A Year of Wonders

Yes, I'm stealing that title from the book I just finished, but I think it's appropriate. In looking back, I completed 10 of the 15 things from my list last year (not surprisingly, the recurring commitments fell off, but I did clean my bathroom more often than I otherwise would have). I am sad I didn’t get to Coors Field, or any field for that matter except my flag football field (another 2 championships baby!) but I wouldn’t have traded the year I had. Here are some highlights:

1. Seven months and counting with an amazing man—God has truly blessed us and I’m excited for the year to come.
2. SUP’ed—Stand up paddleboarding. Didn’t even fall in. Bonus: got to see baby dolphins learning to fish.
   
3. Creative Writing Workshop—this pushed me and encouraged me. I loved it! Everyone should take more classes!
4. Rocked the Ugly Christmas Sweater in an epic way.
   
5. Camp Doc Episode 2—in which I learned to hammock, did a 13 mile hike, had Mass in the car wash parking lot, and did a lot of lightning protocol.
6. One award and another nomination at work. Don’t worry, just when I feel like I’m doing something right, a med student evaluation says, “Dr. Z was usually a great teacher, unless US Soccer was on.”
7. Speaking of which… Cheered the USWNT to World Cup victory (pretty sure it was all me)
8. Zombie target shooting with mom and dad. What? Our family is normal.
   
9. Watched “White Christmas” for the first time. Apparently this is a big deal. Who knew?
10. Trained as a Peer Supporter to be able to respond to adverse events at work.
11. Did my first (and second and third) liquor shot ever (not on the same night). I mean, it only took me a decade, but I felt like I was actually able to enjoy the experience instead of puking on the carpet.
    
12. Lit my birthday cake with a cautery loop. I have the best coworkers.
    
13. Puzzle room victory! Michelle wins for picking the lock.
    
14. Bartender’s choice at a speakeasy.
15. St. Louis trip—the zoo, Kelly’s graduation, MMMHops.
    

Not sure I can (or want to) come up with 16 things to do in 2016, but I do have some goals for sure. It’s going to be a big year.

1. The Camino—my goal is to go outside my comfort zone speaking Spanish, to live simply, and to enjoy the journey.
2. I want to continue to grow in love and holiness with A, who helps me be less selfish and more courageous. And yes, next year will probably involve some event planning, so there’s that…
3. I’m going to re-instate my letter-writing and new-recipe resolutions from last year. Can’t hurt to try.
4. One Rockies game. That’s it, just one. That shouldn’t be too hard, right?

 Happy New Year!!!

Again I say rejoice!

As we wind down Advent in preparation for the birth of Jesus, I wanted to reflect a little on joy. Joy is inherent to the season of Advent; the third Sunday of Advent is Gaudete (“Rejoice”) Sunday. The second reading that day was from Paul’s Letter to the Philippians, which is also known as the “Epistle of Joy” (shout-out Lanky Guys!). Writing from prison, Paul could have easily penned the “Epistle of Suffering” or the “Letter of Judgment,” but he doesn’t.

Instead, Paul writes “I…am praying always with joy”, “I shall continue to rejoice”, “I rejoice and share my joy with all of you”, and “Rejoice in the Lord always! I shall say it again: rejoice!”

What is it that gives him the ability to rejoice in such circumstances? Not in a superficial way or by wearing a mask for some secondary gain, but to have true, deep, abiding joy. Paul identifies over and over again that Christ is the source of this joy, and every other good thing, and that the more the Gospel is proclaimed, in any circumstance, the more cause there is for joy.

Do we live like this? I know I can’t speak for you, dear reader, but I know I don’t. I get embarrassingly bogged down in a very narrow "woe is me" worldview. I count my blessings, sure, but I would venture that the first word used to describe me is not "joyful". In confession last week, the priest reminded me that Advent is a time to let others see the JOY we have in the birth of our Savior, which was perhaps what led me down this path to begin with.

Most of my emotions are so short-lived that I can barely keep track of them, but I’ve felt that peace that comes when I’m resting in the Lord, the security in knowing I’m doing His will. And as many times as I’ve tried to take back the reins, I’ve laughed (or cried) as God shows me His way is better anyway. Take yesterday for example: I had been praying just that morning that God would use the sense of uneasiness I’d had lately to nudge me forward in a direction that would glorify Him. I wasn’t sure where my desolation was coming from, but it hung around clouding the air. I won’t go into all the details, but suffice it to say God brought about some answers in the least expected (and probably least desired by me) way. And so, despite my tears, I knew it was cause for rejoicing.

Every struggle we have in life is an opportunity to share the joy that Paul has in prison. Whatever happens, as long as we think on the things that are good and share the Gospel, we win. It doesn’t mean we’ll always be happy. Even Jesus cried, yelled, and chastised. But I don’t think He ever was without joy.

As we reflect on our Almighty God becoming a tiny, helpless newborn in order to bring us back to Him, may we receive the gift of His joy this Christmas. As we wait with longing for His return, may we rejoice in His victory, in our salvation.

Grateful

For a Church that is home no matter where I am, and a faith that gives me consolation and strength every day. For God’s constant presence in my life.

For a family that is all together in Colorado and actually gets along most of the time. For their constant support and love.

For a wonderful man that makes me a better person and helps me grow in holiness. For the opportunity to pursue my vocation, be challenged, and learn how to love better.

For growth and fulfillment in my job, for mostly healthy kids, and for financial stability.

For all my needs being met—a warm house, enough food on the table, my health, recreation—and much more.

For so many abundant blessings in my life.

I am grateful.

Calling names and being called

It has been said, pardon my language, that the worst thing you can call a man is a coward, and the worst thing you can call a woman is a whore. While you may be able to come up with a greater insult for a specific individual, it seems to be mostly true. It has no doubt been the start of many bar fights and cat fights. But why?

What is it about being called a coward that makes men raise their fists, even when they don’t respect the opinion of the offending party? What is it about being called a whore that makes women bristle, even when they know someone is just being catty? Why is that so much worse than being called stupid or fat or ugly or mean?

I may be reading too much into it, but I suspect it’s because those things go against the very nature of what it means to be a man or a woman. And it cuts to the very heart of our fallen nature. Hear me out.

If we’re to believe countless saints (and I’m inclined to), man (as a species, not a gender) is most fully alive when we become the people God has created us to be. If we remember back to the story of Genesis, we can get some idea of what that looks like.

When God created Adam, He “took the man and put him in the garden of Eden to till it and keep it.” (Gen 2:15). The word for “keep” here is the Hebrew shamar, the same word used when describing the covenant between God and Abraham and how priests would defend the temple. It means to guard over and protect. Then when God gives Adam the animals, and more importantly Eve, these come under his purview to shamar as well. So the responsibility and desire to protect and defend is ingrained in man (gender this time) from the beginning of creation.

What about women? Woman was created from Adam’s very side to be his “helpmate”, a word that I’m sure riles feminists everywhere. But the Hebrew word for helper here is ezer, a word mostly used to describe God in the Old Testament, as one who comes to the aid of, rather than as a subordinate, one who demonstrates power and strength, and therefore has the ability to help. “Therefore a man leaves his father and his mother and clings to his wife, and they become one flesh” (Gen 2:24). From the very beginning, woman was made to give her strength and self to one man, as a visible sign of the creative and self-giving love of God, in whose image she was made.

Now it’s starting to make more sense why we get so worked up by the words coward and whore. They are contrary to our very nature. Not only that, but they remind us of original sin, of us turning our back on God, and I think on some level, even for nonreligious people, that feels wrong.

When the serpent came to Eve, he played on her insecurity that she couldn’t sit back and receive God’s love, but had to grasp it for herself. She had to give up on Adam’s providing for her and do things for herself, in a sense giving herself away to the most seductive bidder.

And where was Adam? Sure as heck not shamaring his wife, not protecting the garden like he was supposed to be doing. He let evil in, and it cost him paradise.

So now, in this culture where masculinity and femininity are under attack and seem to shift with the daily newsfeeds, no one really even knows what it means to be a man or a woman. Yet deep down, we must still have some idea, or those insults wouldn't hurt so much. We know, intuitively, at our core, that men are to protect and defend. Women, children, the truth, goodness, beauty, all of it. And when they don't, when they act cowardly, they are not being the men God calls them to be. They know it, and they hate being called out on it.

We also know, at our core, that women were created to receive love, to bring their special gifts to the service of their loved ones, to trust God to provide, and--if married--to trust our husbands as well. When we start grasping at love or desires ourselves, when we abandon our commitments for the sake of things that are "a delight to the eyes"(Gen 3:6), we lose our dignity as women. We are no longer able to be a "helpmate" to anyone; we lose our strength and power. And when someone accuses us of that, even in a superficial way, we feel it.

So more than not calling people unnecessary names, I hope you take away from this a renewed sense that it is possible to recover our greatness. It is possible to become the men and women God created us to be, and in doing that, we will be fully alive and bring glory to Him. We just have to go back to the beginning.

How to deal with the doctor in your life

Everybody has bad days at work, I won't argue with that. But in medicine, it's a little bit different. We can’t come home and vent our frustrations with just anybody. As part of the training I did this week as a peer supporter, we were discussing coping mechanisms, like talking things over with friends and family. Specifically non-doctor friends and family. The facilitator asked, "What does it look like when you go to a family member, or a friend, someone outside medicine, and they are able to help you cope?"

We all looked down at our papers, back up at her, thought about it. Finally, one of the anesthesiologists spoke up. "It's never happened. I always get blank stares, or horrified looks at what we deal with every day."

We all nodded. No one disagreed.

I’m sure it’s similar with fields like the military, first responders, law enforcement—where they see things the rest of us can only imagine. While any non-medical person could sympathize with a parent or patient yelling at me, an incompetent co-worker, too many demands on my time, or any number of other hassles of the day to day, they can’t understand what it’s like when a kid you sent home to get better comes back horrifically sick and has permanent damage. They can’t understand what it’s like when you have to tell a parent their child has cancer. They can’t understand when making a mistake really is life or death.

I’m fortunate to have two sisters in medicine and a host of friends from residency, as well as supportive co-workers that I can go to when I have a rough day. But the truth is that most of my family and friends aren’t that helpful in getting past those adverse events. It sounds harsh, I know, but it’s true. It’s not their fault, and I know they love us and want to support us.

With that in mind I’d like to offer a few tips for you non-medical people who know and love us doctors (God bless you).

Please don’t be offended. We still love you, and we appreciate that you’re not in medicine because that can often be a much needed distraction (when we want that, you’re the perfect person!). Just because we don’t come to you first about work stuff doesn’t mean we don’t value your support.

Don’t try to understand the medicine. It can be even more stressful to have to explain the jargon and physiology when we’ve had a bad event. The details of it are not as important as the fact that it makes us feel awful, so if we do talk about it (and we may not), don’t interrupt when you don’t know what a word means, or miss a piece of the story. Don’t try to figure out what it was that went wrong and offer suggestions. Just listen and offer a simple, “That sucks, I’m sorry.”

Don’t compare. This one seems unfair, I know, like my problems are bigger than yours. In general, I want to hear about your good days and your bad days. And when I have a story about a crazy parent, go ahead and one-up me with your crazy client story. When I have a co-worker driving me crazy, please tell me you do too, so it doesn’t seem like the worst thing in the world. But when I have a truly bad outcome, it’s just not helpful to hear about how much grading you have to do, or how you had to work through lunch. I still want to be supportive of you, but it’s not the same, and I need you to understand that.

Pray for us. We’re not perfect. We don’t handle stress perfectly. God’s grace is always appreciated.

Sharing stories

I mentioned in my last post the notion of Second Victim for health care providers who have experienced an adverse event. Every physician has been there. Whether as a result of something we did, or as part of the disease course, sometimes patients have bad outcomes. Those patients stick with us, their memories intruding at inopportune times, making us wish for a do-over, making us think maybe we don’t have what it takes.


There’s a certain pressure to be perfect, coupled with stakes of life and death, that make the Second Victim Syndrome almost ubiquitous among doctors. Yet we often hide our insecurities after such an event, not wanting to admit our human frailty, not wanting to be judged. Isolation can become the norm.


The training session that I went to this week for our new Peer to Peer Support Network aims to break through this isolation in the hopes of preventing some of the PTSD-like symptoms that doctors suffer after an adverse event. The program allows doctors the chance to emotionally debrief with a colleague who knows exactly how they are feeling. Sounds kind of touchy-feely, right? But it works.


As part of the training session, we each shared a story of an adverse event in a small group, and the other doctors just listened. It was incredibly therapeutic to open up and to have three faces of complete understanding looking back at me, nodding, knowing. They knew exactly what it felt like to get news of a poor outcome and have to wonder what you could have done differently, if you could have changed the course. They knew all too well that intrusive voice saying, “You’re not good enough. A better doctor would have done this right. You’re going to mess up again.” They know the panic of seeing that patient’s mom again, wondering how she remembers you. And they don’t even have to say anything, because I know they know.


As we shared our stories throughout the morning, you could see shoulders become less tense, faces become less masked, and affects become brighter. There is amazing potential for this program, and it’s exciting. It’s exciting because I think we’re accepted Second Victim Syndrome and burnout as inevitable for too long. We assume that doctors are capable of bearing these burdens silently and still being flawless. We expect the high rates of depression and suicide as a hazard of the job. But it doesn’t have to be that way.


This Peer to Peer Support Network, and others like it around the country, is changing the norms. Isolation and shame can give way to understanding and healing, just by talking about it. And that can make us better doctors, more able to learn from our mistakes, bounce back from setbacks, and not carry our work home with us.

The Second Victim

I recently had at work what we call an "adverse event". These are cases where something goes poorly, either because of an error, or just the natural progression of disease, but everyone feels it. A kid is very sick, or passes away, or is harmed in some way, and it shakes all of us out of our happy pediatric comfort zone. I obviously can't go into details, because HIPAA, but it hit home for me a concept that I wanted to share.

In 1999, when the Institute of Medicine published their famous (infamous?) "To Err is Human", detailing the widespread prevalence and effects of medical errors, a brave physician from Johns Hopkins thought to go one step further. In his sentinel paper, "Medical Error: The Second Victim", Albert Wu outlined the idea that medical errors, and all adverse patient events, harm more than just the patient and their families. He observed that "although patients are the first and obvious victims of medical mistakes, doctors are wounded by the same errors: they are the second victim".

I can feel the cynicism rising up right now: How can doctors even compare their "suffering" to a patient death? Shouldn't they feel bad if they've done something wrong? Shouldn't we focus on the medical errors and stopping them instead of telling doctors "it's okay" after they mess up?

Those are all valid questions, and the answers to the last two are surely "yes", but that's not the whole story. Second victims have symptoms very similar to PTSD, experience higher rates of depression and burnout, and can have impaired performance due to maladaptive coping behaviors, decreased confidence, or fear of making a further mistake. I will attest that these are not theoretical; they are very real. And I think we can all agree that if we can avoid these effects, that's a win.

We are about to launch our own Peer to Peer Support Network at work to help second victims, and this experience has taught me a lot of things that I hope to carry forward..

I've learned that adverse events are going to happen, and that we all make mistakes. Let me repeat that: We all make mistakes. It just so happens that in our job, mistakes can range from forgetting to bring someone a blanket to causing a death, and that's terrifying. We make hundreds of decisions every day in a very stressful environment. We set up our systems to try to prevent as many errors as possible, but you can't remove the human element. We have to learn from our mistakes instead of letting them cripple us.

I've learned that I work with amazing people. One of the nurses I work with found out I was upset about the patient and said, without hesitation, "You know we all stand behind you because we know the kind of doctor you are." The other doctors, who had every right to critique the situation, instead offered their support and acknowledgement that our jobs are very difficult and we all have these days. It makes all the difference in the world to be able to have that support at work, which makes me excited to train as a peer supporter.

I've learned it's important to take a deep breath and remember why we do this. It can be so easy to get caught up in a busy day and miss the small details, miss the opportunities to really meet our patients where they are and be part of that encounter. Yesterday, with this fresh on my mind, I spend a few extra minutes in each room, talking to families, being thorough, not letting the 18 patients in the waiting room get to me. And I could feel it make a difference. I was a better doctor because of it. Hitting that reset button every now and then, without waiting for an adverse event, is crucial.


Finally, I've been reminded that I'm not doing this of my own accord. God called me to this profession, has given me the things I need to succeed, and can decide what to do with me from here on out. And that's okay. I don't have to be perfect, because He is. He is bigger than the adverse events, than the mistakes, than the bad outcomes. He also cares for His children and gives us the tools we need to move forward if we let Him.

Those who are healthy

Working in urgent care and emergency rooms, we see whatever walks through the door. That means whatever. It means the 64-year-old with appendicitis (yes, at the Children's ER), the 8-year-old who ran over his ankle with a motorized scooter and has severed nerves and blood vessels, and the toddler who had a black marker stain on his foot. At one in the morning. True story.

In the midst of all the real emergencies, it's so easy to become cynical towards the families bringing their kids in with marker stains (and trust me, it happens WAY more often than you would think!). It's so easy to judge parents, grandparents, foster parents who I think should know when to bring their kid in and when it's okay to watch at home. I get frustrated that after motrin, a popsicle, and a sticker, they look just peachy and ready to go home.

Then I read in the Gospel of Luke about the call of Levi, where Jesus tells the similarly judgmental Pharisees that "Those who are healthy do not need a physician, but the sick do." Can you see the 2x4 shaped mark on my head? Obviously no one wants to bring their kid to the Urgent Care at three in the morning. No one wants their kid to be crying and sick and miserable. They came because they need a physician. Even if all that physician needs to do is reassure them, give their kid a popsicle, and tell them what to expect for the next few days. Even if all that physician needs to do is check for an ear infection, eyeball a rash, or, yes, clean off the marker stain with an alcohol wipe.

And what a privilege it should be to treat those kids. What a privilege it should be to offer a little bit of hope, help, or healing. No matter what.

The last few days I've tried to remember that as I walk into my shift, to bring compassion to every patient, not just the ones who I think are sick enough to see me. After all, they wouldn't be there if they didn't need something.

Into the desert

Today marks the beginning of 40 Days For Life, a world-wide initiative to fast and pray and peacefully demonstrate for the end of abortion. I'll be honest, I've been remiss in the past, largely ignoring these events and just shooting up a couple of private prayers every time it came up. However, thanks to the myParish app (weird, but true), I found out about the opening Mass across from Planned Parenthood, said by our own Fr. Greg, and lo and behold, had the day off with no excuse to miss.

One thing Fr. Greg said that struck me was regarding the Israelites in exile, and how exile was a "severe but merciful" response from God to wake them up to the fact that they had already turned away from Him in their hearts. The exile was merely an outward manifestation of the inner truth, but it ultimately led to repentance and redemption as the Israelites were shocked out of their complacency and sin by physical suffering.

As we are also celebrating the Pope's visit to America and the World Meeting of Families, and in the midst of some of the most despairing times in terms of religious freedom and anti-Christianity/Catholicism, it would not surprise me if these 40 days signify an exile for our country as well. It's obvious that we could use a wake up call. That the hearts of our citizens are turned far from God's plan for us. That we are in dire need of "severe but merciful" action by our Creator.

It may not be pleasant. In fact, it's almost certainly not going to be. But in the cross is victory. He has conquered the grave and won the battle. We have only to turn to Him, to not be ashamed to wave His banner, to fight under His protection and not fear death. So I pray for the unborn, and I pray for our country. That we will wake up and recognize our pride and selfishness and realize our need for God, our need to become who He created us to be.

Looking back

The other day I was grabbing a quick bite at Wahoo's when my attention was drawn to a large gathering of (pretty loud) young adults. Not unruly, just festive. In the midst of them was a grandfatherly man with a very recognizable white mustache. Dr. French was my medical school pharmacology professor and powderpuff referee. Apparently 8 years later, he's still going strong, celebrating the first exam of the Neurology block with the students and his co-block director and co-referee Dr. Ojemann.

In a fit of rare extroversion, I said hi to the students and my former professors. (Yes, the profs did remember the only first-year team to ever beat the second years!) The students were jubilant with the prospect of an evening without studying (hence the volume of their gathering), and excited to meet an alum who survived. It brought back lots of memories and nostalgia--those of powderpuff were infinitely more positive than those of memorizing The Oje's neural pathways.

The profs commented that it must be nice to be done with schooling and residency and into my real doctor life. And how! Although I would do it again if given the chance, I'm extremely grateful to be done with that part of my life.

It's a rite of passage for sure, but there is a light at the end of the tunnel.

Little lights of dinners out at the end of exams, sure, but also bigger lights of realizing why it is that you spent so long memorizing all of those details. The light when you use that knowledge to treat a patient, when you actually get to do what it is you trained so hard to be able to do.

And the light of still being able to play flag football. That, too.

True love (but for real)

I don't have anything brilliant to add to this saintly wisdom. Even if I did, I wouldn't say it as well. This is from Karol Wojtyla's "Love and Responsibility" (written before he became pope, and a solid foundation upon which was built his "Theology of the Body"). Much of the first part of the book talks about different types of love, and asserts that attraction and affection are not sinful, or even inferior types of love, just incomplete, as they are meant to lead us to a more complete love.

In this part, he speaks especially towards sexual attraction as a key component for betrothed love (he even goes so far as to say betrothed love is not possible without it), but that it grows into a more authentic love as it points towards the value of the person as a whole. Read carefully. And then read it again.

"True love, a love that is internally complete, is one in which we choose the person for the sake of the person, -that in which a man chooses a woman or a woman chooses a man not just as a sexual 'partner' but as the person on whom to bestow the gift of his or her own life. 'Sexual' values, vibrantly present in their sensual and emotional reactions, contribute to the decision and make it a more intense psychological experience, but it is not they which determine its authenticity."

"We are bound to recognize that the choice of a person of the other sex as the object of betrothed love, and a the co-creator of that love by way of reciprocity, must depend to a certain extent on sexual values...[but] the choice of a person is a process in which sexual values cannot function as the sole motive, or even - if we analyze this act of will thoroughly - as the primary motive."

"So that if we consider the whole process by which a man chooses a woman or a woman a man, we can say that it is set in motion by recognition of and reaction to sexual values but that in the last analysis, each chooses the sexual values because they belong to a person, and not the person because of his or her sexual values."

This guy knows what he's talking about

Sippin' Suds

Random Laura memory for your reading pleasure:

One of the first times I ever remember enjoying beer was following an indoor soccer game when I was in medical school. A gal in my women's group played for a team that needed a sub, and being (un)arguably the most athletic option in our group, she asked me if I would join her. I remember sucking wind so hard I had to go to the restroom at half time because I thought I was going to vomit. I remember a few good touches and a lot of bad ones, and the muscle memory of over 10 years coming back to me by the end of the game. And I remember going out for pizza and beer after the game.

This may seem routine to most of you, but to my sheltered, introverted, prohibitionist 23-year-old self, it was quite a thrill. First of all, to think I was meeting new people, going outside my comfort zone, showing off my athletic prowess (that last part may not be what actually happened)--it was kind of amazing. This is what young, single adults do when they're not crouched in their room rotating a model of a human skull to memorize nerve pathways! I was basking in the glow of the guys calling me "Mia Hamm" (so maybe I didn't suck so bad after all). I marveled at our captain's vast knowledge as he discussed draft options with the waiter (How does one even know that many beers?). And I can still taste that wonderfully greasy cheese and Shiner Bock merging together to form perfection.

I remember wondering if it was only because I had exhausted myself and my salt stores on the field, or if it was because I was drinking something besides Coors Light, or if it was because I was enamored with my new-found social graces, but that beer tasted good! This must be why people drink it, I thought. It took a few more years for my palate to fully agree, but considering that now my standard day-off activity is microbrewery flights with the womb-mate, I've come a long way, baby.

Also, speaking of bocks, Paulaner's Salvator is pretty delish as well.

"Take a moment to remember..."

It’s now been over a week that we’ve been down from camp. The end of summer party has come and gone. The counselors have returned to their homes. I am (almost) unpacked. I’m still trying to capture the enormity of the four weeks, to somehow process it. My journal entries provide a raw look at what transpired during those weeks, so that’s where I started.

As I read the musings of my heart while at camp, I was struck by the intensity of it. So much longing, so much doubt, so much desire, so much gratitude and regret and openness. It’s no accident these writings spring from the grace of daily Mass, frequent confession, adoration, and daily prayer. When I am close to Him, my true heart is known. I can know myself more accurately, see His work in me more easily, hear His voice more clearly. That doesn’t mean it’s easy. Camp is hard—the writing is evidence of that—worry, anxiety, frustration. The storms, the fatigue, the soreness, the feelings of inadequacy. But more than that, there is comfort. Prayers of gratitude and safety and confidence in God’s love also fill the pages. I can almost hear the sigh of relief as the words move from questioning to resting in Him, over and over again. He is in control, and He came to give us life to the full.

The Suscipe of St. Ignatius made its way to the front of my mind numerous times at camp, and is one of my favorite prayers. It embodies the abandonment necessary to give completely of oneself without calculating the cost. This is the radical availability that we live at camp, which is one of the greatest lessons and challenges of the whole summer. 

Take, Lord, and receive all my liberty,
my memory, my understanding,
and my entire will,
All I have and call my own.
You have given all to me.
To you, Lord, I return it.
Everything is yours; do with it what you will.
Give me only your love and your grace,
that is enough for me.

The Burning Bush

The things that happen at camp are unlike anything that happen off of the mountain. Ever. How do I explain to people who have never been up here the epic lightning protocol poetry slam, or engaging teenage boys in conversations about virtue and love languages on a 13-mile hike, or a Hanz and Franz 230 wake up call, or Mass every day in front of the meadow (or in a car wash parking lot), or the deep conversations that happen in a pick up truck in the rain while on a sandwich delivery run. 

Those things don't happen anywhere else, and in a way that's what makes this place so special. God works in a way up here that is unlike anywhere else, and that makes it challenging to remember that He works just as much (though differently) off the mountain, every day of our lives. It's easier to see it up here because we don't have the distractions of cell phones and traffic jams and work and television. It's easier because we know that's why we're here and we want to be intentional, because everything here is oriented towards restoring the four harmonies. It's also a little bit harder because camp is exhausting and the definition of sacrifice, but ultimately, it's all more full. Life to the full. 

What's hard about it is bringing it down from the mountain. Because this is a very brief reality that needs to overflow into our lives when we leave. We need to have those deep conversations, take time for prayer, connect to nature, sacrifice our preferences for others, live in the dirt and grime and exhaustion of our state in life. I may still never be able to articulate these experiences, but I hope that they show themselves in everything I do from this day forward. That's a tall order. But our God is big.

Camp Doctor, Year 2

I've come down the mountain for a breather. Laundry, showers, and, you know, having to work. Gotta pay the bills.

The first two weeks at Camp Wojtyla were for middle schoolers. My favorite. #sarcasticfont. The nice part about the middle school camp is that most of their activities take place on the campgrounds, so my job is infinitely easier in terms of treating injuries and doling out meds. The bad part about the middle school camp is that most of their activities take place on the campgrounds, so it's boring. No summit hikes, no rock climbing, no rafting. But it's good to have it both ways. Made for better prayer time and more naps. #pronapper.

Once again, the best part of camp seems to be the counselors--thirty-some college students and seminarians from around the country who give up their summer for these youngsters. They. Are. Awesome.

Sherpa selfie--no stick needed

Also, this year, we have six full-time staff. Six! So things like new water pumps and an organized office and frequent mail runs all happen. Score! The joy of the summer and full-time staff is contagious, from singing while doing dishes to labeling the food all crazy-like.

I've decided that in terms of simplicity and not wrecking my back, hammock camping is for sure the way to go. Look at my tiny little home. Isn't it cute? Bug net, tarp, and a holster for my walkie-talkie. All without killing the wildflowers.

It's true that nature makes a great cathedral--prayer and reflection come super easy at 8,000 feet. And God has been so good moving in my heart the last 2 weeks, drawing me closer to Him and reassuring me in my ways. Looking forward to 2 more weeks, complete with all the fun stuff and no sleep.

Love wins

I’ve been torn on what to say, if anything, in relation to yesterday’s Supreme Court decision. I am not surprised by it, but I am saddened by it. However, I find myself having a much stronger reaction to the social media response to it, and here’s why.

I lament that the left-leaning secular crowds have claimed “Love wins” as their mantra. It sounds so intuitive and so, well, loving, that anyone who disagrees with anything they say is labeled a hater and a bigot. Who doesn’t want love to win? But here’s the truth. Love isn’t 5 appointed judges making some arbitrary decision. Love isn’t being able to be with whomever you wish, for however long you wish, for whatever reason you wish. Love is a man who hung on a cross for three hours after enduring abandonment, mocking, torture, and crucifixion, who then conquered death and rose again. Love is a God who holds us in existence, whose love is so concrete and dynamic that it creates. Love is wanting the good of the other person for his or her own sake (and we could have a whole different discussion about defining “the good”, but suffice it to say it’s not comfort). So, yes, love wins. Love always wins. But I’m reclaiming that phrase for Love Himself, who wants better for us. Who wants us to walk the straight and narrow, which is difficult to be sure, but leads to life to the full.

Furthermore, I’m upset by the subtle, unrecognized discrimination of the so-called “tolerant”. All those people posting rainbows in solidarity with the “persecuted” would never post a cross to support the Christians around the world who are being put to death for their beliefs. They would never post a picture of a church if one were forced out of its tax-exempt status because it held to its beliefs in not holding same-sex union ceremonies. Those posting rainbows are only in solidarity with those who hold their same beliefs, namely that people should be able to do what they want, but only if those people are not Christians who are convinced that God’s law still trumps the law of the land. 

Finally, I’m disturbed by the short-sighted nature of those who are celebrating this decision as a victory. To say that marriage can be defined based on the whims of culture is to lead us farther down a slippery slope from which our society may never recover. This has nothing to do with the “rights” of homosexuals, to things like healthcare benefits, tax status, etc. To redefine marriage is to undermine the foundation of our culture, which is the nuclear family. What is to now stop someone from “marrying” their father, or brother, or dog, because who are you to tell someone who to love? When our children grow up seeing that “marriage” is merely a construct of convenience and enjoyment rather than commitment and covenant, they will extrapolate those values to everything else. I really don’t think it’s alarmist to go down this path. I think it’s ignorant and naïve not to.

So yes, it’s easy to post “Love wins” without thinking about what you are really saying, and it’s easy to say that anyone who disagrees with you is a bigot, but Love has always won and will always win, and Love looks a lot more like this:

Title IX Fail

I'm going to get on my soapbox for a hastily researched, but impassioned rant.

Here's the thing: women's soccer is a real sport. And in the United States, it is really the only soccer (USMNT qualifier thrills notwithstanding).

Case in point: The USWNT has won 4 Olympic golds and 2 World Cup titles (and has been on the podium in every Cup since the first one in 1991). No men's player will EVER come close to touching Kristine Lilly's international cap record of 352, and it's unlikely that any men's player will top Abby Wambach for goals (currently at 182).

And yet, the only media coverage that I saw leading up to this World Cup was over the lawsuit regarding the failure of FIFA to allow grass installation for the matches. The men's World Cup has been played on grass for the last 20 years. Turf not only plays a different game, but is dangerous (heat and injuries are much higher). It's also cheaper. So, turf it is.

Plus who really cares about women's soccer? Not the media. Denver Post coverage for the men's tournament began days before the first kickoff last year. Sunday's paper had one line the day after the women's tournament started, and it was the time of the televised Germany game that day, tucked away in the TV grid. No results from the first two games. No mention of the score to settle from 2011. No preview of the coming weeks.

It. Drives. Me. Crazy.

I realize that not everyone knows the names of the entire roster, or owns a jersey, or saved the picture of former coach Pia Sundhage on their camera from when the team came to Kansas City (because she's only adorable). And I'll also grant that we have lost a little bit of the magic of the Fab Five--women that carried the sport on their shoulders through sheer determination and love of the game. But can we please at least acknowledge that this is a sport? That this World Cup means something? That these women are incredible athletes that deserve far more recognition than they receive?

I would also take another title. Just sayin'.

The Edge of Time

My creative writing final. Not perfect, but I learned a lot while writing it, and a classmate said I'd improved 10-fold. This is a throwback to last summer's camp experience.

I spend most of the morning in the shadow of the cliff, my eyes drawn again and again to the imposing wall as if by some unseen force. It stares back, daring me to a rematch.

Two weeks earlier, I stood in the same shadow, with anticipation instead of wariness. The climbing route is aptly named: The Edge of Time. The edge is what strikes you, no matter how long you spend trying to take it in. A great slab of rock, wedged upright into the ground, as if a huge headstone was cracked in half and this piece was planted as a memorial.

That edge is where I got stuck that first time, forty feet up, my right leg shaking like it was tapping out a telegraph, despite my best efforts to control it. That edge is where I dangled, head heavy under the weight of my white helmet, telling my belayer to lower me down, mortified that the teenage girls had outdone me.

Now I am back, unsure if the possibility of vindication is worth the risk of another defeat. Being the only female on this climbing trip raises the stakes even higher; I can’t be “the girly girl”. I tighten my harness straps around my thighs and tug up hard on the belt loop to make sure it’s snug. My sweaty hands slide over the knots, double checking everything one last time. I turn back to my friend, holding the other end of the rope.

“Belay on?”

“On belay,” he says, indicating he is ready for me to begin.

At least one of us is.

I step closer and lay my palms on the cold granite. Inhale. Exhale. The rope pulls taut into my chest as the belayer takes in slack, forcing me to lean around it. I close my fingers around the first holds and lunge upwards. I settle into a rhythm of reaching, pulling, standing, reminding myself to use my legs, not my arms.

I surge past the point of defeat from two weeks ago, but my victory is short-lived. A few feet higher, I pull myself to standing and reach up yet again. My hands sweep left and right. Nothing. The ledge above me is barely enough to hook my fingernails on. I use my foot to grope for a step to my right, but it is out of reach. I am stuck. Again.

Voices call out from below with encouragement and suggestions, but all I hear is the one in my head telling me I’ve failed. How many more half-hearted attempts before I can throw in the towel? One more?

Resigned, I push up on my toes, pinched in the tight rubber shoes. I lean into the wall and strain upwards, trying to use my momentum to drive me past that ledge. Suddenly I’m 18 inches higher on the wall, not sure how I got here. I hear cheering from below and my fatigue and doubt evaporate. Surging ahead, my adrenaline crashes the same time my fingertips touch the metal anchor at the top. I collapse into the harness, letting it enfold me while I am lowered to the ground.

 

Ecological breastfeeding and the slippery slope

I've recently become more and more aware of a baffling (and for me, frustrating) trend among young Catholic families. As a physician practicing within the reach of Boulder County, I'm used to the "all-natural" crowd. I hesitate to lump all of this into one label, but you know the ones I mean--the babies with their amber teething necklaces, lack of vaccines, homeopathic remedies, breast-feeding until 2, co-sleeping until 8, and a firm mistrust of anything "scientific".

I'm used to it from certain people, but when I started to see more and more young Catholic parents falling into this camp, I couldn't understand why. Now, I realize that to most of the secular world, Natural Family Planning (NFP) and big families and home-schooling place Catholics squarely in the kook camp along with the other stuff. But in my mind, the Church and science have gotten along pretty well since Galileo, and there's definitely a place for both in living life to the full. So why the shift?

I'm obviously not a mom, so I can't say for sure, but I think it comes down to one practice: ecological breastfeeding (EBF). For those moms who are using NFP, a non-hormonal way to ensure birth-spacing is probably desirable. There seem to be two main options--wait until your periods return and resume NFP, or breastfeed to keep your prolactin levels high enough to prevent ovulation. For those who are breastfeeding anyways, return of normal periods can take several months, so many are opting for the latter. There is some science (I haven't read all of it, but most of seems to come from a single source--Sheila Kippley--one of the founders of Couple to Couple League) that supports the best way to ensure lactation amenorrhea (lack of periods from breastfeeding).

The basic premise is that if you follow the Seven Standards, your prolactin levels will be high enough to prevent ovulation for an average of 14 months. Most of the support for this method touts the "natural" and "God-intended" practices, as if failing to adhere to these standards is somehow second-rate. And I think it then leads followers to embrace all other things "natural", especially since many of the breast-feeding, co-sleeping moms fall into that Boulder camp that I mentioned earlier, and that's what's out there on the internet.

I am not against EBF by any means. I think that it can be a wonderful way of bonding with your child, spacing birth without hormones, and supporting good nutrition and health as recommended by the American Academy of Pediatrics. However, there are several conclusions from the EBF mentality that I absolutely disagree with, and I think this is where my frustration comes in--seeing well-meaning, intelligent, faithful people sliding down a path of ignorance and frankly, sometimes danger.

I think if you're going to consider EBF, please also consider the following:

1. EBF is NOT the only way to space birth without hormones or contraceptives.

Those who do EBF can expect a delay in their periods for 4-24 months. That's a big range. Not every woman, even following the Seven Standards, can expect her body to delay ovulation 100%. Studies suggest that those who exclusively breastfeed can rely on their bodies not to ovulate before the return of periods up to 93% of the time (in other words, once you start bleeding again, even if it's irregular, you need to start charting). However, if you continue to chart temperature and mucous like before, you can fairly accurately predict ovulation even without menstruation over 90% of the time as well. I can't find the original data I read on this, but I'm sure NFP providers would know more.

2. If you are unable to do EBF, it does NOT make you a bad mom. Similarly, doing EBF does NOT automatically make you a better mom.

EBF is HARD. Those Seven Standards make it literally impossible to have a job, have a babysitter, be away from your baby pretty much ever, have your husband do one nighttime feeding so you can get some sleep, or use a pacifier in a pinch. Not everyone can do that; not everyone is supposed to do that. If you need extra sleep for your health, if you need to return to work for financial stability, if you need to step away for your sanity, that does not make you a bad parent. It makes you an aware parent who realizes that the baby's health is determined by more than just whether they can nurse on demand.

3. Co-sleeping does not have to mean bed-sharing, and there are safe and not-safe ways to do this.

From everything I've read, the Seven Standards allow for room-sharing without bed-sharing--a bassinet, a crib, a mat on the floor, a side-sleeper--all allowed. Further more, there are safe ways to bed-share and not safe ways to bed-share. You still need to have a firm mattress close to the floor without extra pillows or bedding. Avoid any medications, including alcohol, that make you sleepy, and never co-sleep in a chair or on a couch. Please, please, please talk to your doctor about how to make bed-sharing safe if you want to do it.

4. Using a "natural" method of child-spacing does not make all "natural" things better, and avoiding the "scientific" way of child-spacing does not make all "scientific" things bad.

This is the one that drives me the most crazy. Hemlock is natural. Marijuana is natural. Cocaine is natural. Are those safe? Of course not. Untreated water is natural, but led to extremely low life-expectancy before waste management was developed. Homeopathic remedies are not tested, are not necessarily harmless, and are mostly not effective. I accept that not all available medical interventions are necessary or even right, but there are proven things we can do to improve your child's health. Similarly, just because your doctor recommended artificial birth control after childbirth doesn't mean everything she recommends is against the Church teaching. Find a doctor you trust and make it a partnership. And for Pete's sake, throw away the teething necklaces.

5. The Church does not care whether you do EBF, or whether you espouse Attachment Parenting, whether you cloth diaper, or whether you home school.

The Church is here to guide us on matters of faith and morals, not on what kind of car you drive, whether you buy organic, or how to raise your children. There are obviously moral implications to many of the things we do, but it's not black and white. You also have to think about what your reality is, what your strengths and limitations are, and whether the benefits outweigh the downsides. Of note, the Church does support breastfeeding ("if possible") as the intended means of nutrition and bonding for a new baby, but doesn't care if you use a pacifier. She does, however, think it's okay, and even morally responsible to vaccinate.

 Again, I'm not saying EBF is bad. In fact, if you can make it work, more power to you. But it isn't the only way, and it doesn't necessarily condemn you to a life of following Jenny McCarthy and Dr. Oz.

TED talks for the win

I have taken to downloading TED Talks for the commute to Broomfield (or random jaunts to the grocery store; I'm not picky). I can't remember how it first started. I've been doing Lanky Guys and Catholic Stuff podcasts and decided that I should figure out this phenomenon.

The idea behind TED is to share ideas.

There are conferences all around the world dedicated to just sharing ideas.

Isn't that wonderful?

In today's world that is so bent on productivity and one-upmanship and success and money and comparing yourself to the fake version of someone else that they decide to broadcast to the world, there are whole conferences where people sit and listen to other people share ideas.

There may be nothing more that comes of a talk than an interesting conversation. And that is okay.

Blame it on my introvert nature, or my melancholic longing for something better, but I hate small talk. Hate. I would rather stand in the corner for an entire evening--awkward as that is--than spend time gossiping about co-workers or trying to out-do each other for craziest work story or just rehash some pop culture news item. I want to talk about REAL THINGS. Science and philosophy and history and human experience.

Apparently there are other people who share this desire. Or else why TED talks? The beauty of this, if you can find ones worth listening to (and ones presented by speakers with understandable accents), is that someone else has already done the reading, the studying, the learning--and you get to benefit. You get the bullet-point, sound-byte-sized revelations that are interesting. That are worth sharing.

For example--
The power of games to increase resilience
One really important reason why we need sleep
Apparently my standards aren't high enough

TED talks obviously aren't the only way to get us beyond small talk. I'm just excited that I can slowly expand my universe during my drive. And I'd like to encourage you to do the same. Let me know if you find good ones.

Learning medicine

Last night I attended an awards banquet at the School of Medicine for physicians who volunteer as preceptors, taking on a student one half day a week for their first two years of medical school and part of their third, teaching them about clinical medicine in the real world. When the program was founded 30 years ago, most teaching was done in a university hospital, where less than 1% of those who sought medical care would eventually be treated.

I remember my Wednesday afternoons with my preceptor in medical school, me always feeling nervous beforehand, but excited to get out of the classroom and actually see patients. I left every evening grateful for the learning, but wondering how in the world would I ever know enough to practice medicine?

I remember my own student's first day, me still wondering if I knew enough--this time to teach it to someone else. And I guess it's going okay, because she nominated me for Best Pediatric Preceptor, which if you knew some of the others who were nominated, you'd know was a huge honor.

But there's a lot more than just imparting medical knowledge, and that was the takeaway for me yesterday. The best preceptors also invest in the relationship, becoming a role model for communication, empathy, integrity, balance, and perseverance. We have the opportunity to remind these students why they went into medicine, when they spend most of their days memorizing the Krebs cycle. We can show them the incredible gift it is to take care of patients. And in doing so remind ourselves of that very thing.

I am a writer

Today was Day 1 of Introduction to Creative Writing, an online class I enrolled in through the local community college. I have been wanting to take a class (in anything) for a while now, and wanting to improve my writing always, so this seemed like a perfect step. Not sure why it took me so long.

Day 1, for those of you who have never taken Introduction to Creative Writing in an online format, involves reading a brief lesson (which consisted mostly of encouragement that we are already writers, even if we aren't published--or even good--and that we just need to practice) and then practicing free writing. Free writing is an exercise in futility for the perfectionist. Or so I'm told. One simply takes a pen in hand (or a keyboard on the lap) and writes for a set amount of time. Whatever comes into your head. Some call it "stream of consciousness writing". No planning. No restructuring. No editing. No even fixing typos. Gah! I may not make it to Day 2.

Our class is composed of at least 2 dozen aspiring writers from around the globe (apparently Introduction to Creative Writing is very popular in Australia. Not kidding.) ranging in age from 14 to 73. We have students, teachers, mothers, grandmothers, military brats, and me. I'm sure the experience, talent, and attention to grammar is going to be vastly different among us. I'm told we'll each work on a piece throughout the 8 weeks that should be completed by the end. A finished creative work. You may even get to read it, if you're lucky.

For now, I'm excited to be a student again. After all, doing it for 24 years, I've gotten pretty good at it.

Cultural legacy

I just finished Malcolm Gladwell's "Outliers: The Story of Success"--a thought-provoking read on why we should reconsider what leads to success and how we might be able to increase opportunities for more people to be successful. One of the intriguing points he makes is about cultural legacy. He focuses on two major populations--Korean pilots, who because of their culture of deference to authority have a hard time speaking up to prevent plane accidents; and Southerners, who because of the defensive and suspicious culture that surrounded the settling of the less-than-fertile land are still to this day more likely to react violently to situations. He's careful to say that these are not all-encompassing legacies, but asserts that if you want to change behavior, you have to at least acknowledge them.

It got me thinking about my own legacy. By many accounts (not necessarily our own), my immediate family is considered successful. Parents married almost 38 years, financially stable yet generous, involved in the community. Four kids, all college graduates (assuming the last one doesn't screw up something in the next 6 weeks) and two doctorates among them; hard workers, athletes, volunteers, and faith-filled disciples. What was in about growing up a Zapapas near the turn of the millenium that set us up for success?

Our cultural legacy is built on a combination of Greek entrepreneurship and German blue-collar work. My great-grandfather came over from Greece on a boat as a teenager and opened a candy kitchen that is still churning out homemade confections. His son (my dad's dad) saw the value of hard work and obtained a degree in pharmaceuticals, traveling the world and sending all six of his children to college. On my mom’s side, my German grandfather was a partner in an electrical company, who worked hard until the day he died but never settled into financial security. My mom grew up into expectations of pulling your weight, but she wanted more. She studied hard, graduated college with straight A's and a business degree, making sure she would always be able to provide for her family. Between these two legacies, college was an expectation for us growing up. School was first (well, God and family were really first—another legacy, stemming from two Catholic matriarchs who were both married for over 50 years and had their priorities straight), and everything else was second. You never gave less than your best. Summer time was for playing outside, but also for doing math workbooks and reading. We watched my parents both work full-time jobs so we could play sports year-round and go to a Catholic grade-school. We just never thought about doing anything differently.

Had any of us been born into a family whose legacy was farming, or ranching, or holding down minimum-wage jobs, things would have been different. Had we come from a series of broken families, things would have been different. Instead we were raised in an environment that cultivated our curiosities and strengths, buoyed by expectations of generations before us. Our culture legacy didn't do all the work, nor should it limit us, but I think it's interesting and important to consider. I, for one, am extremely grateful for mine.

Top 5 Ways Hollywood Medicine Fails

I realize that all of Hollywood is fake. And that creative license exists to further the storyline. But I'm pretty sure the "medical consultants" on all major TV shows and movies are from "The Doctors" and don't actually know what they are doing. Or else everyone ignores them. Here are the biggest offenders.  

1.      The biggest flub no matter who you talk to: We don’t shock asystole.

 Nearly every code depicted on TV involves a patient suddenly flat-lining (that dramatic long beep where there is no heart beat, also known in medical speak as “asystole”) and someone yelling “clear!” just prior to the body dramatically jumping off the bed. So you all know, patients rarely just flat-line. When you start circling the drain, adrenaline kicks in and your heart rate speeds up to try to match the demands of infection, injury, stress, what-have-you. The heart tries its best to keep up, its internal pacemaker keeping things going even when the rest of the body is shutting down. Sometimes it works so hard and fast that it can’t beat in rhythm anymore, a condition known as ventricular fibrillation (or V fib).

This is very scary

If that word sounds familiar, it’s because those infamous paddles belong to a device called a de-FIBRILLATOR. Meaning “to stop fibrillation”. In other words the electricity stops that crazy rhythm and allows the heart to restart its own pacemaker. Guys, the paddles STOP THE HEART. Which makes no sense if the heart is already stopped. So shocking asystole is just bad medicine, and every one who’s ever taken an advanced life-support class knows it. Even the automatic defibrillator machines know that. If there is no heart beat, we instead make the heart beat by doing chest compressions and trying to restart it with epinephrine. Which I guess is just not as dramatic as “CLEAR!” But really, how hard would it be to put V fib on that monitor instead of asystole. Seriously.

2.      Medicine is boring. I realize it wouldn’t make for the most compelling story lines, but can we talk for a second about how much of my shifts are spent typing notes, putting in orders, reviewing results, or waiting on hold for a consultant? They’ve done studies about how much of a doctor’s day is actually spent in patient care, and it’s not much. Besides that, most of the cases are routine things like telling parents that their kid’s cough will go away on its own, or telling that adult patient (again) to take their blood pressure medicine. Fascinating, I know. Believe me, I know. So sure, glam it up, script writers, but at least on cop shows they talk about all the paperwork and leg work leading up to the dramatic show-stealing chase scene/shoot-out. Yes, that one helicopter flight to the ICU is what we talk about all week, but it’s a small percentage of what I actually do, and the paperwork from it takes almost more time than the case itself.

3.      Pen tracheostomies aren’t the norm. Speaking of over-dramatizing, I just want to make sure you all know that when someone drops dead in a restaurant/subway station/playground/their kitchen, doctors (especially medical examiners) do not come out of the woodwork to put in tracheostomies or remove bullets or perform emergency surgery with a bottle of vodka and a pocket knife. 80% of the job is having the right tools, which does not include a ball-point pen ever. We all still call 911, and then start CPR. The end.

Never gonna happen

4.      One doctor doesn’t do everything. “House” made it standard, but every show is guilty of expanding the lead character’s expertise to a convenient, but unrealistic scope. We aren’t usually the ones drawing blood, giving meds, hooking up the ventilator, running the CT scanner, and doing surgery. In fact, most of us don’t do any of those things. Medicine is a team affair, and yes, that would involve paying a lot of extras, or having the docs do the more mundane parts of their job on-screen (see #2), so I understand why Hollywood does it. Just don’t expect your doctor to.

5.      Michelle would like to add an honorable mention regarding TV pharmacists: When asked “Do you know what fentanyl is?” The correct answer is not “oh, synthetic heroin?” Everyone knows what fentanyl is.

Fighting the good fight

Had a dream last night that I lost it on the wiffleball court. Lost. It. My team was short on players, the other team kept finding holes in our defense (in fact, I don’t remember us even batting; the Mercy Rule must not exist in dreams), and I dropped three fly balls. I screamed about the teams being stacked, wiffleball being stupid, and other such nonsense, and then stormed out.

I woke up grateful that I didn’t have to go to confession for such shameful behavior. But not surprised. Because I get that worked up playing recreational sports. Or pretty much anything else. I don’t know if it has to do with being the oldest, or a twin, or Type A, or some mutant combination of the three, but I hate losing.
I could try to dance around it, saying that I’m passionate, or dedicated, or that I see things through. But really I’m just competitive. I want to be the best. I want to win.

It’s almost embarrassing to be honest. Sometimes I’d rather just be the person who didn’t care, who was happy just to play, who laughed off mistakes. And while I know it’s good for me to be humbled, I still hate it. But here’s the good news: God is always victorious, and He’s on my side.

Romans 8 reminds us that we “conquer overwhelmingly” in Christ. “If God is for us, who can be against us?” We are on the winning side. Raise the banners, take a bow. God made me just the way I am, competitiveness and all, because He made me to conquer. So it shouldn’t matter that I drop a pass in football (at least it shouldn’t ruin my day) or get yelled at in the OR during an anesthesia day because I didn’t intubate on the first try (I can’t be the best at everything. Dang it!). Because those are just little battles in a bigger war, which we have already won. So I continue trying to funnel this passion towards greater goals, to humbly accept the losses, and to let the victories be His.

A doctor's tools

I like to think of myself as a minimalist when it comes to running tests and ordering medications in the urgent care. The nurses love it. My mother hates it. “You mean all you do is give them Motrin and a popsicle? That’s it?????” Yes, mom, that’s it. That’s all they need. Most pediatric disease is self-limited, either caused by a virus, or idiopathic (that wonderful term for “we don’t know what causes it”). Most pediatric injuries heal without major intervention. And so running a bunch of expensive, sometimes invasive tests that will most likely be normal seems like a waste in every sense of the word.

Plus, there’s a reason I went to 4 years of extra school and 3 years of indentured servitude residency. It’s called making a clinical diagnosis. You know, what doctors used to have to do for every patient, based on a good history and a thorough exam. They had to know how different heart murmurs sounded, because there was no same-day echocardiogram. They had to learn the signs of heart failure, because measuring brain natriuretic peptide hadn’t been discovered yet. And yes, they had to do a rectal exam on patients instead of getting xrays to diagnose constipation (which is still a more effective diagnostic tool, by the way). Call me crazy, but I like being a clinician instead of merely an interpreter of lab results and imaging. I pride myself on it most of the time. I spend a lot of time convincing parents that it’s a better way to go.

But if you want to make me doubt my clinical skills, if you want me to long for the ability to check a quick BMP or grab a chest x-ray, frankly, if you want to make me feel helpless, then take it all away. Put me in a teepee on the side of a mountain trying to tease out post-surgical abdominal pain in a teenage girl. Or on the phone with a worried friend who doesn’t want to make an unnecessary ER visit for her child. Or on the flag football field when someone goes down with a “pop” in one of his joints. My calm reassuring voice becomes laden with doubt, and I forget all of my training. Or at least that’s how it feels. At least for a moment. Then reason kicks in and I start to work through the problem, ruling badness in or out, looking for red flags, gathering as much information as I can.

The few physicians in my Wilderness First Responder course were sick of being outside the hospital, without any of our normal comforting resources (labs, radiology, even monitors) and not knowing what to do. We all needed a reminder that we are, in fact, clinicians first. We can use our eyes, our hands, and our brains instead of machines. I try to remind students of this when they rotate through the urgent care. It’s what I try to practice on a daily basis, even when I don’t have to, because it makes me a better doctor when I do have to.

And in reality, a popsicle is sometimes all the tool we need.