The War on Women (pardon the political rant)

What the hell is this “war on women?” I’m a woman – a thinking, rational, educated and intelligent individual with two ovaries and two X chromosomes – and you know what? I feel neither warred upon nor at war with anyone. Yet everyone is touting this political catchphrase, bandying it about left, right, and sideways. Everywhere I turn, I hear about how my rights are jeopardized and how men are stomping on my ovaries and renting out my uterus. I hear about how outraged I should be…and yet, while I am outraged,it is not the relative state of my reproductive system that is causing my blood to boil.

 I’m not trying to be deliberately obtuse here. I am fully aware that the phrase refers to the conservative movement to restrict abortion rights and funding for Planned Parenthood, erase employer healthcare coverage of sterilization and abortion procedures, as well as discontinue the coverage of contraceptives. I understand that bills have been proposed that would require women to view an ultrasound of their fetus prior to any abortive procedure, and I am aware of the laws in states such as Kansas that protect pro-life physicians against “wrongful birth” lawsuits. And trust me, I’m aware that idiots like Todd Akin – and many like him- circulate within our midst. And yet…I do not feel outraged. I do not feel like a victim. There are many other things on my mind this election season which have turned me into a fire-breathing dragon (the abomination that is Obamacare, anyone? How about the sad state of our economy?) but reproductive rights do not really even register on my scale. It’s not that I’m especially politically conservative (I’m independent) – it’s that I’m preoccupied with things that I think matter much more than abortion. But for the sake of argument regarding abortion:

I believe that each side has it wrong. Each side makes both valid and asinine arguments regarding reproductive rights and how they should be handled. As a physician, I believe that life begins when a fetus becomes viable – and even with modern medicine and its miracles, this still doesn’t occur much before ~24-25 weeks (and even then, requires tremendous medical support). As a physician, albeit it one whose practice has nothing whatsoever to do with gestating females, I believe that a balance should exist between the wishes and best interests of my patients and my own personal values – and I believe that this balance should exist for ALL healthcare providers, be they physicians, nurse practitioners, nurses, or pharmacists. As a physician, I believe that patients have a right to be educated about every scenario, and as a physician I believe that it is part of my professional duties to ensure that each patient has been given this education – to give the patient anything less than the full truth is negligent and morally questionable. As a woman, I believe that I am entitled to all information pertaining to my health, and I have the right to make decisions regarding my healthcare. But I also understand that it takes two people to create life, and as a woman, I believe any discussion of reproductive rights must by necessity include the father of the baby – contrary to popular belief these days, it’s NOT all about the woman. And finally, as a Christian, the idea of abortion makes me a wee bit squeamish. There’s no other way to put it.

 I will never advocate for Roe v Wade to be overturned, and I think that making abortion illegal would do a disservice to patients everywhere.  Regardless of the reason a woman might choose to abort her child, I believe that her right to do so should remain unchallenged. But I also support the rights of those who are vehemently pro-life. I believe that physicians who are morally opposed to abortion should under no circumstances be required to perform such procedures. I believe that pharmacists who are morally opposed to the abortion pill or to oral contraceptives should not be required to provide patients with these medications (although I believe that best practice dictates that they should refer patients to a colleague who WILL offer these treatment options). I do not believe that insurance should be required to pay for abortion services or oral contraceptives and I do not believe taxpayer funds should support these procedures either. Forcing those who find abortive/preventive services morally objectionable to fund them through taxes is every bit as wrong as barring women from having access to these services. Furthermore, I also believe that women must be completely informed before embarking on the journey of termination – and I support laws that require women to view an ultrasound of their fetus (as an aside, I do not support protecting a pro-life physician for withholding information that leads to ‘wrongful birth’ for this reason). I support laws that require mandatory counseling prior to obtaining abortive services. I support these laws and others like them because I believe that anything less is dishonest. It’s dishonest to let a woman pretend that the fetus doesn’t exist simply because she never viewed it on ultrasound and it’s equally dishonest to pretend that abortion doesn’t pose serious mental health risks to a patient who is not fully prepared emotionally and mentally for the procedure.

 None of this, to me, is a war on women. I do not feel like a victim, and I refuse to let people tell me that I ought to feel victimized. You know why? Because there is a war on women happening – and it has very real victims – but this war is not here in the United States. This war is happening every day in nations overseas. It’s happening in nations where women are treated as third-class citizens, as property to be bought and sold at will. It happens daily, in nations where women are not allowed to attend school, where female literacy is non-existent, where women are raped and beaten in retaliation for the transgressions of a male family member. This war materializes when women are beaten and killed for attempting to speak out against these injustices. This war is the story of 14-year old Malala Yousufzai who was recently shot in the head and neck by Taliban members because she had the audacity to believe that women should be educated – and because she had the boldness to inspire others to believe the same. This war manifests when one in every three women in Kuwait are victims of domestic abuse; women who have absolutely no recourse against this violence. In Tchad, it is permissible to beat your woman – as long as there is no blood – and it is equally as permissible to starve your woman until she wastes away to nearly nothing. This is what a war on women looks like. Every day, women in other nations wake up to beatings, starvation, mutilation, and the possibility of death for some small transgression…and we women in America are fighting mad because we might have to view an ultrasound of the fetus before we choose to terminate the pregnancy?

 Let’s get real, ladies – this is not a war and we are not victims.

Canoeing

Over Labor Day weekend, Chris and I were graciously invited to the lakeside home of one of his aunts.  Nelson Pond is a place we both love to visit and so we jumped at the chance to enjoy fabulous company in a beautiful setting unfettered by technology.  It also helps that I love water - in any form.  Give me half a chance to even dangle my feet and I'm an instant fan.  Put me into a boat and I'll love you for life.  Normally, I prefer to kayak (because for me, peace finds me best when I am in my own company) but Chris wanted to give canoeing a shot.  I had no major reservations, so I agreed.  And as it turns out, if you ever want to test the strength of your relationship, canoeing is the way to go.  Trust me on this one.

We walked across the lawn to the area where the canoe was stored, near a small river which emptied into the mouth of the lake.  I looked at the boat and immediately voted to just shove it 2 feet over into the river and walk with the boat to the lake.  But Chris vetoed my idea and insisted that we carry the canoe.  I was dubious but game, so he lifted one end of the canoe high into the air and I lifted my end of the canoe 2 inches off of the ground and away we went.  We'd walked about 15 steps when I looked at Chris and said, "Stop!"

"Why?"

"Because I need a minute.  My arms hurt.  We've been walking with this canoe for days."

"We've only gone 10 feet.  We're not even halfway to the lake yet.  Pick it back up, baby."

Reluctantly, I picked up the canoe and we continued our march to the promised land of pond.  Three staggering steps later, my arms began to give.  "Stop!  I need another break!"

"No.  Keep going.  If we stop now, we're going to spend all day carrying this stupid canoe."

I did what any sane woman would do when faced with an unpleasant option - I made a new one.  I plopped my end of the canoe down into the grass.  Chris may or may not have been walking with the canoe at this point and the sudden change in canoe trajectory may or may not have caused him to trip a little.  Or a lot. While toting the canoe.

"OWW.  What the hell?  Why'd you drop the canoe?  Pick it back UP!"

Since Chris looked a little hot under the collar, I decided the wisest course of action was compliance.  Arms protesting mightily, I picked up my end of the canoe and we eventually managed to put it down into the mouth of the pond.  We walked in up to our ankles, dragging the canoe through a sandbar when I realized I needed to stop and roll up the hem of my capris.  So I stopped.  The canoe rammed into the back of Chris' calves.

"Oww.  What the hell?  Why are we stopped now?!"

"I have to roll up my pants so that the hem doesn't get wet..."

"Why are you even in capris?  Go put your bathing suit on.  We're canoeing.  You're probably going to tip us over and then you'll be soaked."

"I don't want to wear my bathing suit.  I want to wear capris.  And I am NOT going to tip this boat over..."

"Whatever.  Get wet.  Fine.  Just get in the canoe."

I stepped into the canoe.

"WHY ARE YOU STANDING IN THE CANOE?!  YOU NEVER STAND IN A CANOE!  SIT DOWN.  YOU ARE LITERALLY ROCKING THE BOAT!!"

I did what I was told and promptly plopped my derriere onto the wooden board that passes for the seat of a canoe.

"Chelsea, WHY are you facing BACKWARDS?!  Just how do you intend to make a meaningful contribution to our locomotion across the lake facing backwards? Just face the right way.  Now."

I maneuvered myself into Chris's idea of proper rowing position, all the while revisiting the yell-fest of 30 second previously like a case of bad deja vu ("You're standing in the damn canoe again!  I thought I told you not to stand in the canoe?!" Yada. Yada. Yada.)

After a few more minutes, we finally managed to ensure that Chris and I and our various fishing accoutrements were safely and dryly ensconced in the canoe.  Chris handed me an oar and we proceeded to start our trek across the pond.  I grasped the oar and proceeded to dip it under the sparkling surface of the water.

"Why are you holding your oar like that?  That's not how you do it.  That is NOT how you paddle in a canoe."

"Since when is there a right way?  You just paddle and go.  That's the beautify of canoeing.  It's supposed to be simple and relaxing.  So let's just relax."

We continued to try and make headway in the lake.  Apparently, rowing works better when done in tandem.

"Chelsea, just stop.  Stop rowing. Just sit there and look pretty.  I'll do it myself."

Sounded like a great plan to me, so I let Chris row me to the middle of the pond.  I could hear him puffing a little bit but hey...he'd requested the opportunity to row, row, row that boat all by himself.

"Chris, stop.  Just stop.  It's perfect here."

"Why are we stopping?  No stopping."

"Because I brought my fishing pole and I'm not going back to shore without a fish.  And the fish won't bite my awesome pink, sparkly jelly-like synthetic worm if you drag us through the water so fast that it only skims the surface.  Duh."

"The fish aren't going to bite that stupid thing.  Why'd you make me bait your hook with that anyway?"

"Because if I were a fish, this is precisely the kind of worm I'd want to nibble."

"Whatever.  You're not a fish, you're just a weird little woman.  You're not going to catch any fish with that."

An hour later, we were still cruising around the pond with no fish to show for our efforts.  Another couple rowing in their canoe a few feet away made their first cast and pulled out a fish.  I was insulted.

"I hate this stupid pink synthetic worm-thing.  I want something different on my hook."

"No.  Just keep fishing, Chelsea."

"Uh-uh.  I need a new dangly-thing for my hook.  I want to exchange the pink worm for this white thing with the marabou on it."

"You think the fish that aren't eating your pink synthetic worm are going to magically decide to nosh on a vaguely fish-shaped bait decorated in white marabou?"

"Yes.  Just put it on."

Chris dutifully changed my bait.  He dutifully rowed me around the lake again.  I dutifully caught nothing.

"Chelsea, this is stupid.  We should have just brought worms.  Fish like worms."

"But I don't like worms."

This continued for several minutes, during which time the conversation turned from fish food to human food.

"Chelsea, I'm hungry.  You didn't catch anything.  I'm rowing us in."

"But if we stay just a minute more, I'll probably catch something."

"You're not going to catch anything.  We're going back to shore."

"Ok, fine.  Whatever.  Let's go.  But I want to row this time."

"How about you not row?  You don't do it right.  And if you row, you'll move around.  You'll probably tip us over and then later, your arms are just going to hurt and I'm going to have to listen to you complain about how sore and wet you are."

"Ok fine.  I won't row.  I'm just going to enjoy the scenery."

Five minutes later, Chris was puffing a little bit.

"Chelsea, row the damn boat."

"But I thought you said I didn't know how to row and that it'd make my arms hurt?"

"Just. Row. The. Boat."

I rowed.  We did not tip over.   We made it to shore.

"Ok, we've got to put the canoe back where we found it.  Lift up your end and let's go."

"But my arms hurt from rowing and I'm pretty sure if I have to pick up the canoe they will fall off."

"Whatever.  Pick up the damn canoe."

Our return trip over dry land with the canoe went pretty much the same as the first trip.

I admit that I was somewhat discouraged.  Canoeing was supposed to be fun.  It was supposed to be relaxing.  In the movies, the charming, handsome hero always rows the beautiful heroine across a lake so smooth it looks like glass.  He makes rowing look easy and the heroine never has to help row.  They stop in the middle of the lake with a picnic lunch and glasses of wine, and after they eat a romantic meal, the heroine reclines delicately in the hero's arms and they stare at their surroundings and talk about their future.

My handsome hero was grumpy.  He didn't make the rowing look easy, and he made the beautiful heroine row the boat, too.   Instead of a picnic lunch and wine, there were fishing poles and synthetic worms.  Chris was sweating so much that if I'd tried to recline delicately against his chest, I'm pretty sure he would have tossed me overboard into the pond. We both returned to shore fish-less and with sunburns and bug bites. It was definitely not the outing I had envisioned.

But in the quiet moment as we walked away from the lake, as I fought back waves of bitter disappointment, Chris leaned over and slung his arm across my shoulders.

"I had a great time, babe.  It's a beautiful day and I got to spend it with you.  We should canoe again sometime."

And you know what?  There was no sarcasm in his voice.  He was sincere.  He'd do it all over again.

You know what else?  So would I.

Little boxes in my basement...little boxes full of ticky-tacky...

When I moved out to Vermont from California in 2009, I wasn't super-organized (or prepared).  I just sort of threw everything haphazardly into plastic storage bins.  I was really excited to be leaving California, but the end of medical school had really wiped me out and I just didn't have the energy left in me to be organized about the moving process....and what it boils down to is that I wound up moving a lot of c-r-a-p.  Crap that has been sitting in my basement virtually untouched for 3 years.

Currently, the future is starting to share frightening similarities with 2009.  This coming June, after a beautiful 4 years in a beautiful state, I will once again be packing up my belongings and heading off to the (great?) state of Michigan for fellowship.  And if moving across the country several times has taught me anything, it has taught me that I am far happier when I am not toting crap with me.  So, since I am a super-senior resident who no longer works or takes call on the weekends, I decided it was high time to examine the state of my basement.

But first, I strapped on these...

for a short and sweet little jog.

Then, I looked around the stacks of boxes in the basement (no pictures of that attached, because it's pretty embarrassing) that had never been opened in the 3 years I've been here in VT and decided that it was high time to start the cleansing process.

Lemme tell ya what - I am amazed at all the junk that got hauled across the country.  Some of this stuff is legit (blankets, extra pillows) but a lot of it is not (like the non-functional cordless telephone that wouldn't work anyway because I don't have a landline).  Some of it was sentimental stuff that I knew I'd kept around but just couldn't find (pictures from college) and some of it was sentimental once-upon-a-time stuff that I had no idea that I'd kept or even why I'd kept it (like a packet of letters from an old boyfriend during his tenure in bootcamp in 2003 found stuffed into a nondescript manila file folder).  There were monthly statements from the Southern California Edison electric company from 2008 and bank statements from the La Loma Credit Union from 2006 that I'd never gotten around to shredding.  There were receipts and pool cleaning advertisements...and...like I said - there was a lot of crap.  In that moment, every episode of "Hoarders" that I've ever watched flashed before my eyes and I decided it was time to take charge and tackle a few of the bins.  Turns out, the ones that I peeked into all dealt with medical school (not a shocker since my 20's have essentially been eaten up by the medical profession).  

Like this stack of books.  Once upon a time, I knew them all by heart.  Now, I haven't used most of them in at least 6 years and I'll be damned if I'm taking them with me yet again.  

...and this stack of papers, all of which represent some of the notes from the 1st and 2nd year of medical school.  Surprisingly, this isn't even the entire set of notes - I'm sure the rest will crop up later in a box where they clearly do not belong thanks to my mad organizational skills.

I found good things...like my pricey, not-used-in-more-than-3-years medical instruments (minus my stethoscope, which I am sure is lost for permanent)

I found useless things...like a whole box full of the purple envelopes of nauseousness (grades that were passed out into student mailboxes after every exam).  I kept them in case a score ever was in doubt or didn't get recorded, but since I graduated 3 years ago I'm pretty sure they can go.

I found bad things...like an empty bottle of antibiotic which I required when some snotty little child passed on a nasty bacterial pink-eye to me during pediatrics (which is also when I picked up honest to goodness pneumonia as well, but that's another story for another day).

And then I found just plain ugly and disgusting things...like the zippered plastic kit containing the instruments which I used to dissect cadavers during Gross Anatomy in the fall of 2005.  (Please note: since I am a pathologist, it is almost impossible for me not to try and put items against a solid color background before a photo).

I found uplifting mementos...like this grading sheet from a standardized patient exam which pretty much proves that even pathologists can interact meaningfully with patients.

And then, I pitched most of these items into garbage bins (I'm still not entirely sure what to do about my dissecting kit although I am certain it does not need to accompany me on my Michigan adventures - and the voracious reader in me cries in horror at the thought of throwing away any kind of book...) I got tired of cleaning.

So if you know of anyone who might need a used dissection kit or medical books that are several editions out and fairly worn - let me know.

Goodbye July

August is finally here. I have mixed feelings about August - one the one hand, it signals that my summer is more than half over. All too soon the leaves will change, chilled winds will blow, and snowflakes will twirl and tumble. As this is my last summer in Vermont for the foreseeable future, there is a part of me that wants to gather up the summer months and hold them tightly in my fist so that they will never leave.

 One the other hand, it means that July is finally over and I've been waiting for that moment for about 31 days. I suspect that for the rest of my life July will be a difficult month because it brings back a multitude of painful memories that I'd rather pretend never happened in the first place. It's the month of my brother's birth and it's the month of his death and it's the month where all of the joy in the world can't quite overcome the sorrows and stresses of the last year.

 I spent the entire month rotating through the Office of the Chief Medical Examiner. I could say many things about what that means, but the upshot is really that I spent (almost) the entirety of the month with the dead, helping out with the daily autopsy schedule. In a way, going to work every day was almost more than I could mentally handle. It's hard to face death on a daily basis when there are still so many unresolved issues and agonies in my personal life. It was a struggle to stand toe-to-toe with the dead, to look at them and read about their final moments and wonder about their lives and piece together their stories and not run kicking, screaming, and crying from the autopsy suite. And with each Y-incision that I made, it never stopped feeling like I was cutting open my little brother and laying bare his agonies to the world.

I wish I could say that I faced down each day with a professionalism, dignity and grace that would make my medical school mentors proud but I'd be lying. There were some days where all of the mental pep-talks in the world couldn't get me down into that morgue in a good mood and some cases, like suicides, in which I simply could not be anything more than haunted and angry. Each day was repeatedly traumatic and each night a struggle to stop my mind from spinning long enough to catch even four hours of sleep. When I did manage to fall asleep, my dreams were haunted by moments in which I eviscerated random deceased persons on the side of a highway - and, if you can believe it, that was the happiest of my dreams.  There were many nights where sleep brought me only pictures of my brother and one particularly nasty dream in which I was responsible for eviscerating Chandler. Yes...it was a long and relatively sleepless month.

But as traumatic as July was, it also made me realize just how fortunate I am to be in an institution where I have fabulous co-workers, because otherwise I could not have managed this month and come out with even a semblance of sanity. I am grateful for those that let me shut the door to the back office and simply let me be. I am grateful for those that sat and listened to me in moments where the world became far too heavy for my shoulders. And I am doubly grateful for our awesome autopsy techs who wordlessly and seamlessly stepped in and helped me with cases when I simply could not do the job on my own, no explanations necessary and no questions asked.

 So goodbye, July. While I'll miss the living people of the morgue, I can't say that I will miss the dead.

 And welcome, August.

To my brother one year later

You died one year ago today.

 365 days.

It doesn’t seem like it has been that long because the pain is still as fresh and deep as it ever was. And although I feel compelled to write something to you today, I just do not have the words for all the emotions that are swirling in my heart. I feel compelled to tell you that living a life without you has not been easy; in fact, of all the years in my life, this has been by FAR the worst and it's mostly, but not entirely, your fault.  I feel like I should tell you that remembering you – your life and your death – still hurts every bit as much today as it did last year; I suspect that this is the kind of pain that hones its edge on passing time, becoming sharper as the years march forth.

There are so very many things I want to say to you today but… I just don’t have the words. The English language has no words that can adequately describe the deep kind of grief that I feel; I can’t blame Webster because I’m fairly certain that God never meant for the human experience to contain moments like these. I feel obligated to tell you that as sad as I am, that I am still so very, very angry with you. I am so angry that you could throw the love of your family away like it was no more precious than a used Kleenex. It makes me sick that you could ever have thought, even for one moment, that your life didn’t matter. It infuriates me that you thought taking your own life was a solution to everything screwed up in your life. But most of all, I will never, ever forgive you for involving me in your last day and I cannot ever forgive you for breaking your promise to me. That broken telephone call on July 8th, 2011…the one where you PROMISED ME that you would answer when I called you back and then promptly broke that promise…is the most cruel thing you ever did to me, and that’s really saying something because you could be a real shit when you put your mind to it.  You reached out to me that day, but only a small fraction of the way and if I had known what you were about to do/had already done, I would have done things so damned differently. And maybe the ending would still have been tragic, but maybe my last words to you would have been different and maybe your last words to me would not have been a heartbroken cry that still lingers in my head at night.  I wish to heaven that I could forget that sob, but I have a feeling that when I'm ninety and riddled with Alzheimer's, forgetful of all else in my life, I will still remember that phone call.  I cannot forgive you for the feeling of utter terror that surged through me when I called you repeatedly that day and you did not answer your telephone and I cannot forgive you for the stabbing in my chest when I heard what you had done and knew with absolute clarity that it was already too late for you. Perhaps if you had given me a bigger glimpse into your world I would not have failed you so epically – and perhaps I would not feel so responsible and so miserable and so damn broken. You were my baby brother and I failed you completely and for that I cannot forgive myself. You were my childhood partner in crime – we grew up together and we were supposed to grow old alongside one another – and now you are gone and one day I will be completely alone, the last branch on our family tree. It was not supposed to be like this and for that, I cannot forgive you.  At least, not today.

I feel obliged to tell you that I still do not understand why you chose to give up on life when it had not yet given up on you. I will never understand how you believed so little in your tremendous potential and how you were never able to escape the shadows that haunted the corners of your mind. They say that to everything there is a season and I will never understand why your season was only 26 years short when it should have been 90 years long…and I guess that the timing is between you and God but that doesn’t mean I understand and I definitely do not approve. There are so many things that I wish I could have told you – and that I wish you could have understood. I wish you could have understood how very deeply you were loved by ALL of us and I wish you could have really understood that none of us ever stopped believing in you, even though you couldn’t believe in yourself.  I wish you could have realized that life is too short and too precious to be wasted on one moment of darkness. I wish you could have comprehended that at some point in life, ALL of us feel used, wasted, friendless and alone even though none of those things are true. I wish you could have had the foresight to see that even the dreadful moments in life pass, that nothing terrible lasts forever. And I also wish you could have understood that sometimes the bad things pass on their own… and unfortunately, sometimes you have to apply a little elbow-grease and force the bad things to move out of the way. But what I wish for you is, in a sense, moot – because if you had understood any of this, you would still be here with us today.

I know that I will see you again one day and maybe one day I will be able to forgive you for some of what you did when you doused your fire with amitriptyline – but right now that day is just too damn far away.  I’m still no closer to understanding what happens when we die but if there is some form of consciousness left in you somewhere, I hope a small part of you misses us even a fraction of how much we miss you, and I hope that small part of you will run to meet us with open arms in heaven.

I love you, baby brother. Always did….always will.

Happy birthday, Dad. Even if you probably won't read this.

On that hot July afternoon, I was fifteen years old and just beginning to sample the sweet taste of freedom that driving could provide.  I had a valid learner’s permit but limited driving experience, always in the company of a fully licensed parent.  I felt (too?) confident on the back country dirt roads in my neighborhood; I think my parents picked up on this and in their wisdom told me in no uncertain terms that I was never to drive any of the vehicles by myself, not even down the road to the neighborhood mailboxes. I listened – until my youthful hubris decided that it had had enough of silly rules.  After all, I was a good driver (!), so why were my parents stifling my youth?  One day, after a long internal debate about the best way to get to the mailboxes in the July heat, I grabbed the keys to our old, dented International, my father’s “camping” truck, and set out down the road.  My parents were both at work, and no adult accompanied me as I entered the truck. I turned the key in the ignition, rolled down the windows, and flew down that road watching as dry dirt swirled in my wake.  At fifteen, there is nothing more freeing than the wind through your hair as you drive by yourself.  And oh!  How sweet that freedom tasted!

When I finally made it to my destination, I pulled up alongside the old, rusted metal mailboxes and opened the door to our own box.  I grabbed the mail and stowed it on the seat next to me.  Looking cautiously in front of and behind me, I switched into “drive” and attempted to pull forward only to hear the ugliest sound in the world – that of metal creaking, grinding, and jerking against metal.  In my ignorance, I had pulled far too close to the mailboxes and had run the driver’s side of the vehicle into them.  I panicked and stepped on the gas harder and suddenly that same, once- sweet freedom became a dense mass in the pit of my stomach. 

When I finally disentangled the International from the row of metal mailboxes, I drove the half-mile back home as fast as the speed limit would allow, hyperventilating the entire way.  Once the vehicle was parked I hopped out of the car telling myself, “The International is a beast.  There’s probably nothing wrong.”  But, as it turned out, I was oh so wrong.  Jerking along the length of the driver’s side was a long, ugly scrape accompanied in some spots by unsightly dents.  I fought the mailboxes and the mailboxes had won.  Now I was really in a pickle.  Not only had I done something that I had been expressly forbidden to do but I had also damaged the vehicle in the process.  I was in full-on panic mode, fairly certain that my young life was about to end before it had really had much of a chance to start.

I turned to my go-to emergency contact, my best friend’s mother.  I dashed into the house and phoned Anne.  In a panicked voice, I asked if she had in her possession a blue Sharpie marker.  (Yes, that’s right…I was convinced that if I just colored in the scape with a blue Sharpie marker, my problem would disappear along with the scrape).  Using her own motherly intuition, Anne sensed that there was a deeper issue at work and she dutifully walked up the hill to my house with a Sharpie marker in tow.  Once she had arrived, the story spilled out and Anne walked around the side of the house with me to view the damage. 

I still remember Anne doing her very best not to laugh at the notion of a blue Sharpie fix as she looked at the International. Instead, she simply looked at me and said in her knowing way, “Chelsea, we can use this marker to color in the damage, but do you really think that the marker will fix this?”  I knew that Anne was right – no amount of blue Sharpie could fix the damage that my illegal jaunt had caused.  So I asked the only thing that came to my mind, “What should I do?”  She looked straight at me and said, “It will be better for you if your father hears it from you instead of finding out about this in a few days.  Trust me.”   And since even youth recognizes good advice when it is offered and with a heavy heart I spent the rest of the day stewing in my room, nervously pacing the floor and trying to calm the deepening hole that had invaded my stomach.  I practiced my carefully chosen words over and over again. Finally, when the sun had set and the house was quiet, I decided that the time was at hand.

Steeling myself for the yelling and dire punishment sure to follow, I trudged into my parents’ bedroom with my head hung low.  My father was already in bed reading a book.  He looked up as I came in, placed his finger between the pages to mark his place, and smiled at me.  He thought I had come in to give him his customary goodnight kiss and in that instant I felt so very terrible that the tears began to flow.  My father’s smile disappeared and worried creases formed in his forehead.  He patted the bed next to him and said, “Sweetie-pie, what’s wrong?”  I sat down next to him, he put his arm around me, and between wracking sobs the story took shape.

“Dad, I’m so sorry but I did a bad thing today.  I did a really, really bad thing.  I did something you told me I was never supposed to do.  I got bored and wanted to go to the mailbox but I didn’t want to walk because it was too hot and I’m a good driver.  So I drove the International to the mailbox to get the mail.  But then I ran the International into the mailboxes...and Dad…I am SOOOO sorry.”

My father didn’t say a word.  He bit his lip and thought for a moment before rising out of bed and putting on his clothes.  I followed dutifully behind him as he walked in silence to the International to survey the damage that my teenage foolishness had caused.  My father walked around the truck and paused near the driver’s side door, hands in his pockets, his face unreadable.  I was relatively sure that something very bad was going to happen to me and I waited for the yelling to start.  I was petrified.

But them something astonishing happened: my father simply turned to me, put his arm around my shoulders and said, “Well…it could be worse.  The International was never very pretty anyway.   The important thing, Chelsea, the most important thing of all, is that you were not hurt – and you didn’t hurt anyone else.  Accidents happen to everyone but the reason that you are not to drive without your mother or I present is because you are still learning how to drive safely so that you don’t hurt yourself or someone else.  It was only the mailboxes today, but it could have been a neighbor child that ran out into the street.  You could have taken a corner too fast and rolled the vehicle.  Cars are replaceable, kiddo, but people aren’t…YOU aren’t.  Understand?”

I understood perfectly.  And somehow, without yelling or screaming, without threats or grounding or loss of privileges, my father had gotten his point across to me with absolute clarity.  In that moment, I fully understood why my parents made certain rules…it had nothing to do with stifling my youth and everything to do with preserving that youth and ensuring that it would grow safely to adulthood.  My parents’ rules had everything to do with love.  I learned a lot of lessons that day, courtesy of my father.

So here’s to my Dad – the man who taught me that we are meant to learn from our mistakes so that we can do a better job the next time around, and the man who taught me that mercy and gentle words teach stronger lessons than angered denunciations.  But most importantly, here’s to the man who has always shown me, with every breath, just how much he loves me . . . and who has always treated me with care.

Happy Father’s Day (and birthday) to the best father a gal could ever hope to have.  I am so incredibly lucky.  I know you probably won’t ever see this, Dad…but I love you oh so very much and I hope that you always know that.

To mom, on her birthday

This year, more than any other, I feel so very thankful to have my mother in my life.

When she was diagnosed with colon cancer last year, the bottom (temporarily) dropped out of my world.  After my father finished relaying the news to me over the phone, all I could do was sit on the couch and cry for the rest of the evening.  I've always been scared of losing my parents too soon (although, is there ever really a good time?), but in that moment, I was terrified because cancer is a serious thing.  People die.  My mother could die.  I know that I'm an adult and have lived on my own for awhile now...but I am still nowhere near ready to say goodbye to the amazing woman that is my mother.

I've always thought of my mother as this incredible, invincible woman.  Through the years, she was always my Super Woman, ready to come to my aid or defense at the drop of a hat.  She was the woman that worked tirelessly to provide for our family during the years when my father was in college and still managed to make it to all of my high school concerts and piano recitals.  She was the woman who drove me at breakneck speed in a winter storm for nearly 2.5 hours so that I could join my friends on the school bus (whose local departure I had missed) heading to the state Science Olympiad competition.  She is the one person who can always tell when something's wrong in my world, and when I lie and say that "everything's ok," she always calls me out on it.  She's the person who has been by my side at every major turn in my life - whether it was driving me to college, to medical school, or to residency, she's been always been there for every journey.  And though she probably doesn't know this - she's the part of moving that I love the most.  I don't enjoy the packing/unpacking, the sleeping in hotels, or eating crummy food...but I do enjoy traveling with my mother and I am always thankful that she gives up her time (when she might have better things to do) just to spend it with me.  She's the woman who has never let me settle for less than my best and the woman who has never given me less than her best.

I know she'd argue and say that she hasn't always been the best mother,  but trust me when I tell you that's a lie.  Because the best parent isn't someone who never messes up.  It's not the person who always puts a homemade meal on the table, or the one who never yells at you out of sheer frustration - the best kind of parent is the one who is there for you in all circumstances and who loves you in all circumstances, who strives to show you how important you are to them every single day.  And by those standards, I'm pretty sure that I have the best mother in the world.

So happy birthday to you, Mom.  Thanks for being a terrific parent and for always giving me better than I really deserve.  I love you.

A small request, friends

Quit posting anti-abortionist pictures of fragmented babies on Facebook. You have a moral objection to abortion and want to share it with the world. Good for you. But trust me when I tell you that I already know what dead and fragmented babies look like. I wish I could tell you that the sum total of this knowledge was gained solely by gazing upon your useless, graphic, and ultimately Photoshopped Internet images but then I’d be a liar. I know what these little souls look like, but do you? Do you really know? I know what they look like because they are often a part of my daily job. I have reached into more formalin buckets and pulled out more fragmented baby parts than I really care to think about. I have prosected 16-week-old fetuses and watched as their organs are turned into a glass slide. My heart breaks for these tiny beings each and every single time, but this is my job. My job is sometimes messy and nightmare inducing, but it is also very intimate. I am a doctor and these are my patients. I am the last hand that will hold them and the last eye that will see them and the last doctor who will mourn them. So quit your Internet crusades, please. I see these images at work and I see them at night when I sleep and I see them when I look in the mirror in the morning. I’d rather not see them in front of me when I log into Facebook. I take enough work home with me as it is. Let these patients rest. Please give them some respect. Quit using them to further your own agenda. And on a related note:

Quit trying to legislate a woman’s right to choose. I believe in the beauty and the mystery and the miracle and the gift that is life, but I also believe strongly in the right of a woman to choose what happens to her own body. I have seen the abortion procedure, I have met women who have chosen to walk that long road, I have held the consequences of the procedure in my gloved hands, I have shuddered in despair and sadness over these tiny beings – and despite all of the horrors of each of these things, I will ALWAYS believe in the right to choose. I will always believe that what a woman does or does not do with her body and those that may dwell in its depths is solely between the woman and her God. It’s not between a woman and her pastor, her friends, the news media, or her political representatives. And it’s definitely not between an unknown, pregnant female and YOU. Knock. It. Off.

Beautiful days

It was an absolutely phenomenal Vermont spring day today. It was kind of day made for fishing or gardening or kayaking on the pond or hiking and birdwatching. But I did none of that, because today was also, unfortunately, the kind of day made for weekend call {insert a grumbly, frowny face here}. Reluctant to venture too far from home lest the black box of evil (also gloomily referred to as the call pager) begin to shriek, I pondered how to best enjoy the beautiful afternoon. In the end, I gathered up all of my sundry electronics and settled down into one of the wooden Adirondack chairs on the back deck. A perfect amount of gentle breeze was wafting around me – enough to cool down the 80 degree sunshine, but not enough to whip my hair into my face and annoy me. The leaves rustled, the scent of freshly mown grass filled the air, and the distant (and somewhat obnoxious) sounds of the neighborhood ice cream truck filled my world. It was a perfect moment in time. I looked up at the bright blue sky and for the first time in about three weeks, I felt completely relaxed. These quiet moments… the moments where my back doesn’t hurt from carrying around internal stresses, where my head doesn’t ache from all the noise that constantly envelops me, where the headache that lingers between my eyes dissipates…these moments don’t come nearly as often as I would like since I joined the world of medicine, so I’ve learned to seize them as they come and simply enjoy them. They are not

grand moments filled with adventure but for me, they are simply enough. I miss these beautiful moments desperately sometimes. But no matter how quiet and sweet a moment is, a pall always lingers because it is in these peaceful moments that I find I miss Chandler most of all. It is during these moments that my heart breaks over and over and over again. I miss my little brother still. I miss him so very much. It’s been ten months and my world still feels upside down and inside out. And after ten months, I am (still) not even remotely able to understand how Chandler could ever have given any moment of this world up. I can't even understand why that thought even crossed his mind...and I certainly can't understand how he decided that these small moments weren't worth his time, how they weren't enough for him. I am slowly learning to accept that I am not meant to understand these feelings, that none of us are, really, and for that I suppose I am grateful. At the very least this world and these moments are enough for me - so I will savor them enough for the both of us.

Of mice and men. Or dogs. It's the same, really.

The pager’s shrill scream blasted into my stream of consciousness. I immediately put down what I was working on, glanced at the screen to see an unfamiliar name, and dialed the provided number.

The clinician on the other end of the line immediately began babbling in doctor speak: elderly gentleman, multiple bilateral pulmonary emboli, Warfarin, heparin, coagulopathies, ICU, transfer….

My brain immediately skipped over all of the information until it heard the words “pulmonary emboli,” “thrombolytics,” and “coagulopathy.” Inwardly I groaned at the thought of dealing with a coagulation question. Coagulation questions aren’t all that frequent during call, but they tend to be difficult and confusing (for me, at least) and I rarely have a good, immediate answer. It usually takes a fairly detailed search before I find an answer I am completely happy reporting to the cinician. I don’t mind the search if I’m in a coagulation kind of mood, but at that moment coagulation was something I was loathe to consider. So was I looking forward to whatever this particular physician was requesting? Not in the slightest.

The physician kept rambling for another minute, spewing laboratory values in a voluminous verbal emesis with words dripping from her vocal cords faster than I could possibly write. I cleared my throat, about to interrupt her with the age-old, "Can you please repeat that?" and “aside from spitting numbers at me, what are you really wanting from me?” spiel, when the provider abruptly stopped and then said…

“And then, we were going to transfer him to YOU for his coagulation needs, but well…he died and the family wants an autopsy and I’m not sure how to do this particular transfer but we need to transfer him to your morgue.”

Then something terrible happened. I smiled broadly, cheered silently, and fist-pumped the air. No coagulation questions for me after all! Hot dog! Just a morgue question and a call issue that I could punt to the junior-level resident covering the weekend autopsy issues. It took me a full minute to realize that my brain was cheering for something terrible, something sad, and something for which a mental cheer was wholly inappropriate.

It is at times like these where I realize that somewhere along the medical journey, I have lost some perspective. I (still) absolutely believe that I help to make the world better but some days my passion is slightly lacking. There are moments wherein I am so jaded, bitter, overwhelmed, overworked, exhausted, and numb – all things I swore to myself that I would not become. Sometimes I wonder who this cynical skeptic is that stares intently at me from the confines of my bathroom mirror. I wonder how to get rid of her. So I vow to be less cynical, less irritated, less grumbly, more accommodating and a little more passionate. I promise myself that I will remember that wide-eyed college student out to save the world - and that I will find her and bring her back.

Then I remember that sometimes my skepticism and irritation are perfectly allowable.

Like the time that I was called in to the hospital for a STAT CBC with differential for a "sick patient." Try as I might, I could not find them in the computer system and the tech didn't know much about them. So I got into the car, drove for 40 minutes, and discovered upon arrival in the lab that the "sick patient" in question was a dog by the name of Fly.

And on those days where my passion, enthusiasm, and naiveté have been chewed on like a dirty, used tennis ball in the mouth of Fly, I feel somewhat justified in my cynicism. I guess it all balances out in the end.

The great fellowship search of 2012 has ended. Huzzah!

I think most people I chat with regularly are already aware but in case the news has missed anyone in my small world... My fellowship search is over! (Or Ov-ah, if I want to be all Vermont-y about it). Ok, it technically finished in February when I accepted the position...but still...

I am super stoked to announce that I am going to be the 2013 Blood Banking & Transfusion Medicine fellow at the University of Michigan in Ann Arbor. And no, dad...I'm reasonably sure that it doesn't entitle you to any free tickets to the football games. But come and visit me anyway.

It's like a caramel...

I do a fairly good job of blocking the tragedy of you from my immediate thoughts. This is good, because otherwise I’d never manage to do anything but sit in a dark room and trudge through painful memories. But every once in awhile, something jogs my memory. Sometimes a person walks past me and the scent of the cologne you used to wear lingers in the air. Once in awhile, I’ll catch a glimpse of a bright yellow car zooming past in my peripheral vision. Rarely, the song playing on the radio when I screamed out my grief as Mom called me to tell me that CPR was stopped plays once again in the car. I’ll see a face in an advertisement or brush past a blond stranger in a black leather jacket and then it all comes flooding back. My stomach sinks like a stone, a cold iron band compresses my chest, and all the anger and the grief and the fear and the loss and the senselessness rage through my head. All I can do is stop, close my eyes, force air into my lungs, and remember. And when I remember all I wonder is how in the world I ever managed to put you out of my head for even a second. I often meander through my day doing whatever it is that needs to be done.  I have good days and I have bad days but even in my best moments there is something missing. It is like the difference between a dark chocolate caramel topped with sea salt and a regular old dark chocolate caramel. The caramel is good by itself but that little pinch of salt elevates it, adds to it, and makes the moment more singularly sweet. In these moments of grief I figure out exactly what is wrong. You are the salt in my life. Without you, even the best of experiences are only “good enough.”

I guess this is what it means to lose someone.  I guess this is what it means to lose you.


missing someone pics on Sodahead

The Interview Trail

For those of you who are not in the loop, my interview season for a pathology subspecialty fellowship (transfusion medicine) has started. I recently completed 2 (of 5) interviews - hours of perma-smiling while asking and answering the same questions over and over again to different people. I'd forgotten how grueling it was 3 years ago while seeking a residency position...

But you know what the hardest question of the entire interview experience was?

“So, how many siblings do you have? Tell me about them.”

It’s a question that I knew would come up someday, the “do you have siblings?” question that everyone asks to be polite. I’ve spent a lot of time wondering how to answer that question in the intervening months since Chandler’s death. Do I have a sibling? It’s a concrete question that can’t be answered concretely because the answer is both yes and no. I can’t even reliably answer that question in my head without crying – so how in the world was I supposed to answer it during a fellowship interview? How do you give a dignified answer to a question that breaks your heart?

---“No, I’m an only child.”
That’s not a great answer because it’s a big, fat lie.

---“Yes, I have a brother.”
That’s also a lie – because I HAD a brother and tenses matter--at least to me.

---“I had a brother.”
Do I really want to open that can of worms? Do I want to present this wound for the interviewer to poke and prod?  Because if I have learned one thing with interviews, the moment the door is open, some asshole will inevitably take the opportunity to walk inside.

---“Yes, I had a brother, but he was a selfish douchebag and committed suicide in July.”
That sounds…well…truthful, but a tad too bitchy. (One of these days I will move out of the anger stage of grieving...I hope).

I guess the answer is this:  I was once a big sister. Once upon a not so distant time, I had a little brother. We grew up together and when we were small we did nearly everything together and for the last 27 years of my life, Chandler was always there. But now he’s no longer around because he took his own life and even though I know that’s what happened, there’s a difference between knowing it in my head and saying it out loud to the world. I’m not afraid of people judging my family for what Chandler did (undoubtedly some do, but I don’t care because those that judge are small-minded wads of garbage) – I am afraid that once I answer it that the tears will begin to flow. And an interview for fellowship is NOT the appropriate place to look like a tearful, pathetic tool.

So what did I say?

I copped out and skipped over the question as best I could by saying simply, “I’m lucky enough to have an amazing sister in-law. We weren’t born family but we’re family now and I’m incredibly thankful for that.”

While it is only a partial truth about my sibling and my family, at least it is still the truth.

And also - I did not shed a tear. Hooray for small blessings.

The Face of Sjogren's Syndrome

I’m pretty angry right now. I'm not angry at the world (at least not about this) but I am still steamed nonetheless.

I’ve been complaining of a variety of symptoms since I was 17 years old. It started out with my parotid glands (the two main salivary glands located in front of the ears). Periodically, they would swell slightly and ache. When these episodes would occur, even smiling became painful and to eat or drink anything meant having some serious, stabbing pain in those glands. The episodes didn’t happen often – perhaps once every few months. When I complained to my family doctor he told me I likely had salivary gland stones and that it was no big deal. No testing, no referrals…nothing.  I can't be too angry with him because in all honesty, there'd be no reason to assume different in a 17 year old.

Over time, the symptoms got worse. My glands started to swell and hurt more frequently – a few times a year turned into a few times a month which turned into a few times a week and then almost daily. My mouth began to feel as though a wad of dry cotton was always wedged into it, my eyes became to become dry and irritated, my skin started to flake, my hair began to thin, my joints started to ache, and fatigue set in. I complained to the campus physician in college only to be told that I probably had a cold…and that the fatigue was because I was a busy college student. I was sent away with no answers other than to scale back on my semester hours. I complained multiple times during medical school to my medical provider who (in softer terms) told me that I was “imagining things…medical students are always fatigued and always think they have symptoms of some disease.” Again, no referrals, no tests, no answers – and worse, a doctor who thought I was full of beans.

I complained my doctor here in Vermont who essentially told me the same thing – that fatigue is a part of residency, that I probably had salivary gland stones, and that it was no big deal. When I developed 5 cavities in spite of meticulous dental hygiene, my dentist told me I just needed to work at brushing and flossing a little harder. Fed up, I finally gave them all the finger and self-referred to an ENT specialist. I would have done it sooner, but this is the first time I've had insurance where I could self-refer...anyway, I digress. After taking a careful history (the only history that anyone had ever bothered to take), he performed an ultrasound of my salivary glands and told me what I had known for years…that something was wrong and that the scan of my glands showed that I likely had an autoimmune disorder He referred me to one of the local rheumatologists and I felt like I would finally get somewhere.

And then I met the rheumatologist. Again, he took a history and did a thorough physical examination and essentially told me that I was full of beans. After all, when he stuck his gloved finger in my mouth, he could feel saliva – so clearly, nothing was wrong. In fact, he told me that he thought serologies would likely be negative, but if I wanted to really search I could consider a lip biopsy to which I promptly said, "No thanks." In the end he had his rheumatology fellow order laboratory testing.

Yesterday, I received a follow-up call from the rheumatology fellow. He informed me that my ANA (anti-nuclear antibody) testing was “very positive” with a titer of 1:640. Specific autoimmune markers for Sjogren’s syndrome (ss-A and ss-B) and RF (rheumatoid factor) were also quite positive. Adding insult to injury, the asthma that was diagnosed 10 years ago may not, in fact, be asthma – it may be respiratory tract involvement by this autoimmune disease. Voila! It only took 11 years and multiple doctors to prove that I was not making my symptoms up, that my complaints were more than the random complaints of a tired hypochondriac. Ergo, I am now starting on Plaquenil, a drug that I never hoped would be introduced into my life. I will now require yearly ultrasounds to check for lymphoma (patients with Sjogren’s are at increased risk for lymphoma), yearly eye examinations to check for retinal complications from Plaquenil and to make sure that the Sjogren’s isn’t damaging my corneas, and yearly laboratory and rheumatologic evaluations to monitor my organ function for both toxicity from Plaquenil as well as worsening involvement by this autoimmune disease (think renal problems, neuropathy, etc). Sounds like fun, right?

I admit that I’m a little miffed about this. I’m miffed because for 11 years, nobody believed me when I told them that there was a problem. I was brushed off with gentle platitudes and constant reminders that I was just a complaining high schooler/college student/medical student/resident. It makes me a little angry because had anybody ever bothered to take me seriously, perhaps this could have been figured out quite literally a decade ago before all the symptoms really set in. Perhaps I could have been started on medications that would have prevented progression of the disease – or at least delayed the progression.

But instead, I have been living in a state of relative misery for the last 11 years. My glands hurt nearly every single day. They don’t just ache, they feel as though someone is stabbing them repeatedly with a steak knife. They remain slightly swollen, making things like opening my jaw occasionally difficult. My mouth is so devoid of saliva that no matter how good my dental hygiene I will almost always have dental caries. I develop spontaneous small ulcerations of my gums without warning and my nose is often so dry that it spontaneously drips blood.   I can’t swallow bread or other dense foods without drinking copious amounts of water and even then food gets stuck. My eyes feel as though a fan is always blowing in them and no amount of eye drops will permanently combat the slight blurriness that has developed. In fact, just about everything (and yes, I do mean EVERYTHING) is dry. Not even my sweat glands function appropriately these days. My joints and muscles ache and I am fatigued – and when I say fatigue, what I mean is that some days I am almost too exhausted to get out of bed despite having had a full night’s sleep. No matter how much sleep I get or how much rest I indulge in, there are some days where it takes all of my energy reserves to sit through work without falling asleep at the microscope. Some days just walking upstairs to the bedroom takes the wind out of my sails. It is at times almost debilitating. But I deal with it because letting these problems defeat me is not an option.

If anybody had ever bothered to listen to me when I was complaining about mild symptoms at 17, the last ten years might have been partially mitigated with medication. Nothing can really stop or cure an autoimmune disease but symptoms can be managed and disease progression can be slowed. Maybe if something had been done sooner I’d have more gland function than I do – I might have been a “better oiled” machine, so to speak. Perhaps the aches and pains would have been less noticeable, and the fatigue that has plagued me since late college could have been avoided. The “what if’s” are tremendous but in a sense it doesn’t matter because nobody did anything except tell me that it was all in my head.

I am not thrilled to have an autoimmune disease because quite frankly, it sucks. It sucks to have a condition that cannot be stopped, a condition where what has been lost can never be recovered. I am not thrilled to be starting on long-term Plaquenil because it is not a completely benign drug – it can have some very serious side effects. But I am trying to be optimistic – now there is a diagnosis and something is being done about it – and I look forward to the promise of feeling better. I want to wake up in the morning feeling rested and I want to be able to walk upstairs without feeling as though I am walking through molasses. Maybe I'll be able to enjoy a run on the treadmill in the basement. I want to play my violin for long stretches of time without having to take breaks because the joints in my fingers ache. I want to enjoy food without feeling pain and I want my to keep all of my natural teeth. And maybe, just maybe, Plaquenil will allow me these small comforts. The thought is really nice.