The First Lady

Liberty's torch

I put the baby to my breast. She ate greedily. 

So tiny for such a strong suck.

He had not come home yet. He did not know that she was a she and not a he. He would be angry, I knew. Would he let me keep her or would he kill her as he had the other three? Would he beat me as he had before?

Look, she is so beautiful, so perfect! Why can’t you love her?

Why can’t you love me?

The midwife busied herself quietly putting the room back in order. 

He would never pay for a doctor or a hospital. Not for me, he said. I was not worth it. 

A woman. 

A girl.

Someday I would leave him. I would run away. Far, far away. But to where? And they would find me, wouldn’t they? They always did. If I was lucky, they would shoot me where they found me. If not, he would be allowed to stone me to death. He’d like that. Then he could take a new wife. Someone who would give him boys. He never listened to the logic of genetics, that the determining X or Y chromosome actually came from him and from not me. My education, my past… it meant nothing to him. 

Neither did my future. 

No. I will outlive him. I will NOT give him the satisfaction.

The little one scrunched up her tiny baby face and yawned. Enough eating for now, she seemed to say as she looked directly into my eyes and grinned a lopsided baby grin. Then she drifted off into a peaceful slumber.

Born on Independence Day. If I were going to name her I would name her Liberty after the giant statue they tore down decades ago. No woman will stand as a national symbol, they said.  

Now she was gone.

Just like my own Liberty. 

The Boobs Have It

Display in museum in New York City
Do you know how many breasts I have touched? 

Thousands of them.

It is staggering when I reflect upon it. 

So many breasts. So very many. All shapes and colors and sizes. Hairy. Not hairy. Moles and rashes and skin tags galore. Droopy. Perky. Somewhere in between.

During breast exams I have for years and years referred to the exam as the “boob check.” Whenever I made reference to my breasts of anyone else’s I nearly always called them boobs or boobies. 

To be honest, I thought it was cute.

Touching another woman’s breasts makes me uncomfortable, maybe even a bit embarrassed. I feel the same when someone else is looking at or touching mine in a nonsexual, clinical sort of way. So I made fun of breasts and joked about the situation. It took some of the sting out of the situation to act goofy.

One of the many beautiful things about blogging  is that from time to time someone says something that makes me reexamine a part of my life and causes me to make some changes. 

Mark at Exile on Pain Street made a comment on one of my blog posts a while back (ok, maybe it was WAY back in July of 2015) that has stuck with me:

“I hate that word. Boobs…. Boobs sounds comical and crude. It lacks decorum. They’re beautiful! Not something to make fun of.”

This. From a MAN. 

At first, I blew it off. What does he know about women’s bodies anyway? What gives him the right to tell me what is disrespectful about the term boobs. I can can dang well call them anything I want, can’t I? I own a pair after all.

But it ate at me. 

And I felt kind of guilty.

I would take that comment out from time to time and chew on it. The word boob is, after all, another way to refer to someone who is a fool. An idiot. My breasts are way better than that, aren’t they? So are every other woman’s breasts for that matter. They give pleasure. They give life. Right or wrong, so much of who we are as women is wrapped up in these exocrine glands. I would never tell a man to show me his “twig and berries” if I were doing a genital exam. Why do I persist in denigrating the female anatomy during office visits? 

Excellent question.

Yesterday I was telling a woman to change into my lovely blue paper gown so we could do a breast exam when it struck me…

When was the last time I called them boobs?

It had been a long, long time, I realized.

And that made me smile…

Fertility vs. Virility

Gerber Daisy in a pot

“I need help,” she pleaded. “I don’t know where else to turn.” 

“Sure. What do you need?”

“I’m pregnant.”

She was newly married. They were recent college grads, just starting their first jobs and their lives together.

“Congratulations! How exciting!”

Her face crumpled and she began to cry great body wracking sobs. I braced myself. Had he left her? Was she being abused? Was there something wrong with the pregnancy? Had she lost her job somehow?

“My health insurance excludes coverage for birth control. The pills make me so nauseated and the depo provera shot just made me bleed and bleed. I couldn’t afford to pay out of pocket for other forms of birth control. So we used condoms. We tried to be careful.” She whispered hoarsely, “I don’t know what to do.” There was terror in her eyes. “My insurance policy excludes coverage for pregnancy. We made calls. All of the OB’s in the area want at least $10,000 up front in cash. We don’t have that kind of money. We have student loans and a mortgage!”

Could health insurance DO that? Exclude coverage for both pregnancy AND birth control? Oh, yes. Yes they could. And it was always hidden in the fine print. It was the young women starting out in life that didn’t know what to look for, the ones most likely to end up pregnant. 

It made me angry for her. What kind of misogynistic world did we live in where this was allowed? Where women are punished for possessing a functional uterus? The United States of America. The bastion of freedom and democracy.

We talked about her applying for Medicaid. 

It felt wrong, though. A woman… married, employed, insured (sort of, apparently) having to apply for Medicaid. That was not what Medicaid was intended for, was it? Once her dates were calculated, the pregnancy predated her employment contract and would have been considered a preexisting condition anyway, even if she did have pregnancy coverage. No matter what kind of policy she had, she was screwed. Literally and figuratively.

The other thing, which no one talked about out loud, was that the OBs who took Medicaid in the area were typically so awful no one with real health insurance would ever willingly use them. There was a huge stigma attached to it all.

So what happened to her, you ask?

She had an abortion.

Despite what you want to believe, hers was not an isolated story.

What a relief it was when the Affordable Care Act worked to changed that. No matter whatever else you felt about the ACA, it was a powerful step forward for women but even it did not go far enough. We all deserve comprehensive medical care that takes care of our entire bodies, not just the parts that correspond to our male counterparts.

But here we are with some people thinking it would be great to go back to that alternate kind of reality.

Well…

Be careful what you wish for.

Marching and Madness

Statue covered in dozens of breasts
“I like how he responds to the media. I voted for him because of that. I hate the media…” she was watching video of the inauguration on her phone when I entered the room.

I moved to listen to her heart and then her lungs. 

“That sort of thing is how he won the election,” I murmured, careful to keep the judgement out of my voice. I quickly changed the subject back to her persistent nausea. 

My clinic is not the place for political debate. It is for healing.

At the end of the visit I picked up my computer from the counter across the room and caught his face leering back at me from the magazine rack again. I always moved him to the back of the stack but somehow, just like a bad penny, he kept turning up again at the front. How many pelvic exams had I done in this room with him looking on? I have tried to remain neutral publicly but I just could not take it anymore. I snatched up the magazine and threw it into the biohazard bin while the patient walked out of the exam room.

I wish he would shut up.

Does he even hear himself? The things he says? How he appears to others through his tweets?

“Watched protests yesterday but was under the impression that we just had an election! Why didn’t these people vote?” Donald Trump

I imagine there were women out there marching who did vote for him. That does not mean that they cannot stand up and protest. That march was not just about Donald Trump, even if he wanted to think it was.

I did not march yesterday but oh how I wish I had. Do I agree with everything the Women’s March was said to represent? Maybe. Maybe not. But I do stand as a woman who is more than a pussy, a woman who believes she deserves more respect and equal pay and better rights. A woman who believes that people have the right to kindness, love, safety, and respect regardless of religion, gender, sexual orientation, skin color, or country of origin.

This was how he should have responded from the first instead of as an after thought:

“Peaceful protests are a hallmark of our democracy. Even if I don’t always agree, I recognize the rights of people to express their views.” Donald Trump

Yes. That.

So I say this:

Unite us. Stop dividing and provoking. Be someone we can respect, even if we do not agree with you. 

Act like a president.

A Slave to the Face

Victorian tombstone
I am going to let you in on a little secret: I own a Princess Leia slave costume. 

Yes, for those purposes. I am not going to claim that I ever looked good in it but I did purchase it and have worn it more than once. Well. Maybe more like *not worn* it….

You can say all sorts of things about sex and slavery and the subjugation of women and how wearing such a costume betrays feminism at its very core but here’s the thing: Princess Leia choked the ever lovin’ life out of Jabba the Hut while in that costume. She strangled that slimy, disgusting bastard with the chain that bound her to him while wearing a bikini. She wasn’t cowering in a corner, ashamed of how much she hated her exposed thighs. She owned that chain and she used it to her advantage. That is some kind of woman. I long for that kind of confidence.

I am not who you think I am.

You will remember in my post last year that it really bothered me how much criticism Carrie Fisher took for her appearance in The Force Awakens, how I didn’t think it was about her so much as it was about our own aging and mortality. For many of us, she was a tangible way of measuring the passage of time. Her appearance spoke to our own finite existence, our own mortality. It was like holding a mirror up to our souls and for some recognizing that we did not like what was reflected there.

She looks older. 

So do I. 

I am not what others see in me.

There was a time that I would get told by complete strangers that I looked like Nicole Kidman or Jullianne Moore or Bree from Desperate Housewives. No one says that about me now. My face and my body are changing. The days of Star Wars kink fests are over.

I am not who I think I am.

I grappled with the anxiety and panic of that for a few years. I tried laser… once. The pain from that was indescribable. And Botox… once. Let me tell you, there is nothing quite like the contortions and fasciculations from Botox wearing off. Then, I smeared the most godawful smelling stuff derived from baby foreskin on my face twice a day while choking back my own vomit.

My face is NOT all over the big screen and yet I freaked out, doing crazy stuff in a vain attempt to hold onto my youth. There was the dysphoria of not recognizing the face staring back at me from the bathroom mirror and the despair of feeling my sex appeal dwindle away.

Who am I now?

I cannot even imagine what Carrie Fisher went through in her lifetime, the tremendous courage it took for her to play the role of Leia once again decades later. As a little girl I wanted to be like Princess Leia. I wanted to learn to shoot a blaster, sure, but I also wanted to look that good in a bikini slave costume. What I did not realize at the time was that virtually all women, no matter how beautiful, suffer from a distorted image of themselves. Princess Leia suffered. Carrie Fisher suffered. Now I find that Carrie Fisher herself is my hero even more so than her character ever was. 

But then Carrie Fisher died.

So will I.

Suddenly a face seems like such a triviality. I won’t say I am completely over myself or my vanity, but I am working on it.

May we all rest in peace…

A Conversation

Girl sitting on a driftwood stump at a lake
“Mommy, Caden was telling me some stuff about Pluto…” She started to list some facts that were blatantly incorrect.

“Baby, you know that isn’t right. Remember learning about Pluto at the planetarium in Chicago?”

“But Caden said…”

“You don’t have to believe everything Caden says.”

“Yes I do. I’m his girlfriend!”

She is five years old, people. 

Kindergarten.

“Caden? Who is this Caden fellow anyway?”

“He’s in first grade. He’s my boyfriend but we can’t get married until we are twenty-eight. That’s the rule.”

She’s dating an older man?!??!?! Still, 28 is a reasonable age…

“Why do you even have a boyfriend? You can have friends that are boys but you don’t need to have a boyfriend.”

“Yes I do! Everyone at school has a boyfriend or a girlfriend.”

Call me old and outdated, but I sure don’t remember that sort of thing going on in grade school back in my day. And who the hell told her she has to be stupid to earn some guy’s affection?

I remember my mother pulling me aside in high school, telling me I needed to dial it back a bit. “Boys don’t like girls who are smarter than they are.”

Maybe that’s true.

Maybe that’s been my problem all along.

But you know what? 

Bite me. 

My daughter knows that Pluto has a different orbit than the other “real” planets. It is smaller than Earth and is terribly cold. And you know what? It isn’t a planet because it has not cleared the neighborhood around its orbit.

Loving someone does not mean you have to agree with their silliness. Why some people still believe this is beyond me. 

She can still “love” you, Caden, but by golly she is gonna teach you ALL about Pluto today…

In Another Dimension 

IMG_6336

Joey of Joeyfully Stated asked what field of study I would have pursued if I had not become a doctor.

My undergraduate degree is in Genetics and I had intended when I started out that would get my Ph.D. After doing a few years of research on pea chloroplasts, I realized it was going to be a helluva lot of incredibly boring work for very little payoff. 99% of genetic research is very unsexy as it turns out.

So I decided to go to medical school. I really wanted to get a doctorate level degree because my family had told me I couldn’t. I was a girl, after all. I like sticking it to people who tell me I can’t do something because I am a girl.

In truth, my back up plan in case medical school did not work out (because there was no way in hell I was going back to pea chloroplasts) was to get an MBA somewhere. Something practical. Thank heavens that did not have to happen because I would have been absolutely miserable.

Here is a post I did last year on what would be my dream career: My Alternate Reality

Paved

IMG_2054

“A blank wall of social and professional antagonism faces the woman physician that forms a situation of singular and painful loneliness, leaving her without support, respect, or professional counsel.” Elizabeth Blackwell, the first woman to receive a medical degree in the US, graduating first in her class at Geneva Medical College in New York in 1849.

To all of the women who went before, who fought for their own right to practice medicine making a career in medicine possible for women today…. I salute you.

Happy National Women Physicians Day! 

Jumping Back In

  

I had big dreams as a kid. Somehow I just knew I was gonna be somebody when I grew up. I wanted it so badly that I could feel the ache in my toes, the gnawing in my gut… every single day.

Medical school became a reality and I figured I was well on my way. 

After residency, I started a job with a large group of physicians. Within two years I was elected to the executive committee (essentially the clinic’s governing body). A year later I was on the hospital’s quality committee, the hospital executive committee, and then was elected Chief of Family Practice. I was on the Patient Satisfaction committee for the entire system and helped make system wide policy. I had plans. I wanted more. Chief of staff? Board of directors? Yes, please.

Then I got pregnant. 

Pregnancy was NOT in the plan. I never, ever saw myself as a mother. I did not understand those women who were and regarded them generally with scorn and suspicion. I knew that to BE somebody by my current definition I could not also be a mother. If there was one thing medical school taught me, it was how babies were made. I was on the pill and by golly I took it religiously. I tried to avoid sex as much as a married woman could and required the use of condoms whenever I could not.

But that one damn night… 

All it takes is once, folks. Get a little cocky, a little careless, let love/lust get in the way of rational thinking and BAM! You are changing poopy diapers.

I put the positive test in the top drawer of my desk. For weeks between patients I would peek into the drawer and stare at the pink line feeling the panic well up from my uterus.

What was I going to do?

At the time I was practicing both inpatient and outpatient adult medicine and pediatrics. I was there for meconium deliveries and ICU admits at all hours of the night. I worked many Saturdays doing the acute care clinic when I was not on call at the hospital. Then, there were all of those committee meetings.

How would I breast feed? How could I work a sixteen hour day on my feet while 39 weeks pregnant? What about a sick baby or sick toddler? Childcare?

So I walked away from it all. 

I moved to another clinic where I would only do outpatient medicine. I gave up my hospital privileges and committees and meetings and ambitions. I was no longer the Chief of Family Practice. 

At first it felt odd. 

Empty. 

Disconcerting. 

But when my son was born, there was no question I had made the right decision. Evolutionarily speaking, this is why babies are so cute. They HAVE to be to survive. My definition of who I was shifted and interestingly I was at peace with that. 

Mostly.

I hate just griping and complaining. This blog is therapeutic but I like being involved in a solution. Doing something instead of merely pacing the floor, wringing my hands. Now that my kids are older I am ready to get into it all again, just not to the level I was before.

Last year I applied to join the EHR (electronic health record) committee for the system only to find out my arch nemesis was now the gate keeper for all system wide committees. I promptly received a rejection letter hand signed by him with what appeared to be extra flourish (I admit I may have imagined that extra flourish) and I resigned myself to staying involved only at the clinic level until he retired at some unforeseen date many years in the future.

Then, an email…

An invitation to join an EHR subcommittee arrived in my inbox last week. Just like that, I am back in the game. Section chief? Board of directors? President of the system? Nah. I don’t want any of that anymore. I just want my voice back. 

I Need A Wife

IMG_8330

“Mommy, we want daddy to be more like you and you to be more like daddy,” my son said.

We were in the car on the way to school discussing who was going to be picking them up that day (it might be daddy) and that daddy would be making them dinner as per our usual.

“Yeah, mommy,” my daughter sniffed, “be more like daddy. Don’t be like you.”

My heart hurt. There was nothing I could really say to that. My kids recognize that gender roles in our family are different and they do not like it. Short of quitting medicine, this is the way things are, the way they will be.

A mother who practices medicine HAS to have a “wife”, someone who is in charge of the minutia (like birthdays, activities, homework, laundry, dinner, groceries, etc.) and who can be flexible in case of emergencies. I am blessed that I have help. There are tons of working mothers who have no support whatsoever.