Let me tell you its messy for the mom, for the family, for the baby, for the doctor, etc. And not just physically messy. I delivered four babies and received about 40-60ish now (the pediatrician who resuscitates the baby in the delivery room or just dries them off depending how messy it all is).

Its painful and sometimes the sorrow in that room from things not going the way we all hoped is bottomless.

Pregnancy is painful.  Parenting is painful.

Believe while I don’t know personally, I live so close to it on a daily basis ,I know.

Last night I went to the woman’s bible study.  Because it was Monday and my Roommate is interviewing and eating grits (for the first time)  in Charleston, SC. She called me and said Amy, how did you ever leave the 60 degrees in Feb, the friendliness and the laid back, sit on your porch and watch the world go by kind of place.?  I told her I have no idea what came over me.  Basically I was homesick and lonely so I went to bible study even after telling myself that a bible study that looked at biblical womanhood in a church that currently loves Mark Driscoll a wee bit too much was a BAD BAD idea for me.

The passage we looked at was 1 Timothy 2, the part where we talk about not braiding our hair, not wearing gold or pearls and that we will be saved through childbearing.  We spent 45 minutes talking about the pain of womanhood from menstruation to labor to motherhood.  Don’t get me wrong, there are times where being a girl is not awesome but there was this sense of shame in the room. Shame about not controlling our emotions, shame about how painful pregnancy, childbirth, etc is.   I finally just came out and said what was flashing in my brain not out of anger but because I just couldn’t bear to watch the other ladies sit there squirming. And because I have worked 95+ hours in the last week and there is no filter anymore, there is just words.

There is no mold of a perfect woman in Christ, its not the secular mold, its not the evangelical mold (gasp).  This should be  liberating not condemning.  My comment actually was not poorly received, the word liberating caused some general discomfort (tragic…read Galatians…please).   Now I will give this church credit while I have never been to the men’s bible study naturally I have heard the sermon excerpts geared toward guys and they are equally hard on men which is a refreshing change in some ways from the norm.  So I don’t think this is one of those “Its all Eve’s fault” kind of things.  Yet I still don’t think most of those ladies left convicted and liberated.  Just convicted and guilty,

The elephant in the room….is when Paul says women will be saved through childbearing, I don’t think he meant the literal practice, I think he was using it as a metaphor. This is especially important because we take the rest of the passage as metaphoric (we still braid our hair and wear jewelery) , I don’t love the lets pick the metaphors out of literal sentence game…either this is a literal passage or its not. Don’t dance around it to the parts you like.

Child bearing results in children and for someone who spends a lot of time with babies….95 hours in the last 7 days.  Babies are complicated and messy and yes they can even bring us pain.  But for the 40-60 mothers who I passed their child to them for the first time….it was pure joy.  A joy that I don’t think happens to men in the same way and I don’t think there are many better pictures of unconditional love.  Being a woman means we have a special understanding of this because we have the capacity to bear children and experience this.So yes we (men too)  are saved through childbearing…through unconditional love, the kind of love that lays down one’s life for one child or one friend.

kind of like Jesus.

Perfect love drives out all fear, drives out sin and pain and brokenness. That’s the gospel.  God has made a curse into something beautiful.

but we didn’t talk about that. and my 95+ hour work brain couldn’t articulate as well I wanted to in the moment.

In Africa, we would run our list prior to call and come across a name of a baby who was struggling or had an infection we could not beat, there were no ventilators or was just too small, too early for us to give it a fighting chance with what we had.  We would say, Baby so and so is going home tonight. It doesn’t meant we won’t try, it doesn’t mean we haven’t racked our brains of what we can do with with what we have. But we know our limitations and we also know that us beating on the chest of a premature new born who needs a ventilator we don’t have is not going to help anyone.

Home is an evangelical phrase that is a reference to a verse in Paul’s letters that talks about being citizens of heaven and not of earth.

But I like it because it implies that death is not just about leaving, its also about going.  Babies don’t have the need for our theology and politics but  they remember where they came from.

In America, when a baby is dying in the NICU, we stand around running through every physiological rotation, we throw every drug we can think of, we call in the surgeons, who join the circle around the bedside, we try experiments, we give blood, fluids like we have unlimited resources,  we switch around ventilators left and right, we talk about the baby in the circle as some academic enigma whose body is just not doing what we tell it to do. The parents hover just inside the circle. Most are stoic, looking at the baby back to our circle, trying to decipher our academic whispers.  We tell them the truth, we tell them the baby is going to die.

In Africa, the mothers visit every two hours to breast feed or pump to feed through a feeding tube. They are devoted beyond belief.  We don’t mess around when a baby is dying, Mom will sit by the bedside in vigil, holding the baby, loving the baby. Other than making the baby comfortable we don’t interfere. In some ways, its the worse feeling in the world as a physician and in other ways its liberating to be able to give the baby and their family that moment.

Last night, we had a baby that had had every thing we had to offer who was dying, this went on for about 7-8 hours.  The mother was alone, young, she didn’t seem to understand what we were saying when we told her, her daughter was dying. She went home to sleep 20 mins afterwards. Perhaps it was the crowd of onlookers, the 25 people standing around still intervening. It didn’t look like the end, it looked like the middle of the battle. I called the chaplain and we called her back.  It took no less than 45 minutes to change the tubes around enough so that Mom could hold the baby.  I am watching the monitor the whole time and watching the baby heart rate drop alarmingly fast.  By the time Mom got to hold the baby the baby was purple and no longer had detectable pulses, we were breathing for the baby.   But the baby was gone.

Why did we wait I cried out internally?  What in the name of all that is good were we doing??????  WHY is she still on the dam monitor?  If we hadn’t waited till past the 11th hour, we could have found a private room for this Mom, we could have let her hold her, sing to her, cry, call her family. She never held her child alive or if she did it was for seconds to minutes. What really mattered here? We knew 8 hours ago that we were pulling for straws.  What were the extraordinary measures here?

Instead, she held a dead baby for about 45 minutes in the middle of a NICU pod with the sickest patients so with people constantly in and out. Even with screens….it was hellish.   And the moment heaven meets earth should haven’t to be.  It doesn’t have to be like this.

I am not saying the agony of what I don’t have in Africa is better but the agony of having everything except for the one thing that really matters in America is  haunting.   Its haunting because we have lost a grip on life in our attempts to foil death.

Either way the baby dies, its about how they die.

He left Syria in the mist of a near civil war where every day there are reports of people dying.  The Arab Spring of 2011 has not ended well in his homeland.

But for now, he is here with me taking care of ward of children who have succumbed to the various demons of winter.

Late one night, we admitted a Somali toddlerl for observation after drinking some cleaner.  When the ED called to tell us about her, both of us got excited. Me because I took care of Somali refugees in Kenya and him because many Somali folks speak Arabic.

After we had her settled in, we found ourselves walking for midnight shack in the cafeteria. We talk about the famine in Somalia  that no one is talking about, the children who are dying. How our pediatrician hearts break for the children who are caught in the crossfire of country at war with self and a divided world who cant seem to understand each other.  The West has turned their back on Somalia because they harbor terrorists. But the terrorists who have friends in high places elsewhere are not dying, its the women and children.

Our conversation turns to the ground that divides us.  How hard it was for him to get a visa because he is from the other half. How many of my countrymen suspect something of this quiet soft spoken pediatrician because of his passport and his religion. They haven’t heard his heart for children who are dying of repairable heart defects or watched him play trains with a terrified 3 yo to soothe him. And how his countrymen suspect something of me as an American, as a Christian, as a Navy brat, as a global health doctor surely, surely she is an imperialist. Surely she wants the whole world to be like America. Surely she must be like that man in FL who burned the Koran (which apparently is a popular viral you tube like video in the Middle East).  They don’t know that I took an Islam class, read the Koran and that my best friend from medical school is a Muslim. They don’t know that in the end I love the diversity of the world and dress like a Kenyan, cover my head in Eastern Europe and am mildly horrified at how viral McDonalds is much less the rest of my culture.

And our conversation stops for a quiet reflective moment.

In the end, we conclude. It all comes down to pediatrics.

No really it does.

We want a better world for our children.  A safer world. A more peaceful world.  A world where our children are not hungry, are not sick, go to school and grow up free.

We smile.  We eat our snacks and rush back to the havoc of the wards in the winter.

If only we could put aside our fear, our pride, put down our guns and realize for a moment just how simple it really is.

It renewed my desire to be a global pediatrician, to be part of the solution.

Baking something yummy.

North Carolina Wine

Old Friends.

New Friends.

Summer Nights.

Clean clothes.

Good Books

Clean hair.

Pedicures

Grace

Children and their wisdom.

A Good Night’s Sleep

bad lungs.

bad gut.

bad heart.

on a ventilator.

cant eat.

…can’t fix the heart. (inoperable)

The heart will be the end of him.

I got a page asking for restraints.

I go and see him

He is waving his little arms and legs.

Looking at the world.

They tell me they are afraid of toys.

Because it might overstimulate him.

Overstimulate his fragile broken heart.

I find a rattle half buried under blankets.

His eyes light up and his hands reach out.

His heart rate is steady,

his breathing is smooth and unlaboured.

He smiles.

I say to heck with his heart.

which I can’t save.

No I won’t restrain him.

Play with him. I tell them.

I cannot save his heart.

But I can save his baby soul.

A soul that just wants to learn

and play

and love

and be.

1. Moms shell out for organic, soy, sensitive, Free range, IQ boosting formula but won’t breast feed their babies.  They shell out for organic, homemade, free range, rice based baby food…. But they won’t breast feed their babies And they are really snobby about their organic free range formula….  There is nothing more organic or natural than breastfeeding.

2. They shall out for your Baby Can Read products/Baby Enistein….turn off the TV and talk to your baby, read to your baby…..FOR THE LOVE….TURN OFF THE TV.

3. They yell at me for not prescribing antibiotics for their 24 hours of nasal congestion…..ITS A VIRUS. I can’t fix viruses and it will be gone next week Yet they wont let me vaccinate their child against h. flu which killed a un-vaccinated child in this CITY last year.  Nasal drops and Tylenol vs. watching your child seize in the PICU on a ventilator…..  ?!??!?!!?! NOT TO MENTION THAT WHOLE VACCINES CAUSE GREEN HAIR/AUTISM/GENERAL BADNESS is bad, bad science and there is a very expensive law suit in England as a result of it.

4. Moms who yell at our team (including the attending) when we cannot get their child butter pecan ice cream to their child in the hospital and threaten to leave AMA…NO JOKE.  We have Graters for crying out loud on the menu…. and Ice Cream vs. your child has cancer..??!?!?!

5. One of my colleagues spent an hour with her Private Practice preceptor last week consulting an irate family about the lack of success of acne treatment…being  a teen is rough don’t get me wrong, my baby sister struggled with acne but yelling does not make it better and I counter yet again…acne vs. nearly every other medical problem known to man…what would you pick?

6. I recently had a allied health professional make fun of an Amish patient and another make fun of a patient from the inner city….cultural sensitivity is not our strong suit…and still a colleague make fun of a visually impaired fellow We say we want diversity, we say we want tolerance but we like it better when THOSE people stay on their side of town (I dont know if the visually impaired fellow has a side of town…I guess its my side of town….).

7. We say we want women to be able to be mothers and work and do it all but its not acceptable for a women to pump at most places of work (although it is where i work ) and its often not culturally comfortable for a woman to breast feed outside of a cramped bathroom stall in public.  (yes I know two of the top 10 are about breastfeeding)

8. Then they is the other extreme….(and I am about to be called a heretic)…the stay home at mom who is snobby about being an organic, free range, non-vaccinating homeschooling stay at home, Sunday School teaching, Women’s Bible Study leading Mom who will condemn my single Moms/married but working two jobs in poverty sending their kids to day care and public school in the inner city for not staying home.  Where is your compassion that you preach about?  I love you and I grew and went to church camp with you but I can’t be your pediatrician.

9. The Moms who see one of us come into the room and say “No way, I don’t want a  resident, medical student, fellow, attending under the age of 35 touching my child.” Or my favorite: “They can practice on SOMEONE’s ELSE child.”  I understand Moms, believe me I do, I have had many clumsy orthopedic residents do a lot more than examine me over the years but in the end I also helped train a generation of pediatric/skeletal dysplasia doctors so that the next generation of my tribe gets better care.  This is why so many training hospitals/Resident clinic are in the inner city or the worst part of towns because we care for the indignant SOMEONE ELSE’s child so we can finally get enough gray hair to graduate and move out to where we can take care of your grandkids. No Medical Education = No well trained doctors.

10. Another colleague was recently at a church gathering where one of the other girls is pregnant and said: “I don’t think I can go to a pediatrician because they are so militant about things like vaccinations and breastfeeding….”  

yes I am militant but its only because its all about the babies and they are wroth fighting for…no matter where they live, what language they speak, where they go to school or how much free range, organic gruel they are fed.

…..off soapbox….

My patients don’t have a buck and they don’t have a vote, they can’t buy their own health insurance/health savings account/or even barter a chicken in exchange for their care. So no matter your opinion or political affiliation, stand up for your children and grandchildren (Not to mention all my people who always get the shaft any way (all the gimptastic, disabled kids who need health care so they can grow up and become politically incorrect pediatricians if they want)).They are the future voters, physicians, teachers, politicians and citizens of this country. They are also the patients whom if we don’t provide care for now will be the future citizens on disability, medicaid and welfare.

Please help me support children! Please help me by clicking on the link through the National Association of Childrens Hospitals and sending a letter through their program to your representative. (it will link you to the right people in your area through the link and it took me exactly 125 seconds) (or if you have more free time than me and feel inclined write your own letter). Make sure to note your local Children’s Hospital or a Hospital that has made a difference in your life or the life of your child or grandchildren!!!!!!!

HELP KIDS!

Love,

Amy

(just another American voter who just works 90 hours a week to takes care of other people’s babies who apparently are just not that important)

Just keep smiling. Just keep smiling. Just keep smiling. Just keep smiling. Just keep smiling.

Fall down. Get up. Fall down. Get up. Fall down. Get up. Fall down. Get Up.

Welcome to the world of chronic illness. It a series of failures…I mean victories.

You go from sailing above it all filled with gratitude and in awe of the normalcy of your life. You marvel at the beauty of being able to get through your day with ease, without pain or torture or a series of endless decisions that will alter the course of your life.   TO scraping yourself off the bed just hoping you can make it to the bathroom without falling over or depending on the situation passing out/etc.    Some times the fall is a slow slide where you can igore the signs, sometimes its a cliff that you fall and find your hurled to the bottom of the canyon.    You can try to find something hold on to cushion the fall or let you sit on the hill for a little while waiting for the land slide.  You become an expert at denial and justifying away the signs because the last thing you want to do when five minutes ago, an hour ago, last week, two months ago you were living at the top in the glorious glow of what life should be is admit that its back or that you are here again standing in the canyon or half way there looking up at the rock face you have to climb back up.

There is nothing in this world as humbling as the human body capacity to fail. and lack of human ability (particularly that of individual involved) to control it  I would know….on multiple levels no less.

Fall down. Get up. Fall down. Get up. Fall down. Get up. Fall down. Get Up.

I watch it. I live it. I study it.

You would think that after 26 years I would not wake up feeling like I just lost my best friend when this happens but I do. I feel isolated, lonely, anxious and at times a little frantic.  Frantic to be able to predict what happens next and frantic to do whatever I can to get back to the top and pretend like I never had to come back here to the bottom.   And then I feel ashamed even though I know its irrational. I feel ashamed to be in the way, to be less than a 100%, ashamed that somehow I again was not able to make it work even with all the efforts somehow in the end I still failed to hold on.

Its irrational, its futile and no one talks much about this stuff in medical school but in the end to me its the defining experience of chronic medical problems.   And sometimes in the other half of my life, I look into the eyes of sweet children and I see there just below the surface a longing to be free of the cycle or at least be allowed to talk about it…to confess it.

For just a moment they want to not be the hero that everyone around them applauds them for being or not be the withdrawn or the demanding kid with behavioral issues, for a moment they could just be allowed to say they are tired, that they are weary of the procedures, the plans, the protocols and the exercises that are required of them and just for a moment be allowed to choose sanity and scream and wail and say THIS REALLY SUCKS.

and then be allowed to move on.

so yes world having no hip cartilage sucks.

having no hip cartilage and working 90 hours a week really sucks.

having multiple joint replacements before I turn 30 or have a REAL job sucks.

and that my friends is a victory.

saying it out loud.

I sit there in the corner and think about what I was doing at 15.  I was in 10th Grade in FL.  I was in the school play and got to pass out on stage. I went on my first date  by myself without a group.  I flew on a plane by myself for the first time.  I read Harry Potter for the first time. Rebelling was not wearing my hearing aides for two years and refusing to drink milk.  Some of it is that I had to grow up fast because I lived with a chronic illness that was very time consuming especially when I was in middle school.  But most of is it I had parents that loved me enough to fight for my childhood.

Who is fighting for these girls?  Who is their advocate who stands up and says NO this is not OK?   Their parents don’t do it even the ones who know. We their doctors apparently don’t do it either.

I cant not do it.   When I get the chance to have them one on one….I do my best to GENTLY explain to them the consequences of repeated pelvic infections.  I make sure they understand that birth control is not protective against STDs.  And if they give me an inch I go a mile in trying to help them realize that giving themselves to a boy is not going to make them happy or fulfilled especially if that boy is disrespectful, not interested in protection or better yet abusive.

My adolescent attending can call me a bible thumping, naive Southern all he wants.This isn’t even about my bible belt morality.   This is about girls getting sick, babies being born to babies and girls respecting and loving their bodies.  PID, teenage pregnancy THESE ARE NOT NORMAL.  These are not safe.   And by choosing to ignore them we devalue the precious vulnerable teenage girls who are looking for value in all the wrong places and are desperate for someone to say… I care enough to fight for you and tell you the truth.

For the first seven months of my life,  everything would have been a blur.  My first Christmas was when I was 2 months old. My favorite place to be that year was under the tree with the room lights dim.  My Mom tells me I would sit there for hours.  Sometime I still like to do this. In the dark without my glasses I cannot make out anything more than shadows, but lights shine like glowing orbs.  Christmas lights on a tree or in the case of my little poor starving resident flat around my window are many glowing orbs together  each moving slowing as my poor eyeballs try to focus and cannot. Together making a beautiful piece of abstract art that never gets old.  Light in my darkness, in my blindness.

Light.

Of all the things Hallmark, Matel and Wal Mart have done to the Incarnation, they got one part right despite of themselves: Light.  You can call it X-mas , you can call it pagan, you can  cite all the good Egyptian and Greek mythology that went into the choice of Dec 25  and and never mention Christ but if you are transfixed by the lights, you are closer to the heart of Christianity than you know.

The story of Christ’s birth is dirty and dark, it might be rated R.  Its about poverty, oppression, sex, near-stoning for adultery, a dangerous journey, child birth in cave with animal dung with no birth attendant, its about smelly, poor outcasts having visions of angels (bet that went over well with the religious authorities…can you say pysch admission?) and then it ends with the  flight of a young family back into poverty with the wails of mothers holding the bodies of their murdered sons who were unlucky enough to be born in the wrong year echoing in the night.  Its not cute. Its certainly not a children’s story.  Its raw, its painfully human and really its rather uncomfortable.  I mean who is excited about worshiping a dirty, smelly baby in a cave with animal dung whose parents are oppressed religious fanatics who everyone thinks is crazy. Its really not surprising that we gloss over it or create simpler, easier to contemplate stories of grace like a St Nicholas (a nice guy who gave out presents to poor kids a couple of centuries ago), or Dr. Seuss.

Despite this its my favorite story in all of Christianity.  Not because I like presents or pumpkin pie or vacation…This is the story that sets Christianity apart from every other world religion.  This is the story that ties the narrative of scripture together.  This is the story about the light coming back

Light is something that cuts across religions and pagan traditions but it clearly claimed by Christianity as a symbol of not just hope or prayer or even wisdom but of God himself coming into the world.

What other faith has God having such a human experience? God comes in human form in ancient mythology and in some Eastern Traditions but never in such a humble, dirty, R-rated form.   Then there is the light…In the beginning there was light that is how the bible begins and for much of the Old Testament we see human beings searching for the light, testing the light or completely missing the light.  They live in darkness most of the time and no amt of human striving can seem to ever fix it.  So then first  long anticipated he prophets and then in the gospels the light of the world comes to earth to be the light for the people who can’t seem to find a way out of their wretched darkness.

so light a candle,  a luminary, or hang a string of lights.  And let it shine in your blindness, in your darkness and realize in our raw, horrible at times human experiences on earth rather it be poverty, the brink of war, homelessness or oppression-grace and redemption arrived amongst those very circumstances.

let there be light.