Author Archives: Abi Schildcrout

A Letter to a Young Writer

So.

Doug and I have grown three pretty amazing people. Mostly by luck, but we’ll take credit for having introduced them to good music and the great outdoors, and for teaching them to cook and to change a tire.

One of the best side effects of growing these people is that they end up finding other amazing people and bringing them into our lives. They’ve brought us a nice bunch of extra humans to love.

One of these delightful bonus kids is Caroline, a brand-new college graduate with fantastic culinary, percussion, and theatrical skills. She is also a writer. Her latest blog post deals with sensitive personal medical issues and she does an excellent job of explaining the clinical aspects. Her account is raw and honest. She also touches on doctor-patient relationship and communication issues, and she has kindly given me permission to weigh in on these. (You can read her post here – you’ll want to keep that tab open so you can click through and read more of her posts later – she’s a great storyteller).

Dear Caroline,

In your post, you share openly about experiences with very personal gynecologic issues, and in doing so you give other people the power of knowledge to seek help for themselves. You describe some interactions with doctors that are far from ideal, far from helpful, and which need to be addressed.

One can read what’s behind your words. Your title: “My Vulva is Melting (And Yours Might Be, Too),” was developed because of the shock/impact your physician’s specific word had on you. You put a picture of a slightly melting ice cream cone in the part of your story where you relay your doctor’s words. And you repeat the word “melting” a few different times. It obviously (and understandably) disturbs you.

Doctors learn a whole language of medical terms. We learn to speak precisely with this language. And then we learn to translate it back into language our patients can understand. Sometimes the translations leave something to be desired. What your doctor was describing is called “adhesions” – tissue can adhere to other tissue and become permanently attached. This is what your doctor meant. By trying to simplify medical terms, your doctor conveyed a confusing and upsetting image. Thankfully she was later able to explain what she had meant, and I am glad that she is helping you deal with your medical issues.

Several parts of your story hearken back to experiences with prior doctors, ones who do not seem to have been successful in positioning themselves as listening, caring, medical professionals who were in your corner. This is not to say that they weren’t, but they did not succeed in convincing you that they were.

When you describe an episode in high school in which mononucleosis caused gynecologic symptoms, you describe your doctors as not believing you (they were sure you had an STD even though you had told them you weren’t sexually active). You put a GIF in your post describing doctors as sadists who like to watch lesser people scream, and the caption of that GIF describes the physician doing a procedure roughly, as if to be punitive. It was humorous – you frequently use humor in your writing, and it’s humanizing and wonderful. But there are elements of truth behind much humor, and I worry that you thought a doctor was trying to hurt you or didn’t care that they were causing you pain.

I believe fully that this was your experience. And I highly suspect that this was not what was in the brain of the doctor.

My medical school class had 300 students. I knew most of them. One was an irredeemable asshole. The rest genuinely were there because they wanted to help people, but some didn’t have the best communication skills. I have found a similar pattern among the practicing physicians with whom I have worked. In fact, the doctor assholes are generally assholes to other doctors who they believe are not doing the right things for their patients. The overwhelming majority of doctors really do care about and want to help their patients, and they dedicate an enormous proportion of their lives to doing so. But sometimes they suck at parts of it.

Doctors are trained to look at signs and symptoms of a patient and synthesize everything they’ve learned in in-depth academic and clinical courses to come up with a differential diagnosis – a list of things that could be causing a patient’s presentation. Docs are taught that, in general, hoofbeats mean horses, but occasionally there’s a zebra. If it looks like a duck and quacks like a duck, most of the time it’s a duck. But not always.

If a doctor suspects an STD in an adolescent, it would be gross malpractice not to test for one, no matter what the patient says about risk factors, because missing that diagnosis could result in irreversible long-term sequelae, such as permanent infertility. Or severe systemic infection. And, for a variety of reasons, people frequently don’t give their doctors the full story (and a large proportion of sexually active teens deny sexual activity if they think their parents could find out). It’s simple to check and rule out an STD that could have potential devastating consequences. But that needs to be done in a way that respects the patient so that she feels she’s believed and listened to. “I know you told me that you’re not sexually active and I believe what you tell me. Because this looks so much like X, I’m going to test for it even though the fact that you’re not sexually active makes it very unlikely. I am looking for other causes, too, and I need to be complete.”

As far as the rough, painful specimen collection, there is of course a chance that the gynecologist was a sadistic asshole. But the far more likely scenario is that the doctor had not established trust and didn’t talk you through the procedure. I suspect it would have made a difference if the doctor had said, “Those ulcers are probably quite tender, so when I swab them to send some cells to the lab to figure out what it is that’s causing this, it’s going to hurt. I am using a soft, cotton swab, and I will be as gentle as I can be, but it may feel to you like I’m using sandpaper. I’m sorry that this is painful – I want to figure out exactly what this is so I can help you get better.”

In describing seeking help from a previous gynecologist for symptoms related to your new diagnosis, again there seems to be a deficit in communication. It seems that the doctor may have only been suspecting horses of making the hoofbeats, or at least the doctor didn’t let you know that other causes were being considered. It’s the doctor’s job to come up with the differential diagnosis, but sometimes it helps if a patient asks, “what else could this be?” – then you know what else, if anything, the doctor is thinking about.

When you reported to that doctor that you had pain during sex, the doctor made sure to tell you to stop your partner if you were in pain. Your response in your piece (not to the doc) was the equivalent of “no shit, Sherlock.” Yup. It’s all well and good to advise a patient not to do something that causes pain, but if a normal activity causes pain, it needs to be evaluated thoroughly. A reported symptom needs to be addressed. Perhaps your doctor would have investigated further had you not politely let it go when you received a “’Doc, it hurts when I do this,’ ‘So don’t do this’” message – a request for more thoughts might have prompted more response. “I of course stop when it hurts. But it’s not supposed to hurt. I’m not doing anything rough or unusual. What are your thoughts about why I might be having this pain?” might help a doctor who’s overwhelmed with patients stop for a moment and really focus on the one in the room. (Please note – I’m not at all “victim blaming” here – it’s absolutely the doc’s job to do all this anyway, but doctors are under significant pressure and sometimes a gentle nudge goes a long way).

Your advice to your readers is to listen to their bodies and investigate anything that seems abnormal for them. You balance this with a caveat against self-over-diagnosis. I second your advice wholeheartedly. Advocate for yourself. Don’t walk out of your doctor’s office if you don’t understand what was said to you (by the way, I’d be happy to discuss ureaplasma with you), or if you don’t think your issue has been heard and addressed. There might not be an immediate answer, but there needs to be a plan in place to find the answer and address the issue.

I also highly suggest that those on their way to becoming doctors listen to these stories. They need to hear their patients. They should be writers themselves – understanding the importance of words, understanding the importance of pictures, and always thinking about how their patients may be hearing them.

Thank you, Caroline, for sharing your stories. People are learning more from you than you know.

Some People Don’t Listen

My official medical advice is to avoid hot tubs. Always.

They’re germ soup. The temperature is perfect for bacteria to thrive and multiply. You can get some nasty skin infections from going in those things, it’s possible to get lung infections from pathogens aerosolized by all the bubbling, and heaven forbid you should get that water in your mouth.

Just say no. Period, the end.

So after my workout this morning, I got into the hot tub at the gym.

When you’re a doctor, you’re always weighing risks and benefits. You’re uber aware of risks. It’s such a bedrock of the years of medical education and training that it becomes ingrained, automatic, a reflex, to think of what can go wrong with any decision you make and how you could kill someone. You’re also weighing how any decision you make can help someone. It’s a balance.

Anyhoo, back to the hot tub.

I recently decided to kick my fitness routine up a few notches. I pushed it a little too hard, and a few days ago I pulled a muscle.

Nothing like doing that to make you feel old.

I rested it a couple days and got back to my workouts yesterday and today. And today’s workout finished in the pool. Right next to the hot tub.

My muscle was a little sore. And the pool was a little cold. And the jets in the hot tub were on. And I knew how good it would feel to get in that hot water and hold my sore muscle near a jet.

I thought about the likely bacterial level. And I thought about how I see gym personnel checking pH levels and adding disinfectant regularly in both the pool and hot tub.

I thought about potential skin infections. And I thought about the fact that I haven’t shaved my legs since two days ago so probably didn’t have any micro-nicks in my skin where bacteria were likely to get in.

I thought about potential lung infections. And I thought about the fact that I have a good immune system and healthy lungs.

I thought about the potential of accidentally getting any of that water in my mouth. And I thought about how easy it would be to keep my face out of the water, and that no one was splashing.

I got in. And put my sore muscle against the jet. And stayed there a good 10 minutes.

And damn, did it feel good.

And it stopped the soreness.

I got out, took a shower (I may or may not have soaped up a second time), got dressed, and went on with my day.

Glad that today I did not follow my own medical advice, and will let you know if I end up with hot tub lung.

New Year Wishes

May your last few hours of this year be relaxed and happy, whether that be reveling with family and friends or snuggled up on the couch in pjs.

May your new year be filled with triumphs big and small.

May you have enough challenge that the above triumphs mean a lot to you.

May those who are mean to you develop recurrent hives.

May your teams win, unless they’re playing against the University of Michigan. Or unless your team is Ohio State or Notre Dame.

May your family members tease you about your teasable traits, and may you come back with your comebacks in the moment, not hours later in the shower.

May you find really good recipes that make kale, quinoa, and other stuff that’ll make you live forever taste good enough that you don’t want to die while eating it.

May you see a bunch of really good movies and read a bunch of really good books.

May your favorite Netflix series be renewed for another season.

May you spend enough time in the mountains or on the ocean or in the woods or on a lake or in the city or whatever floats your boat. Figuratively. I know mountains, woods, and cities don’t float boats. Well, Seattle and Venice float boats. But I digress.

May you breathe, love, and laugh deeply.

May the children in your life provide you with multiple moments you’ll tell their dates about in the future.

May your arguments change someone else’s opinion, and may someone else’s arguments change yours.

May you find physical exercise that relieves your stress and makes you stronger. Unless you’re on a Notre Dame or OSU team (see above) – then the stress relief wish holds, but not the making you stronger part.

May the people you spend long times in the car with enjoy the same music you do.

May you dance.

May you sing.

May you learn.

May you grow.

And again, because I cannot stress this one enough, may you laugh.

Happy New Year.

Love,

Abi

A Pleasant Touch of Insomnia

I can’t sleep. It happens sometimes. So I’m downstairs in my parents’ house, reflecting.

Today I’m not annoyed at being awake this early, where normally I would be. Normally, when I do this early-wake-up thing (one of the joys of the hormonal changes of getting older that no one really warned me about), I look at the clock and get really pissed off. I lie there angrily, sometimes for a couple hours, until it’s time to get up. I play with my phone. You know, exactly what I tell my patients not to do.

I stayed up too late last night. I do this frequently when we’re all together. My son’s friend, who is with us for this trip, described it just as I experience it – wanting to be with people means he stays up way later than he should. I, too, am fueled by being with people. At least with people I care about. I probably wouldn’t want to stay up late hanging out with a bunch of assholes. But when it’s MY people, the draw of the social connection is stronger than the draw of my bed. It’s actually stronger than any other draw I can think of.

The four boys and I (and yeah, the “boys” range in age from 18 to 23, and they’re fully men, but from what I can tell about myself, I will always refer to them as the boys or the kids or the babies) went skiing/snowboarding yesterday. It was fantastic – conditions were perfect. It wasn’t crowded, the temperature was in the mid-to-upper-20s, the view was beautiful, the snow was great, and the feeling of flying over that snow was everything it always is. And it was physically exhausting – in that every-muscle-system-got-a-workout, got-my-heart-rate-up-for-hours, laughed-enough-that-my-abs-got-even-more-workout kind of way. So I was tired. I needed a good night’s sleep.

Around one a.m., I fell asleep in front of a movie we were watching together. That happens frequently – the family is together, we’re happy, and I feel so relaxed and content that I just fall asleep while watching a favorite. And of course the being-tired-from-staying-up-too-late probably plays a part. Movie was over around 1:20, and I went to bed and fell asleep next to Doug. A deep, contented, tired, good sleep.

And then I woke up at 6:30.

I talk to my patients all the time about sleep. I talk to my weight loss clients about it as well. I talk to my kids about it. It’s so basic, and yet so many of us don’t do it right.

We just don’t get enough. Adults really do need about 8 hours. It helps with brain functioning. We’re sharper when we sleep well. It helps maintain healthy cortisol levels. Our metabolism works better when we’ve had enough sleep. Our stress levels are better. Our blood pressure is better.

When we don’t sleep well, we don’t function at our prime. We handle stressful situations with less resilience. We put on weight. We don’t remember things as well. Our bodies and minds aren’t at their best.

And I’ve just had a 5-hour sleep.

But this morning I’m enjoying it. I am fully content. There are seven people I love sleeping peacefully under this roof. The view outside the window of the pond and trees covered in a light layer of snow is peaceful. I’ll read for a bit. Eventually others will awaken and join me, and we’ll talk politics and movies and music and sports and people. We’ll play games. We’ll eat. We’ll laugh a lot.

And I’ll stay up too late again.

So yes, it would be better for my health not to wake up early like this. But sometimes these late nights and early mornings are good for my soul.

A Well-Balanced Breakfast

So.

I was frying up some eggs this morning for me and my youngest son. Three of the four were in the pan, and as I tapped the last egg against the side of the pan to crack it, I saw a Huge. Ass. Motherf#@ing. Spider. In the pan. Sizzling in the oil.

I did what any reasonable, smart, well-educated, outdoorsy, nature-loving, competent adult would do: I stood there with the cracked egg dripping into my hand, and screamed.

Andrew ran into the kitchen. “Mom! Are you ok? What’s wrong?”

All I could do was gesture, egg dripping down my arm, to the pan.

He looked. And he did what any reasonable, smart, well-educated, outdoorsy, nature-loving, competent adult would do: he screamed. Well, to be fair, it was less of a scream and more of a really loud “holy shit,” but I’ll count it as a scream for literary purposes.

At this point, the sizzling spider popped loudly. I screamed again. “Do something!”

So my resourceful college sophomore grabbed a couple of spoons and extricated the deep-fried arachnid from the frying pan.

As he dumped the spider in the trashcan, I plopped what was still contained in the open eggshell into the pan.

I tossed the shell into the garbage and washed my hands, as I contemplated the big question: Do we eat the eggs from the spider pan?

Medical analysis: as Andrew pointed out, the pan was full of boiling oil – no spider-trafficked microbes were likely to maintain their pathogenicity.

Human analysis: Ew.

Medical analysis: any potential toxin from semi-exploded spider unlikely to be potent enough in whatever traces might have reached egg to cause any noticeable clinical effect.

Human analysis: Ew.

Practical considerations: out of eggs upstairs, in a bit of a rush, and hungry.

Verdict: Meh.

We ate the eggs. I gave the ones furthest from the spider to Andrew, took the somewhat close one for myself, and tossed out the one that had gone directly onto the spot where the eight-legged creature had actually been. I viewed that as a reasonable approach. You know, from a clinical standpoint.

Anyway, the spider was much worse off for the whole experience than I and my son.

We discussed the situation over breakfast, noting that we all eat plenty of bugs and bug parts all the time, in blissful unawareness.

But seeing it is different.

Our minds are powerful. Our defense mechanisms are powerful. We have the capacity to contemplate our mortality, the vastness of the universe, the complexities of DNA, or the presence of bug parts in our food. But we also have the capacity to put those thoughts aside so that we can get things done and live our lives.

Sometimes something comes along that knocks us out of our blissful, practical-repression-of-stuff state and makes us face our mortality (or a spider). The mortality is always there. We ignore it. The spiders are always there. We ignore them.

Until one drops into our frying pan. At that point, we deal.

Sometimes it’s a little spider. Sometimes it’s a really big one. Sometimes it’s venomous. Sometimes it’s kinda cute. Sometimes we notice its magnificent web. Sometimes it scares the daylights out of us. Sometimes we just brush it away.

And, the vast majority of the time, the spider causes us no harm.

But worrying about the spiders, thinking about the spiders, can be paralyzing.

Some of us live where there are dangerous, potentially lethal spiders. In those areas, it’s wise to take precautions.

We should shake out boots that have been left outside or in the garage before we stick our feet into them.

But worrying about any potential spider in our house? Not practical. Not helpful. And if we’re too meticulous about removing every known spider, who’s going to eat the other bugs?

There’s always a balance. Always a weighing of the pros and cons, the risks and benefits.

The eggs were good. As was the coffee.

We didn’t look too closely in our cups.

A Creep in the Deep

Ick. Just ick. I’m angry. And I feel gross. And did I mention I’m angry?

A little back story.

Late last month I had a “big” birthday – I’ve entered my second half-century on this planet. I’m a firm believer that every birthday is a good one. Each birthday spent in good health is a “win.” I’ve never shied away from telling people my age – it’s just a number. But this one held some gravitas for me. Not completely sure why, but it’s probably multifactorial. Part of it is that I’ve now entered the age of invisibility in the media – ads on T.V. for anything fun feature people my sons’ ages. There’s no beer commercial featuring 50-year-old women having a good time watching a football game. Part of it is that my 40s were really good, and I’m a touch sad to see them go (not that my 50s can’t be just as good, if not better).

So anyway, Doug and I went out of town for this occasion. I made my birthday temporarily invisible on Facebook. It was, of course, lovely to get birthday wishes from family and close friends, but I was not inundated by reminders of my age by hundreds of people who only knew it was my birthday because of a social media prompt. I played my hand close to my chest, deeply enjoyed a vacation with the love of my life, marveled at the beauty of mountains and oceans, and quietly contemplated the fact that women with grey “highlights” like mine have bit parts in television shows as someone’s mom or as some random administrator in a hospital, but almost never a main role.

As kids-these-days say, “whatevs.” Every grey hair on my head has been well-earned, I am deeply satisfied with my life, Doug and I have raised three pretty spectacular human beings, and I have another half-century’s worth left to give to society, both personally and professionally, fun-media-demographics be damned.

And hey, if I’m in the no-longer-sexy demographic, at least I don’t have to deal with unwanted male sexual assholery anymore, right?

Wrong.

Which brings me back to my feeling-gross/icky/angry introductory sentiments.

I may be a bit understated in my descriptions because, as a woman-of-a-certain-age, I of course have a certain level of propriety in my speech and demeanor, so due to my expressive subtleties you may have to stretch a bit to grasp the intensity of my feelings in this story:

I work out in a pool three mornings a week. My regular fitness center was closed today, so I went to the branch in a glitzy suburb a few miles north. I arrived early enough to get in a quick dozen freestyle laps before the Aquafit class started. I pulled up for air at the end of my swim, and took a minute to catch my breath. As I did this, some man was taking down the lane marker so the pool would be ready for the group fitness aqua class. He looked at me, started talking about how he might be screwing the lane line hook the wrong way, and asked me how I was. I said “fine thanks, how are you?” to which he replied (I kid you not): “Much better now that I see your beautiful blue eyes.”

Um, what the ever-loving fuck? I did not know this guy. This was not someone with whom I had a friendly, joking relationship. This was a total stranger in a pool.

I gave a one-eyebrow-raised look of shock, hopped out of the pool, and went to rinse off my goggles before the class started. I got back in the pool, with about 30 other people, as the class began. The guy seemed to know a bunch of the people there. I kept my distance, and noticed him eyeing me not infrequently.

 The class involves a lot of movement and travel around the pool. I’m fairly fast, so was able to stay away from the dude for the first part of the session. Then the instructor handed out the water-dumbbells for the second part. I nabbed a pair, and made my way towards the shallower end of the pool. I was filling my dumbbells up with water as I headed away from the deep area, and noticed I was approaching where the man was now standing. I made a sharp right to go around him, and as I did, the motherfucker reached one of his dumbbells out under the water and hit me on the ass with it.

Again: What. The. Ever-. Loving. Fuck?!?!

I gave him a glare that would have frozen molten lava, and placed myself several people away from him for the remainder of the class.

I have been armchair quarterbacking the play-by-play in my head the rest of the day.

After class, I felt like I could not shower enough – just felt disgusting. Soaped and rinsed three times.

Went to the front desk on my way out and asked to speak with a manager. The lady at the front desk asked what it was regarding. “A creep,” I told her. She stepped to the side with me and asked what had happened. I relayed the story to her. She said she was very glad I said something, and went to get the manager. Told the story to the manager, who also said she was glad I told them, and wrote down my description of the jackass. We looked at a few pictures of people who had signed in that day, but not everyone swipes in and his picture was not there. The manager said she thinks she knows who I was talking about, and would get the sign-ins from last week and will call and have me come in to look at a picture and make an I.D.

So I didn’t let it go, but I should have played this better.

I should have said something about the impropriety of his comment as soon as he said it. When the pig had the audacity to touch me, I should have yelled loudly right then for him to keep his hands to himself. Or given him a punch to the throat. Kind of a toss-up on that one. Or I should have said something immediately to the instructor.

I fed into, and by doing so, contributed (just a skosh) to the fucking rape culture that still fucking exists in this country in 20-fucking-19. I didn’t want to make a scene. I wanted to give his inappropriate comment the benefit of the doubt – maybe he was just socially awkward and trying to be “nice.” And the fucker was really big – at least 6 feet tall and probably 250-300 pounds – I was actually physically intimidated by him and didn’t want to piss him off. So he got away with it. He got to keep his sense of entitlement.

If this prick feels comfortable enough to behave as he did in a natatorium with 30 other people around, what would he have felt comfortable enough to do if he had crossed paths with me in an unpopulated parking lot? What else does this fucker feel entitled to do? Who the fuck does he think he is?

No, it wasn’t rape. Not even close. But it was disgusting. It was threatening. It rammed down my throat a reminder that this world is full of pig-men who think that women exist for their pleasure and amusement. A reminder that rooms full of men make laws about my body, so that if this pig were to rape me, he could be assured that I’d have to carry his child if he impregnated me (and yes, I still ovulate). So I spent some time today contemplating whether, with the current multi-state attacks on women’s reproductive freedom, I and all women who are done having children should take on the risks of having our uteri, ovaries, and Fallopian tubes surgically removed (since nothing else is 100%) to take away some of the potential power of rapists in a society that is moving back towards treating women as incubators and chattel. The repulsive, entitled behavior and the reproductive legislation is undeniably linked.

My eldest son, when I told him about today, asked if I had “kicked him in the fucking balls,” and assured me that he’d immediately post my bail if I were ever in such a situation again and reacted with that particular maneuver. My middle son stressed that this asshole should have no power over me and my feelings – that if I’m upset by him, then he’s won, and I should write and process and then try to let it go and let myself feel strong. My youngest made me lunch and spent the day next to me.

All three of my sons, and husband, and my brother, used the same exact words when I finished telling them about today: they all said “I’m really sorry you had to deal with that asshole.”

Not all men. Definitely not all men. But the disgusting few, that repugnant segment that thrives on wielding their perceived power over others, makes me want to puke.

I’m fine. I will not allow that dick to cause me any more stress (and if I were to feel ongoing or undue stress, I’d be sure to debrief with a professional). I will make sure the athletic club identifies who he is so that it’s on record and if someone else complains about his assholery in the future it will be a documented pattern. Fuck him. And next time I will have the presence of mind to say something in the moment. I’m 50, for fuck’s sake, and I’ll say what needs to be said.

No. No. Just No.

Words matter. Words have consequences. Lies matter. Lies have consequences. People have understood this for a very long time – note the biblical prohibition against bearing false witness against one’s neighbor (that one actually made it into the Top 10 list).

What our current president stated at his recent rally in Wisconsin is false witness, defamation, slander, against doctors. It goes beyond that to incitement. His words, his lying, defamatory, slanderous words, will cause death.

Doctors do not “execute infants.” Full stop.

They do not wrap a living, breathing baby in a blanket and “determine whether or not they will execute the baby.”

This particular outright lie of Donald Trump has painted bullseyes on doctors, nurses, and patients for violent anti-abortion extremists. Doctors may be killed because of his words. Nurses may be killed because of his words. Patients may be killed because of his words. His false words. His slander. His lies.

He has harmed doctor-patient relationships with his slander. His defamatory words drive a wedge between those who have spent lifetimes dedicated to helping others in their times of greatest need and those who need their help.

He has born false witness. He is quite possibly inciting murder. He has put my colleagues’ lives in danger. He has put my patients’ lives in danger – both from direct violence by those agitated by his lies attacking people seeking care, and by alienating patients from doctors who are there to help them.

The blood will be on your hands, Mr. Trump.

It Happens

Spent a big chunk of the afternoon cleaning up shit.

No, this is not a metaphor. We have a dog, and although most of the year we make it a point to clean up the yard daily, it’s been really cold and snowy and rainy and cold and snowy and muddy and cold and rainy and did I mention cold? and I just haven’t been in the mood to do it for a while. And today it’s in the 40’s and dry and actually (I think) supposed to stay warm for many days in a row, and so it was time to get out there and clean up the mess. And today is garbage pick-up day, and although the recycle truck comes early, the garbage truck comes late in the afternoon, so if I got out there and did the turd pick-up quickly enough, I could get it to the curb in time to be taken away from my house today.

So out I went.

The process involves significant risk of stepping on poop land mines, so, wisely, I wore Doug’s shoes (sorry, Dougie, but you weren’t home and your shoes were conveniently located at the back door and I love you!).

In my “reduce/reuse” effort to decrease our plastic impact on the planet, I save produce bags and newspaper delivery bags to pick up after our pooch, and I filled up quite a few.

So here come the metaphors (you knew they were coming):

Health? Life? Politics? Let’s throw in a little of all of the above.

We’ll start with the produce bags: onions, broccoli, and zucchini in, poop out. So the produce bags can be a metaphor for intestines. And we’re discussing chores we don’t necessarily want to do. Perfect segue for an update on the American Cancer Society’s colon cancer screening recommendations. They now recommend that people of average risk for colon cancer begin screening at age 45 (the old recommendation was 50). Gold standard for screening is colonoscopy (starting age 45 and then every 10 years for the average-risk folks). Those at higher-than-average risk likely need to start earlier and do it more frequently. The prep isn’t overly pleasant, but it’s way better than late-stage colon cancer. So talk to your doc about it. This public service announcement brought to you by a bunch of canine backyard bowel movements.

Moving on:

It’s fairly easy to be methodical in the collection endeavor, as our pup is quite consistent in his tendency to defecate along the periphery of our property – he’s an edge-pooper. For the most part, I knew where to look: within a foot of the fence. This is true for most of us. We learn when and where to expect crap. Yes, every once in a while, there’s a big steaming pile in the middle of the lawn where you don’t expect it, but by and large, in the day-to-day, it’s where it usually is. There’s a lot of traffic at rush hour. There are long lines at Trader Joe’s the day before the Super Bowl. You don’t get as much sleep as you’d like when you have exams or when you’re on call. Your spouse is snippy when he/she is under stress. You expect it. You plan for it. You deal with it. It might not be pleasant, but it’s not surprising.

Along the perimeter of our fence we have all sorts of perennials – day lilies, crocuses, hydrangeas, peonies, various other pretty green and/or flowery things that I don’t know the names of. And under the piles of fecal matter I found a plethora of green shoots. The icky and the good are right up next to each other. The fertilizer feeds the flowers.

Much of the excrement has been through multiple freeze-thaw-get-rained-on-and-snowed-on-and-frozen-again-and-thawed-again cycles, and although you can certainly tell that it’s shit, it’s not fresh shit – a lot of it is really dried out and actually somewhat easy to scoop up and most of it doesn’t really even have much of a smell. When life throws general crap at us is can seem pretty awful at first. The fresh stuff stinks – we should pick it up right then and get rid of it, because if you step in it, it embeds in every crevice of your shoe and you have to do the twist on the grass to get the big chunks off and then bring the shoe straight to the utility sink and scrub the rest out of the treads. But if you’ve just stayed away from the crap for a good part of the winter, it might not be so bad when you come back to deal with it later. Works for some things, not necessarily others. Breast lump? Deal with it now. But some things that seem like a big deal right now turn out not to be such a big deal through the lens of time.

Of course, we’d never leave our dog’s waste on the ground when out walking – you don’t leave that for someone else to step in or have to clean up. But we don’t always afford ourselves the same courtesies we give to others. Maybe we should.

I seem to recall I said I’d find a way to tie this to politics as well. I used a bunch of newspaper bags. Need I say more?

Truth be told, I only got around 40% or so of our property’s perimeter-o-poop (there was only so much I wanted to deal with at one time), so will head back out later today or maybe tomorrow. My shoes (well, Doug’s shoes) are clean for now.

It Could Have Been Worse

Well, I just had a relatively shitty morning. But it could have been a lot worse.

I have a lot in my head these days – plenty that’s good (like starting a new business venture with another doctor), but quite a bit that’s not so good (relatives with health concerns, multiple friends with significant health crises in their families, a friend who just lost a sibling), and I’m a little tired. My brain is doing a lot of multitasking.

Our dog’s annual checkup/vaccine visit was scheduled for 9 o’clock this morning, and he gets very stressed out at the vet’s office (read: “wont-even-step-on-the-scale-so-I-have-to-lift-and-hold-my-60-ish-pound-dog-while-I-weigh-us-both-together-and-then-weigh-myself-and-subtract-my-weight-and-then-heaven-forbid-the-vet-should-try-to-look-in-his-ears”). So I started to think about how much I hoped he wouldn’t stress too much, took him for a walk, and seat belted him into the car for the 20-minute drive. Perfect timing, since it was 8:35 when I left the house.

Except it wasn’t perfect timing, because the freeway is under construction and they closed the exit ramp that I needed to take to get there. Not a huge deal – I’d have to take a later exit and wiggle back to get there from another direction – GPS would get me there just fine. I called the vet’s office to explain what happened and tell them we’d be a few minutes late – they said “no problem.”

Thought about friends’ family members. A few miles later, there was an open exit ramp. I took it, and started using my internal sense of magnetic north to navigate until the GPS recalculated.

Again, no problem. Cell signal was strong. Map was on the screen. The little blue circle representing my car was on the blue preferred route. I glanced down occasionally at the navigation as we made our way to the vet’s office. Thought about the condolence call we’d be making this evening. Thought about the website copy I needed to complete today. Thought about the talk I’d be giving tomorrow to the Science National Honors Society at the high school my boys graduated from. I had a lot to do.

And then the map shrunk down to a tiny little box in the bottom corner of the screen. No clue why it did that. Glanced down and tapped the little box with my thumb. Eyes back on the road. Thought about my friend’s father.Glanced back at the phone – map still tiny. Crud. Eyes back on road. Tapped at the tiny map square again. Eyes back on the road. Thought about the new business bank account I needed to open. Glanced down – map still tiny.

Of course, what I should have done was pull into a parking lot and figure out what my phone map was doing, but what I did instead was continue to repeat my same action while expecting a different result. I didn’t have time.

Eyes on the road. Glance down. Tap. Eyes on the road. Glance down. Tap. Eyes on the road – oh SHIT. The pickup truck in front of me was stopping because there was a bus stopping in front of him.

Slammed on my brakes. Hit him anyway.

We pulled immediately into the driveway/parking lot of a bank. It took all my strength to turn the wheel – the power steering was dead. I jumped out of the car as he exited his and asked immediately, “Are you OK?” “Yes, are you?” “Yes. I’m so sorry.”

The front of my 14-year-old minivan was hemorrhaging red liquid onto the ground. I started to smell something burning and realized I hadn’t turned off the engine, so I immediately turned it off. Our dog was sitting calmly in his seat.

Called the police. Stared at my bleeding car. Looked at the hole that was punched in my front bumper by the trailer hitch (now slightly bent) on the back of the other guy’s pickup truck.

And now there were no other thoughts intruding on the issue at hand. Nice timing, brain.

Police officer showed up, took our info, and was just generally really nice, as was the guy whose truck I hit. Called my husband, told him what happened, and asked him to call the vet’s office for me.

Called our car guy (when your family’s “fleet” consists of vehicles that range in age from 6 to 22, you have a car guy), who told me where to have it towed. Called AAA, who told me a tow truck would be there within an hour.

The police officer stayed until I knew the tow truck was on its way. He offered to drive us up to the vet’s office (about a mile away), but I needed to stay with the car until the tow truck arrived. The officer gave me his card and told me to call if I needed any help with anything.

A woman pulled into the bank parking lot to use the ATM. She saw me and asked if I was OK. I said yes and thanked her.

I called the vet again, and they said they’d fit our dog in whenever we got there.

After just a couple minutes, someone from the towing company called and said he had a truck nearby that would arrive within five minutes. It arrived within three. The driver was also extremely nice – offered to drop us at the vet’s office, but my dog did not want anything to do with going up the steps into the truck (and I was NOT about to attempt to carry him, struggling, up them – picture, if you will, a 60-pound bucking bronco with nails that need to be trimmed). So I paid the tow truck driver for the miles-beyond-which-AAA-covers and started the walk to the vet’s office.

I may not have mentioned that it was about 25 degrees. My hands were frozen. I stopped at a store along the way, where the employee kindly allowed me to bring the pup inside for a moment to warm up.

I may also not have mentioned that one of our other cars (the 1997 model) is in the shop, so My husband didn’t have a car at work. One of his colleagues lent him his car so he could meet me at the vet’s office and bring me home. His colleagues also changed the location of their afternoon meeting to be near where we live so that Doug could get there easily.

I still had to pick my dog up and weigh the two of us together and then subtract me, but he is fully vaccinated and healthy.

The collision shop has managed to find used parts for the bumper replacement. The red liquid was not coolant – I had just squashed and punctured the power steering fluid line. I should have a functional car back by Monday.

It could have been a lot worse. I could have caused an injury. The repairs could have ended up costing a lot more. Any of the people mentioned in this story could have been unkind.

So it allows for perspective. Because of my line of work, and because I and people around me are all getting older, I am frequently exposed to people’s sadness, worry, pain, and frustration. It can really get stuck in my head, because my drive is to fix it. And when it can’t be “fixed,” I still want to make it better. So sometimes I think about it more than is helpful. Sometimes, like last night, I lose sleep. Sometimes I think about it when I should be getting other things done, so I end up thinking about getting those things done when I should be thinking about the smart thing to do when my GPS screen shrinks.

Perspective. Priorities. I can’t let thinking about the big things get in the way of thinking about the little things, because a little thing, like driving to the vet, has the potential to become a big thing. Perspective. Priorities. Even when you can’t change what’s happened, you can change the experience of those it’s happening to by being kind. I called the towing company to tell them how helpful their towing guy was. I called the police chief to tell him how helpful and kind his officer had been. Perspective. Priorities. Allowing the stress of being late and of having things to do cloud my judgement so much that I thought it was reasonable to try to fix a GPS issue while driving caused worse issues than just being a little behind schedule and could have caused much worse still.

I’ll consider this a wake up call. And I hope that, if you need it, my morning can serve as a wake up call to you as well, so that you don’t need your own.

It’s Complicated. That Cannot Stop Us.

I am a medical doctor. I was trained to look at a whole person, to evaluate and assess every human system – renal, cardiac, digestive, circulatory, hormonal, neurological, psychiatric, social, immunologic, and many others – and to keep my eyes and brain open to systems I might not think of at first. I was trained to think clinically, empathetically, and ethically. I was trained to advocate for my patients, to serve in their best interests at all times. I was trained that “hoof beats mean horses,” but to look for the zebras. I was trained to ameliorate symptoms while working to correct underlying disease and to look for ways to prevent disease from occurring in the first place. I was trained to recognize that causes of illness are multiple – that there is an interplay of genetics and environment, of biology and social factors, of pathogens and immune responses. I was trained to attack each of the underlying causes while looking at the whole person and keep his/her overall well-being in mind at all times. I have been trained to look for cause and effect, to understand human processes from the molecular to the sociological, to weigh risks versus benefits, to use scientific knowledge combined with psychological understanding and empathy to work to relieve suffering, and to work to provide the conditions that will be most conducive to health. It’s complicated as hell.

I am a parent. I was trained to distinguish my children’s hungry cries from their “I’m in pain” cries from their tired cries and many others – and to keep my eyes, ears, hands, and brain open to cry causes I might not think of at first. As my children grew, I was trained to listen not only to their cries and their words but also to what they did not say. I was trained to control my emotional thinking and combine it with my rational thinking while at all times keeping my children’s long-term well-being in mind. I was trained to recognize that there is an interplay of genetics and environment, of personality and friends, of strengths and stress. I was trained to combine my scientist’s mind with my mama bear instinct with my understanding of risks and benefits to work to provide the environment that would be most conducive to my children’s healthy, adjusted progression to adulthood. It’s complicated as hell.

I am a human. I have been trained to look at society globally and locally. I have been trained to rejoice in the goodness of humanity and to balk at the evil. I have been trained to recognize the interplay of psychology, sociology, religion, economics, philosophy, politics, technology, and more in how they promote good and how they promote evil. I have been trained to consider the risks and benefits of the manipulation and modification of all of the above. It’s complicated as hell.

I watched the footage two days ago of the high school in Florida with a lump in my throat, a rock in my stomach, and tears in my eyes. I watched and listened to the video taken by a hiding student and heard the gunfire that went on and on and on and on and on and on and on while children screamed. I now read the words and hear the voices and watch the faces of those grieving, of those lamenting, of those judging, of those blaming, of those who are sure they have the answers even though those with completely opposite views also are sure they have the answers. I listen to people discounting the arguments they don’t believe and discounting the people who hold the differing views. I look at this shooting and the ones that came before and the ones that will come after as an interplay of psychopathology, of sociology, of religion, of philosophy, of history, of politics, of ethics, of ineffective laws, of imperfect systems, and more. There are risks and benefits to the ways in which we address different aspects of all of the above. It’s complicated as hell.

I listen to very smart people for whom I have the utmost respect espouse combinations of diametrically opposed and surprisingly in-synch opinions. But during the discussions, the subject of which is so emotionally charged, the defensiveness kicks in, the self-righteousness kicks in, the name-calling kicks in, and these very smart people’s thoughts are almost immediately drowned out by the sounds of heels digging in and minds shutting down to ideas not already firmly entrenched in those minds. Unless the discussion is taking place in a venue only open to one opinion – then the discussion is infinitely more amicable but really not productive, since you cannot understand something and figure out how to deal with it if you only consider it from one vantage point. It’s complicated as hell.

What seems logical and obvious, what is taken as truth, is not infrequently wrong. This is nowhere more demonstrable than in the field of medicine. As medicine has evolved, we have looked at the theories, the treatments, the outcomes, and we have refined our methods continually. We delve into the basic sciences – the biology, the pathology, the physiology, and we figure out what the cause of an illness is and how to cure it and prevent it. We run trials. And we are frequently wrong. And when we are wrong, which we discover because we look at outcomes, we change what we do. We have come so very far by doing this. And we have done this not by dividing up into our own little labs or offices, but by listening to what the other smart minds have found. We don’t approach a patient with cancer just from a surgical angle, nor just from a chemotherapeutic angle, nor just from a radiotherapy or immunotherapy angle. We look at the disease from all the sides we can think of, we talk to one another, and we listen when someone thinks of another angle we hadn’t thought of before. And we think about the potential risks and benefits of each approach – there is nothing in medicine (including the option of doing nothing) that is without risk. It’s complicated as hell.

We need to hear the thoughts of people who approach the problem of gun violence from different angles. We need to look at the numbers. We need to verify the numbers. We need to evaluate risks and benefits to every approach. We need the minds of people who look at the problem differently than we do – we need a holistic approach to an enormous problem that is complicated as hell.

NRA members are as equally horrified as Moms Demand Action members by what happened two days ago. Republicans and Democrats feel equally as sick to their stomachs. And as long as no one trusts “the other side,” we will continue not to evolve, not to refine, not to fix this horror. I am currently gathering a select group to set a course of action. It will include Democrats, Republicans, centrists, NRA members, Moms Demand Action members, gun owners, gun haters, gun tolerators, people with backgrounds in mental health, people with backgrounds in education, people with backgrounds in the military, people with backgrounds in law enforcement, Christians, Jews, Muslims, people of other religions, atheists, agnostics, Blacks, Caucasians, people of other races, people from urban, suburban, and rural areas, and other areas of representation. We will develop a core set of goals and a core set of questions that need to be answered, numbers that need to be found. We will consider physical safety, civil liberties, societal factors, public health factors, racial factors, religious factors, physiologic factors, psychological factors, ethics, politics, and whatever else we come up with. It’s complicated as hell.

We will listen. We will discuss and argue with respect. We will find research that is objective and unbiased, and where that doesn’t yet exist we will outline the next steps for creating it. We will do this because there is no other choice. And it’s complicated as hell.