Organic Free Lunch….or why I can’t be a pediatrician in the American suburbs

As I ponder the mysteries of being an American pediatrician again. I find myself struggling to relate to American Moms who come from my socioeconomic level….

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….

SOAPBOX

President Obama’s budget as it stands will substantially slash pediatric graduate medical education (PEDIATRIC RESIDENCIES) and funding for all of our nation’s childrens hospitals on Sept 30. The current plan would force many smaller pediatric training programs particularly the primary care based programs to have to close their doors to new residents. Larger programs would have cut their numbers and cut out benefits and educational funding for research and care for the underserved. It also cuts crucial funding to all childrens hospitals many of whom (like mine) give care to children who otherwise would have limited access to care. Ironically we desperately need more pediatricians in the US, particularly primary care doctors yet this plan would make it nearly impossible for us to expand our numbers and would in fact CUT THE numbers of pediatricians that graduate every year!

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)

Its the circle….circle of…

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

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 choose to fight…

Its like they are a all the same girl.  14-16ish, beautiful and full of potential.  Some still bring bears or blankets from home. One brought a bible with a book mark.  They all have PID (Pelvic inflammatory Disease->aka a sexually transmitted infection that has been there long enough it has found its way up into the uterus and ovaries, it can lead to sepsis (near death blood infection), infertility, abscesses that can cost you a fallopian tube or ovary and they can lead to chronic pelvic pain).  ITS NO JOKE. We prance on in on rounds every AM and talk about this like its pneumonia. Like its bad luck.  We encourage girls to call their partners and get them tested. We keep the fact that they have a sexually transmitted infection that could kill them if they were not treated a secret from their mothers and grandmothers.  Occasionally, we talk about condoms.  But in the end there is an air of normalcy in the room.  That this is just standard adolescent stuff  like starting your period or graduating from high school or  turning sweet 16  or being allowed to vote.

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.

and then there was light…a great light

I am legally blind.  With contacts or glasses I can see about 20/30.   I have about -14 in one eye and -15 in the other. I have worn glasses since I was 7 mons old. My parents tell me that when I got glasses my whole life changed,  I waved to everyone on the street and I would cry when my glasses had to be removed. I was happy to sleep with them, bathe with them. I never pulled them off or try hurt them.  I may have been far too young to articulate it verbally but I knew which view of the world was better.

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.