A Gratitude Manifesto

For true freedom, freedom to love because He first loved us. For salvation. For a God who stands by my side every moment of every day, who daily blesses me beyond what I deserve or expect. For knowing I will never be alone. For the truth and beauty of the Catholic Church, in her liturgies, her saints, her guidance and wisdom.

For a family that chooses life. For an example of sacrifice in marriage from my parents. For sisters who are also friends. For memories of laughter, hugs, tears, adventure. For all of us being safe, healthy, and together today.

For friends that have walked with me through many challenges and celebrations. For love that is unconditional, for my everybody committee, for being able to be my weird self. For those who have known me for a long time and have grown with me. For those who have allowed me to share their lives and who have been willing to share mine.

For the opportunity to be a pediatrician. For my training and education, my teachers, my mentors, my patients, my coworkers. For the families that let me in to a vulnerable time and trust me with their most precious gift. For the ability to see kids get better. For the heartache of watching kids die, because it reminds me how precious life is. For a job that I love, because I know how rare that is.

For my health and the ability to enjoy leisure. For the grace to appreciate literature, music, art, food, sports, and nature. For all things, big and small, that enrich my life, from a barrel-aged quad to a Colorado sunset to a book that makes me laugh out loud.

For the chance to give back, both financially and personally, for all that I have been given. For the challenge of giving more, for the knowledge that my life is not my own, and this is not our home.

I am grateful.

Looking back

Today Mass was celebrated for a doctor who changed the life of a priest—Fr. Riley was one step from abandoning the Midwest misery of Notre Dame for the glamour of Hollywood, but typewritten letters from a friend convinced him to stick it out and here he is. Quite the legacy. It made me think of a priest who changed the life of a doctor…

Apprehension filled my heart as I sat in the stiff chair, clutching my test results. What if he couldn’t tell me what my career path was? What if I answered some of the questions wrong? What if he told me something I didn’t want to hear? I almost laugh looking back at it now, how anyone could be fearful of meeting with a soft-spoken five-foot jolly caricature of a Jesuit. 

As freshmen at Creighton, I’m sure there were many opportunities for career advice, but the only one anyone took seriously was Fr. Schloemer. (Reverently picture a garden gnome. In a collar. That's him.) His formal title escapes me, but he worked in academic counseling, and the general sentiment was that he was the one to tell you what to do with your life. There was a prerequisite personality and skills inventory whose results I carried to my appointment that day, but I was still skeptical.

The structure of the meeting was informal. We mapped out a sample course schedule based on my chosen major (biology) and I don’t even think he looked at the test. Near the end of the discussion, he set the course for my vocation as a physician. With his dulled pencil in hand, he humbly asked, “May I make a suggestion?” I nodded somewhat hesitantly. He scrawled “MCAT” on my schedule between the column of my prospective sophomore and junior year. I cringed.

“I don’t want to take the MCAT. I don’t think I want to go to medical school.”

“You’ll have all your prerequisites done. It’s better to do it before you forget. It doesn’t mean you have to apply to medical school.”

He had a point there. So I resigned myself to this new development and left feeling somewhat unfulfilled. I still didn’t have an answer. Or so I thought.

From that moment on though, I could see God chipping away at my wall. I wasn’t confident enough, or smart enough, or dedicated enough to be a doctor. But I started to want it. I would see a cluster of short white coats shuffling through our science building and I began to tell myself, “That could be me.” I began to see myself in medical school, taking care of people, studying for the long haul, and I was at peace with it, even excited about it. Within a few months, it was as if there had never even been another choice. This was what I was meant to do.

From the beginning of this long journey, I knew this was God’s plan for me, obviously not something I came to on my own. And every time I hit a road bump (from a failing grade—yes, those happened—to being belittled by a surgeon to staying up 30 hours straight), I knew I wasn’t doing this by my strength. I knew I wasn’t alone. God had foreseen this when I was a scared little freshman, and He knew I could it.

So thank you, Fr. Schloemer, for those four letters and your humble “suggestion”. It changed my life.

PSA for MIA parents

Imagine this. You finally get a vacation. With your spouse. Away from the kids. Hooray for Grandma and Grandpa! You hope they have everything they need, but really all you can think about is that king bed next to the window overlooking the beach. And sunshine. And quiet. You promise you'll check in every night...maybe.

Now imagine this. While you're gone, your slightly clumsy 4-year-old walks straight into a door, splits her head open, and gets taken to the wonderful pediatric urgent care down the road. Only they can't treat her. Because you are unreachable (darn cell reception on the beach), it's not a life-threatening emergency, and you forgot to give power of medical decision making to Grandma and Grandpa. Whoops.

This actually happened to me last week (well, I wasn't the one on vacation, obvi. I was the treating doctor). Mom and Dad were on a plane over the Atlantic and Grandma had one traumatized little girl and her restless older brother with no way to consent for medical care. Thankfully the plane landed and we got phone consent in time to get the patient the stitches she needed and home to bed, but there's an easier way.

If you are going to be out of town, unreachable, or leaving your kids in someone else's care for a prolonged period of time (in my mind, that's a couple of hours, given that you never know what kids will do), it's a good idea to give the caregivers medical power of attorney (MPOA) for your kids. Every state is different, but from what I know, here's the basics.

1. The MPOA does not ever supersede your rights as a parent, nor does it allow the temporary guardian the ability to let your child be adopted or get married (I know, we were all worried Grandma might go a little crazy, right?)
2. The MPOA is good for up to a year and allows a designated guardian the ability to make medical decisions for your children.
3. An MPOA is not necessary for emergency treatment. This qualifies as life- or limb-saving measures that any reasonable person would agree to for their children. This does not apply to cosmetic or non-emergent issues, even including facial stitches or broken bones (which can be set a few days later with good outcome).
4. The MPOA should be a signed document designating specific (named) people to care for your (named) children (include date of birth) during a specific period of time and should be signed and dated by the parent.
5. Our hospital (as far as I know) does not require a notarized form, and Kaiser's form says notary is optional, but for water-tight agreements, notary is preferred. Here is an example of the form for Colorado. Every state may have their own requirements.

So, next time you flee the madness of your offspring for sandy beaches (or if you know someone planning to do so), make sure an MPOA gets filled out so that we can take better care of all those kiddos.

Burnout and what to do about it

Physicians have the highest rate of suicide of any profession.

I told this to a friend of mine the other day and she was shocked. And I was shocked that she was shocked. To me, it seems obvious—we have high stress jobs, high rates of depression, and knowledge of as well as access to lethal drugs. We take on the suffering of the world without training in how to deal with burnout, loss, abuse, and failure. Residency is only possible for those who become, as Dike Drummond notes on The Happy MD blog, lone-ranger-superhero-emotionless-workaholics. How else are you supposed to survive being solo on an overnight call with the sickest patients in the hospital? So that’s how we cope. But that’s not the answer. In one study, 40% of interns (first-year residents) met criteria for major depressive disorder.¹ Forty percent!

I was discussing this with a colleague recently, lamenting the fact that we have to turn off our compassion in order to survive difficult situations. If you get too close to the teenager dying from cancer, it’s too hard to do your job. So you create distance. “You have to!” I said, meaning it. She looked at me sadly. “No, you don’t.”

I’m not sure I completely believe her, but I think that’s because I was trained (as we all were) to become a lone-ranger-superhero-emotionless-workaholic. Thankfully my faith and my amazing support system have kept me from going too far over the edge, but what if there was another way? One that didn’t involve having to always be right or never being able to ask for help? Medicine will always be difficult (especially in today’s world with its constant fight for reimbursement, poor access to care, and patients who diagnose themselves with Dr. Google and get their vaccine advice from celebrities) but we don’t have to get burned out.

General estimates among practicing providers are that anywhere from one-third to over half suffer from symptoms of burnout (defined as depersonalization, emotional exhaustion, and decreased sense of accomplishment). So what do we do?

There has been a lot of promising research in the areas of mindfulness and positive psychology, and I’m starting to immerse myself more in it as I take on the task of improving wellness and reducing burnout within our section (not a small challenge, with some 100 providers and the lowest employee satisfaction rates within the hospital).

I’m not under the impression that things will change quickly, or by great percentages, but I’m going to try to do something. I have to. Because the alternative is to accept the unreasonably high rates of depression, burnout, and suicide in my colleagues and friends. And we were made for more.

To finish, I’m going to borrow an exercise from the Positive Psychology department at Penn to challenge you, dear reader (and myself). It has been shown to improve wellbeing and to have lasting effects even 6 months down the road. It’s called “What Went Well”.²

Here’s how it works:

            For 2 weeks, at the end of every day, write down 3 things that went well that day. Doesn’t have to be big things. Then write down why those things went well.

            Example: I was able to work out today because I was disciplined and had the time to commit to exercise.

            Another example: My best friend called me to catch up because she cares about me and wants to know how I am doing.

            That’s it. That’s all you have to do. You don’t have to show it to anyone or make it eloquent. Just give it two weeks.

Here’s to wellbeing. For all of us.

1. Guille, C., et al. (2010) in Journal of Graduate Medical Education.

2. For more exercises and resources, visit www.authentichappiness.org

American Tradition

Whenever I see the richness of cultural traditions in other countries, I lament the fact that Americans have nothing. We’re such a melting pot that our one claim of cultural identity is to sit on the couch on a Sunday in late January with piles and piles of food and beer and scream at the TV while 22 grown men attempt to demolish each other. Oh, and the commercials. Yes, American tradition consists of Super Bowl commercials. I suppose you should add baseball to the list. After being tied to the Fall Classic this year because of my time in Kansas City, and seeing the entire city rally behind their boys in blue, we definitely claim baseball. But when you compare that to the elaborate costumes, recipes, liturgies, dances of almost every other culture in the world, you realize that we care much more about capitalism than tradition.

However, I’ve come to realize lately that there is one thing we should claim proudly. S’mores. Hear me out. Regardless of how often your family camped growing up, chances are you are well versed in the art of browning (or burning) marshmallows over a fire, carefully balancing the chocolate and graham cracker on your knee, or a tree stump, or picnic table, and then gooing up your fingers to complete the masterpiece. Everyone has their own style—finding the perfect s’mores stick, one or two mallows, the cracker to chocolate ratio, the technique (I’m a slow and even, golden-brown kind of girl. Michelle is definitely a scorch and run).

It’s something so innate that I’ve never thought about the fact that it’s a uniquely American practice. Michelle went to Nicaragua this summer and the group made their hosts an “American” dinner (think Thanksgiving, which I suppose is another tally in the win column) complete with s’mores. Padre Simon was incredulous…“You mean you light a fire for no reason? In the summer? Just for fun?” After being introduced to this shining example of American culture, he promptly ate five.

Fire just for fun

I also had the chance this summer to take this tradition to the limit—s’mores more abundant. At Camp Wojtyla, John 10:10 stands as a reminder that Christ came for us to live life to the full, every aspect of life. Even s’mores. So one night during the week, we traipse up to the fire pit with boxes and boxes of candy bars—Twix, Reese’s, Snickers, of course Hershey, even Starburst—and spend the night taxing our pancreases.

So someone remind me, the next time I lament of our tradition-poor consumeristic American lives, of Padre Simon and Twix-marshmallow heaven, and standing under the stars, with a fire “just for fun”, living life to the full.

Perfection