Sunday, September 16, 2018

My Faith to Non-Faith Journey- Part II

Part II.   If you didn't read part one you should.   But here is the the same prologue as the last one

I honestly have been back and forth on this particular blog entry even though it was specifically requested. I know religion discussions can get very emotional and isolating.  But after recently listening to the Ebony Exodus Project, I was re-inspired to share my story.  This is loosely based off of a talk I gave in 2014 to the Asheville Humanist Group.  I actually sang the songs that start each section. And just FYI  -- This is super long and written over several sessions.  Here is part II

International Travels 

Well I'd Like to visit the moon,
In a rocket ship high in the air.
Yes, I'd like to visit the moon,
But I don't think I'd like to live there.
While I'd like to look down on the Earth from above
I would miss all the places and people I love
So Although I may like it, for one afternoon
I Don't want to live on the moon.  - 1978 Sesame Street - as sung by Ernie



At the time I went to Peace Corps I was pretty comfortable with my concept of God as a warm comforting presence i.e "The Purple Blanket."   In my going away gifts I got some meditation cards which I was looking forward to using and decided to continue my yoga as I set off to  Ovamboland in northern Namibia.  Remember my problem with "The Great Commission?"  Well the relationship between religion and Namibians was a perfect example.  There were two major religions in our region Lutheran and Roman Catholic.  The Catholic churches actually still said the mass in Latin.  While I could appreciate knowing and understanding what was going on -- thanks catholic school friends and 6 years of latin -- it was very clear that the traditional cultures were buried.  Even the word for Sunday in Oshiwambo was the same for tobacco; because that was the day the missionaries would given them tobacco if they went to church.  The clothing women wore the "Meme dresses," were still in the style given to them by colonizers related to prison clothing.  The Ovambo didn't seem to have taken back their dress in the same way of their sister tribe Ojihereo.  The Ovambo people had a saying "We are born to suffer," that seemed related to fatalism and giving up of both will and responsibility. This worked well with the religions of the missionaries and colonizers.    While I went to church a few times with my host family,  I stopped as soon as it was culturally appropriate to do so.



Peace Corps was also the first time I had long discussions about faith with an atheist. While I had an atheist friend in high school (I think), I never really spent long periods of time discussion religion in high school.  One fellow Peace Corps volunteer who had also lost her mother earlier in life spent an evening talking to me about her lack of faith.  She admitted it was something that she had tried to have many times, especially after her mother died, but she just could not believe.  Here was someone who was lovely, reasonable, and working just as hard as I was for a different people in a different culture who did not have the ability to believe in god.  Clearly she was a good person and in every other way very similar to me.  This definitely made me think.

After I completed my service I got to travel around the continent for a while.  At the time I completed my service I know I had done some good, but also felt very defeated.  The White Male Supremacy which was rampant through the Ovambo culture makes service hard for a Black American Woman.  Add in the fact that many Ovambo at that time didn't think there were any Black Americans (Colin Powell and Alisha Keys were White, Micheal Jackson was Angolan, and Whoopi Goldberg was South African so I was told) and  I was pretty exhausted after two years.  My travels were a great way to get out of my village and culture.  I was able to see how other countries and cultures were not still under the thumb of missionary and colonizing influences.   My time on the continent really showed the harm of Christianity.


Hare Krishna, Hare Krishna
Krishna, Krishna, Hare, Hare
Hare Rama, Hare Rama,
Rama, Rama, Hare, Hare -- Traditional Hindu Chant




Peace Corps Service had solidified in me a desire to practice medicine, but now I was off the school cycle.  I decided to get back on schedule and expand my skills with the America India Service Corps, now known as the Clinton Fellowship.  -- Aside,  I'm really glad I went when it was the original name. --  I took my MCAT worked for P&G for a summer before heading out for Kolkata, West Bengal.   Kolkata was surreal, and probably a topic for many more blog posts (some of which are still up).  I have never been in a culture where religion was so tied in to every part of life.  One would walk down the street see a shrine.  Say a small prayer of offering and keep going.  There were literally gods for everything (creation, destruction, study, wealth, love) still actively worshiped and incorporated into life.  I participated in the holidays and religious culture.  I did note that Mother Theresa's mission was right next to Kalighat one of the largest temples to Kali in India.   Through my Kathak dance classes (I was with the small children)  I learned how Classical Indian dance had to go underground during the time of British Empire because of its relationship to Hinduism.  I felt fortunate to be welcomed into this culture and honored these beliefs.



While in India is also when I had the second time I felt like I heard god talk to me.  While I was in the states I had reconnected with a friend.  This friend happened to be the first person I had fallen in love with  and for a short time it seemed like we could be more than friends.  But he told me that he had no desire for this to be.  So I was pretty heartbroken for the first few months in Kolkata. I would literally schedule time in my day to cry for an hour or so, then go to the market, finish a project etc.   One time, early in my service, I was riding home in a taxi and making such a plan when out of the blue, it seemed I heard a voice saying,  "Why are you wasting time like this?"  "Don't you know you will find someone better who will better fit your life and your plans?"  This was so abrupt and not at all my current line of thinking that it shocked me.  I knew the statistics.  Black women are often considered the least desirable, and the least likely to get married.  Moreover I knew the statistics from my own family.  Out of 19 grand children (7men and 12women) at that time only one of the guys wasn't married (by choice) and only 2 of the women were.   But here was something telling me that I wouldn't be alone for ever and to stop wasting time crying over what wasn't.   That afternoon I didn't go home and cry but figured out what positive I received from that relationship.   I dated a bit in India and actually started planning my future wedding (positive thinking).  I became more comfortable with my bisexuality and in all left in a much better place than where I started.


Public Health School & Medical School

I am a girl,
I am a woman,
I am connected to earth and sky
I know the secrets they only dream of
Girl you are who you are so am I -  Kindred and the family soul 2003

By the time I left India and started public health school at Ohio State University, I was very comfortable with a very fuzzy, vague god idea.  At this point I did not really believe in the Christian God any more.   The Bible was too contradictory.  Moreover, if the God of the bible was true he didn't deserve to be worshiped.  The relationship between the Christian God and man is abusive to say the least.  There some small stories of cruelty: when God sends bears to eat children because they called Elisha bald, turning a woman into salt for grieving the loss of a city, demanding the devout to kill their children.  The two stories I found most egregious were Job and Pharaoh.   Why would you challenge someone you have already defeated to torture a man  just to prove he will still say he loves you?  That is literally abuse.  If that person was man he would be in jail for intimate partner violence.   My problem with Pharaoh is that God "hardened Pharaoh's heart" which ultimately lead to the death of the first borns and Pharaoh himself.  Now why would God do that unless he just wanted to kill some kids and keep the Jews in slavery longer?   I knew all of the debates about the New Testament from my studies with mom.  There are gospels that are not included in the New Testament.  Paul was always shown to be a bit of a misogynist.  Also historically there are so many Jesus like figures who are Virgin born or died and came back.   There was also the First Council of Nicea who decided Jesus was actually divine.  If that can be decided by council it probably isn't true.

So I was an Agnostic Theist.  I did not know there was a god, but I did believe there was one.  It was clear that we are all interconnected with each other and the universe and that seems very god like.  I started attending a Unitarian Universalist Church which was very accepting open and more about humanism than anything. Though my cousin really wanted me to be Quaker instead, "Because they still believe in Jesus."  I didn't have the heart to tell him not all Quakers do.  My boyfriend, later husband, was Athiest but he would come to UU church with me when I asked. We had lots of conversations.  In one conversation I remember saying that "god is a nice idea."  His question back to me was is god necessary?  Is there anything that I believe in that couldn't be explained by natural means?  This I thought about for a long time.  I didn't believe in ghost, miracles, auras, or prayer.   My concept of god was really just the fact that we are all connected.  Is supernatural needed for this concept?

You say you want a revolution
Well you know,
We all want to change the world.
You tell me that's it's evolution
Well you know
We all want to change the world.
But when you talk about distruction
Don't you know you have to count me out.
You know it's going to be Alright - Beatles, 1968

Changing your concept of religion can feel very isolating.  I became a evangelical(ish) Agnostic Theist.  I noted that technically everyone of every faith is agnostic.  Since being agnostic means you don't know.  If people of faith knew they could not have faith.  Since faith, by definition, means belief in that which is not known.  The short version was "I don't know and you don't know either."  This way I tried to point out our similarities and continue feeling connected to my (very) religious family and some friends.   Meanwhile I was going to Medical School and learning more about the vestiges of evolution that are still present in our development and the fact that if this was design it was poor.  Embryology is pretty much a study in evolution from fish to mammal.   I remember our anatomy teacher pointing out that there are only two blood vessels that feed the heart which he noted was "poor design" and probably the reason for so many heart attacks.   I was actually interviewed as an agnostic theist for an article and found it a bit hard to truly explain my position.



Though the local UU Church was not as vibrant and welcoming as my previous one, I found community in the Wright State Freethought Group.  This group was great for in depth conversations about science, religion, skepticism, and humanism.  Through our discussions I examined my belief in god more and more.  I realized that none of my beliefs required the supernatural.  "We are all connected: to each other biologically, to the earth chemically, to the rest of the universe atomically," as Neil deGrasse Tyson stated.  I didn't need god to be or feel connected to the universe, because I already was atomically connected to the universe.   The atoms in my body came from a star that died.  It is true that a sun died for my existence.  The more I learned about what is true the less I needed the concept of god to explain it.  I came out to myself and to everyone at a Secular Student Alliance Conference.  There was supposed to be a lecture about from a Black Athiest group but the speaker didn't show up.  I figured I could moderate a discussion about diversity in atheism, and I introduced myself as a Black Athiest.



I realized that this was true.  While I did not know if there was a god still (agnostic), I no longer believed there was one (atheist).  I later came out to my parents as non-christian for the above reasons I figured out years ago. While my father questioned me, he ultimately understood (especially when we discussed the Job story). My mother (the good reverend) pretty much ignored it.  I didn't really discuss my beliefs with the rest of the family. My siblings knew I didn't go to church regularly.  Only my brother had great contention with this; my sisters were accepting.  Given the high religiosity of many of my cousins I didn't want to get into a session of "come back to Jesus," or start any prayer circles.  Mostly I didn't want to worry them or create more separation between us.  Church is such an integral part of the Black American community and culture, that leaving seems unthinkable.  I still appreciate a good choir, and miss the support that one feels in the church.  I also appreciate all the leadership skills I learned through church.  However I couldn't continue to state belief in something I did not just for the community.

My friends were still of all faiths and backgrounds and our house in medical school became a safe haven for a friend of mine who was muslim.  However it did make when the surgeons wanted to pray before surgery awkward, and it made me annoyed when they thanked god at the end of surgery and ignored the fact that I held a retractor for the last hour.  The hardest time I had was when I went to Swaziland my last year of medical school.  I did not realize the group we were going with were Christian . . . Very Christian. . . like showing "Passion of the Christ" in the mobile clinic Christian.  This was very difficult for me and my muslim friend.  The group did not want her to pray in an area where people of the community could see when in our mobile clinic, "they [the Swazi] might get confused."  --not condescending at all right? -  We were not to answer if people asked us about our faith directly.  The colleagues we traveled with were christian and soon started having conversations without us after the first night when an open discussion did not end up the way that they desired.  I ended up losing a friend on the trip because she could see my point of view and I made her "doubt too much."  This experience reaffirmed the type of international medicine I did NOT want to participate in.  No one should be required to pray or watch "Passion of the Christ" to get medical care.  They also participated in just giving things to communities rather than helping communities build for themselves.   It also helped me solidify my place with muslims as the most hated group of people in the US.


Then to Now

Somebody once told me
The world was going to roll me
I ain't the sharpest tool in the shed
She was looking kind of dumb
with her finger and her thumb
in the shape of an L on her forehead
Well
The years start coming
And they don't stop comming
Fed to the rules and I hit the ground running
Didn't make sense not to live for fun
Your brain gets smart but you head gets dumb
So much to do so much to see
so what's wrong with taking the back streets
You'll never know if you don't go
You'll never shine if you don't glow  - Smash Mouth 1999



So that's the main part of the story. I am an agnostic atheist.  I am also a humanist, a freethinker, a scientist, a Black American Woman, a Brown Girl with Curly hair, a friend, a wife, a doctor and lots of other things.   I had an AMAZING wedding including multiple traditions that didn't mention god at all, and my family didn't seem to notice.  --Well my mother did complain later that she was not allowed to pray over us, but I didn't hear anything else -- I went to residency down south in North Carolina and joined a Humanist group.  Life proceeded as normal.  Though I didn't go to church I did find Sunday afternoon naps sacred and enjoyed them when my resident schedule allowed. It was not until my behavioral health fellowship that I realized it was easier to talk to colleagues about being a bisexual atheist than my family.  This seemed wrong.  I wrote a Facebook post about it which my friends responded with support and my family was silent.  I gave a talk about my faith to non-faith journey at the humanist group which became the basis of this blog.  Now living in California religion seems much less crucial than it did in North Carolina.  If "the family" is going to church I still go as a part of my culture.  I send positive thoughts and energy as well as asking if there are actual things to help when people ask for prayers.  When people say they are praying for me, I note the fact that they wish me well.  Though it's been a long journey I'm still the same me.



I can change my socks
And I can change my hat
And I can even change my mind
I can pretend to be anything
But I'm still the same me on the inside

I imagine I can fly like an eagle in the sky
I can dream I'm a big ole tiger
When I open my eyes
It's no surprise
I'm still the same me on the inside

Happy me, Fussy me
The me that gets tired and sleepy
Mommy and Daddy love me as I am
'Cause I'm still the same me on the inside

My imagination takes me anywhere       (My travels have taken me far)
From Africa to Australia                         (From Africa to Asia . . . Austria, Honduras etc. )
I'm an ancient king or a movie queen     (Dancing on the beach in Ghana to the clubs in Kolkata)
And I'm still the same me on the inside

I can wear a frown or a magical face
I can make believe I'm a lion
When I go out of bed and close my eyes
I'm still the same me on the inside

Scary me, hungry me,                           (These may be the same person)
The me that needs a nightlight
My best friend loves me as I am
'Cause I'm still the same me on the inside

The universe is a wonderful place         (This is 100% true)
And there's no thing I can't try
Happiness is when I do my best
Still the same me on the inside

Quiet me, Cranky me
The me that sings off-key
I'm growing me and I'm feeling free
Still the same me on the inside

Still the great me on the inside
Loving who I am on the inside
Loving who I am on the inside
I'm still the same me on the inside
YES!  -- Sweet Honey in the Rock 2000


Also this is just one of my favorite positive videos 

Monday, September 03, 2018

My Faith to Non Faith Journey - Part I

I honestly have been back and forth on this particular blog entry even though it was specifically requested. I know religion discussions can get very emotional and isolating.  But after recently listening to the Ebony Exodus Project, I was re-inspired to share my story.  This is loosely based off of a talk I gave in 2014 to the Asheville Humanist Group.  I actually sang the songs that start each section. And just FYI  -- This is super long and written over several sessions.  Here is part I

Early Life -- 

Jesus loves me this I know
For the Bible tells me so
Little ones to him belong
They are weak but He is strong
Yes Jesus loves me
Yes Jesus loves me
Yes Jesus loves me
For the Bible tells me so -  Written by Anna Bartlett Warner 1860

I grew up in the church.  My family went every Sunday to the (Black) United Methodist Church in Milford, OH.  Between the ages of 5-10 I was in the church building at least 3 days a week.  Every Sunday morning for 9am Sunday School 11am church service and until my Mother stopped talking.  One of my first public performances was standing on a table in front of the congregation when I was 3-5yrs old singing "Jesus Loves Me."  Though it could've been "Jesus Wants me for a Sunbeam;" my 5 year-old memory is hazy.  Apparently before I was born (there is a 8 year gap between me and my closest sister, so I heard this phrase a lot) there were times when we stayed home if someone was sick.  There were rare times when we would have Sunday breakfast and skip Sunday school.  But most every Sunday we were in the pews.  Wednesday nights were choir rehearsals and Saturdays were committee meetings.  I would spend Saturday afternoons watching The Greatest Adventure and playing with The Whole Amor of God.  If there were other kids at the committee meetings we would lay under the tables in the choir room (it had carpet) and play astronaut, play Red Light- Green Light, Mother May I, or just make up funny songs and dances.


I was very aware of expectations and did my best to live up to them.  Which is pretty easy when you are 5.  A little less easy when I was 7-10yrs old.  According to Sexual Behavior in the Human Female  I am on the early part of the curve when it comes to starting masturbate.  All of sudden Sunday School songs become more sinister and shamey.  "Be careful little hands what you do. Be careful little hands what you do.  Because the father up above is looking down on you with love.  Be careful little hands what you do."  All of a sudden everything I did was a sin.  According to Ravi Zacharias, one of the preachers we would sometimes listen to while driving home from Sunday Dinner with grandmother, anything that glorified the flesh and not God was a sin.  I didn't feel that playing outside really glorified God.  Plus you start learning all about unforgivable sins and that's another stressor.  The fact that I was an anxious kid probably didn't help.  I did my best to do what was expected of me.  I was: in children's choir, an acolyte, leader of the children's story.  I didn't question much, and one day when my best church friend told me to "go up there" during an alter call I did.

Age of Reason--

Here I am Lord
Is it I Lord
I have heard you calling in the night
I will go Lord
If you lead me
I will hold your people in my heart.  - Written by Dan Schutte 1981.

Around 10-11 years old is when I started getting in to the politics, philosophy and history of being a United Methodist.  One reason was my confirmation into the church.  But this is also the age that my mother went to seminary to start her Masters of Divinity.  I would sometimes go to her classes and look through her books.  My Methodist upbringing did a pretty good job of instilling the need to educate ones-self about the Bible.  I knew there were different translations and would sometimes read from my mother's Strong's Concordance of the Bible which discusses different translations of different parts.  It was a big thing when our church changed from the New King James version to the Revised Standard Version of the Bible. I admit I would sometimes parrot what I heard our preacher say in my mother's classes, but I was getting oohs and ahhs from the adults so I still felt good about it.  I knew we were founded by John Wesley who had some very different views than his other Protestant colleagues.

I started going to Connections, which was a United Methodist Church Arts Camp for 1 week over the summer.  Teens could major in liturgical dance, drama, song, christian clowning, preaching and audio visual.  There were minors in miming, banner making, American Sign Language and poetry. Connections was for High schoolers but my mom was a counselor so I got to go for the first time when I was 10 and it was my sister's last year.  Ages 12-17 I went to Connections Every summer. It was one of the highlights of my summer.  Though we progressed from hiding in the basement reading "Song of Solomon" and giggling about the dirty parts of the bible, to hiding on the 3rd floor and mixing drinks during FOYOB (Feet On Your Own Bunk), we were all pretty good kids.   Unlike the stories my sister told, no one was pregnant after our Connections Weeks.  Connections was all about a loving God and loving one another.  There was a Designated Hugger and that is where I got my Doctorate of Hugs. There was Jerry who was one of the counselors who was gay and had AIDS and we loved him anyway.  It was at connections where I felt God.  We were all gathered together one evening after dinner and I knew that everyone in that room loved me.  It felt like my skin was buzzing and I was warm all over.  Connections started one year before my Brother went in 1983 and ended one year after I left in 1999.  This is honestly a bit of a tragedy. 

Around 10-12 is also when I started going to the Annual Conference.  Methodist are - Method-ists so every year they get together and create the "Book of Recommendations" which every church should do.  It was at annual conference that I heard people debating whether you could call God, Sophia, or is this a separate entity.  Should the Methodist Church apologize for their participation in slavery or table it for another year?  Should openly gay people be allowed to be ordained and lead a church?  Like the translations of the Bible I realized that all these decisions were just made by people and some pretty flawed decisions could be made that were not based in love.

The Teen Years - - 

Listen as the day unfolds
Challenge what the future holds
Try to keep your head up to the sky
--
Harald what your mother said
Reading the books your father read
Trying to solve the puzzles in your own sweet time
Some may have more cash than you
Other's have a different view
My oh my, yeah, yeah, yeah - Written by Des'ree 1994

Growing up in Cincinnati I always had people of different faiths around me.  In my kindergarten we celebrated Hanukkah and Christmas as well as Easter and Passover.  I loved mythology and read Greek, Roman and Egyption myths through middle school.   I often babysat for the Jewish couple next door on the Holy days and got Matzah Ball Soup as a part of my payment.  The year wasn't complete until I had gone to Synagogue and Mass at least once.   My best friend in high school was raised both Hindu and Catholic which added a whole new set of deities to start to understand.  One of the hardest concepts for me in Christianity was "The Great Commission."



This felt more like "Go out into the world and tell them that everyone else is wrong."  At this point I had been to too many Seders and Shabbats to feel that this was the right action.  It became more complicated when I started to go to Navratri and Diwali celebrations as well.  My mother had started her time as a associate minister at a large suburban mostly white church.   The senior minister often preached on Grace, but this seemed to directly contradict other parts of the Bible.  By auditing some of the confirmation classes at the new church where we discussed the differences between Methodists, Catholics,  Muslims and Quakers.   This brought up more questions than answers.


They all deserve to die.
Tell you why Mrs Lovett, Tell you why.
'Cause the life of the wicked should be made brief,
For the rest of us death will be a relief  - Stephen Sondheim "Sweeney Todd- Epiphany" 1979

Love's in need of Love today
Don't delay send yours in right away
Hate's going 'round breaking many hearts
Stop it please before it's gone too far. - Stevie Wonder,  Love's in Need of Love Today 1967

Junior & Senior Year

My Junior and Senior year were marked with an uptick in religious events and activities.  At this point I was pretty sure this was just to try to keep all the hormones in check.  Which wasn't really a problem with my group of friends.  I had Connections as I did for one week in the summer and it was still a wonderful comforting place.  Though at this point it was more for the bonds I had with the other campers than anything else.  Escaping during FOYOB (Feet on your own bunk, AKA when the counselors were napping or meeting) to go the top floor of the dorm and hang out talking about geeky things and deciding if we were brave enough to mix drinks.  We were not.

My mother was also getting a Masters in Religious Communication as well as her Masters in Divinity.   At this point I was reading and editing her papers as well as critiquing her sermons on a regular basis.  An interesting thing happens when you being to critique religious writings; you start really looking at everything with a critical eye.  I already loved science and the scientific method since the age 8.  I began to see more contradictions and less coherency in the bible as well as its teachings.  Aside from trying to keep my mother from using SNAFU and FUBAR in sermons (She didn't know they were acronyms that included curses), I started to listen to everyone's sermons and see lack of context and cherry picking.  These careful listening skills and critique skills would continue to help me in my scientific reading and writing as well as make me really critical of what people of faith said and did.

There was also UN/DC a biannual event where the West Ohio Conference of United Methodist Youth took a trip to either NY or DC to talk about an international or national issue.  Our year we went to DC stayed in Dupont Circle and talked about "Sexuality A-Z."   This was actually an amazing trip.  We got to hang out at some youth centers and had multiple sessions which really made us figure out what our definitions of sex and sexuality were.  We also saw some "Transformation Gay" programs and I noted how they would condemn someone in one verse but disregard the verse afterward that said they should not cut their sideburns.   They clearly cherry-picked the bible to justify cruelty and hate.   I definitely understood why people in the GLBT community (now GLBTQIA) would leave religion.

My senior year I also was able to go to Chrysalis.  This is a teen version of an adult retreat called "Walk to Emmaus."  It was three days of bible study and self reflection.  Doing different parts of the weekend you were to write down a character trait or sin.  Nail it to a cross and then they were burned as a symbol of Jesus taking on this burden.  One of the last days we walked through the church which was lined with people holding candles and were given a box of letters from friends and family to read while meditating in front of the cross now clean of all the nails.

--- So this could've been a powerful experience if I hadn't been to Connections so may times.  I really felt like this 3 day weekend was trying to fabricate a feeling that did not come up organically.  I had never met these people and had little connection to them.  I liked receiving the letters but the knowledge that all these people were depending on me to have some change or new commitment was uncomfortable.  There are also people praying for you each hour of the weekend which I also found stressful.  (Actually we know that people who know they are prayed for tend to fair worse in healthcare.) It was around now that I started to come up with my Purple Blanket concept.  Since technically God is neither male nor female, I saw God as a warm Purple blanket that comforts and covers me in time of need.  I articulated this to one of my Mother's Prayer Group friends and she seemed quite dismayed, but this seemed to match the most with what I felt.  I pretty much tabled the whole Jesus thing until later.  I mean Pascal's Wager is still a thing right.


College -

Here come the sun, little Darling
Here comes the sun
and I say
It's alright.
Little Darling,
It's been a long cold lonely winter
and
Little Darling
It feels like years since it's been here
but
Here comes the sun.  -Written by George Harrison 1969, as performed by Nina Simone 1971

I went to the doctor, I went to the mountains
I look to the children, I drank from the fountain.
There's more than one answer to these questions
Pointing me in a crooked line,
And the less I seek my source for some definitive,
The closer I am to fine.  - Indigo Girls 1989

College was interesting.  For the first time in my life I didn't have someone waking me up and taking me to church.  By the time I came along (8 years difference between my sibs and I) church every Sunday was a given.  We would go even if I or one of us was sick.  Apparently this didn't happen according all the time when they were young according to the lore of my older sibs.  Now, I did have a cousin who was in Seminary also at Emory.  The deal was if he picked me up for church I got a Sunday Dinner after.  Who would say no to Sunday dinner?  He was doing his student preaching at a Disciples of Christ Church.  I knew a lot of denominations, but this one was new to me.  This one had way less tests.  Rather than having to prove your baptism (Methodist) and by a certain way (Baptist) and taken classes (Catholics), you just have to say you believe in Jesus and you are in.   "No creed but Christ" is often what they say.  They were much more on the Grace and Love train.

For part of Freshman year I was apart of the Gospel Choir "Voices" at Emory.  We visited many churches which I found questionable (an armchair on the pulpit, or only pictures of the founder in the sanctuary).  It also seemed another place where there was a lot of performance.  Students would whip themselves into a frenzy crying and singing at the rehearsals.  That just wasn't me, or some of my friends luckily.   The same folks who would whip into a frenzy were also the same ones being questionable at the frat party on Saturday night.  The whole thing seemed again another way to keep young people out of trouble, with rehearsal on Friday night and Sunday morning engagements.  It was a bit of a scandal if you were seen at the Frat party Saturday night but didn't come to the engagement Sunday morning.   Again, it seemed performative.

I also got involved with some of the Youth programs there now as a leader.  I found that the "Adults" didn't really seem to have an understanding of what Youth needed.  One time assisting in a youth program in Cincinnati I felt like I was batting clean up after everything the actual minister said.  He was harping on about obedience to God and your parents (basically lecturing these church youth).  I had to come up after and note that God could be a source of love, comfort and protection when you feel like it is not coming from anywhere else (Purple Blanket concept).  Sometime between Freshman year and Sophomore year my cousin realized that I fell asleep in church a lot and he said it was okay to stay home.  He also graduated and I did help out at his church occasionally.

But over all going to church just didn't seem that important for me.  I would go to my mother's church in the summer so she felt supported.  I would go help with my cousin's church to support him.  But it wasn't really apart of my practice  I was pre-med, Neuroscience and Behavioral Biology major, Anthro minor and almost had a second minor in dance.  I was pretty busy.  The religious critique skills I picked up from going through seminary from my mother led me to question and often disregard some of the religious teachings around me.  I also was introduced to yoga and meditation by this point.  These I could do on my own time and in my own way.  Similar to connections it was about the people, not the actual religion or faith.  I was very comfortable with my warm purple blanket concept.




Well that's all for part I.  Next time - Peace Corps, India,  more education and the ongoing journey. 

If you haven't heard some of these songs -  check them out.

Saturday, May 19, 2018

Developing Thirst

Inspired by Thirst Aid Kit --  for your thirsting needs -- and a conversation with one of the nurses while I was on night shift.

thirst (Google definition)
THərst/
noun 1a feeling of needing or wanting to drink something.

  1. "they quenched their thirst with spring water"

thirsty (Urban Dictionary definition )
when you are horny for some ass
         "I always get thirsty looking at your fine ass"

I remember the exact moment I realized it was okay to find White Men attractive.  It was Sophomore year and I was in my High School Latin room after school. --  I spent a surprising amount of time after school in my Latin classroom, and that probably says something about me. -- I was one of the last people in the classroom after either a Certamen practice (Latin Quiz Team, don't judge me) or club meeting.  I had recently seen "A River Runs Through It," and I was trying to describe Brad Pitt.  Obviously he was a wonderful actor, but there was something else.  I remember as I was leaving the classroom and thought "Oh my God, Brad Pitt is Hot."  Immediately followed by "Am I allowed to think this?"



As a Black Girl growing up I understood from TV, movies and family who was attractive.  I was lucky to grow up in the 90's when there was a bevy of attractive men of color in the media.  Everyone could agree that Denzel Washington was attractive. Wesley Snipes was also shown to be particularly desirable.  Though honestly I probably got most of my thirst pallet from sitcoms, especially "A Different World" and "Living Single."





The witty banter between Max and Kyle, along with his stunning afrocentric fashion sense, made him clearly attractive.  The "Dufus turned cool" manner of Dwayne Wayne along with his devotion to his love interests taught me that brains and passion could be found in a single person.  (For more check out this compilation). Ron Johnson was always smooth and cute.  Shazza was just unreasonably large and attractive; although his personality sometimes left much to be desired.  Showing that just because they look good, doesn't mean they are good.  I was pretty clear on all kinds of brown being reasonable thirst objects.  My first really memorable crush (outside of elementary school) was on an Indian kid in my Latin Class.  It was a long lasting crush even when he switched schools.  This may be because I was also often the only Black American in my classes and there were not a ton of guys of color in my classes either.  Though my mother insisted that many of my guy friends (I had way more guy friends in high school than girl friends) had crushes on me, they were all White and therefore off limits. . . Right? 


 



Maybe it was the fact that Brad Pitt's character in "A River Runs Through It" has a love interest who is a woman of color.  Maybe it was the fact that this is the beginning of peak Brad Pitt acting and attractiveness.  But something at that point clicked and I realized that White Guys could be hot too.  Later watching movies like "Corrina, Corrina," I had an example of a White (ish - for a long time I thought Ray Liotta was some kind of brown) man who could find a Black Woman attractive as well.

-- Can a take a moment to note that we don't get another major movie example of this until "Something New" 12 years later.   Something New came out the same year as "Broke Back Mountain."  But the plot with a White Man and a Black Woman is called "Something New."  But I digress --

Possibly much to my guy friends' dismay I didn't find any of them particularly hot.  --Really what high school student is?-- However, I was able to start looking at all people through new eyes.  I started to think it was possible that some of my guy friends could theoretically be attracted to me. Also that it would not be the end of the world if I ended up with someone who was not Brown.  I was still shocked when riding home from church one day my father went into a lecture about "If you decide to marry a white man" completely unprompted by any of my actions.   The realization that I was "allowed" to fancy who ever I found attractive, also helped when I realized, a short time later, that I found some women attractive.



We are enculturated to believe certain things are expected of us romantically.  Through many conversations I realized not everyone has examined the origin of their thirst or questioned it.  Junior year of college I went on "Alternative Spring Break" building trail in the cumberland gap.  One night we had an in depth conversation and one of the White Guys on the trip was horrified to realize that the could not find Black Women attractive.  He was distressed to find out he was that programed. One colleague in medical school was attracted to Black Women, but married an Asian Woman instead because that is what his family expected.   I recently had a conversation with a Black woman who stated she could not find white men attractive nor even light brown men of any race.  When we pressed her on how she could find her nephew cute (who was light brown) but not other men she avoided the question. 

My general "type" is nerds/geeks of all races and genders.  I'm more of a 2-3 on a Kinsey scale and lean a little more toward masculine than feminine.  I'm excited that we are moving to a time when media is more than a parade of similar looking White Men and people of all colors and cultures are starting to be portrayed as attractive.  Every person deserves to feel people like them are attractive and have the option to find people who don't look like them attractive as well.

Thursday, May 10, 2018

Don't Wish Me Happy Mother's Day.

Warning: This talks about loss and infinity wars.

Mother's Day after a miscarriage is hard.  There are plenty of other websites and blogs about this.  Every person who has experienced a miscarriage feels it differently.  Some would actually like the acknowledgement of the loss in some way.  According to an informal pool on one of the TCC apps I put up when I realized Mother's Day was coming, about 57% of people who have had a miscarriage are dreading mothers day.  Only 8% are looking forward to it and the rest are just trying to ignore it.  The thing about miscarriage, just like any loss, there is no straight line through grief.  I have often wished that the stages of grief were linear and simple to go through


The reality is that it is not linear but convoluted going back and forth with being okay one minute the next wanting to cry when you se a mom with a baby in target.   It's like ripples on a pond. There is still water between the swells. Some you can prepare for like a co-worker's baby shower.  Others you can not like "Infinity War."


  SPOILER ALERT -- 
MCU - AVENGERS, INFINITY WAR 
-- SPOILER ALERT 


Tony Stark at the end of "Infinity War" has the same feelings as a woman who has gone through a miscarriage.  He realizes he would like a kid at the beginning at the movie; all of a sudden he realizes he is now responsible for this new young being.  Just as he is getting used to his role, the child literally turns to dust in his arms.  He is left empty wondering what he could have done to change that fate.  That is exactly what a miscarriage feels like.  Watching that scene was strangely cathartic.

SPOILERS OVER


Every person who has had a miscarriage experiences this differently but for me please don't wish me "Happy Mothers Day."    For me it will just bring up my loss and cause more ripples and possibly tears. Here are things I will accept -

  • Extra Random Hugs
  • Good Wishes via text, phone, Facebook, Twitter, or Marco Polo
  • Fertility Gifts - One of my colleagues made me a bracelet,  and it was an amazingly touching gift. 
  • Random gifts that make you think of me (if you already have them and just haven't sent them, or were thinking of sending me something anyway)


This is just for me and maybe 57% of people who have experienced a miscarriage.  There are some who like to hear they are a mother.  If you know someone else who had a miscarriage just ask.  "What can I do to make this Sunday better for you."

Tuesday, April 03, 2018

GAD-ing

My instinct is to make a joke about how this will not be about Gilderoy Lockheart's best-seller Gadding with Ghouls, but I realize not everyone would get this obscure harry potter reference so. . .

The DSM-5 defines Generalized Anxiety Disorder as :

  1. Excessive worry about a variety of events for at least 6 months
  2. Worry that difficult to control
  3. The worry is associated with at least three of these symptoms: restlessness, easy fatigue, difficultly concentrating, irritability, muscle tension, or sleep disturbance.  (only one symptom needed for kids)
  4. The anxiety causes significant distres or impairment in functioning socially or with work
  5. You can not attribute the worry to the effects to a medical condition (like hyperthyroid) or drugs (Cocaine)
I've had GAD since I was about 5 or 6 yrs old.  I remember staying in the bath tub until the water was cold and I was shivering because I was afraid that ALF - yes that ALF - was going to eat me.  I loved muppets but for some reason Alf always wanting to eat the cat made me worried that he would one day turn his taste to children.  My older siblings would chase me around the house saying "Pac-Man" making alligator type arms to demonstrate how large Pac-man would be if he was out of the screen, and how he would probably eat me if he could.  




Between the ages of 7-9, I started realizing how scary the world was.  I realized that at anytime I could die.  I had a lot of deaths in my early life; so I thought about it quite a bit.  I would worry every day my father drove me to school that we would get into an accident and die. I worried when I was carrying scissors from room to another that I would trip and they would go into my eye and I would die.  I worried that The sharp edge of the TV tray that was often up in the family room would be sharp enough that I could fall and it would impale me.  I worried walking home from school to my grandmother's house that I could be hit by a car or abducted.  Those were the big fears.  There were always the smaller fears of failing a test, disappointing my parents or family, or generally not doing something correctly.  

Some of this can be explained by being born into my  amazing family. Three generations of Graduate school graduates (on both sides) and over a dozen Doctors (MD &PHD) is a lot to live up to.  The fact that my elementary school was in inner city Cincinnati in Walnut Hills, which used to be an upperclass black neighborhood and in the 80's had seen better days, could account for some of my neighborhood fears.  Even a  8-year-old knows car accidents are common.   However all of these factors don't explain why these thoughts kept me up at night and a fairly stressed child.  It also lead to a slight break down in 7th grade.  

For each class, in 7th grade, I would change my attitude and personality to be what I thought the other students and teacher expected of me.  The only ones which were similar were Latin and English.  All of the changing and trying to live up to expectations took its toll.  Around the end of first quarter I had a breakdown while working with my best friend Anjali on a Latin project in the library after school one day.  I don't remember what quite set it off; it may have been a minor argument.  I do remember putting a book on the shelf, saying good bye, walking down a hall, riding the bus home, and being in my basement.  I have no memory of anything in-between, but I have a clear feeling of being outside of my body.  That disassociation was way more scary than disappointing some teachers or classmates.  After a few hours of crying in my basement and another month of school I was finally myself for all classes. 

My coping mechanism, that I figured out around age 10, was to figure out what the worse case scenario  for each situation and prepare myself for it.  As long as I was prepared for the worse then I could deal with everything else.  What if I'm a disappointment and dishonor my family?  Just work harder and do something original (like going to peace corps) so they have to keep you.  What if I don't pass my medical boards?  Study harder, take some time off and do them again in 3 months.  Make sure I have money saved or work arrangements so I can support myself.  But this drives me to study harder now.  What if I get pregnant but there is a chromosomal anomaly like Trisomy 21, 18, or 13 where my child could not have a complete life?  We get genetic testing at 10 weeks so if I have to terminate it will be early and do all of the other things I can possibly do to have a healthy pregnancy.  This has led me to saying things to my husband such as "So if you are going to leave me, please do it now so I can recover enough for: medical boards, residency interviews, Medicine Senior rotation, etc."

The other part of my early coping mechanism was likelihood.  I could be impaled by the corner of the TV tray, but how likely is it?     My computer could explode sending shards of glass into my heart and causing me to bleed out right now.  However, it is not likely.  I could be sued tomorrow for a mistake I made medically as a first year resident, causing me to never be able to practice medicine again and the government take all of my belongings because I owe over 300,000$ for my education, and have to live on the streets.  But it is not likely. . . I hope.   As a scientist this plays well into my desire for data and evidence.   Having the numbers helps put my fears in their places. 

Not all anxiety is bad.  Because I grew up when HIV was being discovered I was extremely careful about washing my hands, checking for rogue syringes everywhere (including under movie theater seats),  and delayed intercourse until well into my 20's.  My highly educated family instilled a drive to uphold the name.  I traveled the world, have multiple graduate degrees and even an extra fellowship on top of my residency.  I had the wonderful honor of being hooded by my big sister the  orthopedic surgeon at my medical school graduation.  The continued desire for data and to do the right thing keeps my medicine evidence based and documenting as much as I can for my patients.  Even though there are multiple times I wish I could be lazier. 


The down side are things out of my control or that I can't prepare for.  Hospital credentialing and trying to find someone to notarize one of the forms literally left me shaking in my front room and crying at an insurance office.  My schedule changing frequently - which it did in residency and now in an area of physician shortage - causes insomnia, tension to migraine headaches, and trying not to fall apart in the hospitalist dictation room.  Oh and panic attacks are a major down side.  Panic attacks are full on activation of your sympathetic nervous system i. e. the "Fight, Flight or Freeze" system.   When I found out that I did worse on my MCAT than I did on my first practice test, I ran to the highest stair well, took about 30 minutes to stop hyperventilating  (okay it was probably more like 10 minutes but it felt like 30), and called my best friend 14 times zones away at 3am.  Panic attacks literally make you feel like you are going to explode and implode at the same time.  I'm fortunate that for my last one I could walk myself through the sympathetic nervous system and talk myself out of it.  Panic attacks are terrible.  

Over the years I have picked up more coping strategies: yoga, deep breathing, exercise, and open honest communication.   I had counseling in public health school, medical school and residency which was extremely helpful each time.  My counselor in residency convinced me to actually try medication; Celexa was amazing.  Just 10mg helped make everything a little bit easier.  As soon as the whole TTC adventure is completed - either with a small person or an IUD and a dog - I am planning on restarting Celexa.

The thing about GAD is that so many people have it, but like all mental health problems it is stigmatized.  Society doesn't look favorably on people who are "nervous," need counselors, or have had breakdowns.  Anxious kids are often either seen as "sensitive" if they cause an outburst or ignored if they are not causing problems.  GAD is a chronic disease.  I know it's not going away.  GAD has been with me my entire life and will be there until the end.

Thankfully my laptop did not explode while making this blog . . . yet. 

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.

HOW DID NONE OF THE 4 DOCTORS I INTERACTED WITH NOT TELL ME I WAS 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.