Monday, March 12, 2018

Miscarriage Lessons

WARNING-  This one is way longer than I expected it to be.

I have a long history of processing things in life by figuring out what lessons come from painful experiences.  Fell in love with a high school friend who is dating someone else; what lesson can I learn from this?  Took 26 credit hours and when making a study schedule couldn't schedule sleep until Thursday; what lesson can I learn from this?  The friends with benefits situation suddenly and dramatically fall through; what lesson can I learn from this?  Find out there is "Not a place for you," at your place of work which is actively trying to hire people; what lesson can I learn from this?

So as I'm going through this new journey of miscarriage I'm looking for the lessons.  Here are some that I've found, but I'm sure there will be more.

This is a different kind of grief. - I've had a lot of loss in my life.  I lost Papa Shegog, my paternal grandfather, when I was 4.  I lost Grandma Shegog when I was 6.  I remember being sent out to the car to get something and screaming at the sky when my grandmother died.  Since then I've lost family friends, Uncles, Aunts, Cousins, and most recently powerful my Aunt Rose and my Father.  I've grieved a lot, and been trained to help people through it.  I know that this is a process.  There is no drug that can make it go faster and no short cut around it.  One has to just go through grief.  It never really goes away. 

But this grief is different in many ways.  It is physical in a way that no other grief is.  There are so many hormonal changes that my body is going through in addition to the literal loss through bleeding and passing tissue.  The physical pain in someways mirrors the emotional pain.  I literally lost something that was apart of me. 

The grief of miscarriage is also different in the fact that it is lost potential.  In other losses I have been able to celebrate the lives that my friends and family lived. Take solace in the lessons my loved ones have taught me.  This loss is the loss of what could have been.  It is also feels like the loss of time, money, effort and energy put into getting to that point (see TTC ).  There is literally nothing good that I can see in this loss other than that I found out at 9 weeks and not later.

Because I didn't find out until after the pregnancy was over I still can't quite process the fact that this was a loss of twins.  But it does make the loss literally and emotionally greater.

Grief or Depression or Anxiety is not a fun new game.  -- Since I already have anxiety and history of depression, when I let myself think about my emotions, there is a constant wondering which element is contributing most to how I feel right now.  I've always treated my anxiety by figuring out the worse possible situation and trying to prepare myself for it.  My depression I've treated with counseling and medication.  Grief has always amplified these, but, as I mentioned in the beginning, this is a different kind of grief.  There is some time in each day that I try to figure out if I'm back into a major depressive episode or just grieving.  This does not help my baseline anxiety, but it does make me feel like I have a little control.

You can never hear "It's not your fault" too much.  - As far as I have read about other's experiences formally in blogs and informally in online support groups, all people who are pregnant wonder if there is something we did to cause it.  I was working a hospital shift when it happened, was it because I was working too hard?  I had caffeine two days this week, was it that?  I started spotting after orgasm once, did that cause it?  Am I just too darn old? 

For the first two weeks one of my fellow family medicine docs, who had a similar experience, texted me "It's not your fault," about every other day.  Every time she text it I needed to hear it.  It is easy for me to fall into feeling like I need to punish myself; the constant reminders that it is not my fault help.

There are triggers everywhere.  -  I was looking forward to going the farmers market.  We haven't gotten a chance to go since we moved here.  It was almost 3 weeks since I found out and two weeks since my last cytotec.  I've been seeing patients; therefore, I can go out in a social situation.  What I was not prepared for was all the people walking around with their babies: in arms, in strollers, in carriers.  Each one dripping a little bit of salt water into my wound. You never realize how many pregnant people there are in the world until you are suddenly and unexpectedly not.  You can be watching your previous favorite TV show then, BAM, one of the main characters is pregnant, delivering and making your wound bleed a little brighter.

It's pretty easy to start to feel resentful of anyone who has not gone through this.  Even more frustrating are those mothers who are "accidentally pregnant," on their 4-6+ child, or on any kind of substance from tobacco to meth and heroin.  I want to yell at them - DO YOU KNOW HOW HARD I WORKED FOR THIS TO HAVE IT END LIKE THIS?!?! 

I really want anyone lucky enough to have their G's (pregnancies) and P's (live deliveries) match to know how lucky they are.   I pretty much only want to surround myself with other people who have experienced a pregnancy loss,  because they are the only ones that get it.  It's an exclusive club that no one wants to be in.  Annoyingly this is not completely possible.

Bleeding like grief can pop up at the most random of moments.  - I chose to use Cytotec/Misoprostol, a medication to help cause uterine contractions and opening of the cervix,  instead of an procedure to help complete my miscarriage.  There was cramping and bleeding for about 8 days and then just spotting for 2 weeks.  Then out of the blue more cramping, bleeding and clots again pretty heavily for about 45 minutes.  I was worried until my husband, after lots of searching,  found that this can be common.

 -- Why isn't miscarriage more studied?  This data was surprisingly really hard to find. There are some, but they often stop after 2 weeks. (example 1 and 2)   This may be another example of women being ignored in health care research.  But, I digress. --

Because of the physicality and pretty much ignoring how I actually felt all week.  It brought all the feelings from the background to directly in front of my face.

Ignoring your feelings can help temporarily but only temporarily. -- See above lessons.

What not to say when people have a miscarriage. -- Here is a list of things that have been said to me that are not useful

  • "Everything happens for a reason" -  Technically yes,  it was probably a genetic abnormality.   But this is not helpful in anyway.
  • "I know what you are going through, I had a abortion/spotting in my successful pregnancy/lost a family member/pet." - Unless you have had a miscarriage of a wanted pregnancy,  You Don't.
  • "At least you know you can get pregnant." - Again, Technically true.  But that excitement sailed around week 6.  Two-thirds toward the end of first trimester it's just painful: so close to the end of the first trimester when miscarriage is less likely, almost done with the fatigue and nausea, and the point when I already had to start buying new clothing to accommodate my physical changes (34 G Bras are impossible to find). 
  • "I'm sorry for your loss." - This might be specific to me, because I have gone thorough so much loss,  but I hate this phrase.  I'd rather people say "I'm so sorry,"  rather than qualify it.  It seems more empty and trite.  For me it is similar to when people say "I'm sorry if you were offended," instead of "Sorry for offending you."  
There are some more things not to say in this article.  

Here are some useful things people have said to me. 
  • "It's not your fault."
  • "I can't imagine what you are going through."
  • "I also had a loss, here's what happened to me..."
  • "Sending Hugs/Love/Warm Fuzzies."
  • "Can I give you a hug?"
  • "I'm here for you for whatever you need."
The best thing was how many people opened up about their own experience.  We don't talk about pregnancy loss enough, but finding a community of my friends and family who understand is a refuge. 

Music still helps.  -- I often have a soundtrack of my life and what things are happening right now.  Music has always helped me express emotions that are hard for me.  When I realized I was in love with one of my friends in college, and my roommate was gone for the night, I would put on a playlist and cry under my blankets.  This strategy can still be very cathartic.  Here's my current play list

I'm In a Sexy French Depression - Crazy Ex Girlfriend Cast (I still have a bit of sense of humor,  plus the end french monologue is pretty spot on)
Tears of a Clown - Smokey Robinson  (this is work mostly)

It's constantly updating so I'm sure there will be more.   --- Yes I know in theory I could do this with some Spotify type thing, but that takes way more effort than I'm willing to put into it right now. --  Watching movies and shows about people with a loss is also helpful.  I've watched "Frida," and may watch "Pan's Labyrinth" next. 

Trust your body, or try to.   -- With PCOS (PolyCystic Ovarian Syndrome) I often feel like my body has betrayed me or that it just doesn't work.  Although my body doesn't work like normal.  It makes extra ovarian cysts for no reason.  It is resistant to insulin and doesn't process sugar making it unreasonably hard to lose and maintain weight.  It doesn't ovulate monthly without a lot of effort and medications on my part.  In the early part of my pregnancy I was surprised to that my body was acting like normal: nausea, some breast tenderness, increased urination, and fatigue.   There was so much fatigue I wasn't able to exercise as I usually did.  With the miscarriage I feel like this is one more example of my body betraying me.  However, with the cytotec it did what it was supposed to do.  My beta HCG levels are dropping appropriately, and my basal temperature is back to normal.  Working out again feels wonderful. 

 If I get lucky enough to be pregnant again I will try to be a little active in spite of the fatigue. 

If you are able to be pregnant again, this miscarriage will color that pregnancy.  -- Even with this loss we are still TTC (at least for the next 11 months or so). So the first cycle after a miscarriage tends to be more fertile.  I was reading up on how miscarriage can affect your next pregnancy.  But so many of the things I was already doing because I know everything that can go wrong.  I was already checking for spotting obsessively, anxious about all the visits, and not super excited for a positive pregnancy test.  All of this knowledge did not make the loss hurt less.  I'm not sure if I'm going to want to get an ultrasound earlier or later than 6 weeks.  I'm not sure if I want to just wait until 12 weeks before having my first prenatal appointment or want to be seen super early.  I had already kept my pregnancy a secret with a select few;  maybe I really won't tell anyone else until third trimester or tell everyone at 20 weeks.  I'm not sure what changes this will have if I get pregnant again, but I know it will change my next pregnancy as it has changed my life. 

Monday, February 26, 2018

Nonviable Early Twin Pregnancy

Warning: This may get a little rage-filled and preachy

I was five days in to my miscarriage and going to an OB/Gyn for a completely different problem.  We had actually scheduled a pretty simple office procedure about 6 weeks previously.  I was starting to feel like I was healing a little bit.  I could put words to emotions and even mention to the nurse, that my urine pregnancy test would probably be positive because I was in the middle of a miscarriage, without signing or tearing up too much.

-- So while I love OB/Gyns for procedures and high risk pregnancies, for my prenatal care I stuck (and hopefully will get to stick) with my Family Docs and Midwives. --

I knew that he probably knew about the miscarriage since he is apart of the same hospital system as the ER.  But I was hoping to get at least one of my gyn problems taken care of.  I was also hoping to get a copy of my ultrasound read from the ER.   When I was led to a normal exam room and not the procedure room I suspected something was amiss.   Even more curious was the fact that there were no instruments for any procedure prepared in the room.

"Twins, huh?"  The OB/Gyn greets me.  Confused I say " No, Nothing."   We have some mundane conversation about delaying the procedure until we have a repeat ultrasound proving that the Cytotec worked. 

--Cytotec/Misoprostol is a common medication given for incomplete miscarriage, or in medical terms incomplete & missed abortions.  I was given a prescription for 400mg BID x 3 days.  Which is not the dose recommended by anyone as far as I could tell.  I checked ACOG (American College of Obstetricians and Gynecologist) and gave myself the correct 800mg with 1-2 repeats three hours later, which has a 66-99% chance of working --

He checks my uterus, orders the ultrasound and leaves.  My husband and I disappointedly walk out and I ask for a copy of my ultrasound read, for which I have to sign a release of information (ROI).  It is not until I read the ultrasound impression that I find out that I was pregnant with and miscarrying twins.


I talked to 2 ER docs. An OB came down in the ER to talk to me, and I stayed in the ER until the radiologist read the images.  My first US showed only a "Single viable intrauterine pregnancy corresponding to 6 weeks and 1 days." I did not mention having a twin pregnancy, which is generally a pretty key piece of information.  None of them felt it was appropriate to tell me what was happening with my body?! 

Devil's Advocate says: "Would it have made a difference given the fact that there were no fetal heart beats?" "They were probably busy and thought someone else told you.  You know how things go at shift change."  " They probably didn't want to make a bad situation worse."

However the primary care doc in me -- the one who has to give bad news on a daily basis, the one who has to translate the actions of other physicians so that patients understand the treatment they received, the one who believes that I am not just a physician but a doctor, which means to teach -- cuts them no slack. 

Why do people feel they can make decisions about other people's body and the information they should know?   This reminds me of all the injustices and decisions the government is trying to make about women's & fems' bodies (here is summary from BOOM Lawyered).  Is it because I'm Black?  We know that Black Women have worse perinatal health outcomes.   If I had not wanted to see my ultrasound read I would not have known that I had twins, which may have ramifications if I do get pregnant again. (And I had to sign an ROI for my own records?!?) This is the treatment I received when they knew I am a doctor; it was incomplete, with incorrect dosing, and extra hoops to jump.  What would have happened if I wasn't one?

There is now an inquiry in the hospital ED and radiology, and my prenatal folks are checking in with their ultrasound tech since they were missed first time.  I need to tell the OB/Gyn that "Twins" is not an appropriate greeting to someone in the middle of a miscarriage.  That is another reason I will not be seeing him if I am fortunate enough to conceive again. 

I would have rather every single one asked me if I knew I was carrying twins, than be set back to the beginning of my grieving process.  I was without words or expression, trying to figure out what went wrong and what I could have done differently.  Again. 

Tuesday, February 20, 2018

9 weeks and 2 days

I'm still processing so this may not be pretty.  Trigger warnings this talks about loss and body issues.

I've been exhausted for weeks.  I had a weekend hospital shift (which are notoriously hard). I was coming down the the virus that everyone else in the household had.  Everyone knew these facts.  What everyone did not know was that I was about 9 weeks pregnant.

My husband and I had made a clear decision to tell as few as possible in the first trimester.  I took Reproductive Epidemiology in public health school.  I knew that about 1/3rd of all pregnancies end in miscarriage especially in the first trimester.  Also I just didn't want the questions and the looks.  I honestly intended on not telling anyone I was pregnant until they asked and then make them feel guilty for calling me fat.

I expected things to go terribly as my baseline anxiety kicked in.  I literally know everything that can go wrong.  However after a "normal 6 week US" and 8 week first prenatal.  I was cautiously getting comfortable with just making it through the first trimester.  Which is what people kept telling me that was all I had to do. 

Easier said than done with the bone deep fatigue, growing out of all reasonable bra sizes (34 G+ are hard to find), and my baseline duties as a new doc in a resource poor area.  I felt terrible canceling morning or evening clinics when I just could not do another thing other than fall into my bed.  I also have PCOS (Polycystic Ovarian Syndrome) and Insulin Resistance which makes eating more more than 1200-1700 calories against what I've practiced for the last decade.

But as the weeks racked up I was cautiously hopeful that I could make it one more month. 

So I did the right thing.  I called in back up for my hospital shift, which was amazing. I saw patients. I admitted patients.   I did a little clean up work from the previous hospitalist.  I got home about at about 12:30 intending on sleeping for 7-8 hrs before doing it all again.   Then right before I went to bed I went to the bathroom for the last time and saw bright red blood.

This led me to handing over my shift to my amazing medical director (one of 2 people at work who knew).  And heading to the ER at 1am. 8 hours some blood tests and the most uncomfortable ultrasound I've ever had later the verdict was in.  Where there were heart tones before, there were none now.  I got my meds for a missed/incomplete abortion (medical language for miscarriage) went home.  On the way I texted the 6 people who knew who responded with great outpourings of love and care.

It is impossible not to think about the what ifs and possible signs, even though I know the most likely cause is chromosomal abnormality.  At my dating ultrasound I was dating 4 days early was that a sign?  I had a terrible allergic reaction to the sheets at the ultrasound place was that a sign, or a cause?  I knew I was working too hard was that a cause? At my first prenatal 5 days ago she said my uterus was enlarged, should I have pressed to make sure she thought it was 9 week size?   What earlier sign could there have been to tell me that things were not going well?  What could I have done to change this situation?

It's strange to hope for cramping and bleeding just so this part completes itself.   It's strange to still have symptoms of first trimester even though I know I'm not now.  This directly plays in to my appreciation/distaste for my body (love/hate is not quite accurate).  Of course my body which can't process sugar,  lose weight, and makes unnecessary cysts would fail in these ways:  both in staying pregnant and not allowing it to end when it should. 

I'm hoping the meds did their job and this doesn't linger on.  In someways the physical pain is appropriate to the emotional pain.

I find it hard to give myself permission to feel during this.  As a doctor I'm so used to putting everyone's needs before my own, and yet I'm finding it very hard to care about (or even check) my inbox.  While I know that's probably appropriate, I still feel guilty.  I'm also not dealing well with the other pregnant people around me.  Yep,  I'm I little bitter and jealous at this time.

Part of me wants to hurry up and get this over with so I can move on to the next month. In theory my chances are higher the cycle after a miscarriage, but as I said previously my eggs are old.  So should I just go to reproductive endocrine? I only have about 1 year left of my trying (see TTC), so time is running out.

So why write about this?  I was talking to one of the 6 people, another family medicine doc, who knew who noted that people don't talk about this much even though we know from medicine it is so common.  Why don't we talk about it?  Because it's one of the sad realities of life, maybe.  Is because it feels like failing and people don't like to talk about their failures?  Is it because though I've lost so many people in my life (my Father and Aunt Rose most recently) the loss of potential relationship is harder? I don't know.  But I am writing to process, tell my story, and maybe help someone else feel not so alone.

There are no words for the difficulty of this experience.

Sunday, November 26, 2017


Spring of 2014 I was finishing my intern year of Family Medicine residency.  I would be turning 34 in July, and I was FREAKING OUT.    You see I had gained enough medical knowledge to understand all the things that could go wrong in pregnancy and delivery.  I also knew because of my PCOS I had lower fertility than others my age; also I was 1 year away from the dreaded AMA.

-AMA stands for advanced maternal age.  The term for when you will deliver over 35.  Of course with the update of the diagnostic codes it has been changed from the sad but acceptable "Advance Maternal Age" to "Geriatric Gravida"  which is infinitely worse-

Thankfully I had a visit from a friend who just had her first child who helped put my anxiety to a little bit of rest.  "If you guys have kids you will be great parents and it will be wonderful.  If you don't have kids you will continue to be great people and it will be wonderful."  So I allayed my fears for a few more years and made a plan.   The main way I deal with my anxiety is by making plans.

I figured I'd give myself 18 months to see if I could conceive (by which ~91% couples do).  So in typical fashion I started to research.  I started Pintrest boards, a Amazon wish list for possible registry, and started following some blogs.  I had already been following my cycle since I had an IUD and I added a few more apps specifically for tracking.  There was a whole set back with the Nov 2016 election.  (see Nov 9 2016 330 am)  After that experience I realized that though attempting to have a kid may be a fundamentally bad idea (given the fact that the world is pretty actively terrible), If we the US was not in nuclear holocaust by July 2017 would try anyway.

Armed with 2 new apps I entered a new world of acronyms and short hand.  If you are not apart of this world I will give you a taste because they are truly non-intuitive:

  • AF - though I initially thought this was the more common "As F**k" it actually means "Aunt Flo" or period.   
  • BD - Baby Dance.  Why people can't just say sex, intercourse, nookie, or any other euphemism I don't know. 
  • Baby Dust - Not to be confused with BD-  It is wishing someone good luck, though I sometimes think of it as fairy dust and is therefore wishing more GLBTQ children into the world for fun. 
  • DPO & CD - Days post ovulation and Cycle day.  These actually make sense and are useful
  • DH - Dear Husband - I first came across this one in wedding groups.  Still don't like it. 
  • TTC - Trying to Conceive.  Which is what most people are trying to do on these groups anyway and I'm not sure why this is an acronym.  There should be one for the folks who are not trying.
  • BFN/P - Big Fat Negative or Positive in reference to pregnancy tests.  Why they have to be "big and fat'  I am unsure. 
  • TWW -  Two week wait.  Also known as the truest purgatory known on earth.  It's the two weeks after ovulation and before your period.  It is HELL.
  • EWCM - Egg White Cervical Mucous.  Yep it's what it sounds like.  
So now I'm apart of this very strange community of people actively trying to get pregnant and generally complaining about it/confused/wondering if they can check a pregnancy test 2 days after ovulation, "I mean I know it's really early, but. . . "  

I started out doing more stealth doctoring.  "You know the best medications for PCOS is Metformin low carb diet and exercise."  "There is no evidence to having your legs elevated after sex to insure conception." "No a BFN two days after ovulation does not mean that you have not conceived this month."

I've found that there are 3 large categories in these groups.  1) TWW screams from purgatory:  to check or not to check, how sucky this, I just checked but I can check again.  2) What to try next: better supplements,  fertility meds experiences,  should I go to the doctor?  (I generally answer yes) 3) Hoping: baby dusting, wishing they could by baby clothes, hoping this is the month.   

Then I realized this is a group of strangers who don't know I'm a doctor and I can ask stupid questions that I also already know the answers to.  I also realized that though there is a group of people going through the same thing, TTC is a very isolating experience.  Though my partner is amazing and there is a group (though sometimes questionable) of people going through the same thing, at the end of the day it's still what's going on with my body.   While I can track my basal temperature, check my cervical mucous, take my meds, try to exercise and fit in nookie with my new grown up doctor job which inconveniently schedules events every fertile weekend so far, it still feels wildly out of my control.  I'm still AMA, PCOS, in a high stress job, and my body doesn't seem to like to cooperate. 

It's a month to month rollercoaster over 4 weeks ultimately waiting to find out if I am infertile enough to get help or will it magically happen.  Using my planning skills I have kept myself on track with adding something every 2 months or so.  First adding cheap ovulation tests, then the expensive ovulation tests. 

(Can we take a minute to talk about how unreasonably expensive conception items are.  American consumerism truly makes all large events in life more expensive than needed:  Weddings, TTC, actually having a baby.  I mean really. It should not be 45 dollars for 1-2 months of ovulation tests and 39$ for one month of a supplement that actually has medical evidence.)  

But I digress

After 4 months I added Pregnitude which actually has evidence of supporting ovulation for people with PCOS. Then after 6 months I officially get to go get the whole fertility work up as appropriate for people over 35 TTC.   I am hoping that with the work up that more things keep getting added, because I need a plan, and my plan runs out in January. 

I realize I'm only 5ish months into this journey and I'm already over it.  I would like to know if my body will cooperate or not.  I also feel comfortable with my limits.  I'm not doing IVF or any truly invasive procedures.  If I'm in that 9% then I shouldn't be having kids I can just get an IUD and a dog. 

Wednesday, August 23, 2017

Dear LeVar Burton,

Caveat:  This is a reforming and updating of a previous letter I wrote while I was in Peace Corps Namibia (Group 20 Represent) approximately the spring of 2003.  I wrote the letter and literally had no place to spend it.  It had been years since I saw the PO Box that came up at the end of Reading Rainbow and the internet was not where it is today.  I'm not entirely sure what happened to this letter.  I think I tried to send it to PBS, but it also could be in some of the Peace Corps boxes I still haven't completely unpacked.  (I was warned this would happen literally and figuratively.)  I've thought about this letter repeatedly and how to possibly get it to him.   Should I do a series of tweets (a long series)?  Maybe on Facebook it could work (too personal or impersonal)?  This desire was rekindled as I started listening to "Levar Burton Reads".  When he showed up on my favorite podcast "Another Round" I figured I had to do something.  As this is a testing ground for my memoirs someday I figured . . . 

Dear LeVar Burton,

  Like many children born in 1980 I remember coming home from kindergarten and first grade and watching Mr Rogers, Reading Rainbow and Square One TV.  I was excited to get any book that had the stamp of approval "Reading Rainbow Book."  I loved watching all of the shows new and old. I still remember the plot from "A Chair for My Mother," and all the words from the song in the Team Work episode.  The concepts of "Ty's One Man Band," that everything can be music (not to mention Ben Vereen's song), continues to enhance my daily life.   At one point in my childhood (maybe when I was 7)  I wanted to be a book refurbisher, an idea I got from the library of congress episode.  

I took for granted that every afternoon I could go on a new adventure to find out what happens at fashion week, or on a farm, or all night in New York City.  As a teen and I caught a rerun here and there (at one point I wanted to work for PBS [also wouldn't life be better if we all lived by the things we told children to do?]).  Watching Reading Rainbow as a teen I started to realize who the readers of the books were.   Finding out that Phyillis Diller read "Ludow Laughs" and Hoyt Axton read"Meanwhile Back at the Ranch,"  I started to appreciate Reading Rainbow on an whole other level.  

As a Star Trek fan raised on TNG you were one of  my favorite characters.  The only collectable TNG characters I had were a small Enterprise NCC-1701-D and Geordi LaForge. My short lived - incomplete TNG fan-fiction was about Geordi LaForge finally getting his love story. (Even as a 14 year old my Trekkie friend and I could tell that this was an injustice.  Yes there was that episode or two with the designer of the engines but that really doesn't count.)   I was elated with the cross-over episode between TNG and Reading Rainbow. I didn't realize how much I took your place in my life and the things I loved for granted until I was in Peace Corps.  

 I was a Peace Corps Volunteer in Namibia in a small Ovambo tribe about 20 km from the Angolan boarder.  In order to get to my homestead you had to drive about 1.5 hours from the nearest town.  After the tarred road turns into a dirt road you travel about 30 more minutes then walk another hour and fifteen minutes into the desert until you get to the village of OshiKuKu and my homestead.   Namibia has 3 desserts that converge and the landscape is fairly barren save a few bushes, anthills and the occasional tree.  The water was a public tap where community members can collect water in 5,10, and 20L jugs and take it back to their homesteads.  There was no electricity to the village though the school was wired for it and did have a telephone. 
The Leaning Tree landmark on my walk from the dirt road to home

The folks at the water tap my last night in my village

As a Peace Corps Volunteer at the Illonga School I taught English and Science to grades 8-10 as well as art classes.  I was also raised in a house that fostered a love of reading and books.  I was surprised to find out that the school library was stored in the teacher's office and had a very small selection.  I was even more shocked when I saw an occasional book weather-worn just laying in the sand.  Children treated their books roughly and without the respect and care I was taught.  What was sadder to me was the lack of imagination.  I would ask my English students to make up a story or write poetry and all of the responses were very concrete.  Rarely would I have a student write about something that had not actually happened.  If we had just read a story they would mostly repeat what they had heard or understood.   This limitation in imagination was more obvious in art class.  When I asked them to draw items it was mostly copied from what they saw in front of them be it a magazine, picture, or item in the classroom.  

My school first thing in the morning

My 10th Grade Class - I'm in the center with my dog Nando

I started to seriously consider why students'  imagination was so limited.  I figured the landscape was one reason  Though the landscape could be breath taking during the rainy season, during the dry season (which was most of the time) it's pretty bland
My walk to school in rainy season
I then started thinking about my influences as a child.  Though I lived in Cincinnati, OH I had seen what New York and New Orleans were like, because of your show.  I knew about different careers in aerospace as well as farming because of your show.  I realized that through Reading Rainbow I had an understanding of vast worlds beyond that which was in front of me.  This is an advantage my students did not have.  I had book donations to the library and encouraged reading, but I wish I could have shown them your show. Though I come from a family of readers you show made it clear how transportive reading could be.  

Moreover I saw all of these things hosted by a Black man.   I can not state the significance of this enough. 

 Every afternoon I had a Black man on my television taking me on new adventures and teaching me We would laugh, learn, and I always knew I would  "see him next time."  I had a pretty stable childhood with two loving Black American parents; I can't imagine what you meant to those who did not have this.  I never wondered if there would be people of color in space because of you (and Mae C. Jemison.)  As I grew up, I realized I had a very revisionist history of my childhood TV.  I found out: "Benson" was not the governor, "Gimme a Break" was not about a Black woman adopting three White children, and "Sliver Spoons" was not about the friendship of a rich White kid and rich Black kid.  However you and your roles stayed true and genuine.  

I know you are a human being and I appreciate you letting us see that side of you as well in your interviews and conversations.   I remember on one of the PBS promos you mentioned your own children.  It was kind of like when you see your teacher at the grocery store and you realize they are a person. When I got back from Peace Corps (and India, and had enough people bug me to do it) you were the first person I followed when I joined twitter.  I was so excited to hear that you had a new podcast. When I got to listen to your first podcast it brought tears to my eyes.

Thank You LeVar Burton.  Thank You for showing children worlds beyond what they can see in front of them.  Thank You for being an example of a Black man that much of America pretends does not exist.  Thank You for teaching our past showing our present and the possibility of our future.  Thank You for continuing to act, teach, and inspire.  

Thank You for being You.

Honestly &  Sincerely,
 Margarette MD, MPH


Wednesday, June 07, 2017


I saw a white dude with a t-shirt that said Mzungu.   Now most people would not know what this shirt meant.   It's probably just a funny word to them.  I -- having worked in Southern Africa -- knew this was the word for white people said by Africans.   As I continued to look I noted that the shirt was in fact from Tanzania. So it probably did mean what I thought it meant.   Being that I live in Asheville -- Home of hippies, hipsters,  and people who will sing along with you at the gas station (that actually happened) -- I figured I would ask.

"Excuse me,  I noticed that your shirt says Mzungu and is from Tanzania.  Since I worked in Southern Africa I know that means white person.   I was just wondering why you would wear that shirt."
White guy looks awkward "Yeah it's from Tanzania,"
"I was just wondering why you would wear a shirt that pretty much just says white guy."
He now looks even more uncomfortable and starts to ramble.  "Oh well, it reminds me of being in Tanzania when I was at this awesome snake ranch, we were hiking,  and this kid bought me this shirt . . .  It reminds me of good times I had there . . . It's not racial."

At this point I could tell he was feeling pretty uncomfortable.  He probably had never thought about his shirt before or that someone would ask him about it. I could see clearly one of the Peace Corps Guys wearing a T-Shirt that said OshiLumbu ironically. (Actually I think the group before us did make those shirts ironically.)  They would've probably noted that's what they were called all the time and laughed.  I tried to give him an opportunity to let him in on the joke.

"I just saw the shirt and knew the meaning and wondered if you were wearing it ironically, or if you were wearing it just for the memories."
"Just for the memories."

So he was not in on the joke.  This is was probably a white male who had never thought about it.  I realize that most of the white men in my life have had to recognize their color and privilege at some point. My husband who wears "Not an accurate representation of a white person" T-Shirt ironically.  My best friend who I had frequent debates with in High School.  While he was coming out and we discussed our disadvantages, I told him that walking down the street no one could tell he was gay, but everyone could tell I was black.  That statement pretty much ended the debate.  All of the guys in Peace Corps had to deal with their whiteness on a daily basis.  But this guy had probably never really thought about it.

I could tell he was uncomfortable; in retrospect I wish I had let him sit with his discomfort.  Why shouldn't he think about his whiteness, or how what he wears means something.  But on instinct if rushed in to make him feel better.  I joked about how I was called Oshilumbu myself even though it means white person.  How my Namibian students told me I was not black.  His female companion joined and we laughed it off has he left the area and I could order my coffee.

But I wish I had let him sit in his racial discomfort.  I wish as a Black American Woman my training and instinct was not to make sure that the white guy is okay, even in this small moment of discomfort.

Monday, March 27, 2017


Today in the shower I had a reconciliation of sorts.  I said "yay thighs."   Now for most people such a statement may not mean much, but for me that was monumental.  I have not had the best relationship with the top half of my legs.  It probably started around the age of 10.  As I started to develop, having a little bit of curves was something I wanted.  Mostly I wanted breasts (irony), but a booty was okay too.  However what I did not forsee was the mental havoc that would be wrought by my legs.

Honestly it may not have even been a thing, if it wasn't for Shane Parish. (That's right I just name dropped) My parents moved from the country to the suburbs of Cincy when I was 9.  I went from inner-city (primarily Black-American) elementary school to E. H. Greene in Blue Ash (primarily white).   This transition was hard enough (changing classes every 2 weeks because they put me in remedial classes, working my way back up to gifted classes, trying to find new friends, riding the bus for the first time instead of walking), but gym class made it that much harder.

 We had gym on Tuesdays and Thursdays.  We were all working for the presidential fitness test: running a mile, sitting up, pushing up, trying to do pull ups.  You know all the "up" things.   Over the summer I had started to wear a bra (ooh) and had more weight on my legs.  I honestly did not think about my thighs much other than wearing cords or track suits that now made sounds as I walked.  But when I stepped into the gym I now heard every step echo.  The green gym shorts were not the most flattering either. However what made it life scarring was Shane Parish calling out "Here comes Large Marge with Thunder Thighs," every time I walked into the gym.   It was terrible.

Even now my heart rate increases thinking about the anxiety caused by trying to figure out when to walk into the gym.  Was there a way to walk in without him noticing?
With a group of girls - nope.
Right before the bell - nope.
Maybe super early before anyone else was out - well I just never changed that quickly.
Suddenly for the second half of the year I came down with a terrible illness Wednesday night which would cause me to miss school for Thursdays and many Fridays.   If I went to school I would be sent to the nurse before PE with a fever up to 101.9.  My parents took me to my pediatrician, Cincinnati Children's and specialists trying to figure out what was wrong.  I had tons of lab work done, which I enjoyed more than walking into the gym.  Suddenly when I started the summer and then went back to school in 6th grade when Shane was no longer in my class I didn't have the end of the week illness.

Only when I was in medical school did I learn that this is a common and normal coping strategy for children.

Though I no longer had to hear him say those words; the image and the sound stuck with me.  I stopped wearing shorts in the summer and only wore long baggy pants.  Luckily it was the 90's and this was the style.  I gave up on wearing women's clothing and shopped in the men's section where I could buy a 40+" waist which I knew would go over my hips.  All of my skirts or dresses had to go below the knee.  That experience started anxiety, stress, and dislike of my thighs which so far has lasted over a quarter of a century.

In college I came to terms that my thighs were never going to change size and get smaller (my hip bones are actually set wider than others) and they were either going to be fat or muscle.  So I danced and worked to make my thighs as much muscle as possible.  But I still didn't like them.  I actually managed to lose weight in Peace Corps, but still didn't like my thighs.   I did yoga and jumped rope in India, and fortunately saris and most Indian clothing covers the entire legs so less worries.  I was getting my legs waxed regularly and there are few things worse than holding your fat taut so someone else can remove hair.

In pubic health school I started volunteering at Shadowbox.  (If you live near Columbus Ohio and don't know what this is do yourself a favor and go)  Shadowbox (Sketch Comedy and Rock & Roll) is known for having people of all sizes in all costumes.  So I had some fun and got into the spirit.  I forgot my pants one day and needed to borrow the skirt from one of the cast members.  I was amazed to find the skirt fit when I always thought she was way smaller than I.  So as a volunteer with fishnets I showed my thighs for the first time in years.

I still pretty much only show above the knee for performance or costume.  But with continued exercise and time I got to the point where I don't actively hate my thighs.  I can appreciate what they do for me on a daily basis; start to like them.  I can even say "yay thighs."