Fleeing Florence

We started to worry when we heard that Jane was leaving.

Jane never leaves.

At nearly 85, she’s stared down her share of hurricanes, undaunted. But as Florence approached, Nat’s brother had traveled from Connecticut to her house near the NC coast to help her move all her stuff to a safer area, then drive with her to Richmond, where she would literally wait until the coast was clear.

For those of you who don’t know Jane, this is Jane, circa 2013:

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After I had my first child, Jane came to help care for her while I went back to work for a few weeks to finish my year as Chief Resident before moving to Boston. Not only did she take care of the baby, she dusted, cleaned windows, planted flowers, swept the porch,  took her on long walks, made dinner. One of my friends said “I went by your house today and saw your mother-in-law up on the roof, baby in one hand, hammer in the other, nailing down a shingle.” That was only a slight exaggeration. That is Jane.

So you can see why we raised an eyebrow when we found out Jane was packing up to get away from this hurricane.

Meanwhile, in Rock Hill, we fretted. We had tickets to fly out of the Charlotte, NC airport, for our long-awaited bike trip WHEN? Mid-morning on Friday .

The hurricane was scheduled to hit our area WHEN? Mid-morning on Friday.

“Can’t you cancel your patients on Thursday and leave a day early?” a friend suggested helpfully.

In my brain, that question sounded like this:  “Do you want to cause your scheduler, Tammy, to have a heart attack?”

No. When I already work part time and people are constantly letting me know they can’t get an appointment with me (or sometimes anyone), I can’t cancel a day of patients. I love Tammy. I cause her enough stress already on a daily basis.

We decided to leave on Thursday night after work. There was an 8:00 o’clock flight out, and we could both work a full day, then go straight to the airport. My husband, who could moonlight as a travel agent if he wanted to, got on the computer and the phone and rebooked our flight.

We weren’t here for Hurricane Hugo in 1989, but it remains the stuff of legend in the Charlotte area. No one had imagined the destruction that a hurricane could bring so far from the coast. People described all sorts of chaos, finding porch furniture down the block at the neighbors, windows shattered by flying debris, trees down on houses and cars,  flushing toilets with bathtub water for weeks (or not flushing at all), walking around with candles and flashlights in the dark. KWg87bGyTLKlVroPRYEwEQWith that in mind, we spent Wednesday night redecorating our house, because what living room is complete without a gas grill in the center of it, along with all sorts of wicker porch furniture, outdoor umbrellas, and an outdoor heater thoughtfully placed hither and thither?

 

 

 

The next morning, we carpooled to work. This is only the second time we’ve done this in 20 years of working near each other (and 4 of working in the same building). As we did the first time, we parked here: %hKAvfU9RGOY7QtRuqZsxw

 

 

 

 

(Because here is where you always park when you carpool with a cardiologist whose motto is NOT  “do as I say, not as I do” as mine is,  but “I walk the walk….and walk and walk.”

I briefly considered calling an uber to take me to the entrance of our building.)

We went to work. We saw patients, answered messages, sent in refills, signed orders, reviewed lab results and studies, saw more patients. Then it was time to go.

As the clouds gathered, we jumped in the car and headed to the airport, parked, shuttled in, checked our bags, only to find when we got there that the flight had been delayed. Then it was delayed again. The wind began to pick up a bit.

We worried that if the flight were delayed more, we would not be able to take off.  My husband asked the ticketing lady if we could get on an earlier flight as we checked our luggage. “There’s one boarding now,” she said, and gave us seats on that one. We zoomed through security, rushed to the gate, climbed aboard the plane, and the door closed behind us.  The engines roared. The plane backed up, found its runway and soared into the gathering clouds.

Not only had we escaped the hurricane in the nick of time, we had gained a bonus night in New York City.

Sometimes life calls you to stay and face a storm.

Sometimes you get the hell out.

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Tow Ropes

I stared up at my husband’s face from where I lay on the tile of a hotel bathroom floor in New York City.

“We really can’t go to Spain. I can’t be doing this in Spain.”  March, 2018.

I’d been here before, staring up at faces from the ground. From the pro-shop floor during  tennis lessons in high school, in Europe on a boulevard with friends in the middle of the night, in the Port Au Prince, Haiti airport, on the sidewalk after a talk I gave one spring morning in Charlottesville, from my own bathroom floor in my PJ’s at dawn where we had to call the neighbors to load me in the car to get fluids at the emergency department.  The  episodes are unpredictable and there seems to be no rhyme or reason. They are related to travel. Or not. They are related to hydration. Or not. They occur in the wee hours of the morning. Or not. They come with a dose of vertigo. Or not. One was anxiety-, stupidity-, and stress cardiomyopathy related, but the others were not.

Ultimately we have determined that most episodes seem to be an evil migraine prodrome. They are always followed by several days of an ice-pick-through-one-eye type of headache.

The problem is not so much that I go down, turn pasty white, vomit, and faint, but that I can’t get up.

I knew that if I gave it a few minutes, an  hour, a couple of hours, I’d likely be here still, on these tiny black and white tiles,  vomiting and miserable.

“I think I heard that you can get an IV nurse to come to your room in New York City,” I said.  My husband was the King of Google long before googling things was ever a normal thing to do. It took him less than a minute to confirm that yes indeed, having an IV nurse uber over to your hotel room with a bag or two of resuscitation fluids was on the list of otherwise abnormal but normal things to do in NYC. Apparently, there are enough hung-over people and GI viruses in NYC to support a moderate sized army of traveling IV nurses.

How sad. But how wonderful.

My son and my husband lifted me onto the bed, and within an hour, there was the IV nurse, a halo of glowing light above her head, a 24 gauge needle and 2 liters of normal saline in her rolling suitcase.

I slept the rest of the day away and tried to ignore my raging headache while my son and husband explored the city and found time to get my son a New York Haircut.

Months went by with no more episodes. I dared to start thinking about going to Spain. Two years ago, we had made a plan to accompany friends on this trip in September, after settling our final child in her dorm room in college. But it wasn’t going to be the kind of trip where we traveled around in trains and crowded into unreliable Fiats. No, we were planning to spend most of the trip on bicycles, far from big cities or traveling nurses with IV hydration kits.

fullsizeoutput_64deOur biker friend insisted I’d be fine: “No worries! If you can’t travel with three doctors, who can you travel with? You will have an e-bike. And if your e-bike breaks down, I will bring a rope and tow you up the hills.”  He really could do that, his wife assured me. With no e-bike. The idea that he not only could do that, but would consider doing that is what made me finally commit to the trip.

There are other reasons I shouldn’t be thinking I can bike in the middle of nowhere, up and down hills, in the heat for five days in a row. The first that comes to mind is lingering lower extremity paralysis from a gymnastics injury at age 15. My quadriceps are awesome, but pretty much everything else from the waist down, not so much. Try going up several flights of stairs sometime on your heels, with no assist from those muscles in your calves. Imagine your butt, hamstring, and hip muscles refusing to do their fair share as well, and you get the idea.

What is amazing is not so much that our bodies fall into disrepair or play evil tricks on us from time to time, but that there are people who surround us, pick us up, and help us move forward even when it seems impossible. They offer tow ropes, reassurance, and seem comfortable with the idea that your presence may slow them down immensely. “Come on,” they say. “It will be fun. You will be fine. And if not, it will still all be okay.”

fullsizeoutput_6639That is how I found myself outside a small hotel, in Ronda, Spain, a two thousand year old gleaming white village, standing at the top of a rain-drizzled, cobble stone street, about to try out the bike that I would use for the next week.

I put a leg over the seat and pushed off, teetering a bit, headed down the small hill toward the main street below.  As I approached the bottom, I tried to turn left, while putting on my brakes which responded poorly on slick, wet  cobblestones. The bike spun and went down. I fell hard. I walked the bike back up the hill, bruised and embarrassed, then I got back on.

For the next week, I rode slowly up impossibly steep, long inclines, at full speed down roller-coaster gradient hills, with brakes near-fully engaged down hairpin curvy roads on mountains, past sheep and cows and roosters and barking dogs, on remote roads, through long dark scary tunnels.   I sweated and laughed and mostly kept up.  The battery never gave out on my bike. I never needed towing.  And I never fell again.

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Two Things

Simplify. It’s always my goal, but my tendency is always to complicate. I am an overachiever, always explaining a little more than I need to, checking off more boxes than are required, looking for problems that may not need to be immediately addressed. Hence I run chronically behind.

Seems the longer I practice pediatrics, the more I have to say and the less time I have to say it.

After assessing growth and development and advising parents on how to handle things like symptoms of teething, introducing new foods, potty training, car seats front or back-facing, signs of illness, safe storage of weapons and medications, sunscreen, asthma education, not letting a baby go to bed with a a bottle all night due to risks of cavities and obesity, managing screen time in a pre-teen and so many other important things, I have about two minutes left to impart some parenting wisdom.

Over time, I have come to believe that those two minutes are the most important of every visit. There is so much to say, so much to convey. In two minutes.

I want to share that children who are raised in a house filled with literacy, language, and books are likely to hear 30 million more words by age 3 than those who aren’t.

I want to share that families who sit down to meals routinely increase the odds that their children will attain higher levels of education, decrease their chances of substance abuse, obesity, early intercourse, and odds of ending up in prison.

I want to share that attending to a child’s mental health is just as important as attending to his physical health. Make that more important.

I want to share that discipline should be guided more by positive attention and teaching good habits than reacting strongly to bad behavior. Time ins > Time outs.

I want to share that family walks are a great way to diffuse the stress of the day. They can be done with talking, without talking, at any age, for any distance or length of time. They promote exercise, connection, mindfulness, and are never a waste of time.

I want to share that children are watching parents and will model what they see and hear, what is said, what is done, what is eaten, how others are treated. Everything.

I want to share that bedtime should not be about turning on a TV, turning off the light, and saying good night to a child with a bottle or sippy cup in a crib or bed, but instead should involve an intricate ritual created by each family in which teeth are brushed, fears are discussed, prayers and gratitude are expressed, books are read, and children are snuggled.

I want to share that it’s okay for children to feel happy, angry, sad, anxious, or frustrated, that they should be taught how to name those emotions, sit with them, and learn how to channel them into strong, healthy relationships.

I want to share that sometimes bad things happen to good people, and sometimes good people do bad things. Sometimes these things affect children, affect their growth and development, affect their behavior, can even affect their future mental and physical health.

I want to share that it’s important to acknowledge these things, accept responsibility for them, then learn how to use these hard lessons to strengthen a family going forward.

I want to share that resiliency in children has been studied and that we know that, even when a child’s life is full of challenges, the most important factor to insuring a positive future for that child is having at least one caring adult who is consistently present and offers unconditional love.

How can I cover all this in two minutes?

Two things:

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Every visit.

Every time.

 

 

 

*(or any meal)

 

Or. But. AND.

 

A little over a year ago, I wrote a post for my daughter. It had to do with grammar and more. You can link to it here.  Unlike 17 teachers and children in Parkland, Florida, she will be participating in high school graduation ceremonies in a few short months.

Time for another grammar lesson.

In the last few days as I’ve scrolled through newsfeeds, I’ve found myself noticing the conjunctions.

Or. But. And.

The assumptions involving OR make me angry:

17 students and teachers were assassinated in a high school. Again. People want to find something to blame. It’s a mental health problem OR it’s a gun problem.

It can’t be both?

You can blame the guns for all this heartbreak OR you can blame the people that shoot them.

We can’t blame both?

OR is problematic for me.

 

The BUT sentences fill me with anxiety and confusion:

The murderer was not allowed to carry a backpack at school—too dangerous– then he was not allowed to even go to school, BUT he was allowed to legally purchase a gun.

People suggest arming teachers, putting more armed security guards in schools, using our tax money to pay gun manufacturers for those supplies, BUT we can’t seem to find the money to reimburse teachers for things like Kleenex, school supplies, teaching assistants.

No one would disagree that access to mental health care is a huge problem in our country, BUT we just slashed corporate taxes, gutting our federal budget, insuring that cost effective healthcare will remain out of reach for millions.

 

The ANDs, on the other hand, fill me with hope:

We know that mental illness is often passed on through adverse childhood experiences, ACEs, which change the brain and the DNA, affecting generation after generation. I speak about this locally for the Palmetto Peace Project. My daughter just wrote a big long paper about how ACEs and childhood exposure to toxic stress change a developing brain on the anatomic level, the cellular level,  and the DNA level, hence the generational effects.

As a pediatrician, I see families every day in my office for whom I know this science to be true, especially now that I have begun routinely screening for ACEs using the questionnaire developed by Dr. Nadine Burke Harris and the Center for Youth Wellness.

We know that by investing in children AND families that we can reverse this trend AND promote resiliency through simple, inexpensive things like parent coaching by home visitors AND family dinners AND good sleep routines AND reading with children AND decreasing screen time  (especially violent games) AND making sure every single child has at least one, loving, buffering person in their lives.

 

We can invest in better mental health for families who are struggling in our country

AND invest in simple things that promote lifelong resiliency in children

AND ban assault weapons

AND use technology to do more careful background checks

AND close loopholes for gun sales

AND create guns with childproof locks (like our smartphones)

AND establish policies for ammunitions background checks

AND prevent those with domestic violence charges, stalking behavior, or significant mental health issues from having access to guns.

Polling suggests that our country is not divided on these things.

 

 

My daughter is turning 18 and graduating in a few months.

I hope I have taught her that we can do hard things, individually AND as a country, that life does not have to be filled with ORs and BUTs.

I hope she and her friends know that life can be filled with a series of infinite ANDs.

I hope that she and her friends will cast their 18 year old votes with the ANDs in mind.

 

 “Turn It Up: Lessons Learned While Trying Not to Listen.”

(Words shared at my father’s memorial service this weekend.)

When I think of my father, a couple of things immediately pop into my head. The first is his concern for everyone and everything. I remember asking him simple questions on car trips –I mean simple questions like “are we there yet?”– and getting detailed answers over not just the next few minutes, but sometimes hours, days, and (I am not kidding) sometimes years. His appetite for knowledge was insatiable, even when mine was satiated.

 

The second thing was his love for music and especially opera, played at full volume. I remember getting into his car or walking into the house and hearing the music he loved playing full blast.

 

And I would say “Turn it down!”

 

As happens often as we grow into adulthood, I find myself regretting my teenaged eye rolling, my impatience, my constant hurry. I realize now that despite telling him to turn it down and trying to tune out his long answers, I still managed to learn so much from my dad.

 

I thought I’d share those lessons with you in a poem I wrote. It’s called:

 

“Turn It Up: Lessons Learned While Trying Not to Listen.”

 

Turn it up. Turn up the volume on the Pavarotti. Ignore the pained expressions. Turn up your own voice. Sing solo, or blend it with others, but sing out.

 

Turn up your curiosity. Ask a question. Then another. Find out that thing that makes someone else amazing. Turn up your curiosity about how to turn down pain for others. Try to know it all, including the unknowable. Make people wonder how you can possibly care so deeply about everything. Make them wonder why they don’t.

 

Turn up the light. Your grandmother wouldn’t want you reading in dim light. Tolkien, Kipling, Dickens, Dickinson deserve bright light. Turn up the spotlight on someone else and applaud their accomplishments. Turn on the flashlight: help friends find a path when they lose their way.

 

Turn up the elegance. Set the table with polished silver, sparkling crystal, fragile china. Treasure things that have endured for centuries, especially family.

 

Turn up your faith. Because though you can’t see it, God is working

Through hands that play drums, strings, woodwinds, brass, keyboards.

Through voices raised.

Through endless questions, endless answers.

Through spotlights and flashlights.

Through extra silver place settings at family dinners.

We are, all of us, meant to turn up the sound, the light, the curiosity

As we seek ways to love each other perfectly.

 

Ready, Set, Breathe

I see them, a steady stream of them. I know you see them too. In my office, in the classroom, in the grocery store, maybe in your own home. We all see them: children who are melting down inwardly, outwardly, silently, loudly. They worry their classmates, their teachers, their parents. With their challenging behaviors, anxiety, or outbursts, they worry me too.

People ask why. Why so many lately? Why so much?

There’s not a one size fits all answer. Some young brains have been exposed to things well before they were able to process it and store it safely away. They have been raised from birth with adrenaline and cortisol coursing through their bodies to help them flee from real or perceived threats. Some young brains have been built with DNA that has been shaped and reshaped by generations of trauma and stress. Some young brains are just very sensitive, take in everything, feel a responsibility to fix it all, start feeling overwhelmed as they try to figure out where to start.

Think before you act or speak, we tell them, forgetting that most behavior under stress is automatic, reflexive, powered by adrenaline– that fight or flight hormone that simultaneously makes us panic while making us strong.

I sometimes prescribe medication that helps children engage their prefrontal cortex, the thinking part of the brain, more effectively. Sometimes the medication works well and is game changing. Almost always it has side effects.

Lately, I’ve been prescribing something else:

Breathing. 

“There are two ways of changing the threat detection system: from the top down, using rich connections from the front of your brain, or from the bottom up, via the reptilian brain through breathing, movement, and touch,” says Bessel Van der Kolk in his book “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.”  “Whenever you take a deep breath, you activate the sympathetic nervous system. The resulting burst of adrenaline speeds up your heart, which explains why many athletes take a few short, deep breaths before starting a competition.  Exhaling, in turn, activates the parasympathetic nervous system which slows down the heart. If you take a yoga or a meditation class, your instructor will urge you to pay attention to the exhalation, since deep, long breaths out help calm you down.”

Not everyone can access the thinking part of the brain during times of stress. I know I can’t.  But all of us can start to  to notice our breathing: how it feels to breath in and fill the chest, then the ribs, then the belly with air, how it feels to let it out slowly, how the heart rate goes down the more deeply you exhale, how the jaw relaxes, the shoulders drop, how the feet securely connect to the earth below.

Recently,  I took myself on a field trip to a local elementary school. I’d heard rumors that there were some teachers using breathing and mindful movement in their classrooms. I wanted to see for myself, and what a gift I gave myself by spending time with them.

I started with Ms. Allan’s media class, and here is what I saw: the children came in with their teacher, Ms. Stewart. The teacher apparently had the option to take some time for planning or even (gasp) herself, but she chose to stay with her class, to move and focus on breathing with them. Each student chose a carpet square and got settled while Ms. Allan read a book about kindness. Then she began to ask the children to begin to pay attention to their breathing. I watched as eyes closed, shoulders fell, wiggling slowed. Over the next 25 minutes, each child engaged, on his own square, in his own space, with himself, his breath, his heart, his mind. Each child listened, tried, stretched, balanced, felt safe, because they were focusing completely on the present moment, not what happened earlier, not what might happen later. Not one child was asked to refocus or calm down. Every child was already focused. Every child calm.

I followed the children back to Ms. Stewart’s class. Transitions between classes are always hard for children, especially those with special needs or high energy levels, but  all children often struggle with moments of transition. The energy changes from room to room. The rules and expectations change from teacher to teacher. The lighting in Ms. Stewart’s classroom was low and warm. The fluorescent lights were turned off and there were table lamps and many different seating options available. Without instruction to do so, each child took a seat, put head down on folded arms, closed eyes, quietly breathed. Screen Shot 2017-10-28 at 1.03.03 PM

After a minute, they formed a square, with the “VIP’s” for the day leading the conversation. They spoke softly about what had gone well in the previous class: who had done a good job following directions, who had treated someone else kindly. “What other compliments are there?” asked Ms. Stewart, and several children described specific behaviors they had seen in their classmates that impressed them.

She invited me to come back some time at the end of the day. If the children collect and organize their things in time, they are allowed to spend 5 minutes quietly breathing and getting ready to make the transition to after school care or the bus home. They consistently do their best to get things in order so that they can take this time for themselves, she says, and bus drivers, parents, and after school program teachers seem to appreciate that it helps them to make that transition more successfully.

Next, I had heard that I needed to connect with Ms. Joyner and her first grade class to see how she had set up her classroom, so I found her and introduced myself. She had no assistant, but a volunteer was settled on a blanket outside her door, working one on one with a child on his reading. Again, the fluorescent overhead lights were off, and there were areas where the children could work together. There was also a little desk in the back where they could choose to be alone if needed. My favorite space was the sensory corner near her desk where there were yoga cards, calming strategy cards, and a book about an angry octupus that learns how to calm down after getting all worked up and spraying black ink everywhere. The book comes with a bottle containing a toy octopus and tiny shells which can be shaken up, then held as the observer watches everything settle slowly to the bottom.

As I spoke with Ms. Joyner, a child approached and obviously had something to say. She waited politely, but due to a medical issue, she was having trouble getting out the words when it was her turn to speak. I watched as Ms. Joyner knelt down and took the child’s hands. “Inhale,” she said, softly. “Exhale….”

“Inhale…..Exhale…..”

“Inhale…. Exhale.”

They breathed together.

Then the words began to come.

“I.” Inhale. Exhale.

“Need.” Inhale. Exhale.

“A.” Inhale. Exhale.

“Book.” Inhale. Exhale.

Breathing in the classroom. It works for teachers. It works for overachievers. It works for underachievers. It works for everybody in between. (And if it doesn’t work, the side effects are minimal).

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Limbo

I pride myself on being decisive.

In a busy pediatric practice, in the practice of motherhood, hesitation is weakness.

But sometimes it’s important to be indecisive and take a breath, to delay a resolution of a problem until you know more, to live awhile in Limbo, powerless to call the shots.

Limbo: an uncertain period of awaiting a decision or resolution; an intermediate state or condition.

I do my best to avoid that place. It’s an uncomfortable place for me, full of waiting, filled with questions and no answers.

A few days ago, our beloved 14 year old lab, Lou, had taken her usual morning stroll behind the high school with me. Several hours later, my daughter came home from school to find her unresponsive, glassy eyed, breathing, but shaking with each breath. With the help of dear friends, we loaded Lou in the car and headed to the vet. Somehow, they were able to make us feel that late Friday afternoon was an absolutely perfect time for us to come in with a minimally responsive old dog.

The doctor laid out the options for us and for our girl, now a little more aware, but still “with slow mentation.” Clearly something neurologic had happened to add to the challenges her 14 year old lab body was already facing.

I was about to be decisive.

But my daughter pulled me into Limbo. I was going full speed in the other direction, toward a decision, toward resolution. The vet was going with me.  But my daughter’s pleading eyes, her tears and desperation stopped us. “Can’t we just see what happens?” she asked. “This just started. She may get better.”

So a few negative x-rays and normal blood works later, we loaded her back into the car and headed home. To Limbo.

And Limbo is not so bad. Here’s what happens there:

Many reach out through texts and social media to say they know just where you are. They’ve been there too. They understand, and they care.

You come home from work and are greeted at the top of the stairs, just like you always are. IMG_0054

You and your husband and sometimes a child or two go on your evening walks around the block, or maybe a quarter of the way around the block, or to the mailbox next door, a little more slowly than usual, or a lot more slowly. Any speed is okay.

Your friend Teresa and her husband Jeff come over (even though it is well after their 9 o’clock  bedtime) to help you carry your dog inside after she can’t make it the last few feet after her walk to that mailbox next door.

Your friend Robin decides that rather than attend her favorite Saturday morning yoga class, she will come do yoga in your backyard with your dogs.  She knows you can’t be there because you are scheduled to work on a Saturday and your daughter is taking SAT’s and your husband is out of town and both other children are away at school and doing life, and you are stressed. Between handstands and downward dogs, she sends photos of the dogs to you at work, and you shed tears of gratitude between patient visits.

Your neighbor, Jill (a reformed “I am not a dog person” person), comes after Robin leaves. She gives Lou and her buddy some uplifting words of encouragement along with some pats and sends you more photos, so you know they’re okay.

 

 

 

 

You contemplate other recent examples of limbo:

Your friends in Charlottesville who waited, waited, waited when they heard the news that white supremacists and members of the KKK were going to rally in their town, wondering how they should respond as they waited and prayed, gathering their strength and their outrage, trying to decide what to do with it.

You think of those in Houston and surrounding cities, waiting out Hurricane Harvey, walking, wading, through chest high waters, with children and pets, not knowing what will become of everything they left behind, not knowing where they will be in the next hour, looking up to find a volunteer citizen or a first responder holding out a hand or throwing them a rope, inviting them into a waiting boat going….where?

You think of your friends who have loved and lost a terminally ill child. You wonder how they spent days, months and years in Limbo, wondering “Are we doing the right thing? Should we be doing more? Should we be doing less?” And all the while, they just kept lovingly doing.

You realize that through all these difficult times, when answers are in short supply, God  is there always in the form of small kindnesses and friends who care.

Limbo may be scary, but it’s filled with love.

The opposite of limbo is resolution: going back home to a flooded house and finding that it’s gone, along with all of your belongings. Witnessing white supremacists who show up  with semi automatic rifles and tiki torches and lethal cars. Caring meticulously and lovingly for your sick child for days and nights and weeks and months and years, then opening a door to an empty bedroom after she is taken too soon.

Limbo does not always evolve into happy endings.

 

Less than 24 hours before I sat at the vet, on the floor, beside my daughter and my sick dog, I spoke at the Pause for Peace event downtown, organized by the Palmetto Peace Project. Here’s a bit of what I told other people, but failed to remember myself one day later:

“Sometimes the strongest medications I can think of are not strong enough to fix someone.

Sometimes, rather than medicine, it is more powerful to offer outstretched arms

And open ears

And open mind

And open heart.

 To take a breath with a family who is hurting.

Then another.

Healing sometimes involves simply sitting with pain

And acknowledging it,

Rather than fixing pain that is not quite ready to be fixed.”

I should listen to me sometimes.

This morning I woke up no longer in Limbo. There were no imploring eyes, watching me come and go. Had those eyes been in pain? Did they want a walk? Another dose of medicine? Some water? To be carried outside? I think those eyes were asking me to simply sit awhile with hand on head.

Today I woke to a house with a little more peace and a lot more emptiness.

I pray for those who are in Limbo now and those who will wake tomorrow to start the next chapter in their lives, whether with happy endings or sad.

May they be greeted with outstretched arms, and open ears, and open minds, and open hearts.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do the Right Something

 

Ever since the Affordable Care Act (ACA) went into effect, allowing healthcare access to tens of millions of people who previously had none, we have heard a constant refrain: “We have to do something about Obamacare.”

Key features of the ACA include: Permitting children to stay on their parents’ plan until age 26; requiring insurance companies to cover such women’s health issues as family planning, pregnancies and C-sections; covering mental health; providing basic preventive care; overriding exclusions for pre-existing conditions; and enabling people with part-time jobs who lack insurance to purchase coverage through an exchange.

This additional coverage has come with a cost, hitting affluent citizens the hardest. Premiums have continued to rise exponentially, although less than many predicted prior to implementation of the ACA.

In recent months, I hear the drumbeat grow louder: “We have to do something.”

I agree, but I thought doing something meant doing something to improve the situation, not make it worse.

Doing something should mean lowering drug costs for a child with a peanut allergy whose mom is suddenly told at the pharmacy that a refill for that epipen will be $600 please.

Doing something should mean finding the means to provide more – not less — help for those heroic families caring for, adopting and raising children with complex medical conditions and special needs.

Doing something should mean trying to reduce healthcare premiums for the middle class.

Doing something should mean that after increasing health insurance coverage of children in our state from 88% prior to the ACA to 96% today, we should strive to cover 100% of our children.

Doing something should include paying adequate rates to those in the mental health field who help families with the most challenging, gut-wrenching diagnoses. Suicide is now the number one cause of death in South Carolina among children ages 10-14.

Doing something should not result in the resumption of lifetime caps on payouts for health conditions, so that a premature infant in the neonatal intensive care unit does not use up her entire lifetime allotment during the first week of her existence.

Doing something should not drive rural hospitals and health clinics into bankruptcy so that for many people the nearest hospital will be hours away when it’s time to deliver a baby or when a loved one has a heart attack.

Doing something should mean that physicians have more time to talk to even more parents about the importance of reading with children, how to handle a tantrum, setting limits, instilling healthy eating habits, promoting oral hygiene and discussing the importance of safe sleep routines.

Doing something should not mean that 22 million people lose their health insurance.

“Something” certainly must be done to insure affordable access to healthcare and to reduce the many unseen costs to our society when that access is restricted.

The bill currently before the U.S. Senate is the wrong “something.” It is opposed by the American Academy of Pediatrics, the American Academy of Family Physicians, the American Congress of Obstetrics and Gynecology, the American College of Physicians, the American Osteopathic Association, the American Psychiatric Association, the American Medical Association, the Children’s Hospitals Association, and the March of Dimes.

Please encourage our lawmakers to work together to improve the Affordable Care Act, not destroy it.

Martha Edwards, MD
Immunization Chair and District Representative of the SC Chapter of the American Academy of Pediatrics

 

 

 

Roman ER on the Itinerary? Fear Not.

this memory from July 2012 popped up on my Facebook feed this morning, and it seemed a good time to share it again. 

Italian kidney stones are less expensive than American ones. This is how I know:

On our second day in Rome, my husband started writhing on the floor of our hotel room in agony. We initially assumed he had strained his back, and I was overwhelmed with guilt since he had carried my bag as well as his (it was small! I swear!). But then we figured out it must be a kidney stone. He has never had a kidney stone. Apparently Italy is as good a place as any to have your first one.

So off I went in search of narcotics in Rome on a hot Sunday morning.

Times like this, it is good to travel with friends. The Schauers whisked our children away to tour every Roman ruin in sight while I repeated the “for better or for worse mantra” over and over in my head.

Here is a little known fact about Roman pharmacies: they are all closed on Sunday morning. At least the ones within a mile of our hotel were. I returned to the hotel room narcotic-less, much to my husband’s dismay. He had now been writhing in pain for about four hours. Agony does not to begin to describe his condition.

When I imagined touring Rome, I imagined touring the Coliseum, the Forum, the Spanish Steps, the Trevi Fountain, the Pantheon, with several stops along the way for cappuccino and a gelato. The Roman Emergency Room was not on my list. But it became clear that would be our next stop.

The taxi dropped us off at the door and zoomed off.

There was no wait. Because everyone in Italy has access to healthcare, no one was there with a cold or a hangnail, waiting for hours to be seen, then sent to collections for a bill they could never begin to pay.

We rang a little bell, and out popped a provider who took a brief history, did a brief physical exam in which Nat ran away from her when she tried to thump on his left flank (inflamed, hydronephrotic kidney located there), then showed me to the waiting room and took him back for further evaluation.

Evaluation included a urinalysis, some blood work, and a renal ultrasound (done by the radiologist himself, not a tech) which confirmed that he did indeed have a kidney stone, and he received IV fluids and toradol resulting in immediate relief. Ninety minutes later, he was dancing down the hall, insisting that we tour the Coliseum, the Forum, the Spanish Steps, the Trevi Fountain, the Pantheon, stopping along the way for a couple of cappuccinos and a gelato.

But our first stop was a little shop down the street so that he could buy his new ER buddies a couple of boxes of chocolate because when he asked about the bill for the excellent care he received, they laughed and said “there is no bill for this!.”

Nat and I fully understand that there are some drawbacks to socialized medicine, but as patient and patient spouse last Sunday, we became fans. As we toured Rome, we did not come across any physicians begging for Euros on street corners and wondering how they were going to feed their family that night. It is true that the Italian economy is not in great shape… but last time I looked, neither is ours, and healthcare bills remain the number one cause of bankruptcy and misery for families in our country.

I have a friend whose daughter recently suffered a complicated course of kidney stones (to be fair, much more complicated than Nat’s). Last I checked, the bill was nearing $100,000. Fortunately, she remains on her mother’s health insurance because of Obamacare. Another friend recently had knee surgery and spent one night at the hospital. She recently received her bill: $70,000.

We liked our bill better.

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Meetings at Meetings

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I hate meetings. Everyone hates meetings. But I show up whenever I can. Here’s why:

There are other people at the meetings who also show up even though they’d rather be doing something else more “productive.” They show up because they care.  They are the people who inspire me, who want to help, who go to boring meetings because they want to make life better for their community and the families in it.

I love these people.

When I imagine the Medicaid chief of staff, for example, I imagine an aloof, distracted guy with dark suit and sunglasses who is not aware of  the challenges people face in filling out Medicaid applications. He is probably not aware that those applications are often lost. Again and again and again.

When I actually meet the Medicaid Chief of Staff (at a meeting), I am face to face with a fellow parent who gives me his cell phone number and his “go-to problem solver’s” back line phone number. I discover he cares deeply about children, especially those with special needs, and in speaking with him face to face, I begin to understand the challenges of running a life-saving organization on the shoestring budget we provide for him in SC (though he does not make excuses or complain). He encourages me to call him or email anytime, and he will try to help.

When I think of a DHEC medical director, I think of an austere, box-checking person who dreams of rules and regulations in her sleep.

When I actually meet the DHEC medical director, I meet a joyful newlywed woman who could be making much more money in a private practice somewhere, but who cares deeply about public health and doing the right thing for SC.  We arrange a lunch meeting in my town, and I take her on a little tour of our practice and our community. She is excited about working with members of the South Carolina American Academy of Pediatrics to try to increase immunization rates in our state.

When I think of administrators at our local hospital, I imagine a grumpy man who is all about the bottom line and profit.

When I actually meet one of the administrators of our local hospital, I meet a compassionate, hilarious mother of two young boys who recently completed her MBA in between going to ball games and scouting events and working full time, but who still makes time to serve on boards (aka go to meetings) and to reach back when someone reaches out to her for help.

Last night I got an email from a fellow save-the-world friend of mine, a fellow meeting-go-er. She was forwarding an email from a save-the-world friend of hers about a client at a local soup kitchen who had been hospitalized for weeks in our local hospital. Prior to that, the patient had been living independently. She had recently been deemed ready for discharge, but it was clear she really couldn’t care for herself and had no friends or family to step in and help. Her Medicaid was not yet active. Her Social Security was not in gear.

Did I know of anyone who might know how to get her social security benefits in order so that she could have some source of income to help her move forward (and out of the hospital)?

Did I know of anyone at our local hospital who could help with case management issues while she waited for Medicaid benefits to kick in and help with longer term placement?

I did.

I emailed my Medicaid friend. I emailed my hospital administrator friend.

I emailed them both around midnight on Saturday night.

By 7:00 am on Sunday morning, they had both responded with a plan.

The hospital administrator was checking with contacts who might be able to help with Medicaid approval. She provided a contact in the social security office, and offered to contact a legislator to help–people she had met in meetings.

The Medicaid Chief of Staff promised to have his member services team “dig into” the case first thing Monday morning.

Last week, I looked at my schedule for this week and was feeling a little overwhelmed when I saw the meetings on my agenda. Today, I am grateful for meetings, the people who organize them and attend them. I am grateful for the people who show up, who go above and beyond when it is not always fun or easy. I am grateful for these people who care about the most vulnerable members of our community, who reach out and reach back and make things better for all of us.