But, what if someone dies?

Tonight, my husband told me I was "stressing him out." I asked for clarification, as I've actually felt the most at peace I've been since March! So, this came as a bit of a shock. He told me it was because of my "defeatist attitude about the start of school".

You see, like most parents (and I'm assuming teachers) felt, I am straight up terrified of a repeat March and April. It was a DISASTER. There was the underlying stress of the panic due to the pandemic with the expectation to carry on, at home, with some kind of continued education of our grade school age children. In my case, a 5th, a 3rd, a 2nd, a K and a Pre-Ker. I am NOT exaggerating when I say that we accomplished nothing. Nada. Zero. If my kids managed to turn in even 50% of their assignments, I guarantee you they were neither complete nor correct. The level of home discord we achieved on a daily basis was enough to send even the most sane human to the funny farm. My children could mostly be found on the floor crying if not on an electronic device.

Let me be clear, I'm not criticizing schools or teachers. They were tasked with the impossible, and I applaud their effort. I applaud their continued efforts. I just cannot go through it again and besides abandoning my patients during their time of heightened need (because, turns out long-standing stress, panic and fear wreaks havoc on more than just the mental - which I also treat - but the physical begins to deteriorate) I can't stop working either. I say this, because if someone tries to argue that the true fault is that of the American work structure, I'm calling BS in my particular situation, as well as many others. 

I need to see patients. Period. There's no getting around it...and for a lot of jobs...there is NO getting around it!! (Well, unless we mass produce robots to stock the grocery shelves and bag up groceries and deliver them to your door. Or robots to take vitals and manage meds on inpatients, flip them, help them to the commode, you know, all the things. Or robots to take over my job even...hold on, I think I'm on to something!!)

Because of this experience, as well as my area of expertise (Family Physician, with a side of super stats/data nerd) I decided, with some encouragement of some other school members, I needed to be part of the school's re-opening process and task force. It shouldn't be that difficult, since somewhere around the last week in February, I've been incessantly studying (from afar) the Coronavirus. These motives were not purely selfish. My privileged, white children will be fine without a year or two of education and socialization. I could not, however, get over the idea that if I struggled this much to stay mentally healthy, physically healthy, electronically savvy, organized enough to do anything, then how on earth are those in far worse conditions faring??!!!

We {the task force} spent hours. Days. Pouring over and coming up with good strategies. Strategies influenced by the top pediatricians, Harvard, the CDC, and multiple incredibly reputable resources. I'd been trying my best to come at it from a place of reason and logic.

Weighing the benefits and risks of everything we do as individuals as well as everything we do as a society. Like peeling an onion, we went through layers and layers of situations. What ifs. Weighing both the now and the future.

I obsessed and poured over the data.

I wanted so badly to be able to come up with good solutions. Good options. Something that might work for everyone involved. Words of comfort and wisdom for my colleagues, administrators, patients, friends, family.

But, no matter the solution, there were always critics to shut down every option. No answer pleased everyone. 

Turns out, there simply is no reasoning when the only barometer against which we are measuring what we do, which next steps to take, how we should go about living and moving forward is, "But, what if someone dies?"

I've treated this no different than any illness I encounter as a physician.

But. That's where I went wrong. That's the piece of the puzzle I could never solve, nor overcome.

There is no other illness as publicized and polarized than this. It defies all logic and reason from every dimension.

Did you know, there are currently estimated to be 2.1 BILLION mentions of Coronavirus in the media, whilst tuberculosis - THE NUMBER ONE WORLDWIDE CAUSE OF DEATH BY AN INFECTIOUS DISEASE - has less than 3 million mentions. TUBERCULOSIS!! This has both a vaccine and a CURE. *mind blown emoji* And since children always seem to be such a gut-wrenching figure - there were 205,000 TB deaths under the age of 18 last year. By comparison, (reports worldwide range with 0-0.8% of all COVID deaths are children - definition varies, so for argument sake, I'm going with the highest percentage) there have been approx 5,486 deaths of children, worldwide in 5 months. That would end up with around 13,167 deaths in a year, IF nothing gets better.

Try, now, to convince me that we care about lives...

...ALL lives that is. Black lives. American Lives. European lives. 3rd world country lives. Poor lives. 

Because, I can't help but see it that we let thousands upon thousands upon thousands of people die. EVERY year. From a treatable disease...simply because it doesn't really affect us directly. It's not really here. In America. Amongst the rich. The white. The healthy. The successful.

But now. NOW. All of a sudden there's a virus that affects US ALL. "No one is safe" (though, clearly there are demographics who are...) so let's drastically change all of society!?? To the potential demise of our entire country for one reason or another. I know, I'm getting off topic, but my brain goes down this perplexing rabbit hole. Every. Time. 

...ok, back here again, waiting to hear about how much we care about our lives...

If the barometer I used was simply, "but, what if someone dies". I would never, ever, EVER prescribe another medication again. EVER.

I ask all physicians, how often do you refrain from prescribing a recommended and vital medication because compliance might not be 100%? How often do you prescribe a new medication and tell the patient it is 100% safe? That there is no chance of adverse reaction? Ranging from a simple rash to kidney damage to death? If you are, then please, tell me!! What are and where are these meds!!!?? 

Ok, ok.  You're not going to tell me...because they don't exist.

So, returning to reality and good old-fashioned medicine, we have to deal within the constraints of what we've got...and that's simply, WEIGHING THE BENEFITS VS THE RISKS.

I do not recommend the same medication for the same disease to every person. I take into account many things, age, presentation, other medications, vitals, previous treatments, compliance, cost, labwork, etc.

Just like, I don't think there is one solution that works for every single family or teacher. This is a novel virus with bizarre and wide-ranging presentations. From asymptomatic to deadly. The spread isn't fully understood yet (but in my vast researching, my personal hypothesis is that a person is highly infectious for only a very short period - possibly less than 24 hours - but during that time they can get to a lot of people. It's really the only thing that makes sense...but I digress). You are absolutely allowed to be scared, nervous, and make the decisions you deem right for you and your family.

I'm tempted here, to go into a long drawn out explanation of the numbers. The stats. The facts. The COVID numbers vs flu, vs car accidents, vs suicides, vs all of it!!  But in the ever so wise words of my husband, "facts don't change minds". And, my goal here (if I have one...I think that ship sailed about 17 paragraphs {ramblings} ago) is not to change anyone's mind, but more to urge you to use it. Use your own brain. Please, stop being convinced by one-sided, dramatic, click-bait media. Take a deep breath and look at what you really think/want/believe for your own family. 

We all have some really hard choices to make.

At some point, people need to be accountable and responsible for themselves. I have not seen my own  father for 6 months. He is physically distancing and taking all the precautions. Benefits vs Risks. He weighed his own. He's retirement age at nearly 70 with a history of cancer, among other health issues. He misses us and we him. We usually spend time at the farm and lake together. He knows he has done his best to stay safe and healthy, and that's about all we can hope for...the rest is up to fate. 

If you need your kids home to feel safe. Keep them there. If you have the opportunity to teach remotely or take the year off the job, then do it. (This is a personal decision, we all had to make. Anyone in the public, essential, front line has had to make this difficult decision, keep my same income? Or find an alternative? What's the benefit of keeping this job vs the risks?) These options exist!! But steadily, the other option, that is so needed for so many, of sending your young children somewhere for care and education is slipping away. These people don't even get a choice. 

Sigh.

Now to quote my even more wise 11 year old: I hate COVID 19.

Is it ok to always be "Wonder Woman"?

I've been barreling down this hill of life, never looking back...always steamrolling forward toward some goal or destination. 

My hill of life seems to have no steep peaks or valleys...it's straight down . 

And, the material I wear acts as a lint roller...just picking up more and more items as I go. 

None of them slowing me down. 

Yet.

Then, when I hit these tiny bumps, such as boulders or trees in my path (I get sick or pregnant or injured), I get this little glimpse of what life would be like if I suddenly couldn't carry these items anymore. 

Some of the items fall off, and need to be gathered back up quickly before they roll away. And as much as it pains me to the core, it's not a job for just one person. I need help...or to simply let go.

As these items scurry away, I see it's way too much for another person to add all that I can no longer carry to their own load. 

I don't care how much this person loves me, or my items. 

How selfish of me to think it's ok to carry all of this. 

I think: I owe apologies to my loved ones. But, hopefully, they all support me, because they see where I am going?

Yet...try as I might to let them roll away, I still want these items. And more. I still want it all. 

So, I pop back up, sometimes stronger and more determined than before. I gather it all back.

I feel so unsettled and unsatisfied, all the time. But just within myself. There's just some gnawing little fire, whispering...keep going...you're not there yet...there's more...

My fire to live every moment to the fullest and BEST reignites, and my engine starts pushing me back down that hill. 

And here. Barreling forward, is where I feel at peace. 

And I wonder. Does everyone feel this way?

Does everyone feel that they have some unspoken message within them? Some unexplored, dormant or inactive  potential? 

Or do people exist that are simply complacent? They are exactly where they want to be? Could I be like that? Will I know when it's too much. When to let go?

I wouldn't change a single thing that led me to here. I LOVE here. 

But, not enough to stay put.

So, I will continue to travel, hastily down this hill, and I'll continue to pick things up. And I just hope, in the end, I'll have made a only a positive difference. 

I think that's what makes it all worth the trip?

The Problem with Panic. Hysteria. And Chaos.

Like most people, I typically keep my keys in one of three places: my purse, the key hooks or the counter by the door (or more recently, on top of the microwave). On occasion, I might leave them in my coat pocket, or a sweatshirt pocket. On even rarer occasion, that sweatshirt makes it all the way up to my closet. I might even empty the contents of my pockets and set it on the mantle in our bedroom. And, much to my husband's chagrin, I will also occasionally leave them in the car. 

When not in a rush, I very succinctly go through these procedures to find my keys, and invariably; I am successful. I've never actually lost my keys (*knock on wood*). 

When in a rush, this process becomes a bit more sporadic. Instead of starting from most likely spot to least, I sort of bumble around. And, eventually, after location after location proves unfruitful, I start to feel the panic.  I start to actually question what I know to be true! The simple procedures that I once knew to work without fail, that seemed almost reflexive...seem to have vanished.

When did I last have them? Where could they be? I rush to make sure the car is still in the driveway and hasn't been stolen.

Because I was already in a rush, and now I've been bumbling around for 10 minutes that I didn't have to spare to begin with, I'm now in full on panic mode. Hysterics really. 

I can feel how clouded my brain is. I can feel my heart rate rising. I can feel agitation.  

So many unnecessary thoughts flood my brain. I can't stop for coffee now. Patients will be waiting for me. Is my kid is sitting alone feeling scared or sad no parent is there to pick them up? Do I keep looking for keys or do I take the time to stop and call to give a heads up that I'm late...further delaying my departure? Could they be in my husband's car and he's gone?

Question, after question, after question comes wafting in like tsunami. Questions I can no longer prioritize. Questions for which there used to be clear and simple answers.

If someone's home, I've looped them into the search. I'm insisting my husband help. He's calm, because he's thinking the obvious: "Where's the last place you saw them?"

But, in my current panicked state, that information, which is normally VERY retrievable, is simply gone.

It's vanished. 

I am almost paralyzed.

At this point, I fear I might never find them. I feel defeated. 

If no one is home, I'm considering who I can call to get me to work. Or who can bring my kid home? I've looped so many unnecessary people into this procedure. I've interrupted their lives and routines. I'm frustrated, mad at myself, mad at things that don't have anything to do with the current situation, like "if our house wasn't such a disaster in the first place, then this wouldn't happen."  "Why do I even need a purse!? Clothing should have more pockets." "How dare Matt leave this house before he's sure I have and know where my keys are." (Everything's his fault...am I right?)

I've done all the texting. I've got arrangements made, and take a deep breath. 

I calm down and start again.

Not on the key hooks. Not on the counter.

I go look in my purse...

...and there they are. Buried under some coupons that I always keep and never use. (Why!!!???)

And that, my friends and colleagues, is why I choose to not panic. Why I refuse to watch and listen to this hysteria. Why I will read educational articles from non-political sources and simply...

...remain calm, follow procedure and continue to use the knowledge I know to be true.

George turns 8.

As Matt and I sat, listening to George's teacher discuss his progress, we glanced throughout the room, noticing all the 2nd grade classroom art and various decor. Directly behind the teacher was a large billboard of adorable pink pigs, relatively uniform in their construction. Clearly, the children were given pre-cut pieces for each of the body parts, and potentially shown an example of how one should/could assemble them (which was the pig with it's head situated on the right, facing you, attached to a standing profile of the body.) Though each pig had its own little flair of uniqueness, they were all relatively identical.

With the exception of one pig.

This pig was sitting on it's rump, it was squarely facing you, it's body behind it, and it's tail behind that. This pig seemed happy, and content, and really not anything like a rebel. Just, simply different from the others.

Maybe this pig didn't listen to the instructions?
Maybe this pig did, and just didn't feel like facing the right, today.
Maybe this pig heard everything, actually wanted to follow instructions, really tried, but for some reason, signals just get crossed. What goes in, does not necessarily come back out as we all expected.

As if, maybe, instructions go through some sort of jumbler.

I'll give you zero guesses on who's pig was sitting, staring us directly in the face.

Since his birth, George has done things *not quite* right. (Literally. He actually came out "sunny side up" - aka upside down.) Though we always attributed this to his goofy nature...we've actually never been quite sure if his antics are purposeful or a happy mistake. I'm not sure he knows either.

His faces. The way he talks. The words he uses. The way he holds a pencil. The way he dresses. His accessories. His ideas. His stories.

{I think people take psychedelic drugs to bend and warp the world around them to see what George sees naturally.}

Of all my children, he is the one I've worried most about sending to Catholic school. Or, pretty much any school. He's as square a peg as I've ever seen...and we are trying to send him through a round hole.

He's smart. He's kind. He's funny. He has friends. He's compassionate (so much so, he's won this virtue twice.) His teachers love and appreciate him.

He's CREATIVE. So incredibly, naturally, accidentally creative. It's as if every experience involves all 5 senses for him. You will never see George simply eat a meal with a spoon or fork. His fingers get involved somehow, his face, his clothes...a slotted spoon, a straw...you just never really know.

I don't worry about his success, or making his way in this world.

I do worry about crushing his spirit. Seems that's the only way to get a square peg through a round hole - you know - to crush it a bit.

George turns 8 this week. I want nothing more than for him to continue to enjoy this life to the fullest! I don't want him to see it as a bunch of difficult, stringent hurdles he's being forced to jump. I also want him to find a way to fit in, just enough, to get through those round holes without losing his shape.

Gosh, I just love that kid and his incredibly distinctive peculiarities.

I mean, and maybe I'm just partial to the misfits, but long before I knew the fat, front facing, sitting pig was his, I knew it was my favorite.

Physician as a Career?

On a rare Sunday morning, I woke and had the time to make breakfast for my kids and their cousin who'd stayed the night. My nephew said, "Thanks Aunt Erin, I feel like I never see you." To which my oldest (10) stated very matter-of-factly, with no ill-intent, "That's because she's never home."

Being a full time, private practice physician and mom to 5 kids, with a healthy social life, it's extremely common to get a variation of the question, "Will you support/suggest your kids become a doctor?" More specifically, I've gotten, "Would you want your daughter to go into medicine?"

You can't help but take this to mean, "Are you happy with your decision to go into medicine?"

Despite the ever-changing climate, and somewhat significant downsides (insurance requirements/EMR/ commitment in both time and emotional energy), medicine still remains a stable career. If you become a board certified physician there is (are) a (million) job(s) for you. This job will not be low income. This job is something you can always be proud of (if practiced correctly) and full of satisfaction, knowing you are helping and treating your fellow man. This job typically comes with an element of automatic "respect" in society. This job allows you to use your knowledge daily, as well as expand your knowledge daily. It's good for the curious, it's good for the creative, it's good for the caring. This job has no specific personality type.

As a mother, probably my single greatest goal is to raise 5 happy, self sufficient, contributory members of society. That's it. Do I think having a career in medicine can accomplish this? Absolutely.

Will I caution them? Yes. Will I sugar-coat the state of medicine? No.

I think as a mother, we can see, from an extremely early age, our children's strengths. Their weakness. Their struggles. What motivates them. What frustrates them. So, I'd like to think I would counsel them appropriately if they came to me, interested in the medical profession. 

I'd tell them that becoming a physician requires patience, determination, dedication, confidence, sacrifice. So, so, so much sacrifice. 

I'd tell them, no matter what you go into, inpatient, outpatient, surgery, specialties, primary care, you will work more hours than you want to, and some days will be hard. So very hard. 

Some days will be hard and without reward. The outcome won't be great. The patient you spent so many hours treating, worrying about, caring for might not get better. You might be giving the hardest news any human ever has to hear. They might die. They might not appreciate your services. They get mad at you. Give you poor reviews. Abuse you, for lack of better term, all because you did what was best for them to the best of your knowledge and training (which will be extensive, grueling and perhaps the hardest trial of your life.)

Some days will be hard, yet wonderful. You might deliver a baby, bring life into this world. You might be the one to tell someone their cancer is gone. You get to help someone through a rough patch. You are trusted by your patients in their most vulnerable of times. You'll get to hug someone who comes in with a smile on their face to thank you for saving their life. You save lives. 

You save people from acute infections, from ruptured appendixes, from traumas, from cancer, from mental illness. 

YOU SAVE LIVES! You change lives. You improve lives. 

But to do this, you risk destroying life. You bear the heaviest of burden. Practicing medicine is such an honorable profession that comes with the deepest responsibilities. And the scariest outcomes.

You have to KNOW the answer. And if you don't know the answer, you need to KNOW that you don't know. You must first be humble...and then you better figure out the answer, or where to get it. There is no giving up in medicine. 

And, because there's no giving up, some days you will miss Holidays. Your family. Your friends. Your spouse. Your kids. 

The hardest part, as a parent, will be missing your children's sporting events, school programs, recitals, birthdays, bedtimes, bath times, and yes, even Sunday morning breakfasts. 

You hope they all understand. You hope they know you'd be there if you could. You hope they know you're not picking a stranger's well-being over theirs. 

You hope they know that you've been bestowed an incredible gift, and that, for some reason, you've been called to share it. Really, one of the truest forms of altruism. You hope that maybe they even love and respect you for it. 

In fact, maybe, just maybe, they will love and respect you soooo much for it...they want to be it. 

So, when you ask, will I support my child going into medicine? The short answer? Absolutely, and with caution.