Saturday, May 28, 2011

Courage and the Elementary School Play

Well after months of preparation Henry's elementary school production is now a moment for the history books. The "Mousical" was staged three times, once for the littler ones, yesterday afternoon for the 3rd-5th graders and last night for all of the obnoxious parents, grandparents, siblings, and neighbors. In what I can only describe as a true stroke of genius the mastermind of the event, Mr. Scheuer, raised the house lights and said to the audience,"Let's just get it out of the way-this is your turn to wave at your kids and let them wave at you."

So we all got a little goofy and then the play began. As far as I'm concerned it could have been Hamlet at the Globe for all the sincerity the kids and their teachers poured into the production. This being his last year in the school I found myself becoming very emotional watching these "big kids" perform, sweating in felt mouse ears under the hot lights, trying not to fidget or play with their tails. The performance was not perfect-but it was exquisite in its imperfections. There were missed lines, stumbled over words, North Carolina British accents that came and went with the imaginary tide, and an errant double decker bus.

It was simply divine.

I told Henry after the play that I was so proud of him, not because of his performance, which was delightful, but because of his courage. This week he had a hard time going to sleep on two nights and fretted over the possibility of forgetting his lines or missing his cues. On the nights where he climbed into our bed Bob and I reinforced to him that everyone gets nervous before a performance. Actors on Broadway, surgeons in the O.R., me before I start a new patient in the clinic. Those nerves are a part of life and so many people miss out on life because they are too scared to get on their own stage.

I told Henry I was proud of his performance, but that his courage was what I admired most, because I knew he was scared to get up there at 11 years old in front of the whole school wearing mouse ears and a British policeman's cap, but he did it anyway. And that kind of courage makes all the difference between a life well lived and a life of "what if?"

When Henry's father died I was 31 and a college drop out who hadn't managed to drop back in. I was scared, sad, angry, overwhelmed and grief stricken, but I knew then that this was my only chance to go back to school and become a nurse. So I reapplied and come August I was sitting in the front row of Anatomy and Physiology.

Over and over again people told me,"I just don't know how you do it." "You're amazing." Frankly, it was a huge source of annoyance to me, because I didn't think I had a choice. In retrospect I can see that what they admired wasn't me going back to school or becoming a nurse or caring for the boys. They admired my courage in the face of what seemed unimaginable to bear. They admired the fact that I was still getting up in the morning and for many I think that alone would have been enough for me to accomplish.

I look back now on days where I am tired or the boys are being miserable little beasts and I think how far we've come, literally and figuratively, and I'm grateful for the grace to keeping getting up on the stage of life, alone or as an ensemble cast of characters. I don't want to miss my chance to steal the show.

Tuesday, May 24, 2011

Earning and Learning What Our Culture Values

New list out on this morning shares the ten top earning college degrees and the ten lowest paying degrees.

Highest Earning Majors

Lowest-Earning Majors

I was stunned to see that 8 of the top 10 are Engineering degrees, not shocked though that all of the top ten require a heavy dose of Math and Science.
To be sure, we need engineers and I know that the work they do is invaluable for every facet of life, so I don't have any problem with them being well compensated for their work. What disheartened me most is the second list. The 10 lowest earning college degrees. There is nothing shocking here either-I know how poorly people in these professions are paid, but I can't ignore it and I can't stop thinking about the constant message the low wages and often rotten working conditions of these professions sends out to students pursuing their educations and to the world in general about what our culture values most and what it values least.
The Washington Post in relating this same information actually had the nerve to refer to some of these majors as "Fluffy." Pardon me? I dare any electrical engineer to go on a home visit with one of my social worker friends and remove a battered, lice ridden child from drug addled, abusive parents. It is with a true sense of pride that I see how many young men and women continue to pursue professional life as social workers, knowing that when they graduate they will have to pursue a 2-3 year graduate degree and will still earn less than a first year computer programmer.
I am not even asking for people in the humanities to earn the same as engineers, but can't we at least make sure that people who go to college and earn a degree and work for a living in their profession actually be paid a wage that does not require them to work two or even three jobs to sustain a family? Forget the nonsense of competing for bigger houses or cars. I mean just being able to raise a couple kids, a dog, pay for karate lessons, and save for retirement.
Our society is dependent on the variety of professions that spring from math and science, but it is also dependent on the humanities, fine arts, and helping professions of all kinds. The world needs art of every kind to inspire everyone from engineers to physicians and we should be happy to pay for it. Every child should get to experience art firsthand and more importantly, try their hand at it themselves with an art teacher or artist.
Our society needs to have advocates for those most vulnerable and they should be compensated well for the emotional and physical work they do day in and day out. Social workers reach every kind of person in every stage of life and without them millions of children with disabilities, aging adults, people with mental illness, and every other kind person in need would go without the support they need to be successful. Two individual examples from my own little corner of the world, Mr. Scheuer and Mrs. Mountz.
Over the weekend and for the last 6 weeks the kids at Henry's elementary school have been preparing to star in an original musical production. There have been myriad rehearsals, set buildings, and costumes to prep and the two adults most responsible for all of this are an inherently goofy and inspiring music teacher who wrote the play and the score, and the school art teacher who helped Henry create his own Andy Warhol portrait. Saturday I watched Mr.Scheuer herd 50 elementary age kids through a rehearsal and direct parent helpers without once losing his temper. When one student was obnoxiously noisy while others were performing he called attention to the quiet ones without shaming the noisier and got the quiet he was looking for at no expense to anyone's pride.
In truth, Henry joined chorus this year on the sheer exuberance of Mr. Scheuer alone. He can't sing like Placido, and will very likely never sing for any kind of recording, but Mr. Scheuer has reinforced and rewarded Henry based on his participation all year along. In fact one afternoon I got home and Henry proudly announced that he had gotten Skittles from Mr. Scheuer during rehearsal that morning. When I asked why he said, "Cause I'm so enthusiastic!"
Every child deserves to have a teacher like Mr. Scheuer and be exposed to the way music can make you feel physically and emotionally, the way music moves you body and soul is a gift worth without price. As for the art teacher Mrs. Mountz, to say she is dedicated is simply an understatement. She has collected boxes and managed to keep a swirling group of parents and volunteer middle schoolers on task and painting and building for the better part of 8 hours Saturday. By showtime tomorrow the Kindergartners will see a working version of Big Ben and a rolling double decker bus. (I myself helped put the cockroaches in the villains kitchen.) Like Mr. Scheuer she makes progress with unruly kids by reaffirming their positives and she manages to keep a sense of humor when all that stands between her and sanity is a cadre of hormonal fifth graders and a sea of tempera paint.
Neither one of these teachers is going to get a financial reward for all their efforts-money doesn't motivate their work-the work and their love of art and children motivates them to devote almost every moment of their free time to productions like this, a production I know will be remembered fondly by every child included in the adventure. When Henry auditioned and got a call back he ultimately got the role he coveted most, police chief. But since the play is set in London he is Constable Wiggins and since the play is about a lost mouse, he is in fact, a mouse police captain. In Henry's mind this was, in fact, a major casting coup, "Mom, I get two costumes! I'm a MOUSE and a POLICEMAN!"

When Henry talks about school he says 5th grade is his favorite year ever and I know in large part it is do to the extra effort of two artists who know their real value no matter what price our culture places on them. As a nurse I get compensated with a living wage, yes, I could earn more, but what I earn is enough because I love what I do, I am rewarded emotionally, professionally, and in so many other ways by the work I do and I know the work I do is valued by our culture at large. Professionals who share the joy of learning, the arts, speak for the least of these, entertain, help others find their voice, and tend to the spiritual health of their communities should be lauded and compensated like their work means something.

Because without it all the well engineered inventions in the world will be meaningless if the culture surrounding them does not inspire creativity, celebrates all kinds of gifts, and is willing to pay the price.

Read more:,29569,2073703,00.html#ixzz1NHB0KOBS

Friday, May 20, 2011

Peace, Antisemitism, and a Palestinian State

Today Israeli Prime Minister Benjamin Netanyahu will be meeting with President Obama at the White House. The timing is awkward given that yesterday President Obama laid out his vision for the Middle East and North Africa, including returning boundaries in the contentious Israeli/Palestinian border back to there 1967 locations. Kind of like telling your mother in law you never intend to bear grandchildren for her and then having a cookout the next day.

To say that this is a hot potato diplomacy wise is an epic understatement. Realistically, making any suggestions as to where the lines are drawn in the Israeli/Palestinian land disputes is akin to political and social suicide. Someone at some point will brand Obama as an antisemite and then the fur will fly and once again any reasoned conversation will give way to extremist nonsense that benefits no one, most especially the people who populate the coveted real estate.

Much like the abortion debate in the U.S. it seems impossible to have a reasoned, thoughful conversation on the topic of the Israeli/Palestinian conflict. Dating back to before many in the dialogue today were even born the debate is rife with feelings of betrayal and anger-much of it directed at groups of individuals who had nothing to do with the centuries old conflict. The debate has become a pivotal issue for politicians seeking backing and more important, money from PACs and private donors with deep pockets and deep ties to Israel.

I don't pretend to be an expert on Arab-Israeli politics. But I do know that for my entire life there has never been a moment of true rest for that part of the world. There is no one my age living in that part of the world that knows what it would be like to live without the specter of violence overhanging every walk to school, to a mosque, to sit Shiva for a lost relative. Every day suicide bombers, gunfire, bloackades, threats, streetfights, discrimination, food shortages, mandatory evacuations or evictions.

A life where by age 5 you have seen a bloodied body in the street and been told over and over again that you are worth more or less than another child who is of the opposite persuasion-when really, all you are is a child stuck in the no man's land of conflict that adults have created and perpetuated.

Therein lies the problem for both Israelis and Pa;estinians-no one alive in either group has any idea what peace and quiet look like and no one is willing to believe that committing faith and energy to a true peaceful resolution of the confict is really worth it. for years I struggled with trying to build healthy relationships with people-I was stuck behaving the way I always behaved in my intimate relationships with family-crazy alcoholic family nuts. I sought out crzy, broken birds to be in relationship with, because even though it was misery-it was a misery I knew how to live with-not an unknown quantity to be reckoned with or learned.

In simple terms that is the crux of the conflict between Israel and Palestine-no one has any idea what it would be like to simply stop fighting over neighborhoods and boundary lines and simply let one another live. The very thought of putting down their arms and simply sharing power is too threatening to even consider and so anone who suggests Israel relent is antisemitic and any one who suggests Palestinians share leadership with Israelis is branded anti Islamic.


The children born this morning to Palestinian and Israeli mothers deserve the opportunity to play in the street without dodging bullets, have safe homes not dictated by arbitrary politics, worship with their grandparents without fear of retribution. And the only way that true lasting peace can come between Israel and Palestine is if the leaders of other nations can speak to the need for compromise without being branded Anti Semitic. Name calling gets no one anywhere, and thousands of years of violent history should be proof enough for anyone.

Tuesday, May 17, 2011

Addiction Apologists

By the the time I post this most everyone in the world will know that Arnie couldn't keep it in his pants and fathered a child outside of his marriage. Probably not the only straw on Maria's back, but I'm guessing it probably lit the match as far as her decision to separate from him formally.

For his part, Mr. Schwarzenegger has been appropriately contrite and apologetic in the press, no looking for redemption or offering explanation as to his shitheel behavior. This doesn't make it any nicer, but in contrast to some of the other celebrity divorces of late it is certainly an improvement. Now for something completely different.

Meet Jesse James, tattoo afficionado, chopper creator, loser ex husband of Academy Award winning actress Sandra Bullock. "I cheated on my wife. Guess what millions of men do that." Indeed they do, but most at least have the good grace to appear contrite and keep their mouths shut. They do not go on to write a tell all book detailing their conquests or describing in detail their preferences and the fact that good old Sandy isn't quite as wild in the sack as say the newer tattoed broad he is currently bedding.

Is it too much to ask to just, SHUT UP.

I do not care that you had a miserable childhood, get in line.

I do not care that you have an addicition. In fact-shut up about your addiction and recovery. You are the reason people and lawmakers do not believe in funding treatment for addiction. If you were truly in recovery you would be making amends to your former wife, your children and your friends. You would not be airing out every bit of dirty laundry, sexual prowess, and history of trysts to the world and making a profit off of it.

There are hundreds of millions of people in recovery and they have worked and continue to work to stay sane, sober, and healthy. They do not seek the limelight, they seek real life, unimpaired by their addiction (s) and you sir are not in recovery and the only steps you are working are the ones that lead further down the path of no return. I believe sexual addiction is a real problem, and I believe recovery is possible for anyone. I do not believe for a moment that Jesse James is in recovery and I am tired of him and others of his ilk bastardizing the process of healing with their moronic, self serving myopia.

At the heart of it all addiction is the most devastating form of selfishness and self absorption. It takes years to retrain and refocus a brain, body and spirit to living life differently. Not 6 months, a new girlfriend and a fresh tattoo. So Jesse take a moment, go to a meeting, get a new sponsor, and SHUT UP.

Monday, May 16, 2011

Making Peace

My favorite patient died on May 1st. I discovered this on Saturday night about 4 a.m. after I finished writing he and his sweet wife a little note to say hello. I went to look up his address and had the wind knocked out of me by the word deceased on his facepage.

He was 83 years old and had been diagnosed with a form of lung cancer over the winter. He had a short course of treatment, lost his hair, lost a little weight, otherwise he did ok. At the end of his treatment though his doctors recommend he do 25 radiation treatments "Just to be sure." He wasn't happy about it. He didn't want to do it, but at 83 he was used to the doctors knowing what they were talking about and so he resigned himself to doing the treatments.

But he also looked to me and the other nurses who cared for him to confirm that he should do it. Now, I sit here feeling like a traitor to him and his precious wife. I feel like I gave him the company line, when what I should have said was, "Well you are 83 years old and you have had chemo and if you don't want to do the radiation just tell them no and make peace with your decision."

But I didn't. I said something like,"Well if the doctors think this will give you the best chance at survival you should go ahead and do it." So, his life ended on a ventilator, in an Intensive Care Unit, with pneumonitis and pneumonia likely brought on at least in part by the damn radiation treatments and here I sit, complicit in the crime.

No, I didn't kill him-but did I do enough to make sure he knew the decision was his and not the doctor's? Not his wife's Not his cancer's or his grandchildren's or his priest's. The decision to endure radiation treatments should not have been accompanied by the external pressure of his healthcare providers-we should have given him all the details, respected his choices, and let him go home for 6 months, a year, or a decade.

But we didn't, he got pushed by all of us into radiation, and now he's dead.

The day I accepted by original hospice nursing position I was working an overnight shift in a San Antonio ICU and the patient was an 80 year old man who had been "found down" in his nursing home, and got "brought back" before anyone checked to see if he had a DNR. As luck would have it, he did. But by the time anyone saw it the poor SOB had been shocked, intubated, and was now spending his last miserable freaking days on a ventilator being continuously dialyzed, and that night every time I suctioned secretions from his lungs I chanted to myself, "This is why I am going to hospice, this is why I am going to hospice...."

And I did. I worked in Hospice for close to three years with adults and children and it was rewarding and challenging and I loved it-but between remarriage and two deaths at home on hospice I had begun to feel like everyday was "Take your sickle to work day" and I needed a change. So I came back to the medical and surgical side of things and there isn't a day that goes by where I do not find myself torn between telling people what they want to hear, what they need to hear, and what I can responsibly tell them as a part of their healthcare team.

This time I didn't do it right and now I am left with my grief, my conscience, and the hope that I will do better next time. The next time you are a patient remember that the people prescribing and providing your care are human too and therefore your care is inherently flawed. 

Clinically he should have had the radiation treatments, but realistically, an 83 year old man with a 50% survival rate after chemotherapy should have been allowed to go home and read the paper and flirt with his wife. Next time I hope I err more on the side of flirtation than radiation.

Saturday, May 14, 2011

Custody and Cancer

This week a woman in North Carolina was told that she has to relinquish custody of her children to her ex husband who lives in Chicago, IL. The woman in question has been the primary caregiver for the children since birth and she is also a cancer patient.

By all accounts the marriage was a miserable affair. Evidentally affair is the operative word in this case as both parties had sexual relationships outside of their marriage, there are also allegations of physical and emotional abuse and both parents spent a night in jail after a fight turned physical.

So let's skip that part of the story. They both kind of suck, and clearly, as is the case in many marriages ending in divorce, they are not quite done shitting on each other yet. Unfortunately their two offspring are in the way and being used as pawns in the 21st century game of custodial chess.

The reality here is that these kids are facing a lot of misery-but maybe not any more or less than if their parents had stayed together in a miserable marriage. There are unfortunately millions of children like them here in the U.S. being shuttled between homes and parents and used as bait in everything from financial to psychological negotiations. I have a wee little girl asleep in my house this weekend who is one of them, and we don't pretend to be a perfect family either.

What terrifies me about the judge's ruling in this case is the fact that a parent with a diagnosed illness has been given a shelf life and an expiration date for parenting. The judge in this case heeded testimony from a forensic psychologist that stated children in these situations do better with more contact with the "non-ill" parent. While I don't doubt that the judge and psychologist could be very well intentioned. I don't believe they thought about the precedent being set by removing children from a parent due to their medical diagnoses.

There are certainly cases where an ill parent cannot successfully or safely parent a child-but by all descriptions, this is not that kind of case. This is a case where a patient has been classified as Stage IV by her oncologist and now the court system has determined that means she is actively dying. But she's not.
She does have metastatic breast cancer and it is in her bones. In all likelihood she will die as a result of breast cancer. But when she will die is anybody's guess. Because of the research and treatments available she is likely to survive 5 or 10 years, quite possibly more and there is no oncologist who will tell you she is dying.

She is living with cancer. Just like parents who are living with heart disease, diabetes, bipolar disorder, Multiple Sclerosis, Parkinson's Disease, and HIV. Custody matters should be based on the parenting ability of the parents in questions-not their medical diagnoses. In her decision Judge Nancy Gordon stated that, "Children want a normal childhood, and it is not normal with an ill parent."

Normal for whom? Is it idyllic? No, but real life very often isn't. Children deserve the opportunity to be raised with loving committed parents. Those parents can be of either gender, any race, ethnicity, religion, or sexual orientation, and they can have a chronic medical condition that does not hamper their ability to love and nurture another human soul. In many cases it may very accentuate their ability to do so.

There is a balance of course, and I am not suggesting children should spend their every waking moment cleaning up vomit after Dad's chemotherapy treatment. But I do know that my own sons learned a lot about caring for others from helping their grandfather when he was unable to do something because of his Parkinson's disease, or walking with their Great Grandmother to and from the sanctuary at church when she needed a little more supervision because of her dementia.

In retrospect some of their funniest memories are of the way Grandpa terrorized people at the hardware store on his scooter, and the way we had to move the salt away from Great Grandma because she would vigorously cover the same plate of food with it three times due to her forgetfulness. The boys were part of the family journey. Grandpa didn't just disappear one day. He died at home, and they held his hands before and after, and they grieved his loss with all of us.

The judge in this case is forgetting that children live in the real world, not in a Disney movie. The real world has flawed parents with crappy marriages, and sometimes those parents get sick. But that doesn't mean they stop being a family and shame on anyone who tells a child they have to lose their mother twice. First, to a court decision that ignores the flawed uniqueness of every family. Second to a disease that doesn't discriminate against anyone-including judges or parents.

Friday, May 13, 2011

The Men I Hope I'm Raising

I have a patient in the clinic right now that is only 33 and is fighting her 2nd round of metastatic disease related to a gosh awful syndrome that effects her family tree. The syndrome places her at high risk for developing soft tissue cancers and so this young woman has experienced a lot of illness and grief in a short life, watching multiple family members fight and die miserable cancer related deaths.

She never planned to marry. She was pragmatic about it and figured, it simply wasn't fair to anyone to put them through all of that misery when in all likelihood she would die and leave them alone again anyway. So she made a life and career for herself and she did some online dating with no intentions of tying the knot.

Enter Mr. Wonderful. He is the same age as her, fell deeply, madly in love with her, and asked her to marry him for five years. She finally relented, they married and three months later she was diagnosed with breast cancer.

Because of her genetic stew the cancers she is prone to are not "polite, sorry to interrupt your life, there is a little spot on your breast" cancers. No, there is nothing polite, tidy, or forgiving about her cancers. They roar into a body that was healthy one day, and riddled with disease the next. In fact she was treated for and in remission from breast cancer in January of this year and six weeks later she had a new metastatic pancreatic tumor.

I met her the very first day she came for treatment in March for this new virulent cancer that was already causing pain along her spinal column and painting spots on her liver. Tearful, frightened, overwhelmed. She looked at me grief-stricken and said, "Is there really any chance this is gonna work?"

I offered her reassurance, a chaplain visit, other nurses visited, her doctor visited. But more than all of that her husband sat beside her and whispered in her ear tenderly, "I'm right here baby, right here."

There are moments as a nurse that simply take your breath away. Too private for you to be privy to and yet you are there and part of the inner sanctum of marriages and families. I try to be what my patients need me to be on any given day: funny, thoughful, prayerful, quiet, listening, distracting. With every visit what they may need from me is different and just as I take their vital signs I also take a reading of their emotions and figure out how to navigate as their nurse in that moment.

In the months since her treatment began I have come to know them well and she has struggled. Her treatments have made her physically and emotionally ill but she has made a turn towards a little respite and I am grateful that she and her Mr. Wonderful will be able to spend a week at the beach pretending to be thirtysomethings in love and not squezzing in romance between chemo appointments.

What continues to stop me in my tracks every time I see them though isn't her resolve or charm, it's her husband. He is easygoing, devoted, and passionately in love with his wife. He loves her bald, pudgy from steroids, tearful, drunk on sedatives. He loves her with the level of commitment that most marriages need years to develop. I care for older patients and see the wisdom of 40 years of peaks and valleys in the way they battle cancer-but in younger patients I never see that, I see impatience and hurried hopefulness usually as a mask for terror.

I've never seen a man who loves his wife the way Mr. Wonderful does-never. I know my darling loves me and will be with me through thick and thin. Thankfully he hasn't had the opportunity to stand by me through this kind of crisis. I know a lot of devoted husbands and I know they will step up to the plate and be the partner their wife needs and deserves if they are needed.

But Mr. Wonderful is different-he is a tangible example to me that hope remains for a generation of young men that the media considers less concerned with the real world and more interested in technology, less concerned with personal relationships than personal status. He's the kind of man I hope I'm raising.

Dorothy Parvaz update

Revolution isn't free

Once upon a time I was a journalism major. I dropped out of college soon after being chosen to be the editor of my college newspaper-when I did return to college I got a degree in nursing but I still relish the news and newswriting. I like being well informed, and as my oldest and dearest friend Denise says, "I am the they in 'they say'."

I torture my children with NPR on a daily basis and love to peek at news sites during my work day. I am not a snob about my information either-I freely admit to enjoying celebrity nonsense as well as the more important world news. The media in the United States gets a lot of grief for being too invasive, too exploitive, too liberal. On any given day most anything published could be accused of at least one if not all of these complaints. But that really isn't the whole story.

Journalists in the United States enjoy unparalleled access to what becomes our news in real time and most of us take it for granted. We assume that if something important happens we'll find out about it at the top of the hour. There won't be a coup or conviction without us getting the full scoop. For many people in the world though that kind of access is not a standard, but the exception.

The Committee to Protect Journalists website keeps a running tally of press freedoms and restrictions around the world and posts information online regarding journalists jailed, tortured, or killed in pursuit of the news. At the end of 2010 the CPJ was able to confirm 145 journalists worldwide that were being held based on their attempts to cover the news. Almost 50 percent were in Iran and China, and given this springs historic events I am sure the number of imprisoned journalists in the Middle East is now much higher.

This year alone in less than 5 months, 16 journalists have been killed and their deaths have been directly attributed to their work. More startling is that since 1992 when the CPJ was formed and began keeping track of its' own-861 journalists have been killed worldwide. 861. Many no one ever heard of, no one ever read their stories.

Currently Dorothy Parvaz, a reporter for Al Jazeera, is being held without any communication in Iran. Parvaz holds dual citizenship in Iran and the U.S. and has traveled many times between the US and Middle East to provide an insiders view on the politics and culture of the Middle East. Parvaz had traveled to Syria where she was able to use her Iranian passport for entry to the country. Once her identity and her dual citizenship were discovered Syrian officials accused her of not telling them she was a journalist and shipped her to Iran, where she has been inexplicably kept without any communication since April 29th.

Iran has absolutely no reason to hold her, other than not liking nosy, opinionated broads, and I feel quite sure Parvaz is both. But Iran and Syria, and other countries ruled by leaders who continue to cling to autocratic and dictatorial rule, are threatened by the very existance of the media, much less  the free and open flow of information that Westerners take for granted.

Here's the truth though, the days of hiding in plain sight while you beat and bludgeon your citizens into submission are coming to an end. The evolution of the media and the innovations provided by technology have all but sounded the death knell for those who would hide their evil behind a cloak of protection for their countrymen.

The Middle East has erupted with a cacophony of tweets and blog posts from the epicenter of the chaos and it is at once both terrifying and thrilling for the soul. I can imagine the palpable feelings of joy and fear intermingling in the crowds and like the rest of the world I have watched in awe as these people have shown unflinching bravery in the face of knowing they would be beaten, jailed, even killed for demanding the right to choose their own way.

Those brave souls found out about the corruption within their own countries the old fashioned way. They read the paper, or heard the news from journalists within their own countries who were brave enough to root out the information without the Freedom of Information Act or the Bill of Rights. The very least we can do is make sure the men and women who continue to spread the word and shine a light in the deepest of chasms are safe from harm.

Becausee if we don't protect the rights of journalists around the world and demand the release of our unlawfully imprisoned US journalists, we may not have anyone around to tell the world about the next revolution, and we'll have no one to blame but ourselves.

Wednesday, May 11, 2011

Who Really Loses When States Stop Funding Planned Parenthood?

I drove home yesterday after a long day on my feet caring for a variety of patients with cancer. The last patient of the day is 23 and was diagnosed with a virulent form of cervical cancer related to a Human Pappilloma Virus (HPV) infection just six weeks ago. She was initially diagnosed by her nurse practitioner at a Planned Parenthood and came to my hospital for surgery and chemotherapy. She has a more than 75% chance of survival and although she will never bear children of her own, she will live to adopt, be an aunt, finish college, get married and get on with her life. Her journey to my chemo chair was heavy on my mind as I listened to All Things Considered on NPR and heard the story I have linked to below.

Then this morning I saw on CNN that the courts have said Indiana can restrict funding to Planned Parenthood so I guess that makes it official. If you are poor and uninsured in Indiana, you can also plan on not having access to contraception, an affordable pap smear or a mammogram. Good times.

Every few months, and certainly every election cycle, the far right anti abortion advocates sprout up like weeds and begin to spew half truths and out right falsehoods about Planned Parenthood. Elected officials who want to remain elected then begin their difficult tap dance of being "pro woman, but not pro choice." and in the end once again, it is the poor and uninsured that bear the burden of electoral politics. Planned Parenthood is not an abortion factory. In fact only 12% of all people served by Planned Parenthood in the last 12 months sought an abortion. Of all the health care related services provided by Planned Parenthood only 3% are related to abortion, and those services are not federally funded.

That is in sharp contrast to the estimated 600,000 unplanned pregnancies prevented by the contraception provided by Planned Parenthood. In fact with their educational efforts, clinics, and outreach in developing countries Planned Parenthood serves over 5 million people annually. No, they are not all teenagers trying to get condoms, in fact, only about 20% of Planned Parenthood's clients are less than age 20.

Do not misunderstand me, I do not believe 13 year old's should be able to have an abortion on a street corner or have access to condoms in the lunchroom-"juice box or prophylactic?" But I do think it is time to stop making the entire reproductive health conversation about abortion. Frankly, if we have the conversation like reasonable adults, abortion will be the smallest part of the equation when all is said and done.

We can't afford to demonize an entire organization for providing services that are LEGAL. I don't like abortion, and I would prefer no one ever needed one. But I live here, in reality, where women are raped by family members, diagnosed with cancer during their first trimester, and discover Tay Sachs in their genetic stew after becoming pregnant. Sometimes, abortion is a valid choice and it is a LEGAL choice.

I have two biological children, the first was the result of a lot of love, and a failure of our contraceptives. I do not regret him for a moment-but when I became pregnant I was 28, in a loving relationship, employed, insured, and healthy. I had options that many women can't even imagine. I am now parenting that child through the teenage years and having conversations that make my insides squirm.

But again, I am having those conversation now, and offering information now, so that I do not have to be a shoulder to cry on later. My sons will both have the Gardasil vaccine, not because I want them to go out and bed every woman in the county, but because I do not want them or the partner they do eventually have a physical, sexual relationship with to be at risk for HPV.

What makes me angriest is that when "pro-life" organizations rally against Planned Parenthood they are not rallying for the lives of women-they are rallying for the fetuses women could potentially carry, not the living human beings seeking health care. Last year 1 million women got their pap smears at a Planned Parenthood. The bulk paid on a sliding scale and would not have gone to another doctor due to cost. These women deserve to continue getting care that is focused on their needs and those of their families.

Pro life should mean more than anti abortion. Being pro life should mean advocating for safe health care for people in all stages of life. Instead of having the same arguments over funding and Planned Parenthood elected officials should focus on the lives of their constituents, and making it possible for them to have healthy productive lives that fulfill the American dream.

Tuesday, May 10, 2011

Aging Without Grace

I have a patient who weights about 80 pounds soaking wet and tops out at about 4 foot 9. She is beyond petite, but her personality appears to be where she compensates for her diminutive stature. She is to put it mildly, a pistol.

Actually she falls more into the category of cranky old battle axe-but for whatever reason I have fallen for her and her cranky pants demeanor.

She is bald and slightly stooped and resembles the actress, Margaret Hamilton, who played the Wicked Witch in the film version of The Wizard of Oz. Her husband is about 6'5 and weighs at least 250 and is without question the most henpecked SOB on the face of the earth. From the moment she sits down until the moment she stands to leave after her chemotherapy she does not draw breath. She instead produces a constant stream of bitching and complaining about everything from the dinner menu to her children, the weather and the economy.

I, being the obnoxious sort, have now developed a relationship with her that allows me to interupt her perpetual bitching with, "For the love of everything M, stop fussing, you needed to breath." Pause.
"Oh, Patti...cackle cackle cackle."

There are other patients who will see her coming and actually pull the curtains around their area for fear of having to listen to her bird dog her husband all day, and some who will ask to move. When she is in rare form she will ask everyone around her what kind of cancer they have, where it started, if they have a colostomy, and so on. I have actually interrupted her treatise on bowel movement management more than once to save a patient who was looking green at the gills.

The first time I had her as a patient she was with me for four hours and at the end I said, "Mrs. M what kind of work did you do before you retired?"


"I bet you were a lawyer," I said.

"Oh no dearie, I don't like to argue with people."

Silence throughout the clinic followed by an eruption of belly laughing from every patient and family member within 50 feet of her.

She glared.

She pouted.

Finally, I stopped laughing, wiped my eyes and said, "M, you are lucky it isn't storming because you would have been a lightning rod with that whopper you just told."

She grinned. Her husband to his credit spent the entire time behind his newspaper, for fear of her seeing his smile I'm sure.

Turns out she was a fifth grade teacher. I cringe at the thought of her tending to one of my kids. I can only imagine her teaching style would be brusque and uncompromising to a fault. As petite as she is-she completely fills the room with the force of her personality, no doubt a vestige from her days of being a tiny woman in a man's world.

She is a pill to be sure, but I find her transparent nosiness and irritability somewhat charming. I appreciate the fact that she does not want to be the, "sweet little old lady with cancer." She intends to be a complete and total pain in the ass-and most often she succeeds.

She continues to care for her husband and remind him about his doctor appointments and medications, plan their meals and grocery list, and set times for them to perform their yard work together. "If I don't get him out there early he'll keel over in the sun honey and I'll play hell dragging him in the garage to recover."

There is a deeply ingrained cultural myth about aging women, mothers and grandmothers that is I suppose meant to be a compliment or at least it was, but in today's world the constraints of being the doting grandmother would be too restrictive to a generation of women who worked outside the home earning their own salaries, and no longer define themselves based on their relationship with or without a man.

She is more a caricature than I think she realizes, and if she had been born fifty years later she might not have developed such a coarse way of dealing with the world. The reality is however, that she is a remarkably spry 80 year old woman with cancer playing the cards life has dealt her with spirit and determination and an unwavering belief in herself.

What's not to like about that?

Monday, May 9, 2011

Women, Nonsense, and Hillary

So I don't know if any of you heard, but the U.S. finally offed Bin Laden last week, but by Thursday the web was abuzz with discussion of the now infamous Situation Room photo with President Obama looking stoic and presidential and Secretary of State Clinton looking concerned and with her hand in front of her mouth.

Was she worried? Upset? Scared? Feeling Maternal? Confused by her ovaries in some other way?

Oy vey. Enough already. The woman had her hand in front of her face-that's it. She was not crying hysterically, clutching prayer beads, or holding hands and singing Kum Ba Yah with her neighbor at the table.

Why does every reaction by a woman in a position of leadership provoke concern or questioning by the media? It's 2011 and yet if a woman is in command she not only needs to perform her duties better than a male counterpart but she needs to look and behave like a man while she's doing it. And woe betide the woman who expresses emotion about a difficult decision:she'll be labeled as "dramatic" or worse yet, "tenderhearted." Then of course if she doesn't react enough, she's a bitch.

It's the age old double standard. President Obama gets flack for being emotionless, but the same behavior from a woman would mean she's able to put aside her feminine qualities. Really? Is that what it takes for a woman to be in charge in 2011?

I am biased obviously, because I am female. But here is the raw truth of it, I have had male and female managers, and I have been a manager myself. Through every part of my professional life over the last 8 years I believe my gender, my experiences as a mother, and my experiences running a family have made me better at what I do, more capable, more creative, and more determined to find the best outcome.

Women are still perhaps more in touch with their emotional selves, and that isn't a leadership deficit, it's an asset. Being able to fairly assess your colleagues based on not only their professional skills, but also based on their emotional intelligence makes for a healthier work place. To be fair I have also had male leaders who were more emotionally in tune and provided better management than any of their female counterparts in the same organization.

It's about leadership skills-not gender-and again, it's 2011.

I think what may have annoyed me most about the whole debate is the fact that Mrs. Clinton had to wade into the fray and state she thought it was a symptom of her spring allergies...Really? So it's ok to have the sniffles, but not cover your mouth in shock at a display of violence and the end of an era for our country?

I do not want leaders at work or the leaders of our country making decisions and reacting to them with only the analytical part of themselves. I want the whole enchilada-I want leaders who are engaging both their heads and hearts in their decision making. I want leaders who reflect upon their decisions and what the consequences of them are for the people on the other end of the bomb, raid, or embargo.

I want leaders who recognize that decisions have ramifications that can't be analyzed in a completely clinical way-there is a human cost to every endeavor and leadership that doesn't acknowledge that fact is at its best, ignorant, at its worst, incompetent.

No Golden Ticket Here

So when my son Nicholas was about 3 and a half, he finally began to notice that not everyone looked the same. In fact some of the differences were meant to call attention to if you asked his opinion.

His cousins are mixed race and so he suddenly noticed his best bud Cole was a different shade one day and said, 'Cole's brown." "Yes he is, just like his Mommy and Daddy," I said. pause. "Aunt Gegea is not brown(my sister, Genea). "Well what color is she?" "Grey." (Lucky Uncle Carry is the color of warm mocha.)

So began the slide for me into the perpetual parental embarrassment of having an articulate child. Nick's younger brother was 18 months old and both were seated side by side in a giant shopping cart at the local Petsmart. "Look at the bird!" "Look it's a ssssssssssssssnake!" "Mom that guy only has ONE ARM!"

Cue complete and utter silence in said store, except for the crickets chirping out their beleagured version of the Ave Maria before being eaten by the store iguana. "Sweetheart shhhh, we don't want to hurt anyone's feelings." "BUT MOM WHERE IS HIS ARM?"

"SSSSHHHHHHHH please lets use our quiet voices and I will tell you."

"okay....." So I began,"Nick sometimes people are born with only one arm or leg, or some times they lose an arm or a leg in an accident."


"Hush and listen, he looks very healthy, he works here with the kitty cats and see he is able to carry big bags of food and help people. God makes everybody different."

So from then on there were multiple situations each week where Nick would notice something different and we would review the ways in which people are different from one another and I would wind up each and every conversation with my best rosy comment that, "God makes everybody different!"

Six months later the day began as any other, I loaded up the minivan with the boys and drove to meet another mama at a local bagel store. I parked by the store and helped Nick out of his car seat and onto the curb next to the car where he could wait while I did the same for Henry. Suddenly, in full voice Nick bellows, "MOM, LOOK AT THAT GUY!"

(Cue sounds of internal maternal sirens on continuous loop)
Panic stricken I pulled Henry out of the car and turned to see a man about 3 feet tall at most, a little person.

"Nicholas shhhh, remember we don't want to hurt anyone's feelings."

The man smiled at the boys and continued waiting for someone in front of the bagel store. "Nick smiled back and pokes Henry in the arm and says,"HE LOOKS JUST LIKE AN OOMPA LOOMPA."

And then my precious now four year old turned and looked at me as the little person wisely chose to move farther away from our family,"I guess that's just how God made him, huh?"


Friday, May 6, 2011


I forgot to give the boys their ADHD medication before school yesterday morning. By the time I realized my error they were at school and Bob and I were at work and I had to let it go. In the big scheme of things this seems like no big deal, and to some out there I know there is a wonder as to why I would ever want to medicate my sons.

Here's the truth of it-I don't want to medicate them-I never have and I resisted for almost two years although my son's pediatrician from birth looked at me when Nick was 4 and said-"we probably ought to talk about ADHD." When I finally relented after he almost failed first grade I took both boys in and told Dr. Elliott I was ready he looked at me and then at the two tornados dismantling his exam room and said blithely,"so, can I go ahead and write two or do you want to wait?" I waited.

I also wandered through multiple trials and therapies with Nick to find medication that would help him manage his own behavior and be successful in school. He spent almost the entire year of Kindergarten at a separate table by afternoon because every other kid in the class was exhausted by him. As time has gone by we have had to adjust, readjust, stop, start over, revamp and reevaluate his treatment. The onset of puberty appears to have been similar to throwing a can of gasoline on a forest fire and his ADHD has erupted again to the point that there have been many moments I have cried and felt like all the work we did together, he and I, was for nothing.

But we have perservered. His school is working with us to develop some modifications to help him succeed, his current medications are working, and he is responding to our behavioral interventions at home. At the heart of it all he is a beautiful, loving, funny, articulate fellow and all I want as his mother is for the rest of the world to get to see who he really is behind the mask of ADHD.

Henry also takes medication for ADHD, but unlike his brother his has always been simple to manage with a low dose of medication. He is enjoying success at school, makes friends easily, is well liked by his teachers, self motivated to do his homework, etc. Without his medication though he is like a squirrel on speed, and if he and his brother are together it is like watching a couple of feral cats in a dryer running a marathon. They exponentially expand to fill all air space within 500 feet of them and within moments I find myself contemplating how long it is until bedtime, and when is it ok to start drinking heavily.

Because I am a nurse I have been fortunate enough to know how to advocate for my children with physicians, how to understand terminology, dosing, when to tell the doctors-NO. This is a long road and I believe Nick will need some medication throughout his life to help him manage his ADHD. Henry I am not sure-he may be one of the few who grow into adulthood and with a combination of behavioral interventions and maturity he may not need medication every day.

Some families have to worry about diabetes and cancer, my family tree is riddled with mental illness and addiction-addiction that was very often self medicating to deal with mental illness. I am honest with the boys, I do not forcibly shove medicine down their throats, and both boys are able to tell the difference in themselves when they miss a dose. I don't like that they are on medicines that can cause serious side effects, but I know for sure that life without the medications is miserable for them and everyone around them.

It's easy to be an armchair parent and say,"I would never allow my child..." But as with everything else in life until you have walked the road yourself do everyone around you a favor and be quiet. I see children and parents everyday coming in for treatment at my hospital-children with visible disfigurements and the pallor of professional patients. Often children who are chronically ill can become very demanding and entitled because they are so used to being the center of attention. I won't judge their parents though-because I can't imagine what it is like to constantly face the specter of death with a little one and try to be an effective disciplined parent. I imagine there are days where they are just holding on to make it to bedtime themselves.

I would never tell the mother of a child with diabetes not to use insulin or monitor her child's blood sugar, I won't tell someone to ignore asthma and pretend their child doesn't need an inhaler. Don't judge me for putting my child on medications for their emotional, physical, and and educational wellbeing.

Ask questions, absolutely. But don't judge me-I have two tender boys that deserve a chance to shine and they are going to get it with all my love, all my support, and whatever else they need to make it down the road-including medication.

Thursday, May 5, 2011


It should come as no surprise that the headline I read this week that most disheartened me came from a Fox Network affiliate in Houston. Next to The National Enquirer, and Weekly World News one can always count on Fox newscasts for thinking that strains credulity.

"Is TV too gay?" This is the question posed by a newscaster (African American and female) to her guest, American Family Association (only if it is a white, Christian, two parent, heterosexual family) leader, Bryan Fischer. There was no attempt at evenhandedness, no attempt to present more than one side of this issue or have a real conversation about what time slot is most appropriate for a show with many adult themed elements. The gay activist interviewed appeared stunned to even be listening to the drivel and simply said,"I don't know why this conversation is being held."

The heart of the matter cannot possibly be,"Is TV too gay?" For members of the AFA-any amount of gay is too gay, any amount of unmarried coupling is too much, any amount of non Chrisitan religious views is too much.

Fischer contends that constant exposure to all that is gay is creating an atmosphere of temptation. Uh, no. I agree that too much of anything is too much: chocolate, porn, alcohol are all fine examples. But saying TV is too gay takes us in to the realm where there are too many female focused programs on TV, too many  black folks on TV, too many fat people, too many short people...

I have watched way too many episodes of Law and Order over the years...I have a little obsessive streak when it comes to Sam Watterston, and yet, I have never committed a crime, become a police officer, evaded arrest, prosecuted a criminal, or learned to play the"Duhn Duhn" sound at the beginning of each new scene in my day. I enjoy watching Glee every week but I still can't sing, can barely dance, and certainly don't intend to get knocked up by a member of the football team while having a slushie thrown in my face.

Here's what I think about TV and exposure to things that are different. It's good.

Being exposed to people with different beliefs helps every single one of us learn about the wider world, develop a sense of compassion and empathy for those that are different, and become engaged in things that are happening beyond our doorstep.

When I was little I didn't know anyone with Down's Syndrome until middle school and even then those students were put in a separate room so all I had to go on was the fact that a) they looked odd and b) they were a little slow. Then in college I saw a program called "Life Goes On" with a main character who had high functioning Down's Syndrome and while it certainly didn't expose me to everything about the condition it did help me understand that people with Down's are first and foremost people, and their wants and dreams are very much like my own.

When I was a child my mother took me to the symphony, ballet, and museums. The arts were important just for art's sake, but as I grew older I realized not everyone had parents who took them to see a Broadway musical or a Picasso exhibit. I met people who had never been to a zoo or seen the ocean firsthand. For all the complaining we do about the sorry state of the media-the reality is television is a window to a wider world for many people who live in rural communities, for those who do not have access or the finances to enjoy the arts in person, and yes for some people to understand that gay people are just They love and lose, succeed and fail. They cannot all dance or craft a fancy outfit out of a ziploc bag and strategically placed bandana. All gay women are not golfers, bodybuilders, or k.d. lang afficionados.

There are still many parts of our country where the population is not very integrated religiously or ethnically. Some Americans may never have the opportunity to experience a Seder meal or see the inside of a mosque without PBS or the History Channel. There are lots of people who grow up without ever having a black or latino friend-but most can identify that black and latino families have similar struggles to their own.

No matter what your religious or moral beliefs are -seeing the other side of the coin and becoming educated about another persons life can do nothing but strengthen you for your own life journey-even if it happens at 8 p.m. Eastern/7 p.m. Central.

Tuesday, May 3, 2011

The real Queen Mother

My first real memory of the woman I would come to call Mom Cormie is of a vibrant fortysomething redhead with Union Jack knickers sitting on a piano in pub on the grounds of the Texas Folklife Festival. She was elegant and bawdy at the same time, naughty and ladylike, and always a good hostess. Her daughter was on her way to becoming my dearest lifelong friend and had invited me to the Festival. An annual event for her family Denise was neither shocked nor embarrassed by her mother's pub behavior and introduced me after the crowd finished a rowdy version of another traditional British pub song.

My own home life was neither elegant or ladylike-I couldn't begin to imagine my own mother on top of a piano, much less singing and showing off her undergarments. I was instantly enamored, more than a little jealous, and I knew I wanted more. Years passed and Denise and I grew into women, married, divorced, widowed, degreed, employed women. Mom Cormie became a teacher and earned a Master's Degree and then she taught scads of third graders. She taught for the love of education, never for a test, and she taught more with her approach and care than any book could ever demonstrate.

It was a cruel blow when her diagnosis came, at the time I hadn't really heard of Parkinson's disease and had no way of knowing how the horrible specter of the illness would come to so profoundly effect my life. With her diagnosis came the slow unraveling of her teaching career, her ability to write, speak, walk, her very independence.

She remained throughout every indignity, every inch an English lady. Committed to trying a new treatment, medication, operation-committed to being a mother, wife, grandmother, aunt, and honorary mum to the collection of misfits her kids brought home in need of mothering. She exemplified grace under fire through it all and when the unthinkable happened and her beloved was diagnosed with ALS, she dug deeper and found more strength to be the companion he needed in those last terrible days.

She is a shadow of the woman I met 30 years ago, unable to stand or care for herself any longer. She has lost her vanity in the last couple of years-a change that has been harder to accept for those around her than most anything else. Despite all the nastiness of Parkinson's throughout the years, one could always count on her being impeccably turned out, hair styled, jewelry coordinated with clothes and shoes. It seems the worst affront that her"lady"ness has finally been taken.

This Mother's day there is a lengthy list of things I have learned from the honorary mothers in my life: but the list starts with Mom Cormie. She was there when I became a woman myself and eventually a wife and mother. She was there when I buried my own mother and subsequently my husband. She demonstrated by her daily willingness to get up and face the world what it meant to be a woman, a lady, a mother and I learned from her what grace under pressure looks like, right down to the Union Jack knickers.

Monday, May 2, 2011


"An eye for an eye makes the whole world blind." Mahatma Gandhi

The news this morning has brought tears of joy to many, feelings of victory and satisfaction, a sense of completion. Yet for me I wonder if a death so long anticipated really brings anything to a close, or rather opens a wound in our human family even deeper.

It's hard to attribute human qualities to a man so demonized in our media and culture. The attacks of 9/11are the defining historical moment for so many in my generation. Too young to be truly involved in the national debate over Vietnam the Trade Center's destruction left an indelible mark on all Americans and even the most peace loving were left wanting retribution, justice, and the ability to make it all make sense and have a purpose.

Does the death of Bin Laden serve that purpose or give an America immersed in war throughout the Middle East any real sense of justice or vindication? How does the assassination of one lead to the ability for another to rest easy?

The world is no different this morning because he is dead. In the initial days there will be many who claim victory, even a moral one for the U.S. and there will be many who try to take his place or create terror in his name as a martyr.

U.S. soldiers will be more at risk this month because a new cycle of revenge will begin and the cycle of violence will continue unbroken. There was a time where I believed war was never justified. I had the hippie naivete to think that reason and compromise could result in solutions.

I no longer believe in that simplistic a world or in simple solutions to terrorism here and abroad. I understand that war and indeed violence is sometimes the only way to communicate with evil-but I also know that every time we lower ourselves as human beings to violence our own souls are wounded-our own humanity stained.

Osama Bin Laden was no innocent. By all accounts he was evil incarnate-pursued within by demons that intensified his hatred for the modern world, modern Islam, modern diplomacy. He used money and fear to finance hate and he was a success in a region of the world that is polarized by faith, money, oil, and relationships with Western powers. He preyed on the weakest and least educated and their fears of being overrun by white Christian oppressors and he succeeded because these hapless souls had little else to place their hope in-What futures? What professions? What stability?

The most radicalized individuals with the least to look forward to in their lives. While we Americans have been mired in economic doubt and uncertainty, al-Qaeda forces continue living day to day, hand to mouth. There are no fears of an inability to retire, fears over the stock market or dismantling of Medicare. No worries for the budget cuts of teachers. Nonsense and rubbish. Survival is the concern of these who have come to be known as enemy number one.

So where do we go from here? The violence won't come to an end-there will always be another tyrant to take his place. There is always a "bad guy" to subdue and we like to be the "good guy." But when do we stop being avenging angels on the side of all that is good and become forces looking for vengeance at any cost.

It's too simple to divide the world into right and wrong, good and evil. All of humanity has the potential for evil and when we allow those among us whose purposes are truly evil to determine our own behavior we lower ourselves into the filth with them-and no one comes out the "winner."

I don't have any profound answer. I don't feel better because he is dead-but I certainly won't mourn his death. His death won't satisfy my questions or grief for those lost on 9/11 or in all the days since in the name of justice.

We remain at war today, with one less enemy and a little less of our own soul untouched by violence. I pray for answers, I pray for peace.