Tuesday, June 29, 2010

Freezing my biological clock?

In following up with my last post on families, and my changing perspective on having one, this article was published in the LA Times health section today:

"Meanwhile, Srilatha Gorthi of the Leeds Centre for Reproductive Medicine in England put the question to younger women (average age 21) for whom the idea of egg freezing was more theoretical.
Among 98 hard-charging medical students, 80% said the idea appealed to them. They saw the technology as a way to focus on their careers during their prime child-bearing years. Among 97 students majoring in education and sports studies, only 40% were open to the idea of freezing their eggs. For these women, the primary motivation for delaying pregnancy was to achieve financial independence." -K. Kaplan, If you could put your biological clock on hold, would you?, LA Times, 6/28/10.

On one hand it is nice to feel comradery around putting pursuit of career first at this point in my life; on the other hand, 80%?! First, I'm not sure how I feel about the whole idea of egg freezing to begin with. Just because the eggs are younger doesn't mean the body is as apt to carry the pregnancy or raise the child. (By this, I am not saying that older women should not be having babies, just that I don't think hormones and harvesting and freezing would be the right choice for me personally.) Second, clearly something is wrong with the priorities of the medical profession. And no, this realization of screwy priorities in the profession I am pursuing is not new, just reaffirmed.

With that, I go back to listening to the ticking of my biological clock...

Saturday, June 26, 2010

What constitutes a family?

There has been a lot of talk regarding families this weekend. At yesterday's seuduah slishit (shabbat 3rd meal), table talk was dominated by the invisibility of older unmarried Jews in the observant community; this morning, deficiencies in our current dating cycle were discussed over coffee with a friend; this afternoon I went with another friend to see "8: The Mormon Proposition".

Before this year, in my life before med school (BMS), I was obsessed with getting married and starting a family. When a child walked by, my gaze would follow. Every new dating potential was analyzed for acceptability as a co-parent. Through this year of med school though, I've noticed significant change in my desire to parent. There is much less urgency in my need to get married and have children, and almost a sense of complacency developing.

I can rationalize many possible factors accounting for this change. (1) Increasing awareness that the path to becoming a doctor is isolating and lonely- and that I am, without much of an option, putting my career before my social life. I may very well still be single by the time I complete residency, somewhere between 33 and 38 years old; the older side to find a partner and start a family. (2) Genetics made me really appreciate G!d, and question how a viable, healthy, functioning child can ever develop from the combination of two gametes. My waning faith in the ability to create viable offspring is marring my hopes of ever trying. (3) Already feeling guilty that I would put myself, my career, and my patients, before my family. What effect will being an abortion provider have on my future children? What about the fact that they will likely have two moms? I know intellectually that these are silly barriers and surmountable obstacles, but Jewish guilt is a force to reckon with.

At the seudah yesterday I looked around the table to see my friends, in their late 20s/early 30s, growing into their adult selves. Over the 4 years I have known them I have heard stories of first dates, celebrated their engagements, danced at many of their weddings, and knit hats for the children that are slowly being added into our community. Our roads are diverging: they are throwing themselves deeper into family life as I sink into all consuming medical training and activism. This is not to say that I can't have it all, but choosing to attend med school in the South has significantly limited my ability to meet other engaged queer Jewish women, subsequently slowing my love life to a trickle. As much as I can accept the idea that maybe I wont have a partner and children, I also worry that this will cause me to loose my place at the table. To loose my standing in the Jewish community.

The contrast between this fear and the message of "8" is stark. The movie addressed the lack of space for homosexuality in religion, particularly in Mormonism. The heart breaking reality of those who think their religion would prefer them dead or miserable to creating a loving relationship with someone of the same sex &/or gender, breaks my heart and infuriates my inner activist. I know at my core that I am b'tzelem elohim (created in G!d's image), and my sexual orientation is part of that image. Even still I have worried, and sometimes still do, about my future family being marginalized in shul (synagogue) or the such, but I know enough non-heteronormative families to believe that it is possible. I also believe that there exists more space for familial variability then for singles and those who choose not to parent. How can I use these realizations to help others though? And in helping others, how can I continue to educate myself that whatever happens with my personal life will be absolutely okay?

In this week's haftorah we read:
הגיד לך אדם מה־טוב ומה־יהוה דורש ממך כי אם־עשות משפט ואהבת חסד והצנע לכת עם־אלהיך
"It hath been told thee, O man, what is good, and what the LORD doth require of thee: only to do justly, and to love mercy, and to walk humbly with thy God." (Micah 6:8)
But do we really believe this? How does family, and this tie between religion and family, come about? If doing justice and walking humbly is enough, why can't organized religion make space for every human, regardless of who they love and what type of family they choose to (or not to) create? I know there is more to it than this, there are more texts to cite, and more religious discourse to scrutinize; but the idealist in me wishes it was this simple- and would like to believe the world would be better if religious organizations spent $22 million on health care, education, and global hunger instead of on political campaigns that breed hate.

Wednesday, June 23, 2010

"Can I Physically Do This?"

I am spending my summer doing research on adolescents with lifelong, and function limiting, chronic illness. Spending hours pouring over qualitative data on how teens identify with their illness has reminded me of my relationship with diabetes as I transitioned through adolescents. It also reminded me of the summers I worked at diabetes camp, and my tween and teenage campers who I desperately wanted to grab by the shoulders, look in the eye, and promise that it would get better in a way that they could hear.

Today, in hopes of nurturing my professional development, my PI (principle investigator) spoke wise words about my academic future: "You are in a tunnel. There is an end. But at this point you need to be careful that the light you see isn't another train coming at you." These same words so adequately describe the double edged sword of being a teenager and having a chronic illness.

Even now, a few years removed from the turmoil of teenage insecurity, I still struggle with acceptance of future: as a physician, as an adult giving back to society, as a sister, daughter, wife (maybe?), mother (hopefully), AND as a type 1 diabetic. Below is a "fear essay" on the subject that I had to write for our humanism in medicine class this past fall:

Can I Physically Do This?
My biggest fear about becoming a physician is actually less about the process of becoming one and more about my future career in medicine. I am afraid of not being able to physically handle the life-style associated with the practice of medicine. I am also afraid that the stress associated with a life in medicine will have a negative influence on my health. I am afraid of there being truth in all of the nay saying I have heard over the past 19 (plus) years of living with type 1 diabetes.
At six years old I was diagnosed with diabetes after an abnormal result was found on a routine blood glucose test during my annual physical. My blood sugar was 157 and I was completely asymptomatic. Three days later my pediatrician performed a very unscientific glucose tolerance test (checked my blood sugar, sent me out to eat a sugary breakfast, had me come back to check my blood sugar again). This led to me being ushered off to the pediatric endocrinology unit at the local teaching hospital. The events of that day are my first tangible and complete memory.
Growing up with a chronic illness, especially one that is surrounded by a huge amount of misinformation, has been hugely influential in the development of my personality. I believe that my experience as a “diseased” person in society is what led me to major in Medical Anthropology, a background that will be hugely beneficial to my career in medicine. With no one in my family in the medical field, I strongly believe it is also what inspired me to seek a career practicing medicine. This desire was strengthened when I was diagnosed with Celiac disease after many years of seemingly unrelated symptoms. Diabetes has given me a (sometimes overzealous) drive to achieve everything I possibly can and not take a single day for granted.
However, there have been tremendous physical and emotional obstacles to surmount. One of the greatest challenges for me has been overcoming the emotional burden of the “scare tactics” used on me as a child. I grew up in the age of “if you eat that your arm will be amputated”, “if you don’t check your sugars more often, you’ll loose your eye sight”, and “high blood sugars will kill you”. I was taught to weigh my food, to micromanage my sugars, to be meticulous about taking insulin, and to use food exchanges as a way of cheating death. My parents, doing the best they knew how, had the attitude of “everyone has their problems and so at least you know what yours is” which left little room for me to ever be upset or frustrated at the disease that shared my childhood.
I made the decision to pursue a career in medicine a little later then most of my peers, as I had to first determine that diabetes was not going to get in my way. While I rationally know that it wont, and know that it never has before, I am still fearful that it will. There are many events that have happened recently to reaffirm my fear of a future as a diabetic in medicine. Such as my endocrinologist advising me to keep my disease hidden in the application process and in medical school rotations, as according to him, “old world surgeon types will judge you and think you are incapable”. Or having to fight to be able to take my insulin pump and blood glucose meter into the testing room with me during the MCATs. Or that countless numbers of people have given me unsolicited advice about how as a diabetic I should avoid high stress lifestyles in order to avoid complications.
I find myself wondering how I will manage to keep my blood sugars stable during the unpredictable pace of 3rd and 4th year rotations. How will I carry my pump, multiple pagers, and a smart phone on scrub bottoms without them falling down? (I have mastered the pump and 1 pager or radio already, but not multiple.) I worry that I wont be able to fit exercising, sleep, and cooking healthy meals into the packed life style ahead of me. I am concerned that high levels of stress combined with little sleep will lead to uncontrolled blood sugars. And I worry about what will happen if I have a sudden low blood sugar, or accidentally pull out my pump site, while working a code or during surgery? Will diabetes hold me back from a specialty I really want to pursue?
I also find myself worried about diabetic complications, and irreversible past damage I may have already done to my body. If I loose a limb as a result of this disease, will that be the end of my career? And if so, why am I putting all of this time into trying to be a doctor in the first place? Should I be taking advantage of the time I have with all my appendages somewhere else? Or what happens if I go blind?
I also worry about how my experiences with a chronic disease will influence my ability to doctor, and how I view my patients. I already know that I have an unfair frustration towards type II diabetes and diabetics due to the assumptions made about me from the mention of “diabetes”. I need to quickly get over this bias, as I will probably have many type II diabetic patients regardless of my specialty choice. Will I be unsympathetic or judging of non-compliant patients? I really hope not.
I know that I am not the first diabetic to pursue a career in medicine and I am sure I will not be the last. I also know that I have had the blessing to grow up surrounded by new technology and that things like constant glucose monitoring systems will significantly ease the burden of managing diabetes in a fast paced life style. I also realize that it is okay for me to have these fears but I need to ensure that the fear does not become debilitating. Hopefully my diabetes will aid me in my career as the best physician I can possibly be instead of holding me back.

Thursday, June 17, 2010

Atul Gawande's "The Velluvial Matrix"

Atul Gawande spoke at Stanford school of medicine's graduation this year. It reminded me why I was drawn to medicine in the first place. It also reminded me of all the ways the system is broken. Read it!

Wednesday, June 16, 2010

Don’t drink the Kool-Aid

This summer, what is likely my last real summer, I am working as a research fellow in an elite hospital nestled in a North Eastern City that used to be my home. In fact, it is one of the world’s best hospitals, something we are often reminded of. While talking to a first year fellow last week, I was strongly warned not to “drink the kool-aid”. She, a newly minted physician activist, spoke of coercion and loss of ideals. She warned of the magical allure that these old white men have, drawing the vulnerable young idyllic doctors in with promises of prestige. She has a compelling point, but at the same time she seems to be making it work.

Plus, I am learning this summer how tasty the kool-aid is. I have come to terms with the idea that I am smart and capable. But, while smart enough, I have never been THE best or THE brightest, instead always having to settle for my second or third choice. Such was the case with my college selection, with my post college employment, and with medical school. While I loved my college experience, and I am content with my medical school, this was never the path I envisioned myself on. Being at the best hospital this summer in a relatively elite fellowship is giving me a glimpse at the power and freedom that comes from it all. Because they are the best, they are able to talk about taboo topics: sexuality, psychosocial complications in delivering health care, medical standards; and, shockingly, can even conduct research in these uncharted lands. This is not something we can readily do in my southern medical school, where instead we are instructed to not tremble the waters. What I am learning is that the kool-aid gives you a pass to the unknown, but with it comes a signed contract: no matter what, the institution, one of the world’s best institutions, needs to be kept on its pedestal.

The other problem with the kool-aid is it leaves you thirty, and unable to settle for anything less than kool-aid of equal caliber or better. But the better kool-aid is going to cost you more of your ideals and personal autonomy for the sake of protecting the institution. The point of all this kool-aid talk? I am in limbo between loving the reality I am experiencing this summer and being terrified about my future. I want more of this opportunity- more ability to do research at a hospital with countless resources and copious respect. I want to apply for a fogurty or a doris duke fellowship so that I can accumulate prestige to compensate for my decently (but not overly) adequate Southern medical school’s reputation. I also want to be smart enough so that I can work and live in this, or a similar, North Eastern City that used to be my home. The terrified? That comes from feeling insecure by the elite that surrounds me. From worrying that I will never be smart enough for this to be my life, and that again I will have to settle for second or third best instead. That before this summer even ends, they will discover that I shouldn’t even be here now. Even worse, I fear what will happen if second and third best aren’t even options when it comes time for residency matching? What if all this work is for naught, after sacrificing so much, I never become the physician activist I so hope to be? But on a third hand (which anatomically we don't have), I am also learning that sometimes going with the less prestigious option allows for a better fit and more flexibility to be a change-agent, and less hurdles to jump through... a lesson I assume will be important to remember over the coming years.

Tuesday, June 15, 2010

Why blog?

I am taking the plunge and finally joining the blog-sphere. What is that? You want to know why? Because as an activist medical student in the South I often find myself atop a soapbox, screaming until I loose my voice, with still more to say. I've been busy studying anatomy, biochemistry and physiology while fighting for queer visibility and women's rights on the side. While I have witnessed slow and steady changes around me, I realize that I have a long way to go before I am the change-agent physician that I hope to become.
I want my voice to carry further then the soapbox of my medical school community allows for. I want to empower other students to get atop their soapboxes. I want to hold firm to my ideals while being transformed into a physician activist. I want you to hold me to a promise: that I will continue to fight for justice and equality on all fronts, and for access to comprehensive and compassionate health care.