In which I write a long post to answer dumb questions about my medical subspecialty

Questions I get asked about being a pathologist (in no particular order):

“Are you even a real doctor?  You don’t see patients.”

Yes, I am a “real” doctor.  I understand how it might be confusing for a patient, because unlike primary or specialist providers, patients don’t actively choose the pathologist involved in their case.  But please rest assured, I completed the same four years of medical school that your surgeon, internist, pediatrician, or OB-GYN completed.  My title includes the letters M.D.  I also completed four years of general anatomic and clinical pathology residency to learn how to do everything that a pathologist does.  And then I added a year of subspecialty training, too.  Yes, I am a 'real' doctor.  

"So you're like a lab tech then?"

No. No, no, no…just no.  A pathologist is not a glorified lab tech.  Calling me a lab tech is sort of on the same level as assuming all women who work in healthcare must be a nurse - it just makes you look stupid.  Please note that I'm not at all dismissing what lab techs do - which is a lot of really important stuff - but their role in healthcare is different than mine.  In the same way that I am not qualified to do what a lab tech does, they cannot do what I do - we are not interchangeable entities.  {Also, on a distantly related note, when you assume I'm a lab tech and you treat me like dirt *ahem, surgeons*, it makes me angry - not because you are treating me like dirt -  but because it means you are likely treating my lab staff even worse.  I can bust you for your unprofessional behavior on the spot, MD to MD, but my staff doesn't have that luxury.  So please, for the love of all that's good, quit letting your inner jerk out to play}.

“So pathology, huh?  That’s like CSI stuff, isn’t it?”

Wrong.  Stupid wrong, on so very many levels.  I have not once analyzed a soil sample or found a killer using only a strand of blond hair.  I work in a hospital, not in a Hollywood studio.  The killers I look for are tumors of unknown origin.  And what I do to find them is wicked cooler than CSI.

“So what is it, exactly, that you do?”

I look at stuff.  Lots of stuff.  If it comes out of your body, the odds are good that a pathologist has been involved somehow.  This includes the breast (or appendix, gallbladder, uterus, lymph node, prostate, colon, etc) that your surgeon removes.  It includes the skin lesion that your family practitioner biopsies.  It includes the sputum that you cough up, the pus that grosses you out, and the urine that you pee into a cup.  It even includes poo…and semen.  It includes the fluid that your endocrinologist aspirates from the nodule in your thyroid, the lung mass that your interventional radiologist samples, and the pancreatic cyst that your endoscopist biopsies.  It includes the pterygium (or the encleated globe) from your ophthalmologist and the tooth cyst from your dentist or oral surgeon.  It includes blood from your lab draws and bone marrow from the aspirate that your oncologist performs.  It includes the placenta from your newborn baby and the small, 18-week gestation fetus that you miscarried.  It includes the bodies of both the 20-year-old woman who was texting while driving and the 56-year-old man who was found unresponsive on the floor in his home.  It even includes the tick that you picked off of your child’s small leg and the fluid from your lumbar puncture.

“Um…ok.  So you look at stuff, like, all day.  What does that even mean?”

It means that I give you (and your clinician) answers. It means that I can tell you whether or not the lump in your breast or the mass in the head of your pancreas is cancer.  I can tell you what type of cancer it is and if that small hypodense region in your liver indicates metastatic disease.  The immunohistochemistry that I perform on your tumor helps determine both your prognosis and your treatment options.  When your surgeon sends down a sample for frozen section during your surgery, I help them determine how much more of your tongue they need to remove to rid you of your oral cancer.  I diagnose familial cancer syndromes using a combination of histology and advanced molecular techniques.  It’s not just cancer that I diagnose – I diagnose everything from benign skin to colon polyps to neuroblastoma to Crohn’s disease.  Really –I do mean everything.  When I autopsy a fetus, it means that I do my best to help its parents find a cause for why they have miscarried the baby they waited so long to conceive.  And when I find the complete blockage in the left anterior descending coronary artery accompanied by areas of old myocardial scarring, my report tells a family, with reasonable certainty, why it is that their loved one is no longer with them.

It means that I can tell you what kind of bacteria is causing your pneumonia – and the kind of antibiotics to which it will (or won’t) respond.  {Ditto for any organism – fungal, viral, mycobacterial, or parasitic – that you throw my way.  I’ll even tell you what kind of tick your kid picked up during their camping trip and whether or not you should worry about something like Lyme}.  Looking at your peripheral blood, I can tell that not only are you anemic but also the probable cause of your anemia.  I diagnose leukemias and lymphomas by integrating cytogenetic analysis, flow cytometry, and histology.  I determine that the cause of your joint pain is crystalloid and not infectious in nature (this helps save you a trip to the OR, by the way) and I interpret the serologic tests that determine whether you have HIV, syphilis, hepatitis or a host of other conditions.  I oversee the clinical tests that determine how likely your fetus is to have Down syndrome, and if you should (heaven forbid) require amniocentesis or other invasive testing, I also interpret the subsequent testing that gives you a more definitive diagnosis.

It means that when you need a blood transfusion, I am there to help your clinicians select the safest unit for you; and when you need specialized and hard-to-find units, I am there to search the country for those products.  It means that I will beg, plead, and cajole a blood center 2,000 miles away so that you get the best product at the time when you need it most.  When you have a reaction to transfusion, I am there to diagnose what went wrong and help prevent it from happening again.  I provide product support for your ECMO, LVAD, or liver transplantation – and when you crash your car into a streetlight while texting, I’m there to monitor the massive transfusion protocol which will likely help to save your life.  I manage and interpret the coagulation testing for complex, bleeding patients and I help diagnose exactly why a 16-year-old patient with no apparent risk factors unexpectedly threw a pulmonary embolism.  Because tissue typing falls within my jurisdiction, I help patients proceed to organ transplantation.  With therapeutic apheresis, I help you keep your transplanted kidney when your body starts to reject the organ.  I reduce the risk of mortality in patients with acute TTP and help treat leukostasis in leukemic patients with hyperleukocytosis.  I restore quality of life to patients with complex neurological disorders, reduce cholesterol levels in patients intolerant of medications, and collect stem cells that will be transplanted into a leukemic patient.  I even scrub in order to harvest bone marrow from you (or your loved on) in the operating room that will be used for transplantation. 

Believe it or not, this is not even close to being an exhaustive list of all that I do for patients.  When I said that I do everything, I meant it.  You’ll likely never see me face to face, but the odds are good that I have played a role in your care, whether you are undergoing outpatient screening or inpatient intervention.

“So why did you choose pathology?“

That’s easy – I chose pathology because at the end of the day, it’s what I love.  It doesn’t get simpler than that. I didn’t choose pathology because I’m socially stunted or because I hate patients.  None of that is true.  I picked my career like I picked my spouse – for love.  I love pathology because what I do every single day makes me a part of the care team for every single patient, even though most of them will never know that I exist.  I truly believe that what I do has a profound impact on patients.  I love my job because it’s fascinating – the human body, in health and disease, fascinates me.  I love pathology because it’s incredibly beautiful – looking under the microscope at stained tissue, with all its architectural variations, is art in motion.  I love pathology because it astounds and challenges me and teaches me something new every single day.  That’s not to say that I don’t become frustrated – every job has its problems.  Being a medical provider is hard work; it can eat you alive if you let it {a blog for a different day, perhaps}.  I have moments where I forget about the awesomeness and importance of the work that I do – and I’m entitled to those moments when they happen.  But thankfully, they pass, and I am usually left with the feeling that what I do is quite possibly the coolest job on earth.

“You love your job; great.  But what do you hate about pathology?”

I hate how under-valued pathologists are.  I hate how easily we are overlooked. I hate that Hollywood cheapens what I do and turns it into a farce.  I can’t fault patients when they don’t recognize all the services that we provide for them; after all, chances are good that none of them have actually met a pathologist, let alone the pathologist that signed their biopsy report.  I do, however, fault fellow physicians when they overlook pathologists, because they ought to know better.  I can’t tell you how many times I have heard comments like, “Pathology?  Really?  But you’re so smart…,” or “people pick pathology because they can’t hack it in real medicine,” or “…just some dumb pathologist that doesn’t know the first thing about medicine.”  Yes, I am smart.  It’s why I picked a discipline that requires me to use my brain every single day – it’s why I’m considered the “doctor’s doctor.”  I’m not just some dumb pathologist; I’m a physician that knows quite a lot about medicine.  And the medicine that I practice is real medicine – it’s medicine and science in the most pure form, disease distilled down onto a glass slide.  Sure, I can put my stethoscope on a patient’s chest and pick up their soft, holosystolic murmur  (I do this in apheresis clinic, btw) - but can you take one look at a slide and know that you’re dealing with a myxopapillary ependymoma?  Or a parosteal osteosarcoma?  Can you differentiate reactive atypia from neoplasia?  My point is that one good, motivated pathologist is worth 10 mediocre internists.  So please don't make the mistake of underestimating (or under-valuing) my specialty.

Why I wrote this internet novel:

Because I'm passionate about what I do, and I want to share it with others.  And also because nobody seems to have any clue what it is that I spend my days doing - and I think that's really sad, because what I do touches on essentially every aspect of a patient's medical care.  So please, patients - get acquainted with your pathologist.  Get to know what it is we can do for you and for your loved ones. Give us a call.  Better yet, drop by to have us show you your biopsy (or your appendix, etc).  We can't give you therapeutic advice (it wouldn't be ethical), but we can absolutely introduce you to the lab and sit you down to show you exactly what your gallbladder looks like under the microscope and why we made the diagnosis that we did.  We love our job - and we'd love to share our job with you.

Lift up your head, princess; if not, the crown falls

There are many things in life that I will be, many places that I will go and many things that I will do…but unfortunately, joining the faculty in Vermont will not be one of them.  After waiting on tenterhooks for my application to be reviewed, the final(ish) verdict came this evening: my application is, unfortunately, not a member of the “first round” candidate applications. 

I got the call shortly after leaving work.  Ironically, my iTunes app was playing Ryan Shupe’s “Dream Big” song.  I made small talk with the attending on the other end of the line, the one who is chairing the search committee, for a minute before he launched into discussing the status of Vermont’s faulty position.  I got the standard, “lots of outstanding applicants,” and “your application is under consideration,” and all the rest of the platitudes, that I’m sure everyone hears, and then the other end of the line got quiet.  There was some throat clearing and a few pregnant pauses on the line, and those told me everything that I needed to know before the words hit the airwaves:  I was not going to be invited to interview- at least not yet.  The applicants had been sorted into groups according to the strength of their candidacy, and unfortunately, my application had not landed into the top-picks column in the ledger.  I think the moment was awkward for both of us.

I was told that “of course, your application is absolutely still under consideration.”  I was also told that the institution would be following up with me again, likely in three to four weeks, after the ‘first round’ candidates had been through. The utility of the follow-up is questionable.  I strongly suspect that the second round candidates (and third, or fourth, or wherever my application happened to land) won’t be traveling to Vermont.  I am sure that the newest member of their faculty resides somewhere in that first group of candidates.  Sadly, the newest member of the faculty will not be me. 

He kindly asked if I had any questions about the application review process, etc.  In fact, he asked this question three separate times, not out of any sort of meanness, but because I think he genuinely wanted to give me an explanation.   He is the sort of person that treats others gently, and for that I am grateful.

Perhaps someone with more objectivity than I possessed in that instant would have asked dozens of detailed questions about the review process in an effort to figure out how and why it all went wrong.  But in that moment, standing in -10 degree weather on the outdoor commons of the University Hospital, it was all I could do to end the conversation politely whilst not crying like a three year old.  After all, in weather this cold, the tears would freeze on my cheeks, an icy testament to my disappointment.  I’m not prideful, but I have pride enough to want to avoid that sort of public display.

I asked no questions, partly because my mind had gone temporarily blank, but also largely because I’m not sure that the answers (if I’d even really been able to listen to them) would have helped me much.  If there was something fundamentally flawed in my application, there isn’t much I can do to correct that, as the rest of my applications have already been distributed.  If it’s a relative lack of blood-bank related research/publications, I can’t put up much of an argument.  If it’s an experience issue, well, I can’t correct that, either.   It’ll correct itself in about five years…I hope.   And if it’s a lack of significant interest in coagulation…well, that may never correct itself.  Asking questions, learning WHY it is that I’m not a “first round” candidate, wouldn’t change anything at this point.  It would only make me feel more unwanted and inadequate.  And so, standing alone in the frigid, grey Michigan evening, I began to let go of Vermont.

Even the saddest moments in life bring lessons.  The lesson that I was reminded of is something that I have always known and generally tried to ignore – that rejection hurts.  Years from now, I suspect that I will look back on this moment and while it will not be as acutely painful, it will probably always sting just a wee bit.  That’s what happens when a dream tumbles down around your feet.  And though the pain of rejection is fresh in this moment, I am also prompted to consider that sometimes the destruction of one cherished hope scatters around building blocks that can be used to build something magnificent.   Knowing this doesn’t lessen the blow, of course; right now, I’m wounded enough that I am struggling to keep things in healthy perspective and I am by no means able to be completely objective tonight.  But I suspect that one day, a couple of weeks from now, when my objectivity has returned to me, I’ll start to sort out those building blocks.  I’ll decide which to keep and which to toss, and I’ll build a better castle in which to store my dreams.  After all, there are far worse things that life can throw at one than the opportunity to rebuild and rediscover. 

So play on, Ryan Shupe, and let your words be true.

2 years

It’s been two years since you went missing from my life and I feel compelled to say something to mark the day...but I still find myself at a loss for words.

I finished residency in June – and even though you would have made some snide or off-beat comment about the moment – I think you would have been happy for me.  I really think you would have gotten a kick out of the send-off my mentor gave me at my graduation dinner.  After all, who doesn’t love the strumming of a ukulele?  And I still think that you would really have loved Vermont.  After all, you always loved ice cream and Phish – and Vermont is pretty well known for both of those things.  Ben and Jerry’s even managed to combine them both into something pretty spectacular.  We would have had a good time sightseeing there, you and I.

I sit around some days and think about all of the fun we might have had together over the course of the next 50 years, if things had only turned out differently.  There were a lot of things we might have shared, a lot of memories we might have made.  But now there are just a lot of things to miss.  The worst part is that I didn’t even know how much I was looking forward to sharing these moments with you until the opportunity was yanked away.  I always thought you’d eventually find a nice girl and settle down and I looked forward to dancing at your wedding.  I was excited to gain a sister.  I looked forward to being an aunt to the children you might have had.  And as Chris and I casually contemplate the idea of children, it hurts tremendously to think that any children that we might have will never know you.  You were really good with children and I know that you would have been a pretty great uncle.  It makes me so very sad that they will miss out on knowing you, and if/when the time comes, I don’t even have a clue how to show them who you were, how to make them love the ghost of someone they’ll never meet.  

Looking at what might have been generally makes me also look back to what has already been.  Some of the good memories are starting to come back slowly, like streaks of sun shining through the clouds after a thunderstorm.  I suspect that the memories will always be tinged with a lot of sadness and a lot of bittersweet but I’ll take those over the anger and the guilt and the grief any day of the week.  Not that those feelings have disappeared, mind you, but at least they are not as all-consuming as they once were.  Or maybe I’m just getting better at integrating those things into my life – maybe I’ve just learned to co-exist with that part of myself.  Because the truth is that my life was rent into two phases by your death and I can never be the same person that I once was.  Your death changed me in a very fundamental way.  It’s been a hard process, trying to figure out who I am and where I fit in a world without you.  I’m not there yet- but I think I’m getting it figured out.  I’m starting to accept the aching pain that has taken the place of the stabbing grief, and I’m starting to live beyond it.  It’s a lie when they say that time heals all wounds; not all wounds are meant to be healed.  The other adage, however, is true:  time marches on. And so must I.

That’s where things stand after two years.  Things are still a work in progress.  I am still a work in progress.  I still miss you, and you still cross my mind every single day.  Your absence still hurts, though I am no longer inclined to make the pain stop.  I’m changing, I’m growing, I’m both more and less than I once was.  We all are, those who loved you.

To Anne, with love

Today, the world lost someone truly special. Her name was Anne Wolff.

Anne was not my mother, my aunt, or even genetically related to me in any sort of way.  She was, however, family in a different, less tangible way – the family of my heart.  You know, the family that consists of members that you pick up along life’s journey, the ones that you choose, that are not genetically predetermined.  And so while my grief tonight is by no means as overwhelming and wrenching as the grief of her immediate, biological family, my heart aches just the same over the loss of this amazing soul.

It’s hard to find the words to describe the special person that Anne was – and that, in and of itself, is telling.  Anne was always too busy learning and exploring, listening and engaging others, to worry about silly things like labels.  She wore a great many hats - mother, daughter, aunt, teacher, scientist, biologist, cook, chauffeur, Girl Scout troop leader, Science Olympiad and History Day group leader, Vacation Bible School director -  but to me, she was simply a friend.  And when I say friend, I mean it in the best of ways, because Anne was the kind of friend that would drop just about everything to help you if she could.  She was the kind of friend that made you realize that it was ok to laugh at yourself sometimes and the kind of friend that you could always count on in a pinch. She was the kind of friend that could make you laugh even in your darkest moods with one of her corny jokes (“How do you make a whore moan [hormone]?” she once asked my anatomy & physiology class during a lecture on the endocrine system.  The answer was not scientific…“You don’t PAY her!”)  She was the kind of friend who could go for months/years without seeing you and still pick up conversations with an ease and familiarity that suggested that you had never really been gone at all. But most important of all, she was the kind of friend (and person) that understood that the investments that paid out the highest dividends were the investments made in people, not things – and in this, Anne was an investor of the highest form. She began investing in my life somewhere around the time that I turned 6...and I truly hope that at some point, her dividend was worth the amount of energy that she expended on me over the years.

Anne was my emergency contact for many years, mostly because my parents had deep and well-placed faith in her.  If I were ever in trouble and my own parents could not be reached, they knew without a doubt that they could count on Anne to care for me and about me with nearly as much attention and warmth as they could give themselves.  It is no small thing to trust the care of your child to someone else but they knew that Anne could be trusted.  I, too, placed my faith in Anne many times throughout the years, including the time during my teenage years where I took an (illegal) joyride in my father’s blue International that ended, tragically, with several dented neighborhood mailboxes and a ugly dent/scrape down the side of the vehicle.  In panic, I called Anne (it never occurred to me to call anyone else) and Anne came up the hill with rather stunning alacrity… firstly to ascertain that I was unhurt, and secondly, to help me realize that my plan to cover over the scrape with blue Sharpie marker was simply not feasible. Her patience and wisdom when dealing with distraught, melodramatic teenaged girls was nothing short of heroic.

Many of my childhood memories revolve around Anne – the sleepovers that ended up with Sarah and I slumbering next to her in her great big waterbed, exhausted after having stayed up late to watch Saturday Night Live.  The evening I learned, somewhere around the age of 10, that the phrase, “I’m pregnant,” did NOT, in fact, mean that I was deadly serious about something (I’m glad Anne cleared that one up before it got out of hand!)  The Thanksgivings and Christmases that our families shared together, air redolent with laughter and friendship.  The hot summers that Sarah and I spent together digging for dinosaur bones in the backyard while munching on snow peas freshly plucked from Anne’s small vegetable plot.  The summer that Anne, Sarah, Shana and I walked a portion of the Mormon Trail because it would give to us a deeper historical perspective of the Mormon faith, though none of us were Mormon.  The murder mystery birthday parties that almost always featured Anne wearing a brightly colored Mexican poncho and sombrero, head thrown back in laughter as she attempted a Spanish accent (and somehow, she always managed to sound vaguely Russian).  The New Year’s Eve parties full of friends and never-ending games of Star Wars Monopoly.  The pre-teen forays into filmmaking that ended badly for the beloved classroom plant of an elementary school teacher.  The early childhood days full of shaving cream creations and Barbie dolls and dress-up from a closet full of never-ending clothing options and costume jewelry.  The innumerable early morning History Day and Science Fair and Science Olympiad and Girl Scout troop camping trips and the accompanying jokes and laughter.  The rather graphic video of a woman giving birth that still haunts me to this day and did a wonderful job of preventing unwanted pregnancies among our Girl Scout troop.  (And on a related note - sorry, Mom, but almost everything I knew about sex by the time I turned 18, I learned from some very frank discussions with Anne and Sarah).   

As a professor of science at the local community college, Anne introduced me to science and brought it to life in a way only a truly skilled educator can.  Under her tutelage, I learned the complexities of anatomy and physiology (learned on no fewer than 3 unfortunate, formaldehyde-drenched felines), how to mix basic household ingredients to produce colored slime and moldable play-doh, and exactly why you should never put your mouth directly on the spout of a public water fountain (we cultured the fountain outside of her LCCC office for fun). She was the first person to introduce me to a microscope as a child, and I still remember the amount of time she dedicated to making sure that I saw how exciting looking at the microscopic world could be, how there was a whole world that existed beyond the capabilities of the naked eye.  She forced me to expand my mind and to question the world around me, but mostly, she taught me to love science.  This love has stood me in good stead as a physician.  When it was time to pick a medical specialty, pathology was the easy and natural choice – where else could I utilize the microscope skills I had learned so long ago?  More than once, I have gazed through the lens of the microscope at a microorganism or tissue specimen and thought of Anne fondly before returning to my diagnostic task.  I have a career that I {mostly} love based on skills I picked up long ago – and while I might have eventually found my way into pathology, I know that Anne, in her own special way, lent me a tremendous helping hand.

There is so much more that I could say about this wonderful woman who helped to shape my childhood, and I am fortunate that my memories of her are plentiful.  But above all else I could say, I will say this:  I mourn the loss of Anne.  I mourn the loss of one of my earliest mentors.  I mourn the loss of one of my earliest and most constant friends.  But mostly, I mourn the loss of one of the most special women I have ever known.  Anne was loving and kind, generous and witty, intelligent and passionate, vivacious and extraordinary.  People like Anne are rare; they are a once-in-a-lifetime kind of find – a jackpot in the lottery of life.  And with friends like Anne – who needs the winning PowerBall ticket, anyway?

And while these kinds of goodbyes are difficult, I know that they are not forever.  One day, I will see my friend again.  So until that day arrives, here’s to you, Anne, with love, respect, and gratitude.

Why one should never buy me expensive things...

I lose a lot of things...

-iPods (yes, plural, because I've now lost 3 of them)
-Watches (why I almost never wear them anymore)
-Debit/credit cards/checkbook (once, I had to pick through the used laundry in the morgue because forgot that I left my card in the pocket of my scrubs and tossed them in the hamper...totally gross experience, btw).
-Car keys/ house keys/ mailbox keys...any kind of key, really
-Important documents
-Driver's license
-Wedding ring
-A diamond earring (which in all fairness was retrieved after I dropped it down the sink drain but goes a long way in explaining why I've never received any other expensive jewelry from Chris).
-Socks and many other articles of clothing
-Call pager (and oh, how I wish it had remained lost...)
 ... and so forth...

If a vortex of lost items exists, I'd sure like to run into it because I'm pretty sure I've kept it well stocked over the years.

It's so frustrating, being a motile black hole.  And now, I've lost my phone, albeit for very different reasons.  I lost my phone when I failed to keep track of said phone's position relatively to my glass of water.  I brushed my cell phone off of my nightstand and into an uncovered cup of water on the floor when the damn call pager shrieked and caused me to wake up, disoriented and grabbing blindly for the noisy culprit.

If I'm being honest, it was time to replace the piece of junk anyway, because the alarm clock function was starting to get a little sketchy.  And really, I'd been looking at new phones anyway but had been indecisive and somewhat unwilling to shell out several hundred dollars.  But fate (and the call pager) made my decision for me, which is how I find myself with a new iPhone5.

So pardon me if I'm a little obsessive with my new phone - but given the above track record, can you really blame me?

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.