Philosophizing in the Rearview

When reflecting on 2022, there were moments so crazy that it’s almost easier to close the door firmly on the year, lock it, and never look back. As I waxed poetic in a prior post, “don’t look back….your direction is forward.” But, for better or worse, my insufferable inner philosopher simply will not allow for that. So here I am, forced to at least partially process the year that lay behind me. Truth be told I suppose the same could be said at the end of any year, because who amongst us truly lives a boring life? No one? Yeah, I didn’t think so.

Since I can’t cheat the proverbial process, I decided to revisit some of my prior musings on the topic of finding meaning…aka making some minimal fucking sense of the chaos. In general it appears we choose one or more of three options when reflecting on life experiences. 1. We can choose to believe that a higher power, such as God, the universe, or karma “made,” our life events happen, perhaps (to take it a step further) even as a reward or punishment for various things. 2. We can choose to believe that a higher power “allowed,” for certain events to transpire, in the backdrop of other notions, such as having free will or being subject to the laws of nature/science. 3. We can choose to believe that events are merely due to chance, and that events are either random lucky, or unlucky, occurrences.

The most important point, though, is that each one of us has a choice to make. And it is that very choice that can help us transcend from merely surviving life and it’s various events to thriving, because of those events. The use of the word, “because,” instead of “despite,” is intentional, though I sometimes think of them interchangeably. In the past I used to think “despite X circumstance, I accomplished Y.” And there are definitely times during which that was the case. For instance, despite my child’s blood sugar dropping precipitously during our morning commute, I still made it to work in time for my first patient (albeit a few minutes later than intended). But there are other instances in which I, like all of us, accomplished something because of some adverse event. These are usually the cases in which our path was altered in a different direction due to some experience. It’s not the same as starting a task, getting derailed by an event, and getting back on that same track. Rather, it is when we pursue something, find ourselves derailed, and use that derailment to veer in an entirely new direction. It involves a conscious choice to take what we have learned from that adversity, incorporate it into the larger schema of who we are, and allow it to propel us in a new direction.

I firmly believe that if I chose to believe option two, that some higher power “allowed,” for life events, within the confines of free will and nature/science, then I can at least begin to find meaning in even the worst experiences. This mindset causes me to reflect on occurrences and trust that something/someone bigger than me felt that I could endure said event and have the opportunity to learn from it. As such, I might even have the potential to show empathy and/or pass on knowledge to others.

This concept also forces me to consider the role of free will and examine my role in an event, thereby keeping me accountable. And it reminds me to consider the autonomy and free will of others, which highlights the roles they may have played in my experiences, helping me discern which things were beyond my control. Hopefully, this aids in self-forgiveness and mitigating shame. However, being simultaneously accountable for our actions and aware of our limitations takes a tremendous amount of insight and practice. Likewise, with certain events, contemplating the role of nature/science humbles us by reminding us again of what we can and cannot control and of the importance of being prepared. Furthermore, belief in a higher power guiding our experiences can foster gratitude for the times when the free will of others resulted in helpful, kind, supportive, and loving acts towards us, as well as thankfulness for times when science and nature are cooperative in our lives.

And the mere act of believing, in and of itself, is very powerful. Belief takes hope one step further. Hope is rooted in wanting or desiring something and, as such, entertaining it as a possibility. To believe involves taking potential and knowing, at your core, it can be actualized into reality. It is what we do when we not only put something out into the universe, but we know it can be. We can visualize it. It propels us forward and helps buffer hardship.

Now does this mean choosing this option is the best possible choice, purely because I (a random stranger with zero authority on the subject) say so? Um no. Absolutely not. It is honestly one person’s mildly convoluted, meandering opinion amongst many. Am I being overly dismissive of options one and three? Probably, though it is mostly for the sake of brevity. And just because I choose to believe this way, it does not mean I have remotely come close to mastering the process of sorting through the stuff of life and ascribing meaning or using those experiences to better myself or others. To say that cultivating these skills is a work in progress is a gross fucking understatement. I still have a tremendous journey ahead of me and a lot of work to do. And although some days I feel I have come a million miles in my somewhat short life, other days I feel as if I have so much more to do…as if there is so much more in me to give. There are still seemingly countless things I long to do and see and accomplish.

However, regardless of those things I have penciled in my own agenda, I will have to remind myself to be open to the events and people that are part of a higher agenda. Because sometimes those serendipitous detours are the exact things that, rather than merely lead us to where we need to be, help us become who we need to be. For that reason alone, I can be grateful for every bump in the road, even those that humbled me more than expected. And I do feel extremely blessed that amidst the year’s chaos were some amazing, blissful moments of connection with friends and loved ones that made it not merely just bearable but worth it all. Happy New Year! May this next year be filled with growth, blessings, and love.

Time Travel Jet Lag: Unpacking 4 Different Perspectives

TW: sexual assault, abuse

I am not sure if it was the serious jet lag from twenty-four hours of transit across nine time zones, or the rough reentry and integration back into anything-but-normal life. Or perhaps it was the brutal stripping away of female reproductive rights and the threat of repealing so many other human rights, all whilst ensuring that the leading cause of death in children will continue to be gun violence. Who knows? Could be a combo of all of these. In light of these dystopian gems, plus life in general right now, perhaps it is not surprising that it has taken me a full week to process just the tip of the iceberg of emotion brought on by the events of this past week.

But as a pediatrician whose clinical niches are trauma/adversity, resilience, and equity, as well as children with medical complexity… and as a survivor… it is time to emerge from the brain fog of this past week. Personally and professionally there are so many layers of this to unpack, that it made unpacking the actual luggage from my recent trip seem far less daunting by comparison. And like all unpacking, there is bound to be at least a little dirty laundry.

One of the realities of caring for children with special healthcare needs is that for a certain subset of my patients, a pregnancy could be catastrophic, resulting in death of both my adolescent patient and the fetus. Additionally, my patients with intellectual disability, severe autism, or other neurodevelopmental disabilities are already at higher risk of sexual assault, which is, in and of itself, a terrifying experience for them. Now try to imagine the added horror of becoming pregnant for a patient with limited cognition and/or traditional verbal capacity. My own mind cannot process that fully. Maybe it’s the jet lag.

Furthermore, and please bear with my science nerd perspective for a minute, my work in trauma/adversity, resilience, and equity is aimed at the goals of screening for these factors and helping patients and families build resilience, nurture buffering caregiver/child relationships, and address disparities in social emotional determinants of health (food, housing, transportation, insurance, & other financial or social justice issues). Without going too far down the physiology rabbit hole, adverse childhood experiences (referred to as ACEs), especially when unbuffered and untreated, can lead to chronic activation of the stress response. And that constant “fight or flight,” dynamic can lead to future poor health outcomes such as asthma, obesity, cardiovascular disease, high blood pressure, cancer, depression, anxiety, substance use disorders, and others. As such, childhood adversity poses the single greatest threat to the future health and well-being of our children. To add intergenerational insult to injury, trauma can cause actual changes in the DNA (referred to as epigenetic changes) that can be transmitted to future generations; an ancestral curse in the truest sense. Thus, by forcing a mother to carry an unwanted pregnancy, with its implications for intergenerational poverty and widening disparities, especially within the BIPOC community, our country is actually legislating trauma and adversity for our patients and future generations. I certainly did not order the trauma special with a side of racism, so if you could take it off the menu, that’d be great!

As if all of that is not ominous enough, there are still a few other layers worth unpacking. Please excuse me while I take off my white coat and scrubs for a moment to lend a different, more personal, perspective. In other words, it’s about to get a little more real. When I was in my third trimester with my youngest child, I noticed a small growth at my jawline. Initially thinking it was probably a pimple, and given I was on bed rest, it was convenient to simply ignore it. However, it never really declared itself as a pimple, and it persisted and grew, likely thanks to all those fun pregnancy hormones. It turns out that what I had initially dismissed as a pimple, ended up being a rare tumor (now my second rare tumor…but who’s counting?). I was fortunate that it was at the end of my pregnancy, it was relatively slow growing, and it had not metastasized–a trifecta of oncologic good fortune. Under different circumstances, I could have had an extremely difficult decision to make. It is a decision that no mother should ever have to make, but unfortunately it is all too common amongst cancer survivors. Having begun my cancer journey at age eleven, I am grateful to have lived long enough to have three wonderful children. I cannot imagine if that cancer journey had ended during pregnancy, which is now a very real possibility for so many others.

However, cancer survivorship is not the only meandering journey I have traversed (aka stumbled through) in my life. When it comes to vocations, whether due to comfort or serendipity, sometimes you organically find yourself doing what you know. One reason I have gravitated toward work in adversity and trauma is because I, like many of you, have had a little too much experience doing the hard work of overcoming my own past traumas. While those experiences, and the difficult work of surviving and transcending them, are in the past, there’s nothing quite like having your reproductive rights stripped away to remind you of all you have endured.

By the time I reached double digits, I had been sexually abused, and by the time I reached 20 years of age, I had been raped twice. I was extremely fortunate that I did not end up pregnant, but I cannot begin to imagine how much more difficult my healing journey would have been had I been forced to carry a rapist’s baby. Honestly there are days that I still wonder how I survived abuse, rape, poverty, and cancer to be where I am at today. But then there are other days…days in which the residual sequelae of past trauma are just perceptible enough, at least to me, to remind me that survivorship is a lifelong journey. By the grace of God, the Universe, karma, ancestors, holy water, a lucky penny, and favorable winds, that journey has allowed me to live a life that ensures those past experiences were not in vain. But I can say with reasonable certainty that my ability to not only heal, but to utilize past adversity to ultimately help others, would have been severely impacted by forced pregnancy. So the work of advocacy and activism must be tireless to ensure that every woman has that same chance to not only survive but thrive, despite the intergenerational cycles of trauma and poverty that just became that much harder to break. To that end, it is time to unpack the luggage and get to work, because this jet lag ain’t got nothin’ on time travel back to 1973!

Photo Credit: https://www.zacharyleeportrait.com/

The Double-Edged Scalpel

Eternally in a hurry, I uttered my standard-issue, “No, I’m sure it’s all fine. It’s just the typical surveillance testing,” excused myself from the call, and walked quickly toward the hospital.

Five hours of testing later, and I would find myself deflated and wondering if that statement had jinxed things, as I dressed and gathered the paperwork to schedule my next, unexpected biopsy.

Sometimes we become so very used to a particular behavior that it becomes second nature. This is true of a wide variety of both adaptive and maladaptive behaviors…eating healthy, working out, drinking enough water, smoking, working too much, gossiping, shutting people out, making excuses for other people. Actions are so powerful that, when repeated over time, they simply become part of who we are. And after 30 years of cancer survivorship, eleven surgeries, more than eleven procedures, sixteen different types of biopsies, and twenty-one MRIs, I am no different in that regard. Long ago I became so accustomed to reassuring other people that I would fine, that it is literally reflexive. My arguably canned response is always “I know it will be OK.”

However, this is a little more complex than merely trying to placate others with a submissive, disingenuous statement. Though I must admit I am more prone to doing so when really busy and lacking the bandwidth to really comfort other people. But there is something more than just mere habit and convenience at play. For starters, I really do believe that God and the universe (and perhaps a pinch of karma) will ensure that things will work out fine, one way or another. While faith, like anything, may wax and wane at times, it is always there anchoring the journey.

Furthermore, as I have written before, I really do believe survivorship is a “good problem to have.” I try to not lose sight of those who are no longer among us, but who would have given anything to have this type of “problem.” I have also had decades of hearing the phrase “it is probably nothing…but because of your history, we should biopsy… just to be sure.” In fact, during the otherwise seemingly endless days awaiting pathology results, it is not unheard of for me to temporarily forget that I am waiting for that call. Additionally, I recognize how fortunate I am to have insurance and access to great care, and appreciate that I have been blessed with doctors who do their due diligence to ensure that I remain cancer-free. Thus while it may not be ideal to have yet another biopsy, the benefit of those needles and sterile surgical steel is that it is what ensures I remain here…for my kids…for my patients…for anyone else whose life I might have the opportunity to touch…and to continue to share my musings on surviving cancer (and so much more). So bring on the betadine and lidocaine. God-willing, it will all be OK.

*** Photo credit: @auskr (IG)