Lying naked on the bed

A few weeks ago, my husband went in to have a vasectomy.  I am proud of him-- for being brave (only about 10% of US men get vasectomies); for announcing his reason for missing work to his all-male engineering team (imagine the uncomfortable squirms when he brought up the topic at their weekly debrief); and for taking ultimate responsibility for our family's family planning.

And so ends a two-decades long birth control chapter in this woman's life. Woohoo!

In his defense, he did way less milking of the situation than I had anticipated. I had envisioned him reclining dramatically on the couch with an ice pack on his crotch avoiding normal household duties and requesting room service and an endless supply of cereal and Game of Thrones episodes.  Instead, he came home with a smile on his face, exclaimed, "It wasn't really much more pain than a shot of Novocaine at the dentist", and went about helping out with the day-to-day madness that is having three young children. For the next few days, he took it a little easy, occasionally winced in discomfort, and his only recurring complaint was the itchiness.

All in all, it was a success. And a relief-- for both of us.

All said, I cannot help but ruminate on the one remark he made that I find particularly fascinating and somehow shocking: the totally new and "strange feeling of lying naked in the room waiting for the procedure to begin." He repeated a few times, "I've never been in that position. . . just lying there naked."

Lying naked on the bed.
Waiting for a procedure to begin.
Lying naked on the bed.
Wondering.
Lying naked on the bed.
Scared.
Lying naked on the bed.
Vulnerable.
Lying naked on the bed.
Cold.

How long have I been lying naked on a bed waiting for someone to come in?
Cold.
Vulnerable.
Scared.

Twenty-two years.

Since age 18, upon deciding I was going to have sex for the first time, and I dutifully made an appointment for my very first pack of birth control pills and my very my first pap smear. We don't do this, by the way, anymore. We don't pap 18-year-olds. Pap smears in the US start now at age 21, and in some countries in Europe cervical cancer screening doesn't start until age 30. We also don't tie birth control to the requirement you get a pap smear. Turns out that was a dumb idea. In fact, the only thing that birth control and pap smears have in common is that they kind of sort of both involve your private parts.

Again a year later, when I had another pap.

And again, when I had my first vaginal infection.

And again at age 21, when the Peace Corps required I have a rectal exam in addition to a bimanual  exam to be "cleared for service" (WTF?!?). The bimanual exam-- by the way-- is the "two hand" exam-- you know the one-- one hand inside your vagina, one hand outside on your belly, the one that doesn't feel very good and yet somehow seems important. It turns out that physicians don't really know what they are looking for when they do a screening bimanual exam-- our ability to detect cancers or other badness with our two hands is about the same as flipping a coin. In one study of women with known ovarian tumors, physicians were only able to "find" the tumor by examining with their hands 50% of the time. So this type of exam should only be done with forethought-- when your provider suspects you may have a uterine infection or some lesion that could be helped by examining you. 

And again, when I finished my Peace Corps service.
And again, and again and again.
When I got pregnant. And delivered. And got pregnant. And miscarried. And couldn't get pregnant. And had a test. And then another. And then another.
When I had surgery. And then intrauterine insemination. And then IVF.
When I got pregnant again. And delivered.
When the doctor yelled at me for not being undressed and "ready for him" at my postpartum visit with my fussy 6 week old baby who didn't want to be put down.

And again when I was pregnant with my third child and went in for my intake appointment. I was asked to undress completely, as the physician needed to examine my breasts and do a bimanual exam. The funny thing is-- I let her do it-- despite the fact that I know better. That there was no particular reason she should do such an exam at all. Her time (and mine) would have been better spent probing the safety of my relationship, my fears about my advanced maternal age, or heck, just getting to know me.

And yet, there I was, lying naked on the table.

This post is for you, women. For all of you who have laid naked on the table, wrapped in a generic cloth gown that gapes open no matter how you tie it-- or worse, a paper gown that literally rips into shreds as you attempt to preserve your modesty. And then wait for 3 or 5 or 25 minutes for that fateful knock on the door.  To have your very most private parts examined.

Being naked is scary. It's vulnerable. It's raw.  And, unfortunately, it's part of being a woman-- a woman who has sex, a woman whose parts are tucked up inside of her, a woman whose body is both capable and vulnerable-- to being pregnant, to contract disease, to have all the crazy shit that can happen to our amazing parts (everything from vaginal discharge to pelvic discomfort to herpes to a saggy post menopausal bladder).

This is also a post for you, doctors. The scariest part of being a doctor is being vulnerable to forgetting-- forgetting that every single body we have the privilege to see and touch and examine is that one person's only body. It is their most precious and private part. And they are entrusting me and you to acknowledge the power, recognize the specialness, and do what we need to do to care for them with utmost love and respect.

This is also a post for you, men, who may have less opportunity to lie naked on a table at the doctor's office. But your time, too, will come. You will get a hernia or a weird lump in your testicle, or maybe you will be one of the 10% of US men to sign yourself up for a vasectomy.  (It's not so bad, after all). In the meantime, please do us all a favor, and treat every body you come across (particularly those who are lying naked in front of you) with love and respect.

And some day, when you are scared or sick-- may your body be treated the same.

11 Reasons Why You'd Be Lucky to Have a Family Physician and 10 Reasons Why Your Family Physician is Lucky to Have You

Here are two complementary "top 10" lists I felt inspired to write this week. I was going to name them Why you should love us and Why we love you, but this all sounded much too egocentric and a bit too cheesy, even for me.

The first list is inspired by the realization that some people don't really know what a family doctor is or does. I tend to think we're pretty useful, and, quite honestly,  I think more of you should have one of us in your lives. Here's why.

The second list is in honor of my community of family doctor friends, too many of whom struggle with self doubt, high stress, and crazy dysfunction in their work worlds. Sometimes it doesn't feel worth it, but it is. Maybe I can remind you guys why.

I put the two lists together in one post because-- well-- doctors and patients go together. You cannot really have one without the other.

11 Reasons Why You'd Be Lucky to Have a Family Physician ( or Why you should love us)
1) We know our birth control. There is definitely someone in your life who needs good birth control. Perhaps it's you, your daughter, your niece, your nephew, your neighbor, your hairdresser, your grandson, heck even your mother (yes, your mother has sex too). Unintended pregnancy is one of the most avoidable life-changing events on this planet. And birth control can actually prevent unintended pregnancy. Imagine that?! We family docs know a lot about birth control and can help you find the right option for you-- and please remember, we are no longer limited to your mother's birth control pill. Ask us. We'll help.

2) You are not just a blurry eyeball. Or a broken heart. Or a sore hip. Or an irritated gallbladder. You are a complicated coordinated system that, put all together very carefully, is unique you. And only you. Specialists are amazing and important. We need them when things get crazy. However, most specialists are unlikely to make a connection between your blurry eyeball, your diabetes, its effect on your sexual health, your emotional well-being, your neck pain, your new job, your diet, and your dad's recent illness. That's my job. I'm here to look out for unique you.

3) We can talk about death. And we actually want to talk about death. We are poised to help you explore your wishes and desires and fears, and we are trained to help you and your family make the most informed, empowered decisions you can make when death may be near (or far). We can guide you through the process of creating an advanced directive or help your family make a cohesive decision about what to do with a failing parent. We want you to think about death before it's right on your doorstep-- that way you will know what to do when you open the door.

4) We are a one stop shop. We can check out your mole, examine your itchy vagina, and make a decision about your painful ear all at the same time. Well, not exactly the same time, but definitely during the same visit. And we know when we need to refer you to a specialist-- that's part of our training. So, you know how sometimes you have to go all over town to do your shopping: to Trader Joe's to get crackers and cheese, Imwalle to get veggies, Oliver's to get fruit, G&G to get staples, and Costco to get toilet paper? I hate that, but it's my grocery-shopping reality. I'd argue it's pretty unavoidable when it comes to groceries, but health care needn't (and shouldn't) be that way.

5) We like to talk about uncomfortable things. You don't have to be embarrassed talking about your constipation or your diarrhea or your itchy butt with us-- in fact, these are some of our favorite topics (mostly because we can make these things better, and so many of the diseases we manage don't actually get better). We don't even mind talking about sex, erectile dysfunction,  toe jam, or body odor. Or all those put together (see #3).

6) We can translate. So much of what is scary and overwhelming when someone is ill are the plethora of things patients and families literally don't understand-- these include explanations of a diagnosis you have never heard of, interpretation of weird lab results, medications that have multiple names that you cannot even spell, much less pronounce. We family docs can speak both human language and doctor language, and usually we can give you a clear and honest interpretation of what the heck is going on. Try us out. We are even better than Google translate.

7) We know care coordination. Once you actually understand what the doctor is saying the next step is helping to make it happen: get the cardiologist to talk to the oncologist, get brother to talk to sister, get the home health aide into the home to help mom get a shower, help get a breast pump that works so you can get back to work, figure out how to get wheelchair transport or recurring laboratory draws. We are not the gate keepers--we are the orchestra conductors. We want to help everyone stay on the same stage.

8) We have technical skills. Many of us can still deliver your baby (my favorite work activity), sew up that laceration, put in your IUD, take off that mole, circumcise your son (after empowering you to make an informed decision about that), clean out that boil, and even biopsy your cervix. And we can do so with a decent bedside manner. And all, hopefully, causing you less overall anxiety because you actually enjoy coming to see me because you know I know your name AND I actually care about you and your family.

9) We do depression. And anxiety. And insomnia. And panic. And a whole other slew of mental and behavioral health things that come up for people. That's right, that's health too.

10)We take care of people across their lifespan. We can follow you from first screaming breaths into accident-prone toddlerhood, up through awkward puberty, over the hill into birth control and young adulthood, past college, into parenthood, menopause, grandparenthood and off to the grave. Pretty freakin' cool.

11) We do health too (not just illness).  And health is hard stuff to pay attention to. Health includes vaccines and preventive care, diet and exercise, emotional strength in the face of stress or loss, recovery after something knocks you down, avoidance of common health events like heart attacks and strokes (even if you are convince YOU are never going to have one of these). Health is hard to pay any mind until it's slipped away. Don't let that happen. This is the only body you will ever have. And the only mind.
                                                                  
Please note that I am not intending this list just to advertise for my specialty, though, quite honestly, I do think that being a family doctor is pretty freakin' cool; hopefully those of you who have a family doctor who you love and who loves you agree with me.
                                                                   ***

This corresponding "flip side list" is dedicated to my doctor friends, who sometimes lose sight of the privilege of our position because we are so wrapped up by the quotidian bureaucratic tasks, the sense of feeling behind, the belief that what we did was futile and frustrating without actually promoting healing, and our own struggles to figure out how to serve our patients in a horribly broken down system.

10 Reasons Why Your Family Physician is Lucky to Have You (or Why we love you)


1) You honor me by allowing me to be witness to the miracle of your birth. And not only do I get to be there--physically present-- at the moment the world changes forever, one beautiful new baby at a time, but also, I get to be the very first one to touch your sweet baby's head and his strong little body. Such a privilege. So amazing. Every. Single Time.

2) You trust me. When you walk into my office feeling scared and out of my office feeling relieved, my day becomes worthwhile. When we are anxious or worried or sick, having someone we trust to reassure us and comfort us is indispensable. Plus, your trust in me makes me trust myself.

3) You keep me on my toes when you ask me challenging questions about topics like the hepatitis outbreak associated with organic berries, the risks and benefits of starting an antidepressant in a teenager, the weird side effects of a thyroid medication, or the latest study showing that mammograms may not be as important as we think they are. You keep me reading, thinking critically, and reaching for some semblance of truth.You make me smart.

4) You humor me by actually listening to what I have to say, unlike my toddler, my husband, my dog, and my mother. For example, when I educate you about your asthma inhaler and the importance of using your maintenance Advair and not just your rescue albuterol, you nod your head, and at least pretend to agree. This makes me feel valuable, or at least more valuable than when my husband rolls his eyes at the very same lecture.

5) You share your pain with me and trust me enough to tell me you are having thoughts of hurting yourself tonight. Those are thoughts you share with no one, thoughts you can hardly share with yourself. And yet, when I ask, you look me in the eye, and you share the deepest, darkest vulnerability. Thank you.

6) You say "thanks" for something I did last year that put you at ease, something that I did in passing, that I cannot even remember exactly what it was, but it was the thing that needed to be done. The fact that I don't remember what I did or said isn't important--what's important is that it meant something to you in the moment.

7) You quote me to myself (e.g. "Doctor, the last time I was here, you told me. . . ") Who doesn't love being quoted to thyself?! Being told that my words are important enough to you that you replay them (perhaps even replay them over and over) reminds me to be careful and thoughtful and loving with my words. After all, those words that may stay with you for decades simply because I said them.

8) You tolerate my running late and running frenzied and even running out of the office to go 'catch a baby' and then next time I see you, instead of being upset and feeling jipped, you ask me about the baby. Somehow, the short time we have together is precious enough that you don't remind me of how ridiculously long you have been waiting for me to rap on that door. And the time we spend together is enough.

9) You refer your mother to me. I am a daughter, I know how much that means.

10) You tell me that just seeing me makes you feel better, and I think you actually mean it-- even on days when I could do nothing to calm your anxiety or take away your pain. Nothing, that is, except to be present. The interaction is basic. You speak, I listen. I speak, you listen. And through that most simple of interactions, we walk together-- through birth and death, confidence and uncertainty, diagnosis and treatment, illness and wellness. And, hopefully, when all is said and done, we know one another enough to say I love you.