact, most of my memories of my home life back then were my mother anxiously anticipating my father’s level of drunkenness and therefore deciding whether we needed to stay at a hotel or if it was safe to sleep in our own beds that night.  I kept a duffel bag with pajamas and school clothes next to my bed just in case.

There is very little about the original story that I remember as an adult, but it still remains my go-to “favorite” book.  I just remember a missing father and time travel.  A missing father seemed less of a nightmare to me at that time, maybe because I welcomed the idea.

When I heard that a movie was being released, I jumped at the chance to revisit the story, but this time with my own children, ages 7 and 9.  We have been reading it nightly for the past month or so.  I’m not sure if this was a mistake on my part, as I haven’t enjoyed it as much as I thought I would.  I really can’t put it to words, but now I am reading it with an adult mind, one that has escaped such a childhood, one that has made amends and even friends with a father that once tormented me.

I am reading it with a mind that remembers my favorite teacher getting a divorce, changing her last name, and dying from breast cancer.  The weirdest thing I can say is that I still remember how she smelled when she would bend down to my level, look me in the eyes, and tell me how proud she was of me.  She smelled like gardenias.  She was my favorite person.  After she died, they named a road after her.  A road that ran passed the middle school where she taught in her final days.  She must have been other students favorite person, too, to have a road named after her.  I wonder how many of them were lucky enough to read her copy of A Wrinkle in Time.

Secretly, I hope none of them had the luxury, I hope that I was the only one.

 

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Board to Death

UnknownEvery 7 or 10 years, I have to retake my medical boards.  I am currently board certified, but have to prove it over and over again throughout my career.  If I jump through a bunch of hoops, like taking certain designated classes, performing modest in-office studies, and accruing a certain amount of CME between board tests, then I get to retake the boards every 10 years.  If I fail to jump through these hoops, then it’s every 7 years.

If I don’t take them at all, I can still practice, but I lose my board certification, and likely if employed (which I am), I could lose my job.

Sounds so boring, right?  Let me tell you, it is.  Studying for the boards is awful.  The last time I took them I was newly married with a bun in the oven and just starting my career.  I had time.  I had energy.  Now I’ve got 2 rowdy kids, with lots of nighttime activities, and a busy practice.  It’s harder to study now.  I’ve gotten old.

You’d thing just being in practice for the past 10+ years means studying is not necessary.  Isn’t every day just a series of pop quizzes for the boards?  Sort of.  Except answers to questions on the boards don’t always translate to how one practices in the real world.  For instance, an MRI might be the right test to order to diagnose a particular illness on the boards, but in real life, the insurance company won’t pay for it, so one orders the ultrasound instead.  So I have to study for the test so to speak.  What would the right answer be for the boards, not for real life.

The worst part would be to fail.  It could happen, you know.  I could get cocky.  I could be lazy.  I could blame my failure on the stressors surrounding this time, like the recent move from a practice that I was in for almost 11 years to another one closer to home, not necessarily because it was closer to home, but because the alternative was intolerable.

Staying was worse than leaving.  Leaving was intensely emotional and stressful, not only for me, but for my patients, for some of my previous staff, for the new office, their staff, their providers, and all the administrators that facilitated the move, but it was preferable to the stressors of staying.  It was hard, but it was worth it.  The move happened right smack dab in the middle of studying for the boards.  It happened without much of a plan and it happened quick.

There will be another move at some point.  I keep saying a year, but who knows.  I have been working with my employers for a while, expressing my desire to move my practice closer to home, sending them pictures in emails of offices for sale or rent in my town, meeting with them over meals, discussing the benefits to the corporation of having a practice closer to them, too.  Finally, they emailed me back.  None of the locations I had sent them all summer long were appropriate.

Instead, they were going to build a practice.  They sent me the plans.  We met and brainstormed ideas on how to best use the space.  I asked for a “multi-purpose” room for lectures and meetings, but mostly for group yoga.

But it would take time.

In the meantime, I have my boards.  I need to pass my boards.

 

 

 

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Shamrock Shootout

images-1My daughter is 7.  She is in the first grade.  It’s a sweet time of life because she still likes me and she still wants to be seen with me.  In fact, she requests my presence the mornings that I drop her off at school.  She wants me to walk her to her class instead of dropping her off in the car line.  I walk her to class and she always gives me an awkward side hug before she goes inside.  It’s hip to hip with an arm barely slung over the back.  It’s kind of pitiful as hugs go, but I don’t push it.  I want to embrace her, even give her a kiss on the cheek, profess my undying maternal love for her, but I resist.  I relent.  She’s building street cred and I don’t want to get in the way of such important work.

I’m not entirely sure how the awkward side hug came about because we are full frontal huggers in this family.  We hug for too long, no one giving up their end of the hug before the other.  I guess that’s another version of an awkward hug.  We are the kind of huggers that hold tightly, loosening the embrace to sense the integrity of the hug from the other person, but not fully letting go.  If their hug remains steadfast, well by golly, we re-squeeze.  This could go on for a while.  Too long, if you ask me.  I often push away first.  You are suffocating me!!  I think my husband started this, because he hugs forever.  It’s totally awkward.  And it drives me crazy.  I think he finds humor in the squirming that the hugger (him) causes the huggee (me).

I walk with her to class and she typically hangs up her jacket, her back pack, and her lunch box.  She pulls out her notebook, water bottle, snack, and balances them in one arm while giving me the awkward side hug with the other.  Then she bounces into class without a backward glance or goodbye.  It’s the same thing every time.

The kindergarteners are in the room right next door.  I often watch them come and go, their mommies and daddies shuffling them to class, their teacher greeting them only the way a kindergarten teacher can, dressed in full holiday attire -right now it’s all green for St Patrick’s Day, with leprechaun-inspired headband (imagine rainbow with a pot of gold on top of her head held steadfast and immobile), a glittery shamrock t-shirt, and green leggings.

While I waited for my daughter to unpack her things, the kindergarteners appeared to be all in a tizzy.  Something had happened in the night!  All of their chairs were stacked on top of their desks!  How did this happen, they asked?  The Kindergarten teacher, dressed for the occasion, told them about the Leprechaun that must have wreaked havoc in their classroom in the middle of the night.  She explained that they were going to devise a trap to catch him, but he was smart and quick, a mischievous sort, harmless, but prone to causing trouble.  They buzzed with excitement, each of them shouting out ideas simultaneously for the trap that they would build to catch him.

Each day, another incident would befall the Kindergarteners.  One day the chairs were lined up in the hallway, another they were piled haphazardly where they hung their backpacks.  They just could not seem to catch that leprechaun!

In the midst of the leprechaun’s antics, it occurred to me that some people have proposed that teachers be trained to carry and then potentially use a gun to protect their students while in school.  Teachers like this kindergarten teacher with her green leggings and silly hair accessories, with her overly bubbly and energetic personality, with her whimsy.  Could I imagine this woman concealing a weapon on her person?  She’s the kind of teacher where the kids leap into her arms and give her great big hugs.  How would a weapon in a holster affect that kind of relationship?  Would hugs be off limits?

I tried to imagine her with her green glittery shamrock t-shirt, grabbing her gun in both hands, aiming at another human being and pulling the trigger.  Can the same person that dreams up leprechauns to inspire the imaginations of her 5 year old students be willing or able to shoot a gun while her frightened wards huddled in the corner?  Even if she could, would her pistol, likely held in trembling hands, fire a bullet that would hit it’s intended victim?  What if a child were killed instead?  What if the perpetrator had a more powerful weapon, she would be outgunned, out-trained, and all that cost, all that fear, all those awkward and avoided hugs would be for nothing.

Kindergarten teachers should be kindergarten teachers, not trained marksmen, killers, judges, and executioners.

My daughter was ready to go into her first grade classroom.  She went to give me that awkward side hug again, but this time I stopped her.  No, I want a real hug.  She gave me that side-eye of hers that albeit cute now will probably become rage-inducing when she is a teenager.  She sighed, put her notebook, drink, and snack on the ground and allowed me to give her a proper hug and she gave one right back.  Then she picked up her things and bounced into class without turning around or looking back.

 

 

 

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