An Open Letter to my Children

At the end of one of the busiest weeks I have had in recent memory….a week for which there is no adequate word in the English language and “insane” cannot begin to do justice…I paused. There were a number of reasons to pause at that moment, but the reason I chose was that I owed my center offspring a conversation. As we spoke, I told him how proud I was of something he had recently done, but he stopped me mid-sentence. “Mom I know.” I tried to continue, tried to tell him that I am always proud and why I hold him to such a high standard. But he stopped me again. “ Mom (more emphatically)…I know! I literally have the letter you wrote me on my birthday here on my desk.”

Later I reread that letter (which is conveniently my blog entry from a year ago) and mused to a few friends that maybe I should take my own advice. Suddenly, I remembered that I had penned the beginnings of a letter to all three of my kids but had never quite completed it. And just like that, the Universe had spoken. In a week filled with deadlines, check boxes, and turning pages, it was time to finish what I had started.

An open letter to my children…

First off, I must acknowledge that I know that you will not heed all of this advice. As your mother I fully expect you to ignore many of these suggestions, the same way in which you ignore the first six times I ask you to do pretty much anything. But joking/parental snark aside, some things you will simply need to learn on your own. And that is OK. My hope is that if you must experience some things firsthand, perhaps the knowledge gleaned will endure within you. That said, it is perfectly acceptable to need to learn and re-learn these lessons. You will backslide. That is also OK. Be gentle and patient with yourself. As long as you honor your authenticity, continue being a good person, and your overall trajectory is forward, that is what matters most.

1. I am proud of you, and I will always love you… beyond measure, no matter what. If you know nothing else, know this.

2. You are now and will ALWAYS be enough. Always be yourself. If someone does not appreciate who you are as a person, they do not belong in your life. Period. This does not mean that you shouldn’t strive for personal improvement or embrace needed changes throughout life. What you do not change, you choose. But such changes must be congruent with your core values.

3. Your worth will NEVER be diminished by someone else’s inability to see it. Do not waste your time trying to prove your worth to someone who is incapable of seeing it. Run, do not walk, away.

4. Be honest and transparent ALWAYS. There is never an excuse for lying. Integrity is everything. It really is that simple.

5. Action always expresses priority (I remain eternally grateful to Gandhi for the reminder). Make sure your actions align with your words. And never forget that inaction can be as powerful a choice as action. So choose wisely.

6. Be very mindful of how you spend your time, energy, and effort. You have the power to cultivate the life you choose.

7. NEVER diminish yourself to make someone else feel comfortable. If you are “too much” for someone, walk away and let them settle for less. You are not meant to be diluted.

8. Sometimes doing the right thing will be among the hardest things you will ever do. The path of least resistance is very often the wrong path. Choose the other path….that’s your path…and put in the work, even when it’s difficult.

9. Never forget who you are or where you came from. Let the things that you have transcended form your foundational core. And never forget to leverage your place in this world to help others.

10. Happiness comes from within. You, yourself, are solely responsible for being happy. And it is never your responsibility to curate happiness for another person.

11. Even on your hardest days, and even when pain and tears feel unceasing, there is always a reason to be grateful. Always. Gratitude is absolutely essential. Do not underestimate its power.

12. Embrace the fact that individuality means you may not always agree on everything with friends and loved ones. Our world would be quite boring if we all agreed all the time. Be willing to keep respectful dialogue open, but recognize it is OK to “agree to disagree.” One caveat—this advice does NOT apply to racism, misogyny, homophobia, xenophobia, etc.

13. Always be willing to consider the perspective and viewpoints of another person or group. Again, you do not have to agree, but be willing to “hear,” and consider the thoughts of the other person/group, as long as it is presented respectfully. The caveat from #12 above applies here as well.

14. Never ever be afraid to express your feelings or opinions (preferably in a respectful manner, of course). You are as equally deserving of the opportunity to be heard as anyone else in your life. Dispense with people who consistently dismiss or invalidate your feelings or opinions. This takes practice throughout your life. A lot of practice.

15. Do not ever apologize for feeling a particular feeling. Own it, embrace it, learn from it. What does that feeling tell you about life, yourself, another person, thing, event? Some feelings are transient and require nothing more than feeling them and moving on. Other feelings are more persistent and may signify a more important issue worthy of your attention. It will take a lot of practice to distinguish between the two, but it is necessary.

16. Do not ignore or suppress your thoughts or feelings. It is not healthy, and no good will come from doing so. Brief denial, in the setting of trauma or loss, is completely normal. Have patience with a little denial from time to time, but do not set up shop there. You CANNOT cheat grief, hurt, or loss. It will come back like a boomerang every time. Deal with it so you can move on.

17. Humility is essential. No one is perfect. Everyone makes mistakes in life, and you will make more than you ever dreamed. That’s actually OK…it’s part of learning and growing. But you must be willing to admit your mistakes and be accountable. Progress toward a solution even if it means constantly holding yourself accountable. Try to break cycles (both personal and intergenerational). But also show yourself compassion and patience when you falter. And you will falter.

18. No matter how smart you are or how much education you have, there will always be things beyond the scope of your knowledge. There is no shame in saying “I don’t know the answer.” Likewise there is no shame in asking for help. Stay humble. It may be the very thing that saves you or someone else.

19. When you face trauma, you have two choices. You can choose to do the work to survive, thrive, and transcend….to allow it to become part of your story and make you stronger than you ever dreamed. Or you can choose to let it destroy you, defining you in a way that hinders your potential and can leave a wake of destruction along the way. My prayer is that you ALWAYS choose to do the work and transcend anything that life throws at you. In the moment that may feel like the harder choice, but choosing resilience will always be worth it.

20. Show empathy whenever possible. Being an empath will absolutely make you an easy target for some people. Do it anyway. And in the event that showing empathy threatens your own health and well-being, peacefully detach and honor yourself, saving your empathy for a more deserving circumstance.

21. Unfortunately, you will be hurt very deeply more than once in your life. But do not ever let it break you nor dim your light. The one thing that no one can EVER take from you is who you are at your core. Continue shining and being the amazing person you already are. Wake up each day and leverage the gifts God has given you to keep helping others.

22. There will be dishonest, cruel, selfish people in this world. But there are many truly amazing people out there as well. And while it can be difficult to tell the difference between the two at times, be willing to be vulnerable and trust others. I know it’s risky, and yes it means some inevitable pain. Just know that it will be worth it someday. However, once someone shows you who they really are, believe them. Let God, Universe, and karma sort the rest out.

23. Learn, and when necessary, relearn to trust your intuition. Let it be the powerful guide that God/Universe intended. When you feel yourself trying to justify ignoring it, take a step back and recenter. Then trust yourself, even if it means accepting something difficult or painful.

24. True, real love is unconditional. Your presence, however, is conditional. You teach others how to treat you based upon what you allow. Never condition others to take you for granted. Walk away and go where you are cherished.

25. When you inevitably find yourself in the heartbreaking situation in which your love, priority, effort, and support are not reciprocated, please leave. Love yourself more in that moment, walk away, and do not look back. Your direction is forward.

26. Although you will have your heart broken in life, love anyway. Love anyway. It would be a far bigger shame to never take that chance. Love hard and unapologetically.

27. And if all else fails, please see #1

Love always,

Mom

Surprise Party?

I love a good surprise. Who doesn’t from time to time? Perhaps I like them because, as the oldest member of my household, the younger members (14, 11, and 5) are hard-pressed to keep a secret long enough to pull off a surprise. So experiencing the rare “good” surprise is always a welcome treat, whether it be a party with cake or some jewelry. Just kidding about that last part…my children are broke. Anyway, you will note I specified I like “good” surprises. Covid has been one ugly “surprise” after another…and I think we can all agree that it was an unwelcome one. However, Covid is not the only uninvited “surprise,” plaguing us as a society (and no, I didn’t initially intend the pun…but I guess it can stay).

I feel the need to give a little PSA, and I am well aware that I am about to offend some folks. However, I have never been known for my sugar-coating skills, and this week/month/year don’t really seem a fitting time in which to cultivate those particular skills anyway. And it is perfectly acceptable to be mad at me for what I am about to say. You, like anyone, are entitled to your feelings. Sometimes in life we just have to figure out how to take accountability for our own feelings, process them, and either use them to progress and/or move on from them. As such, I will own my feelings as well; in this case they are feelings of anger and frustration.

Why am I angry and frustrated, you might ask (bracing slightly for my answer)? Well here goes. Apparently there was a surprise party, and a number of us were not invited. Now, this could intuitively seem like the set up for my general disdain regarding the stupid number of parties still going on, despite the fact COVID is literally killing one person every eight minutes in my area. But nope. That’s not the type of party from which I, and millions of others, were excluded. Rather, it is a “surprise party,” that I see a number of people throwing lately that does not involve cake, balloons, or even a clever ruse. Rather this particular soiree includes only the “surprise” that white supremacy is alive and far too well in this country, such that it led to an actual terrorist attack on the Capitol.

While no one likes to be excluded, though some people would thankfully sit out a pandemic party, I’m not remotely offended that I was not invited to these various venues, decorated with shock and awe, bordering more on pity parties than actual surprise parties. But what does offend me is the sheer number of people who do, in fact, seem surprised at the events of last week.

To me, there was very little that was shocking about 01/06/2021–not the fact that it happened, not the involved parties, not the police response or lack-there-of (on the part of some), not the incoherent word salad that incited it, nor the tweets that followed, and not the response of politicians to it. None of it. And I know I am not alone in this sentiment. Furthermore, I’m somewhat sure that the social contract into which we inherently entered, as both social beings, and as members of the human race, obligates us to be at least reasonably educated. And that education should encompass not merely a smattering of current events, but also a touch of our country’s history (the real history, not the white-washed version we were fed in school). Thus, if we have been paying any attention at all in the last four years, let alone for however many decades each of us has been alive, we really all should have seen some approximation of this coming.

All that said, knowing that something is inevitable, does not necessarily take away from the pain of experiencing it in real time. So I am not trying to dismiss the grief felt by everyone who watched this play out. However, we must all acknowledge that for those Americans for whom last Wednesday represented “more of the same,” that their grieving process skips the denial phase of grief and moves right along to the re-traumatization phase.

The denial phase of grief is nearly always related to self-protection. So when your grief is personal, this phase can offer some temporary benefit. But when you grieve collectively, the denial phase is incredibly dangerous for a number of reasons. 1. It re-traumatizes others, particularly in this case, those in the BiPOC community, who do not have the luxury of 400 years of denial 2. It causes stagnation and does not allow you to progress personally, let alone at a larger societal level 3. It causes further strain on those in the BiPOC community (and to a lesser extent allies) who should not have to expend precious bandwidth comforting you or coaxing you out of denial 4. It is insulting to deny the lived experience of millions of people to serve either ego or personal narrative.

Now I am a big proponent of self-care and of turning to others, such as a trusted loved one or a counselor, while working through the stages of any grieving process. I even support being open and de-stigmatizing the experience of grief and loss. And from time to time, I have even been known to dabble in some denial myself (most notably regarding my ability to successfully achieve a certain number of tasks in a given day and still get to bed early). However, when your surprise, denial, and shock, paralyze you or prevent you from making the necessary decisions to progress as a person and advocate for equity, then this phase of grief is best experienced with a counselor, consenting friend, or perhaps internally. Not with pearl-clutching and hand-wringing on social media and not at the expense of the wellbeing of those in the BiPOC community.

So while many of us love a good surprise, this is not it. Please stick to cake and (virtual) parties. Or jewelry…we like that too.

Are We There Yet?

At one time or another, all parents have shared in the universal, yet painful, experience of hearing the words “Are we there yet?” It is typically uttered roughly 379 times, in a shrill, whiny fashion, before we lose it a tiny bit with whichever child cannot help themselves but ask, yet again. So it is in that spirit, that I also dare query whether or not we are there yet. Are we finally through with this discombobulated, chaotic, mass casualty dumpster fire that is 2020? Perhaps not, but like all the countless, persistent children, I cannot help but ask.

Recently I took some time to reflect a bit more on the irony of hosting a conference on adversity and resilience during the most collectively adverse year in either recent or distant memory. For many of my patients and families, as well as many of your own families, 2020 has underscored the acute on chronic nature of adversity and trauma.

Many have experienced job loss, food and housing insecurity, loss of loved ones (and the added grief of knowing some of them passed alone), illness, including COVID, and in some cases, long term sequelae–the aptly-termed “long-haulers.”

In addition, there has been loss of insurance and/or other benefits, lack of access to medical care or understandable fear of accessing care, limited ancillary support services (such as physical or occupational therapy or mental health services), especially those previously provided through schools, and lack of reliable, safe transportation.

Even for those fortunate enough to retain employment, there have been professional hurdles—especially for those working from home while moderating virtual learning, the inherent stress of homeschooling—with its tech/wifi issues and lack of available space, childcare issues for those who cannot work from home, the risk of COVID exposure as essential workers, and the very real fear of becoming ill and/or exposing others.

There are those who, like me, have not seen extended family for nearly a year, those experiencing caregiver fatigue while caring for family members with COVID or chronic illnesses (further exacerbated when trying to limit other in-home caregivers/nurses). Then there is the loss of connection with community, reduced access to green spaces, or risk of COVID while visiting them, the pandemic 15/quarantine 19 (depending upon your level of stress eating), and extreme physical and social isolation.

And while it is unfathomable that we add to this already daunting list, I would be remiss to not highlight the toxic stress manifested in times of political uncertainty, as well as violent conflict in other countries, and the 400 year war of racism that continues to wage in this country.

However, this seemingly exhaustive list of stressors is not meant to overwhelm or cause despair. Though I would be lying were I to say that there aren’t some days in which it does feel overwhelming. Honestly, there are days in which the political, social justice, and medical victories feel overshadowed by hundreds of thousands of lives lost to COVID…overshadowed by the loss of George, Breonna, Ahmaud, and countless others. But for those times when resilience feels almost unattainable and reparations seem to not be actualizable, I hope we can reflect on those who have passed and allow their memory to fuel and energize the fight ahead of us. Because in order to tackle not only the acute, pandemic-related adversity, but dive deeper to address the adversity caused by structural racism and poverty, we will need every bit of that energy.

So rest up and stock up, as masks and vaccines (not toilet paper) will be your ammo in the fight ahead. And while we aren’t there yet, I believe we will get there.

Not so coincidentally…

My closest friends and loved ones know that, even when I haphazardly throw around trite phraseology such “coincidentally,” or “as luck would have it,” that I am being dismissive and inauthentic. Those who love me know that I do not believe in coincidences.

So I do not think it mere coincidence that my youngest child, whose name means “victory,” was born prematurely amidst difficult circumstances, and developed type 1 diabetes as a toddler, celebrated World Diabetes Day during Diwali (the Hindu celebration of victory of light over darkness).

I do not think it is coincidental that during what will surely be touted as one of the most significant, most painful years in our country’s history…a year that has seen unimaginable death, hardship, abject fear, and further widening of disparities that have existed for hundreds of years…that we are finally taking some small steps towards racial equity.

And I do not regard it as coincidence that during the week of an historic election, in which love and equity won by a far narrower margin than many of us would like, that my own professional and personal interests intersected as I hosted a conference on adversity, resilience, trauma, and reparations.

As such, and in the spirit of acknowledging that sometimes God and the Universe are more intentional than I realize, I share with you my opening remarks from the conference.

My name is Dr. Piper Calasanti, and I am a pediatrician at Children’s Hospital Los Angeles. I want to welcome you today to the childhood adversity, resilience, and mindfulness conference, otherwise known as CHARM.

About a year ago, I sat in a large lecture hall with a few hundred of my colleagues, listening to Dr. Nadine Burke Harris, our first California surgeon general, speaking about Adverse Childhood Experiences (ACEs). At the time I was working on editing my manuscript, which is essentially a memoir of my life. Although I had never really thought about my own life in terms of any particular academic verbiage pertaining to trauma, I sat there, staring at her slides and tabulating my own score. As the realization sunk in that I clicked off eight of the original ACEs (out of ten possible), in addition to a few of the other supplemental areas of adversity, it highlighted the importance of two things.

First off, although my score of eight should, statistically speaking, portend some poor health outcomes for me (cardiovascular disease, hypertension, etc.)….aside from being a cancer survivor, I otherwise consider myself to be fairly healthy. Yes I know it’s risky to even put that out there into the Universe. No, I am not intentionally tempting fate. So let’s all just agree to take it as gratitude and illustration that the mere experience of adversity does not always necessarily relegate one to a predestined path.

Now I must absolutely press pause and acknowledge that I had a number of things working in my favor, not the least of which is being white, third generation, speaking English, having some bonded familial relationships, and having a mother who learned to be fairly savvy in terms of navigating services that were available. And despite cultivating, which is a nice way of saying clawing and scraping together, a sense of optimism that has, at times, bordered on pathological, there is no denying the role of those other factors.

Second off, sitting in that room reminded me of the incredible amount of work there is still to be done…individually, professionally, and at a societal level. Now if that isn’t the theme of 2020, as well as the 400 years before that, I don’t know what is.

Four years ago, on election night, I found myself pacing aimlessly through the hospital, not because I was working, but because my youngest child was admitted, having just been diagnosed with diabetes at 20 months of life. I had only recently fully committed myself to the arduous work of breaking intergenerational cycles, and yet now I found myself facing a different hurdle. Watching election results trickle in, I feared the dissolution of all the various health and other related safety nets for my patients and, as a single mom of three, my own family.

While my lived experience, and the lived experience of countless others, highlight the absolute necessity of protecting the personal, familial, community, and societal assets that mitigate toxic stress, there is still an incredible amount of work to accomplish. And while at many moments, just in the last few months alone, that work has felt insurmountable, especially regarding achieving equity, we have to maintain hope that it can, in fact, be actualized.

Some days that hope may be merely a tiny spark, other days we may allow ourselves the luxury of fanning it into a flame.

But it must continue to exist. There is far too much work ahead …. too much tireless advocacy ahead…too much essential activism awaiting us, to let that flame die out. And while some days, or even some weeks, we may need self-care, self compassion, and rest, may it allow us to emerge refreshed and hit the ground running once again.

So in the spirit of taking those first steps, whether you run or walk, I am grateful that all of you have shown up to accompany one another on this journey to build resilience, but also to reimagine a world in which true equity diminishes the need to engineer so much resilience in the first place.

Thank you. Welcome to CHARM. And, in solidarity, let us embark.

To my son,

On the eve of my middle child’s eleventh birthday, I find myself devoting a good chunk of headspace contemplating…ok perseverating…on this conundrum that is parenting. With the demands of working from work and working from home, trying to raise three children, and trying to quasi-moderate homeschool for said children, such that they are at least reasonably literate and know just enough math to know that $750 is not an appropriate amount of taxes to pay, I fear that I get it wrong more days than I get it right. I know that I am not alone in that particular sentiment, as we all wade through the pandemic parenting, both racial and COVID, in solidarity. As if keeping them alive, fed, housed, and schooled were not enough, we are charged with trying to raise loving, grounded, emotionally intelligent, empathetic, anti-racist, socially conscious humans. Ideally, we are also supposed to be drinking enough water and getting some REM sleep, but let’s not get ahead of ourselves here people.

As I said, I know I get it wrong some days. But I suppose as parents all we can do is get up and try again the next day… try to model, in action, how we want our children to conduct themselves interpersonally and in the world. And while I am sure I will have more mom fails than I care to disclose, all I can do is pray I get it right just enough times to make it stick.

So on his last day of being ten, I renewed my vow to continue to get up each day and try and reiterated my hopes for him with the following words…

Dear Middle Child (yes, I used his real name in the actual letter),

I love you more than you will ever know. I realize that with our busy, chaotic lives, I do not tell you or show you enough. I also know it is hard being the middle child, bookended between a younger brother with medical needs and an older sister with her own journey. If it feels as if too much is expected of you some days, please know it comes from a place of good intent…because I believe in you. However, impact is more important than intent. So for the times when it feels like too much, I apologize. You are allowed to have your own journey, and know that I will always support you in that.

At eleven, I know your life is barely getting started, but I hope and pray you will always know how loved you are….even on your hardest days…especially on your hardest days. It will always be ok to feel your feelings and to share them. It does not matter if those are feelings of love, happiness, frustration, anger, or sadness. I pray you know you have the safety and space to feel, process, and share. As your mom, I cannot always fix it. But I can promise to be there to support you.

One of my absolute favorite things about you is your empathy. You have an amazing ability to sense pain in others. My favorite examples are when you asked Santa for insulin for Jai, and when you held my hand and comforted me when Ironman died and during my Les Mis ugly cry. And while I would not expect you to understand this at your age, just know that this ability is very special, and I pray it accompanies you throughout your life. I admit it will not always be easy possessing this attribute, but I promise, one day, it will be worth it.

My other hope for you is that you fully realize your gifts in this world and use them to help others. I know it has not always been easy for our family, and you have seen, firsthand, the sacrifices made for you to have the life you do. Please know that if I am vocal about this, it is in an effort to teach you how truly fortunate you are. That does not mean you cannot acknowledge when things are hard, imperfect, or unfair in your own life. You absolutely can. But I also pray you never lose sight of those less fortunate and those who are oppressed, and seek to leverage your place in this world to help others. In my heart I know you will, and I am proud of your growing awareness of social injustice and inequity in the world.

Remember always that action expresses priority, and love is a verb…as is justice.

I know that someday you will no longer want to sing Hamilton with me…or hug me no matter what (even when I am sweaty, post-workout)…or tell me all about your day (eagerly and loudly)…or fight to sit next to me in a restaurant or theater. But I am excited for what God and the universe have in store for you. Happy birthday and I love you now and always (I love you 3000).

Love,

Mom

SPF

The last time my youngest son was hospitalized, nearly two years ago, I lay in his hospital bed with him in my arms. We had recently returned from the recovery room after a successful surgery, and I admit I was both physically and emotionally drained. As a single mom of three, some days are certainly harder and more exhausting than others. However, the combination of having been on call that weekend, grieving the loss of a close friendship, a late night involving multiple attempts to obtain vascular access (place an IV) in my son, and an early morning transport to pre-op to discuss intraoperative management of my son’s medical devices, had left me feeling extra depleted that day.

Perhaps if I had been more awake, I might have had a more thoughtful response. And by “awake,” I do not simply mean more well-rested or caffeinated.

In my partial stupor I lay there intermittently making small talk with my son’s nurse. She looked at him, smiled, and cheerily said “I love his tan!”

My identity as a pediatrician/safety-guru is apparently so enmeshed that my first instinct was to be reflexively defensive. I neurotically and meticulously discuss sunscreen at every single well child check, day in and day out, five days per week. How dare she think I would fail to use adequate sunscreen on my child?

And then it hit me.

My first instinct was to become defensive…but for the wrong reason entirely.

She wasn’t failing to recognize my adherence to sunscreen and skin cancer prevention guidelines. Her comment was not a couched dig at my clinical acumen as a pediatrician.

Before a single word could exit my lips, I let her comment sink in fully. She saw my son as “tan”….not as biracial.

I quietly wondered how many more times he would hear similar comments in his life.

By the time I processed those thoughts, she had fixed his IV fluids and left the room. Having paused too long, the moment was gone. And I had left all the words unsaid.

Looking back, I wish that I would have responded more quickly and with empowering, strong, educational comments. And as a pediatrician, let alone a pediatrician raising biracial children, I am ashamed that my reaction time was slow and my lack of response was embarrassing.

Growing up in the Midwest I felt surrounded by racism. While it can never begin to compare to the racism experienced by BIPOC, even as a white person, I faced the teasing and slurs related to my Italian/Sicilian heritage. And before I understood the importance of using sunscreen neurotically, I would return from my summers in California to comments about how I was so dark that I looked “like a black kid.” My mother had been called the “N” word, due to the belief that Sicilians are descended from Africa, and I still remember her explaining to me what the various slurs and comments signified and how they were inherently racist.

But let me be explicitly clear. I have never had to fear for my safety based solely upon my skin color. Not then in Missouri, and not now in California. As a cis-gendered, white female, even when I did face police harassment in the past, I did not have to remind myself, in those moments, to keep my hands where they could be seen. No guns were drawn. I never called out to my mom.

While I acknowledge my white privilege, I will further acknowledge my extreme naïveté. I believed the endemic racism of the Midwest to be largely a regional phenomenon. It is time for me to be fully accountable for the fact that sunshine and family were not my only motivations for leaving the Midwest. Having been raised by an anti-racist mother, and now raising three children of my own, two half-Asian and one half-Indian, I figured we were buffered from white supremacy, living in Los Angeles.

Yes, that was a one-dimensional, dismissive, ignorant thought process. Yes, there are very lovely, anti-racist people in the Midwest. Yes, racism is endemic here in California as well. Yes, moving 2000 miles from the place where my then 4-year-old daughter was the only biracial child in her class, to a school with more than 50% biracial children, does not grant my own children immunity from racism.

Certainly society is cognizant that our Black Americans have never been afforded basic safety against, let alone “immunity” from racism…right?

Apparently not.

I became even more acutely aware of this cognitive dissonance two months ago, as I was yelling at the TV like a crazy person, while CNN was inquisitively speculating as to why black patients are disproportionately affected by COVID.

“Really? Is this a real question?”

You would have thought I was watching football, the way I was carrying on as my annoyance mounted.

“Social determinants of health, poor access to quality healthcare, intergenerational toxic stress, economic disparities, essential workers!!!!”

It turns out that CNN cannot hear my frustrated pleas nor see my frantic gesticulation. But it was yet another important reminder, amongst a series of countless, painful reminders, that not everyone got the memo that racism is a public health crisis. Thankfully within a day or two, physicians and public health experts had shifted the narrative to expose the root cause, racial disparities, thereby saving my TV further verbal aggression.

However, I sat in my apartment a few weeks ago on a Saturday night, revising a grant proposal that, somewhat ironically, pertained to adversity/resilience, toxic stress, and trauma. As I did so, tear gas was being lobbed about half a mile away, and I was forced to face a larger fear.

At no point in time did I fear protests or tear gas….not for a second. But what I did fear, and do fear, is the legacy I am leaving as both a mother and a pediatrician.

It is not enough for me to merely break cycles of intergenerational trauma in my own life. It is insufficient to simply teach my own three children to be anti-racist. It is not adequate to merely treat my own cohort of patients equitably and advocate individually for them. Voting in November is not an all-encompassing solution.

It is both selfish and woefully myopic to act as if I live in a protected vacuum…a microcosm of perceived safety where, as long as I love and support my circle of black and brown friends, family, and patients, we will be fine. The truth is that none of us will be fine, not friends, not family, not strangers …not until systemic racism is dismantled. There is no room for complacency or neutrality, because “inaction” is a verb that is as equally powerful as “action.”

So while I once lay holding my son in a hospital bed, lacking the proper words, I will continue to find and fortify both my words and my actions, because my children, and all of our children, need a hell of a lot more protection than mere SPF can provide.

Contagion

I guess it was just one of those weeks…

You know the type….several weeks into a pandemic, trending far too close to one million Americans infected….economy so devastated that I’d rather bury my head in the proverbial sand, than think about when we will financially rebound in a meaningful way. I estimate I am at least a few weeks beyond the point at which I might have been able to salvage my childrens’ grasp of math and English language arts, and I have nearly given up on my youngest child having a significant interest in learning to read. I guess two out of three literate children may have to suffice. And I am likely a month beyond the point of returning to my pre-pandemic level of expected chaos, semi-normalish self-care, an acceptable Body Mass Index (BMI) and cholesterol level, and some semblance of my own version of sanity.

From week one of quarantine, I have clung to the notion of an ever-evolving “new normal.” The only thing I can begin to liken this to is the new normal I experienced the year following my son’s type 1 diabetes diagnosis. But even that only affected myself and my three children, not an entire planet! Yes it had significant health-related, physical, emotional, familial, financial, psychological, professional, and social implications. And yes, especially in the first year, it felt like a constantly-moving, elusive target. However, it was on a personal and familial, not global, scale. The COVID19 pandemic, on the other hand, is almost incomprehensible in terms of its scope.

With a vaccine still likely several months away, and the fact that we are not even safely between projected peaks yet, it is quite easy for many people to start to lose hope, at least transiently. Add in to this dynamic the fact that many people have lost jobs, had their hours reduced, given up on the notion of bonuses or raises, cancelled travel (both professional and recreational), are struggling to afford food, and have missed special events such as birthdays, weddings, proms, and graduations. And they are the “lucky ones,” as still others have lost loved ones or become ill themselves. Not shockingly, many people are experiencing high levels of anxiety, depression, fear, and isolation, and with seemingly no end in sight. Even as someone who has survived cancer, in addition to other adversity and trauma, I can quite easily say that I have never experienced something remotely approximating the insanity that is COVID.

Perhaps it is ironic that just prior to COVID’s presumed arrival in the US, a colleague and I had applied for a grant to develop an educational curriculum addressing screening for adversity and resilience and building additional strengths within families. Nothing like a global pandemic to additionally highlight the need for such resilience! So I suppose with my personal past in my heart, and my professional interests in mind, I should dig a bit deeper and try my best to be mindful of those things which potentially foster resilience….even during a week like this…even when the weight of a global pandemic, the hurt of so many loved ones, and so much personal, financial, and professional insecurity weighs on us all.

Now I realize that many of you are doing your part sheltering in, and as such, you may be just bored enough to indulge me as I drone on endlessly. However, for the time being, I will spare you my epically long diatribes on the importance of nutrition, fitness, REM sleep, mindfulness, relationships, faith, etc. in building resilience. While these topics are clearly important, they may require more bandwidth than I can reasonably expect from you, and less hypocrisy (especially regarding nutrition and REM sleep) than you can reasonably expect from me this week. Instead I will share with you an example of one family who is cultivating resilience in a very impactful and, forgive the pun, contagious capacity.

Last week I received a voicemail late one evening. It was informing me that my face shields would be ready the following morning. Face shields? It took a second for everything to click. A few weeks back a dear friend tagged me in a Facebook post about a family who was crowdfunding the 3D-printing of protective face shields. With the days blending together, as I tried to balance clinical, in-person work with remote work and homeschool moderating (what I do cannot be referred to as “teaching”), I had nearly forgotten about the post. Then, seemingly out of nowhere, I had a beautiful voicemail from a veritable stranger, alerting me that there would be 100 face shields ready tomorrow. I called her back immediately to make arrangements to come pick them up the next day. As we spoke I found myself pausing for breaths, trying to keep myself composed, as I thanked her for their generosity.

She thanked me for my service as well, but I still cannot help but feel my verbal gratitude for their contribution was inadequate in terms of honoring what their work has done and continues to do. We have grown quite accustomed to all the infographics showing the logarithmic potential of COVID19 spread. But we do not spend much time considering the potential exponential effects of adequate PPE (personal protective equipment). For instance, a single one of these 3D-printed face shields can protect me as I see numerous patients, as long as I disinfect it appropriately. In this regard they are a bit heartier, so to speak, than masks, though are intended to be used in conjunction with appropriate masks, gloves, and gowns.

For the sake of argument, let us say I see twenty patients in one day. If my first patient of the day is shedding COVID, that face shield protects me throughout that first encounter. As such, that mask protects me from spreading COVID to all subsequent patients I see, both on that same day, and for as many subsequent days as I might asymptomatically shed to others, prior to clearing the virus or becoming symptomatic (such that I self-quarantine). If I never develop symptoms, that is at least fourteen days’ worth of patients I can infect, including newborns, children with medical needs, and immunocompromised patients. And the nature of pediatrics generally dictates that all of my patients live with at least one adult, not to mention siblings, grandparents, or others who may live in the home. Thus, that is fourteen days of patients, plus their collective family members (some of whom are essential workers, and all of whom will need to buy groceries at some point), that may be spared by the use of that one face shield. In addition, it is also my own family that is hopefully spared as well, including my three children, one of whom has an autoimmune disorder. In this way, a single 3D-printed face shield has the potential to protect hundreds, if not thousands, of people.

This is the type of contagion that we need right now. If this type of generosity, selflessness, and resilience can spread in viral fashion, then we might stand a chance at buffering against the collateral damage of COVID19. I hope that the next time we sit in front of our devices, staring at curves with scary slopes and digesting alarming percentages, we can pause to be mindful that COVID is not the only entity spreading in our world!

I cannot thank the Reitman family enough for their donation to our frontline workers, our patients, our community, and our loved ones!

I would also like to give a special shout-out to 8-year-old Stella Reitman for the amazing poem she included in the box of face shields.

Infiltrating Beyond the Front Lines

Expendable. That is what we have become. I imagine that every person has, at one time or another, felt expendable. Perhaps it was inter-personally, when discarded by a friend or lover. Maybe you felt similarly when dismissed by your eye-rolling adolescent child who deemed you lame, as they ran off to hang out with their friends. Or it may have been professionally, as you were passed over for promotion or denied a raise. Everyone has times in which they feel devalued.

But when you feel devalued by a large chunk of society, in addition to politicians and leaders, that is when you know you have really leveled up…or is it down?

Unless you have been residing under an incredibly large rock the last month, you have surely heard the urgent plea on the part of healthcare workers to be provided with adequate PPE (personal protective equipment). But what you might not have noticed is that the discourse surrounding this issue has been the following: “Please, for the love of all that is holy, give us adequate PPE so that we may avoid becoming ill, in order to continue taking care of patients.” Clearly this makes sense for a number of reasons, not the least of which is that we took an oath to help people. So anything that keeps us in the proverbial game, caring for people, is a necessity.

However, the part that seems to be flying under the radar is the subtle…or not-so-subtle….disregard for our own safety and wellbeing. It is as if our entire worth is contingent upon our ability to care for others. “Don’t let the doctors and nurses run out of PPE, or else there won’t be any doctors left to care for you should you get COVID19.” But what about the doctors, nurses, respiratory therapists, phlebotomists, care partners, etc. themselves? Is that all we are to society and politicians? When was our intrinsic worth dismissed by so many? And how did we miss the memo that we were being drafted into a war for which we lack both ammo and protection?

Please do not misunderstand me. Caring for patients is a privilege and an honor. It always has been, and it always will be. But the game has changed. Many of us have been exposed to infectious diseases throughout our career, often on a daily basis. Just last year I had to take prophylactic medication after being exposed to a patient with Pertussis (whooping cough), despite having been vaccinated for it and wearing a mask. I did this so that occupational health would allow me to keep working, so that I did not risk exposing my newborn patients who were not yet old enough to receive vaccination, and so that I did not risk exposing my fully vaccinated children, one of whom is high-risk. These are the types of calculated risks we take…the so-called “occupational hazards.” However, the thing that has allowed us to take these risks is knowing that we have appropriate protective equipment and protocols in place to keep both our patients and ourselves safe. We have received extensive training, the appropriate vaccinations and, in theory, we engage in sufficient self-care, consume a healthy diet, and get some degree of exercise and sleep. Hence, under typical circumstances, we should be able to keep ourselves as healthy as possible. For the sake of time and sanity, I will save discussion of physician self-care for another date/time. But my point is that previously, we were reasonably well-prepared.

Yet now many physicians and other healthcare workers find themselves begging and pleading for adequate protective equipment. When not engaged in that, many of us are imploring others to stay home in order to prevent the spread of COVID19, or lamenting the embarrassing lack of available testing. Then we may take a break to scour the internet searching for the latest information regarding treatment, prognosis, risk factors, etc. Yeah, I know we told you not to google health-related things. Have no fear, we aren’t googling. We are using Facebook groups (which have actually been extremely helpful in terms of disseminating clinical information). Trying to be an informed doctor during this pandemic is absolutely exhausting. It leaves little bandwidth for other things, such as reassuring our patients, reassuring our families and friends, wondering when and where we will find TP or eggs, and home-schooling our children.

With all that on our collective plates, what could possibly deplete us even further? The realization that our intrinsic worth is currently being devalued by a certain portion of the population. Obviously I can acknowledge the irony that most people who would read this blog represent the choir, to which I am currently preaching. Most of you are doing your part. You are staying home, you are washing your hands, you aren’t hoarding medical supplies, and many of you are helping those of us on the frontlines to crowd-source and otherwise fundraise PPE. You are helping flatten the curve and trying to help us respond to this pandemic. To all of you, we extend extreme gratitude. And to the hospitals and clinics, like my own, with administrators working to advocate on our behalf…we thank you as well.

But I would be inauthentic if I did not take this opportunity to remind some others out there, that we are so much more than just doctors or nurses, or front office staff, or phlebotomists, respiratory therapists, environmental service custodians…the list is lengthy. We are mothers and fathers, children, nieces, nephews, spouses, grandchildren, friends. If we become ill, or God forbid worse, we leave not only a hole in the front line of healthcare workers. We leave holes…permanent and unfillable voids….in the lives of our children, parents, spouses, and friends. And because my mind and heart cannot bear to consider it now, I will leave unsaid our silent fears about what happens if we bring this disease home to our loved-ones.

With this in mind, let the discourse at a societal level expand to include our own intrinsic value as people, not merely as servants. And while I still feel honored to serve, please acknowledge that we are so much more. Please protect us, because we deserve that protection. Forget the cape or superhuman strength….we will take a N95, face-shield, gown, and gloves.

Blame It On The Alcohol

Had you told me, even a mere two weeks ago, that I would find myself filled with such emotion over alcohol…no, not ethanol, the lovely type we may imbibe at times in its various tasty forms…but isopropyl alcohol (of the “rubbing alcohol” fame), I would have deemed you crazy. And not the mildly-eccentric-but-still-lovable-and-fun type of crazy, but more on the bat-shit-crazy spectrum. I mean, seriously, who has such deep-seated, intense emotions about isopropyl alcohol?

Well, as I recently found myself trying to process the fact that someone drove to four different stores, close to midnight, during a viral pandemic, to find me rubbing alcohol at a random location 20 miles north of my home, I realized that I am emotional about alcohol.

Now before you dismiss me as the bat shit crazy one (which might be a fair assessment given the circumstances), let me give some context. I use alcohol pads to prep my son’s skin for his frequent device changes, as he wears two medical devices to manage his type 1 diabetes. My son wears an insulin pump in his leg, which is changed every other day, and a continuous glucose monitor in his arm, changed every ten days. These are literally his lifelines! As you likely ascertained from its clever name, the insulin pump delivers insulin, without which my son would not be alive. And his continuous glucose monitor alerts me when his blood sugar is dangerously high or low; this is even more important as my son is almost entirely unaware of changes in his blood sugar, which can lead to hospitalizations (or worse) if left unchecked. In addition, I also use alcohol to clean his fingers when I need to check his blood sugar, something I must do periodically to confirm that his glucose monitor is giving reasonably accurate readings. Typically it is fairly spot on. Other times, like last night, it was off by 110 points! While that is an unusual discrepancy, it can happen occasionally, hence the need to manually check a finger stick glucose periodically. Why not merely use soap and water you ask? Good question. Especially for device changes, which require that an adhesive backing secure his devices to the skin, it is important that his skin be as free of moisture and oil as possible, in order to ensure good adherence. In addition, the risk of a skin infection can be higher and more problematic in the setting of diabetes.

With our contextual science lesson safely behind us, we can get back to my emotional moment. For the last week or so, my usual stores and online sources continued to be out of alcohol pads. On Wednesday evening I had tried a few more stores and was poised to resort to the small supply I keep in our earthquake kit. That is when it hit me. The indiscriminate hoarding practices in the wake of COVID19 were about to affect our family and in a very real way. So it is perhaps not surprising that I felt almost overwhelmed when someone else risked being out in public to do something so selfless for not only me, but my son. Two days later a stranger, located nearly 3000 miles away, mailed me alcohol pads after reading my comment in an online physician group. About an hour later, my amazing cousin informed me that her friend, whom I have never even met, was driving a stash of alcohol pads across town to leave at my doorstep. Within the hour my cousin texted me to check outside my door, and by the time I closed my front door again, envelope of alcohol pads in hand, I had tears in my eyes.

My kids might have just chalked my emotional reaction to medical supplies as further evidence that COVID19 would be the thing that finally put me over the edge. However, for better or worse, my kids are pretty savvy regarding the implications of COVID19 for our community and my patients, as well as the ramifications of something known as “supply chain disruption.” As a pediatrician with a high number of medically complex patients, many of whom rely upon adequate medical equipment, medications, and supplies, the prospect of supply chain disruptions feels very scary. With the additional stressful reality of inadequate personal protective equipment (PPE), and the potential for insufficient numbers of ICU beds in the coming weeks, that fear is compounded ten-fold. The amount of time I have spent thinking about the logistics of this situation for my patients is tantamount to obsession. But I did not expect the hoarding aspect of this pandemic to hit so close to home this quickly!

Yet the truly amazing thing about life is that sometimes…even in the midst of what is ramping up to feel almost like a mass casualty situation…God, the universe, and three extraordinary, selfless people really can make a difference! Words are inadequate to express how blessed I am by their generous acts to keep my son safe (and me as sane as can be expected)! Hopefully some day, possibly months from now, we can raise a glass of the other type of alcohol together as a sign of my gratitude.

#DoctorsSpeakUp

As both a mother and pediatrician, I am pretty comfortable in my bad cop persona. I have fully embraced the fact that I may never be the “fun” parent, nor will I likely be perceived as the “fun” doctor, as I spout such popular and well-received kernels of information, such as “no, it’s not healthy to play Fortnite 8 hours per day….yes, you should still be in a booster, I don’t care if your seven-year-old-friend rides in the front seat…no, cake is not a healthy breakfast… and no, neither candy corn, nor regular corn for that matter, count as a vegetable.” Thus it stands to reason that I should be unfazed by having to dispel various anti-vax-manufactured urban legends that have zero basis in either reality or evidence based medicine.

You know what though? It actually does bother me. I know that I “should” have no issue sharing unpopular, yet scientifically sound, vaccine information. However, I am going to admit that doing so can be exhausting. But why?

First off, it is winter. While to the blissfully unaware non-primary-care-physicians out there, this may mean merely colder weather, holidays, ski season, snow shoveling, and hot chocolate, this season has a different connotation for those on the medical front lines. Pediatricians are typically exhausted during the respiratory season, and this season has been rougher than usual due to the high volume of influenza in the community. Now enter stage right, COVID-19, and our bandwidth is dipping even further below where it was in January, when we found ourselves looking longingly toward April or May. But such is the seasonal nature of pediatrics and medicine in general. Most of us either knew what we signed up for in that regard, or quickly realized about two weeks into our first “respiratory season.” And certainly, this seasonality is something with which any parent of a small child is well- acquainted!

But one thing that no winter can fully prepare a doctor for is having to continually defend science to the general public. Now here is where I will admit that I am extremely lucky and have a really fantastic panel of patients, the majority of whom are fully vaccinated. So I am grateful that I spend very little time having protracted discussions about vaccines, beyond the standard anticipatory guidance. I rarely have to discuss Andrew Wakefield, the UK “physician” who lost his medical license for fabricating research positing a link between the MMR vaccine and autism. I also rarely have to address the lack of evidence that vaccines are unsafe or non-evidence-based alternative vaccination schedules. I only occasionally have to mention that there is far more formaldehyde in a single pear, than in the entire childhood vaccine series. At times I may need to mention that the entire childhood vaccine series contains a much smaller volume of antigens (portions of a virus or bacteria that stimulate the body to make protective antibodies) than that door handle you just touched. But even that conversation is not common in my daily practice. That said, for the occasional vaccine-hesitant or questioning parent, I can certainly engage in this discourse in the interest of health and well-being for my families and the community at large.

However, what I do not have much bandwidth left for is fighting the fear-mongering and ant-vax trolling practices that have become far too common and lead to a deleterious public health crisis. Some of us have almost become immune, ridiculous pun intended, to receiving yet another public health communicae regarding yet another case of measles or pertussis (whooping cough). I would be hard-pressed to think that any of us knew, when we took on $200K of medical school debt, that the medicine and science we learned would be publicly ridiculed on a nearly daily basis, and by people with zero training in science, research, medicine, or public health. In fact, in pediatrics, there is really little else that has such a robust body of evidence to support it. Yet here we are, arguing with conspiracy-theorists on social media. Who knew?

On March 5th, in the midst of an unrelenting flu season, and between answering questions about COVID-19, we will pause as a pediatric community to remind you that we will continue to fight the good fight. We are tired. But just as we used to rally in the 29th hour of a 30 hour shift in residency, we will dig deep. We will continue to support our patients, our families, and those in our practices and communities who are unable to receive vaccines or whose medical conditions put them at higher risk (such as cancer patients, transplant recipients, and those with weakened immune systems, including my youngest child). We will continue to engage in discourse and spread awareness to combat misinformation. We will persevere, to the best of our abilities, in trying to protect the community. All we ask in return is for you to vaccinate, wash your hands, and cover your cough. Also, we would like a nap…or two.

#DoctorsSpeakUp #Vaccinessavelives #Vaccinescauseadults #Vaccinate #WashYourHands #CoverYourCough #supportdoctors #weneedsleep

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