November 19, 2016

History in the making

How do I contain
the multitudes, the
mountains of disappointment
at seeing racism
and misogyny
triumph over hard work and
preparedness and
knowledge and
a woman

The people speak
and now the words stoke
fires in hearts,
fires in streets,
fires in minds,
the whole world burning

Are we the witnesses to
destruction of a nation
first hand, like
being present at
the death of a star,
inexorable -
a gravitational pull
we cannot escape?


If our bodies are temples
my gods are blazoned
on the outside
declaring my denomination
for all to see

You will find no cross here,
no god of punishment,
wrath, or sacrifice

I carry my gods with me
Aesclepius, the healer
Ishtar, the sacred feminine
Athena, wisdom personified

Where others wear a
string of beads for
counting penitence,
I sealed my prayers into skin
I have only to look down
to see my faith proclaimed

April 7, 2016

Foot in Mouth Disease

Let this be my apology to the world.

The problem with having a blog is that, after a while, you start to think that people want to hear what you have to say, or that you speak from some kind of place of particular knowledge. This is a fallacy and it's sheer hubris. I have found that with alarming frequency, I have started to speak when it is not my place to do so.

Humor me and permit me the chance to make excuses.

--Maybe it's because I prefer honesty to circumlocution. Much of polite society survives on the
whispered, hushed conversations behind other people's backs, and since I personally would rather know where I stand with people (and have them tell me when I've upset them or when I've done something stupid), I often opt for honesty when a little tact would go a long way.

--Maybe it's because I prefer action over prolonged contemplation. Stereotypically, this does follow the surgical mindset and temperament. I'd rather do something about a problem than continue to talk about it. I prefer solutions over extended analysis of the problem. I'm a pragmatist. When something is wrong, I want to fix it rather than continue to complain about it being wrong.

--Maybe it's because I'd rather get unpleasant things over with quickly, and in so doing choose bluntness.

The problem is, none of that matters when what I say hurts someone.

I've been trying to work on this all of this year - as I seem to be unable to learn, every time I think I should share what I'm thinking about other people, it turns out most of the time I'm wrong. Most of the time, those thoughts aren't helpful or useful or constructive, and even when I want them to be, they seem to come out as unbridled criticism.  Plus, then I have the pleasure of eating my own words when the subject of my unsought critique proves me wrong.

There is a fable about a man who tells a piece of gossip about his neighbor at the market. Over the next week or two everyone who hears the story passes it along to someone else until the whole village has heard the story. The neighbor is humiliated and followed wherever he goes by this false piece of gossip. When the man finds out he had spread a false rumor, he is upset and seeks the advice of a village elder. He asks him how he can fix what he has done, and the elder tells him to bring him a bag of chicken feathers. The man leaves and returns the next day with a bag of feathers. "Now, walk back to the village and with every step, throw a handful of feathers in the air. Then come back tomorrow." The man does as he is told. When he returns the next day, he asks how the feathers are related to his situation. The elder tells him to go and gather all the feathers back into the bag. "That's impossible!" the man replies. "The feathers have been scattered everywhere by the wind. I could never find them all again!" The elder nods and says that the feathers are like the gossip the man has spread.

Recently, every time I open my mouth unsolicited, I seem to be throwing feathers in the air. I don't intend to hurt anyone, but the way I speak has been hurtful, many times over. And for this, I am deeply, sincerely, sorry. I feel I owe the world - in particular, my colleagues who put up with me - an apology - and hope that this offering will be met with forgiveness.

March 4, 2016


How does the heart know what it wants?
How does it know where - with whom - to put down roots?

I started a new rotation this week - Gyn Oncology at the cancer center. The fellow there is a fellow (hah) Midwesterner from Indiana, who studied in Chicago and in July is moving to St. Louis to do fellowship at WashU. I have found myself awash in Midwest sensibilities and longing for tastes of home. I want to be where they say y'all, where The Lake means one particular place, where the Star Spangled Banner ends in "and the home of the Chiefs!" I want to be where people are nice, and polite, and value each other. I want to be where people know how to sew a hem and bake a casserole, where people go to church (even if I don't believe and don't go) and meet their neighbors and go hunting and have gardens.

Am I missing something I never had? We never knew our neighbors growing up, don't be ridiculous. We each kept to our own backyards. I wasn't raised on a farm; I only went hunting with my father once or twice; but somehow these are things I can cling to, the things that tell a story about who I am and where I come from. Like knowing how biscuits and gravy is made, and even more so - understanding why it's the best breakfast food.

I like Philadelphia just fine - it's a great city. It's fun to be around, fun to live in. Part of me wants to boast that there's tons of culture here, but that's an empty sentence. Residency has been too busy for me to enjoy much of it - though I've been to bars and restaurants aplenty.

But Philadelphia is not where I am from. I am not of this place. My ancestors did not know this town. True, my father's father came from New Jersey - but even still, every other branch of my family is buried deep under Missouri soil. For some reason, those trips when we visited relatives and always included a pass by the graves of loved ones call to me - how do you know your own story if you forget who came before you? Mark Twain and hot, humid summers balance out ice storms and temperamental seasons in my blood. I can handle snow and I can handle heat. I know about caves and rolling fields of corn and soybeans and dozens of creeks and rivers for float trips.

When I think about the future, my liberal preferences are seductive, enticing me to stay here in a blue bubble surrounded by supportive, like-minded people. But my heart says that my home needs me, that there will never be a type of people I understand better than those stubborn Missourians who insist that you "Show Me" proof of what you say.

Maybe I'll never feel at home until I go back. For now, I'm just a little homesick.

January 19, 2016

Incantations and infertility

They say that surgeons have egos. Sure, it takes an ego to take a scalpel and cut into the skin and wage war against illness and injury inside the belly. It takes an ego to remove organs, to tie off vessels, and to control bleeding. But the humbling thing about surgery is that sometimes, you don't succeed. Sometimes, the damage is worse than what you can repair. Knowing when not to operate, in fact, is what makes a surgeon great. 

Ego is one thing; a God complex is another. Infertility doctors are certainly at risk for this. The finely-tuned machinery of endocrinology keeps ovulation on track, your metabolism in check, and all of it can be manipulated with perpetual blood draws and precisely-timed doses of medications. 

Every new patient visit brings a couple praying for a miracle. The fear is in their eyes that tear up at the slightest provocation; it's in their voices that quiver with uncertainty. They come in supplication to sit across the desk from the doctor who is willing to promise that there is still hope for them. He jokes that if he could predict the future, his middle name would be G-O-D. He laughs, but underlying his laughter is belief that he will be able to counter any finding with a solution. When he explains that he can almost predict the hour of ovulation, it's not an empty promise and it's not a joke. That level of certainty is guaranteed to inflate a healthy ego. 

Part of me is in awe. Many couples come through the door and explain that they are back to try again, that the last time they were here they left with a baby, and they are here for the same magic. I see patients' ovaries swell with follicles until they're ready for retrieval, a veritable factory of eggs produced on command. At the same time, though, there is heartbreak here. The cycles that end with not enough eggs, the embryos that never grow, the ones where the heartbeat doesn't show up on the next week's ultrasound, the patients whose cycles once again must end in a miscarriage. Time and again, I see patients faced with disappointment and the betrayal of their bodies. 

Our bodies and minds are programmed by evolution to go forth and multiply. Society ingrains this, too, for without fertility society is destined to fail. The desperation of that primal desire to leave something behind, some vestige of our genetics in the form of progeny, is what makes each consult fraught with emotion. As an observer--nulligravidous, single, not even trying to get pregnant--it is anxiety-inducing. I have to remind myself of all the patients in our regular clinic who barely have to think about sex and end up pregnant, of the patients who are older than myself but still find themselves pregnant without any difficulty. 

Before medicine, a couple might have resorted to folk remedies or charms, old wives' tales or superstitions in order to bring fruit to a barren womb. Now, they sit before the Wizard, hoping that the man behind the curtain with his injections and ultrasounds will give them what they most desire. 

It's enough to swell anyone's head.