Januarys Aren’t Joyful

narnialion

It’s January. Ten years ago on MLK Day, I had a rare day off because the outpatient developmental pediatrics clinic in which I was working was closed for the holiday. This should have been a joyous occasion for a newlywed who had been working 80 hours weekly (that the government knew about, anyway), not counting the hours agonizing over every decision once I got home to attempt fitful sleep at odd hours. I was homesick and mourning the loss of a beloved family member, but don’t those challenges happen to everyone?

 

But I woke up that morning sad that I was still there. I wasn’t suicidal–just apathetic and wondering how on earth my very happy life seemed beyond restoration.

 

Has anyone else lived through this?

 

This was uncharted territory. I’m an unquenchable optimist. My favorite color is yellow. I loved (almost) every minute of medical school. During an icebreaker game on the first day of intern year, we had to choose one alliterative adjective to describe ourselves: I chose “joyful.” Every day of my life had been infused with wonder and delight. I married the love of my life, and he was more perfect every day. I had matched at my top choice for residency. I have a loving, supportive family. My every dream had come true! I tried the Dr. Phil approach: “Hey, stop being sad!” I prayed. I called my closest friends.

 

Smith, not knowing what to do with his wife of just a few months, was steadfast. He listened. He spoke truth to me. He surrounded me by people who loved me. He encouraged me to find better separation between work and home so that I could truly rest. And on that sad MLK Day, he decided to take me on a cold weather adventure to paint pottery in a nearby town. We painted a dog dish for our beagle, Lucy, that has stayed with us longer than Lucy did. To this day, when I look at this dog dish, I remember how much my husband loves me and wants the best for me.

 

Soon thereafter, I was working on the pediatric floor in a particularly severe respiratory virus season and had to send a child to the intensive care unit every night I was on call. At the time, I was so bone-tired and unmoored that I just knew that these children became sicker because I was such a horrible doctor. I thought that my decision to be a physician (my dream for longer than I can even remember) was the sole reason for my state, but I couldn’t fathom doing anything else. I didn’t have the insight to know that I was clinically depressed, but even so, there was little time to deal with it if I had known. I grieved through our Valentine’s Day date and could hardly talk to my husband, my favorite person in the world. Food lost its taste. I would sit through church and cry. Outings with beloved friends became joyless. I would drive home post-call and not really care whether I made it over the expansive Betsy Ross Bridge safely. Realizing that none of this was normal, I saw a counselor. He offered that “practicing medicine isn’t for everybody” and appeared to be reading from a template that I was a “high achiever due to high parental expectations and needed to earn love.” This was ludicrous–my parents would have loved me and would have been proud of me if I had worked at the same dog food plant that gave my grandfather a gold retirement watch for his years of honorable factory labor. I paid the counselor and left, determined more than ever to find someone to help me. I was thankful for a spark of anger—motivated that I could feel anything at all.

 

Why am I sharing something so raw and so real?

 

Because you might be in the same place. Because, on MLK Day 2018, we took our children to paint pottery and watched them cheerfully create some truly hideous ceramic mermaids. I am a practicing pediatric specialist in an underserved area. I am incredibly happy. My faith is strong. My life is full of joy. And if I hadn’t hung in there with the hard work to heal back in 2008, I wouldn’t have had such a magical day–such a magical life. Smith is thriving as a pastor–and speaks of my time of depression as formative in his decision to leave a military career to go to seminary.

 

Looking back, I see God everywhere. I dug as deep as I could, trying to find the answers for the suffering of innocent children as I encountered over and over again the brokenness of our world (that’s a book, not a blog post). In doing so, I built a strong foundation to serve me the rest of my career. I examined my priorities. Fellow residents and attending physicians talked openly with me and extended lifelines. I took an antidepressant for a few months until I was able to maintain reasonable self-care off medication. The following year, I was ready to face a melanoma diagnosis with strength and resolve rather than devastation and defeat.

 

I’m begging you, if you’re struggling, reach out for help. You may have to reach out repeatedly, as I did after my ill-fated first counselor experience. (Please hear me: counseling with a qualified professional is incredibly valuable. And spoiler alert, your pastor or other religious authority may not be a “qualified professional.”) I asked my long-time friend, psychiatrist Julia Wood, MD, for her tips on finding the right counselor. She emphasized, “Fit is incredibly important, so if you don’t have that, don’t be afraid to move on. You can even ask the counselor themselves for another recommendation. They may have good ideas. Also, look for someone who has a modality they draw from—such as cognitive behavioral therapy (CBT), for example. A therapist should be able to explain his or her approach—it’s not just chatting or listening.” She also suggested checking http://www.NAMI.org or a Celebrate Recovery group at a local church.

 

Here are my other tips, based on your experience:

 

  1. Find your village. Find people who you can speak openly to, ones who won’t accept “I’m fine” for an answer when you’re not fine.

 

  1. Establish good boundaries. Do not assign blame to yourself that is not yours to own. There’s no prize for burning yourself to a crisp, and the people you serve won’t benefit from your martyrdom.

 

  1. Don’t be afraid of medication. Depression is ultimately a neurotransmitter problem that needs to be corrected. Refusing treatment is as foolish as rejecting insulin for diabetes or antibiotics for infection.

 

  1. Exercise. Even if that’s running up the hospital stairs instead of using the elevator.

 

  1. Food doesn’t fix depression. I promise. When you’re a bottomless pit of despair, food will not fill it. (Neither will spending more money, so I’m told.)

 

  1. Find every opportunity to be grateful. Gratitude is light in the darkness. I read Ann Voskamp’s One Thousand Gifts nine years too late, but it’s a gem; I’m currently loving Katie Davis Majors’s Daring to Hope.

 

  1. Pray. Pray, and pray some more. Meditate. Center. Talk openly and honestly with God–read the Psalms for inspiration.

 

And perhaps, here’s my most important piece of advice. January is a hard time of year. It’s like the White Witch’s Narnia–always winter and never Christmas. It’s dark almost constantly, and the sun is so very far away. Healthcare workers are especially vulnerable–hospitals are full and busy, we often work despite our own sickness, and surrounded by others’ suffering, we feel that we can never emerge with any joy intact. If you’re a seasoned hospital worker, keep a sharp eye for people around you who are struggling. Offer them warmth and light in a season that seems void of both. You might just save a life that isn’t on your patient census.

 

I’m reminded of my former senior medicine resident Carletta, who was instrumental in shepherding me through my struggle from across the country. She told me about a young participant (let’s call her “Susan”) of a Bible study she was leading who came to a session visibly distraught. Susan confessed that she felt awful since stopping her medication, Lexapro, but that she was feeling so much better in her vibrant church community that she felt taking it was a sign of weakness. Carletta smiled at her and asked, “Well, who do you think made Lexapro? It’s a gift from Jesus Himself!” As Christians who believe that every good and perfect gift is from above (James 1:17), isn’t this the truth? Fortunately, Susan resumed her medication and continued to thrive. This speaks to the lack of openness in the church at large to address emotional as well as spiritual well-being. Fortunately, the tide is turning. Check out Christ Presbyterian Church’s pastor, Scott Sauls, who has written widely about his struggles with anxiety and depression (one particularly excellent post here: https://scottsauls.com/blog/2014/06/20/anxiety-depression-strange-friends/). I am devouring his most recent book, From Weakness to Strength. I am hopeful that continued efforts at honesty from those who have suffered and welcome to those who are suffering that we can lead the way for healing and wholeness for everyone.

 

Remember, I’m a pediatric endocrinologist, not a psychiatrist or psychologist. My experience was mine alone. I hope by sharing it, though, that I can encourage others to seek out help for themselves or their loved ones.

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Do You Know Who You Are?

moanapic

I cried at a Disney movie.

And not because they offed the parents once again (I’m looking at you, Lion King and Frozen and every princess with a widower dad), not because the artificial Disney saccharine contrasted sharply with the brokenness of the world as usual, but because this one hit way too close to home.

Our daughters loved “Moana,” and Hamilton-obsessed Smith delighted in the catchy and surprisingly nuanced music, while his father of two girls/married to a doctor/Methodist pastor/feminist self couldn’t get enough of the girl power story line. We rarely see movies in the theater, and we have never in a decade of marriage seen the same movie twice on the silver screen. But on one restless January evening, following a family dinner that led to some hard conversations after I could hardly finish a sentence due to my highly active pager, we decided to return to see our favorite Polynesian chief-in-training, thinking that even if I had to spend the movie in the lobby on the phone that at least our girls would have a nice evening.

To understand why this happy movie made me weep, you should know some things about me. I don’t remember anything before wanting to become physician. My cousin, who is three weeks younger than me and as close as a brother, was diagnosed with leukemia when we were three. I will never forget trying to press my small face to the phone to talk to him in the hospital for the first time, sitting on the lap of the Santa Claus at St. Jude, hearing my strong daddy cry as he prayed for him, the steroid mood swings, horrid children at school teasing him and calling him “Baldy” in kindergarten. Also burned into my memory was the reverent tone used when speaking of his hero doctors, who with God’s help healed him. I wanted to do that someday. It wasn’t really a conscious decision—it was a calling that my entire family supported and encouraged. This propelled me through organic chemistry, gross anatomy, peanut butter cracker dinners (or no dinners), and hundred-hour workweeks.

My paternal grandmother in particular was a tremendous cheerleader. She told anyone who listened that her granddaughter was going to become a doctor, big news from a lady who grew up poor and had to stop her education in the eighth grade despite being very headstrong and intelligent. She mourned when I moved far away from home for residency; she was unimpressed that I was training in the number one children’s hospital in the country and prayed daily that I would return home to Mississippi. She passed away during my intern year, and losing her wrecked me even more than I thought it could. For the first time in my conscious life, I considered leaving medicine, but I owed too much money for my medical education to pay it back otherwise. I wryly remarked to Smith that God knew I’d need to have a powerful reason to keep working as a doctor, which is why He didn’t provide me with a scholarship and why He called my husband from his career as an Air Force officer to the ministry, starting with three years of very low pay as he returned to divinity school.

Mamaw’s prayers were answered many years later. When I interviewed for my first job, I had very little desire to go back to our rural area fresh out of training, though I was restless in a resource-rich area, not feeling that I brought anything uniquely helpful. I often considered the logistics of short-term medical missions to respond to the abundant riches I had received and assuage my guilt for staying in a comfortable place. Besides, we were Methodist ministry family bound for itinerancy; private practice was out of the question. I interviewed at my hometown hospital to please a long-time clinical mentor and to placate my parents. During my hospital tour, the Chief Medical Officer told me that children with diabetes were dying at alarming rates, with four deaths due to diabetic ketoacidosis in his very short time there. I couldn’t sleep after that. Who better to respond to that need than a pediatric diabetes doctor who happened to be a hometown girl with a bleeding heart? We would make it work. We found ourselves moving back to the birthplace of Elvis Presley, to the poorest state in the country, to start something brand new. I felt like Peter, stepping out of the boat toward Jesus.

But Peter found rocky sea underneath him and very quickly took his eyes off his very Savior. I almost immediately found myself drowning with a complicated pregnancy, over seven hundred days of call in a row, spent by the constant inexhaustible need and suffering all around me in this poverty-stricken state while my children grew up seemingly overnight. Many times I would become frustrated, angry, bitter, destroyed, asking God why He called me to this hard place, to this hard career. Why couldn’t He have called me to anything else? I uncharitably couldn’t imagine that any other field could be so challenging. My husband was pastoring four small churches nearly an hour away, so I found myself alone with two babies twenty months apart, unable to leave the local area because of hospital policies, with an incessant pager. Nothing about this looked like “My Best Life Now.” This looked like Sinai desert. This felt like choking on briny saltwater and seaweed while Jesus stood feet away but being unable to grasp His hand.

Young Moana is “chosen” by the ocean as a toddler as the water entrusts her with a special gift. This desire propels her on a quest to heal her land, and she is often empowered by the knowledge that she was elected for this very task. But even plucky princesses have a breaking point; she eventually sobs before her sending ocean, throwing its gift into its depths. “Choose someone else!” she implores. And as my little girls crunched on movie popcorn, I cried until my shoulders shook.

Seeing the teenage Moana bemoan her special task felt so familiar—then her belated grandmother appears and wraps Moana in her arms. She sings to her:

“I know a girl from an island

She stands apart from the crowd

She loves the sea and her people

She makes her whole family proud

Sometimes the world seems against you

The journey may leave a scar

But scars can heal and reveal just

Where you are

The people you love will change you

The things you have learned will guide you

And nothing on earth can silence

The quiet voice still inside you

And when that voice starts to whisper

Moana, you’ve come so far

Moana, listen

Do you know who you are?”

I imagined my precious Mamaw, so closely that I could smell her Kools cigarettes and Windsong perfume and feel her soft skin. I could hear my parents, reminding me to remember not only who I am, but Whose I am.

I’m a follower of Jesus. I’m a mother. I’m a doctor. I’m a pastor’s wife. I’m a Mississippian. And like Moana, I’ll pick my task back up and charge forward toward victory. And like Peter, I’ve learned that the only way navigating the rocky sea is to keep my eyes fixed on Jesus and trust His entrusting me with this life. Jesus reached down to rescue us both from drowning—in my case, by opening up a new job opportunity with better support shortly thereafter.

My theologian husband has challenged a lot of my deep-rooted and incorrect notions that “God has one specific plan” for my life. The junior high church retreat teachings that persisted through college that if a young Christian ever took a wrong steps, God’s Perfect Plan would be forever be destroyed, and we’d be left with some second-rate Plan B. I know now that this is untrue. But I’ve recognized my need for Christ acutely daily on this voyage and have gotten to help people along the way. And though I have much work to do, I know that one step at a time, keeping my eye on the Author and Finisher of my faith, that I can journey forward, knowing who and Whose I am.

Whatever, I’m getting cheese fries.

Regina

I’m not a Mean Girl. Tina Fey’s masterpiece is one of my very favorite movies, and in addition to being highly quotable, the movie came to mind when I considered my passion for safer cosmetics. Let me explain.

I’m the textbook good girl, the biochemistry major-turned-pediatric endocrinologist super nerd, more Cady Heron than Regina George. No one would call count me among the Plastics, because as the mother of three and five year old daughters and former Mathlete, there is little time left for anything less than authenticity.

My makeup, however, is a Mean Girl. Like queen bee Regina George, the cosmetic industry is rich (to the tune of 445 billion dollars in the United States annually per Forbes), beautiful outside and possibly toxic inside, and, well, plastic—phthalates, a prominent component of plastics, are found in many cosmetics. While Mean Girls and modern cosmetics are alluring with excellent marketing, both may prove damaging to a woman’s health.

One of the most memorable scenes in the movie is when Regina embarks on a mission to fit into a tiny dress for a dance. She is attempting a low carb fad diet and queries her minions, “Is butter a carb?” She finally gives up when she gets conflicting answers and heads back to the cafeteria line in a huff. “Whatever, I’m getting cheese fries.”

When I was pregnant for the first time, I became acutely aware what I was putting on my skin. In my clinic, I had seen the dramatic effects of transdermal hormone disrupters (compounds absorbed through the skin) when young boys would come in with breast development from topical lavender and tea tree oil and when little girls would start pubertal changes when exposed to the residue of prescription testosterone creams when merely sharing towels with their fathers and grandfathers. I wasn’t ready to give up looking cute, and frequent call and a newborn left me with dull skin and dark circles that sent me back to Sephora. Yet when I started reading product labels with more scrutiny, I quickly became frustrated and said, in essence: “Whatever. I’m getting cheese fries,” while slathering literal plastic on my body. “All natural” means nothing—poison ivy is all natural, after all. Some organic compounds have known hormonal effects, after all. Even many over-the-counter skincare products contain known carcinogens (cancer-causing compounds). Best not to read those product labels, but perhaps I shouldn’t use lotion while holding my newborn or nursing her…okay, so no lotion until she’s at least a year old. But then the body wash I chose? What’s actually in her baby care products? Surely they are safe. Who has the time or energy to worry?

I have no patience for scare tactics about nebulous “toxins.” I’ve aced advanced classes on chemistry and toxicology, for crying out loud. But neither could I convince myself that the cleansers, lotions, or make-up I used daily were safe. In my advocacy for skin cancer prevention as a melanoma survivor, I saw quickly that the FDA was overwhelmed and out of step as it moved at a glacial pace to put even the most commonsense regulations on indoor tanning devices. Unsurprisingly, the FDA has not passed a new piece of cosmetic regulation since 1938. I’m glad to know that kohl was considered safe before the advent of color television, and but I would love to know more about the various pigments and preservatives on the market in 2017 so that I could make an informed decision.

Like many other women, my eyes were opened more when I considered my children than when I thought about myself. I didn’t consider that I was actually ingesting all of the lipstick I used until I saw my five year old slather her entire face with a tube one morning (she is not a fan of the natural look). I rushed to wash it off her delicate skin because I was more worried about exposing her to the estrogenic parabens holding the pigment together than the tremendous mess she would make if she took another step. It gave me pause to bathe them in formaldehyde and to moisturize them with petroleum derivatives (seriously, read the labels of the best-sellers). My mother was diagnosed with breast cancer last year—80% of breast cancer tissue samples were found to contain parabens. Countless friends have struggled with infertility. The average age of puberty has fallen by about a year over the past generation. Autoimmune diseases are increasing. What are we missing? These disturbing trends may have nothing at all to do with transdermal exposures, but as long as the over 80,000 new chemicals used in cosmetics remain unstudied, we cannot be certain.

What sorts of insults are we paying to be exposed to on a daily basis? Some of these carcinogens are omnipresent in the air and water. The Endo Society, the national professional society for endocrinologists like me, has been beating the drum to warn of the dangers of endocrine disruptors for several years now. Their excellent research led me to text some other physician mom friends from our last meeting in Orlando this year in frustration: “The risks of exposure are awful, and it seems that there is no escape. Yet another thing to feel guilty about as a mother.” The ubiquitous nature of this pollution can make us all want to slam our metaphorical cafeteria trays down as we head back to the same old cosmetics to settle for the health equivalent of cheese fries. But instead of accepting defeat, I’m taking control.

The Environmental Working Group has partnered with The Campaign for Safe Cosmetics (CSC) (http://www.safecosmetics.org/) and maintains a website, Skin Deep (http://www.ewg.org/skindeep/) to rate various cosmetics based on risk. I’ve found their annual guide for sunscreens particularly helpful as I endeavor to protect my girls from a skin cancer diagnosis like I had in my 20s. A founding organization of the Campaign for Safe Cosmetics, Breast Cancer Prevention Partners (www.bcpp.org), is especially close to my heart as they specifically take environmental links to breast cancer to task. Healthy Child, Healthy World (www.healthychild.org) provides resources to arm families with knowledge to make safe choices for their children. And surprisingly, many in the industry are lobbying for tighter regulation to police themselves, including Beautycounter (www.beautycounter.com), a company that proves with its lovely products that dangerous ingredients are unnecessary for beautiful results. And in our increasingly connected age, I’m confident that we can increase awareness and demand better monitoring and research from agencies whose charge is to protect us. Outrage over cruelty and animal testing led to change in recent memory; it’s time for us to make any company that won’t prioritize consumer safety feel unwelcome at our table.

Here’s to a world with fewer Mean Girls and dangerous beauty products for ourselves and our children.

We Need a Little Advent

We need a little Advent.

Halloween candy is still full price. Temperatures are in the 70s. And yet my social media is already full of photos of artificial Christmas trees. I scroll through as I wait for the doctor to return to the tiny room as we wait.

Haul out the holly;

Put up the tree before my spirit falls again!

Fill up the stocking,

I may be rushing things, but deck the halls again NOW

For we need a little Christmas

Right this very minute…

“I’m sorry. We expect 100% mortality.”

Candles at the window, carols at the spinet…

There’s nothing like the juxtaposition of joy over the weight of our own sadness. A decade ago, my beloved grandmother was diagnosed with fatal lung cancer on Thanksgiving Day as I was covering the inpatient kidney and adolescent ward as an intern in pediatrics in Philadelphia, far away from my hurting family. As I cried into the cold hospital turkey (without anything remotely like our big Southern feasts back in Mississippi on the Styrofoam plate), I couldn’t conjure much gratitude. But the ritual of Thanksgiving, of Eucharist, is what we are designed to do: give thanks and praise to our Creator. On the night that Jesus gave Himself for us, He broke bread and gave thanks. If Jesus could face death and suffering with Thanksgiving, then surely so could I. I refused to let the inflatable Santa Claus shrines contrasted with autumn leaves steal my opportunity to give thanks: thanks for the love of my family, thanks for the life of my grandmother, thanks for the opportunity to live out my calling and childhood dream to be a physician.

And yet. The Christmas that followed was more bitter than sweet as we all gathered around Mamaw for what we knew would be her last time to reign over the festivities around her artificial tree covered in classroom craft ornaments. The holiday made the pending loss crueler. Ask any couple struggling through infertility or miscarriage on Mother’s Day. Ask a jilted single or person trapped in an abusive marriage at a wedding. There are so many opportunities in our daily lives to admit: THIS IS NOT THE WAY THINGS ARE SUPPOSED TO BE.

Countless times, I have watched horrible news be dealt to others on both sides of the bed rail. I’ve often been the messenger and recipient of news that would change lives forever, often sitting across from or beside people on the very worst days of their lives. “The cancer has returned.” “We should consider withdrawal of care.” “There is no cure.” And even more commonly in my current professional life taking care of children with Type 1 diabetes, “Your child will need injections multiple times daily to stay alive for the rest of his life.”

Things are not as they should be.

Come, Lord Jesus.

There is a reason that the ancient Christians anticipated Christmas with a season of Advent, but this reason remained mysterious to me. I never knew anything of Advent as a child raised in a rural Baptist church. My mother told us that our late Methodist grandmother always made an Advent wreath, a creation of pink and purple and white candles that looked like it belonged squarely in the 1970s. Maybe it’s something Catholics did, like the ash crosses and giving up things for Lent. There weren’t many Catholic families in our small town.

I married a Methodist Air Force officer who loved Jesus as much as I did who eventually became a Methodist pastor, which both surprised and didn’t surprise both of us. I observed my first Advent as an intern during our first Christmas as a married couple. In the meantime, I cared for sick and dying children. We walked alongside one of our closest friends until he took his last breath at 33, robbed of the remainder of his life by glioblastoma. My mother was diagnosed with aggressive breast cancer and suffered. I still wake at 2AM covered in sweat and breathless in memory of the cries of families over their lost children even years later. Things are not as they should be. As the prophet Jeremiah cried out, “He has broken my teeth with gravel; he has trampled me in the dust. I have been deprived of peace; I have forgotten what prosperity is. So I say, ‘My splendor is gone and all that I had hoped from the Lord.’” (Lamentations 3:16-18) The minor prophets Joel, Micah, Malachi, Hosea, Habakkuk, and Amos all groan along with the Psalmist: “How long, O Lord?” (Psalm 13:1, Psalm 94:3, Habakkuk 1:2…) The waiting helped me reconcile the groaning, the calling out of all creation for redemption (Romans 8:22).

We are not left trampled in the dust. We were not left without a Messiah, without a Redeemer. Jeremiah continues in verses 23 and 24: “Because of the Lord’s great love we are not consumed, for his compassions never fail. They are new every morning; great is your faithfulness. I say to myself, ‘The Lord is my portion; therefore, I will wait for him.”” And there have been miracles among us: the little boy in Honduras who went pulseless in front of me only to request “agua” just moments later with no intervention from me, the child who thrived after bone marrow transplant who was not expected to even survive, the adoption support checks in precise amounts in our mailbox, an eternal king born to a poor virgin in Nazareth who was careful to name harlots, polygamists, murderers, adulterers, and foreigners His ancestors.

The miracle is around the corner. I want to stand with the Hallelujah chorus with tears streaming down my face: “And He shall reign forever and ever!” I want to smell the evergreen reminders that eternal life awaits us. I want to see the shiniest tinsel and brightest lights that have nothing on the splendor of new creation. I want to shower my family with gifts that will bring them joy as we mark the Greatest Gift of all. I want to taste the bread and the cup and sing of Emmanuel. But first I need to beg him to ransom captive Israel; to ransom captive me as I mourn in lowly exile here. I need to tell His stories to my children, to trace His history, to remind us all why we needed Him to come rescue us.

“The Lord is good to those whose hope is in him, to the one who seeks him; it is good to wait quietly for the salvation of the Lord.” (Lamentations 3:25-26) I wish I had observed Advent ten years ago. I need Advent this year. I need to wait quietly for the salvation of the Lord before I can rejoice fully that I will stand with all the saints and my risen Savior forever.

Let every heart prepare Him room. Especially mine.