I Told Your Child How Babies Are Made

14 years and I finally had someone who wanted to know.

When I am seeing early adolescents for well child visits I frequently start my discussion about sexuality with the question, "Have your parents told you where babies come from?"  Most laugh a little and say they already know and we move on to deeper discussions of the topic.  Every few months a patient will tell me that they haven't learned about it yet.  So I ask if they want to know.  For the first time I had someone who said yes.

I told the adolescent about the fact that babies are made from genetic material from each parent.  (I used basic medical terminology that I won't repeat here because I don't want this page to get flagged as inappropriate content.)  And then I gave a brief description of the basic way the genetic material from the father gets to the genetic material from the mother.  The patient said, "Oh, that makes sense."  The patient then went on to tell me their erroneous thoughts about what the process entailed - the same things I have heard from other kids whose sole knowledge about the process comes from watching PG13 TV shows.

To the parent, I'm sorry if it upset you.  Though I suspect maybe it is a relief that now you don't have to be the one to have "the talk."  Patient education is one of the things I like about being a primary care doctor.

20 Years

Our 20th wedding anniversary was about a month ago.

Brian will brag to everyone he meets about how we have been married for so long.  Even in the hospital after the surgery he introduce me to every team of doctors who came by and tell them that we had been married for 19 years.  They all nodded with a congratulatory grunt.  One morning a resident on one of the teams was making conversation and asked if there was a secret to getting a marriage to last for 19 years. I said, "You make it work."  The attending stopped them all and said, "Do you here that?"  He reinforced that a good marriage doesn't just happen, it is work and you have to make it work.  I hope the resident's learned something that morning.

Here are the beautiful roses Brian got me for our anniversary, surrounded by the bits of our life.  The Cub Scout rain gutter regatta boat, because that is how I spent the evening of our anniversary.  The thermos from the new school lunchbox, the canning jar for the jam I keep intending to make, the McDonald's bag from the dinner I picked up on the way home from the office.  The books and toys of the day.  The actual trappings of family life after 20 years of marriage.

Thank you, Brian, for 20 years.  Kisses.

Seriously, It Takes Time

I am learning patience.  Still.

11 months since Brian's cancer diagnosis.  10 months since his surgery.  6 months since the end of his radiation treatments.  He has come a long way.  He can walk on the treadmill again and drink liquids.  Haven't used the tube feeds for a long time.  Things are much better than they were, and yet things still seem a long way from where they used to be.

Is this the new normal?  A constant question, how much better will things get?  I feel deep down that he will continue to improve and still has lots of improvement potential.  Yet I realize that he may never be back to the same energy level he was before all this started.   So I continue to take life one day at a time.  People ask, "What are your plans for vacation?" and I just shrug and say, "Depends on how Brian is feeling."  I plan but I am emotionally prepared to change at a moments notice.

I guess that is the gift this whole experience has brought to me.  I am not wed to the future, I am more comfortable in the ebb and flow of here and now.

My Kids Don't Do Activities

http://www.nytimes.com/2011/08/13/your-money/childrens-activities-no-guarantee-of-later-success.html

I am no Tiger Mom.  My kids are all older elementary school age and I have never signed them up for activities.  The oldest did piano lessons for a couple years until my friend stopped teaching due to family needs.  That's right, no soccer, no dance class, no karate.  Nothing.  No weekend games to get in the schedule.  No recitals to sit through.  And now with this article, I feel even better about myself.  Isn't it great to find something which justifies your world view?

My kids are kids.  They play, they bicker, they spend way too much time on electronics.  They scooter and play with kids in the neighborhood.  My theory is that when they get to middle school they can sign up for school sports and extracurriculars.  Until then I'm not going out of my way to sign them up for stuff.  When they are older they can complain to friends about what a bad Mom I am.  For now I want my schedule to be free to do what we want when, not juggling to fit in our needs around some activity they will declare they hate after I spent a couple hundred dollars.

Hey kid, go outside and play!

Eternal Salvation is the Best Revenge

I am so proud of my YCLs from girls camp!

It all started when my YCLs (I was YCL leader this year) did a morning cheer that made fun of the 4th years.  OK, I was not proud of that and I stopped them all on their way to breakfast to tell them there was one way out of this to avoid war with the 4th years - an obsequious apology.  (No, I didn't use the word obsequious with them.)  At the first opportunity they needed to do a cheer or sing a song expressing how wonderful the 4th years are.  Nothing makes your enemy look worse to others than being nice to them.  So they sang a "We love you song" to the 4th years and I thought we were done.

Until  the next night some candy was taken from the YCL cabin.  And the next day when the cabin was TP'd and more candy taken.  (Can I mention that this kind of stuff is strictly forbidden at our girls camp?)  I was worried about what the response would be from my girls.  Would they escalate the war?  Certainly some of them were upset.

At evening flag their response was clear - they did a peppy cheer about themselves and then sang a  verse of "I'm trying to be like Jesus."  I got tearful looking at these 18 girls from all over the stake and thinking how much I love them and how proud I was of their behavior.  In that moment they really turned the other cheek and loved their enemy.

Choosing the higher path and enjoying the blessings of eternal salvation is the best revenge.  Even better, though, is when those despitefully use you choose the higher path and get to enjoy eternal salvation with you.

Why are you REALLY declining the HPV vaccine?

It is not evil to vaccinate your child against a sexually transmitted virus.

The Gardasil vaccine has been on the market in the US for 5 years now.  I suppose as pediatricians we realized up front that some people would have a moral issue with this, not sure the message they are sending to their child.  I am OK with that and happy to talk about it.

Please don't lie to me and tell me that you heard there were terrible side effects so you don't want to immunize your teenager.  There have been great studies recently showing that Gardasil definitely causes a sore arm and some people pass out after they get it (we are talking teen age girls getting shots here).  It is no more harmful than any of the other vaccines which you have already quite willing given your child.

But what message are you giving your child by vaccinating against a sexually transmitted infection?  I get it - you don't want your child to have sex until they are married.  Guess what?  I don't want your child to have sex until she is married either - and I told her that during our visit.  So if you vaccinate your child for an STI are you telling her that you think she might have sex with multiple partners anyway?

Let me tell you what I am likely to tell your child.
I don't think you should have sex until you get married.  A lot of people may try to pressure you to do things, and the choice is yours, but please don't let anyone pressure you into doing something that you don't want to do.  If you choose not to have sex until you get married you protect yourself 100% from getting a sexually transmitted infection before marriage.  However, what if the person you choose to marry did not wait to have sex until marriage?  They could be a wonderful person who repented and is fully worthy - and they could also have HPV.  Better to protect yourself.

That is what you can say to your child too.  Getting the HPV vaccine is not a signal that you think your child will have premarital sex.  It is a way of protecting your child from the potential consequences of someone else's bad choice.

Why I Believe

Don't bother trying to post rebuttal.  This post is an essay, not a conversation.

I am fascinated when I read the comments on articles about the Mormon church.  It quickly becomes a discussion of how Joseph Smith was a fraud, physical proof shows something else, yada yada.  So people should wonder why I, a reasonably intelligent person trained in science, would be a faithful, devoted Mormon.  So here goes.

It is because when I was 17 I didn't know if the Book of Mormon was really true or if the Mormon church was right.  So I got down on my knees and I prayed, as I had done many times before, but this time I received an overwhelming knowledge that it was true.  I knew then, and I know now, because of personal revelation from God to me.  Revelation that God knows who I am, loves me, cares about me and lets me know that the Book of Mormon is true.

For those of you who want to point out the evil actions of Joseph Smith or any other human being, or point out that the Mormon church has changed over time or that scientific evidence refutes Joseph Smith's interpretation of the Book of Abraham or whatever - my testimony is not based on today's scientific evidence or my respect for another human being or consistency of actions.  I believe because I continue to have a personal relationship with my Heavenly Father.  I pray and feel his answer.  So don't be sad if you can't convince me with your words and graphs and expert opinion.  For me there is only one expert opinion that counts, and that is the hand of God in my life.

Zen and the Art of Suck it Up

This one is for all my Gen X peeps.

Brian and I were talking the other day about Buddhist philosophy.  You know, "Desire is the root of all suffering."  And he said, "Can't it all be summed up as Suck it Up?"

Made me think.  So here, for the benefit of my fellow Gen Xers, are the Four Noble Truths of Buddhism translated into a language you can understand:

1.  Life is full of suck.

2.  Your desire for life to not suck just makes you unhappy.

3.  You won't be so unhappy if you stop wanting life to not suck.

4.  Suck it up.



Peace.
ALB

All Good Things

"...every thing which inviteth and enticeth to do good, and to love God, and to serve him, is inspired of God."  Moroni 7:13


We have Buddhist prayer flags hanging from our play set in the backyard.  Multi-colored and bright, they flutter in the breeze, saying their prayers.  Brian hung them up a month ago.  He can see their gentle waving from our bed as he lays there recovering from his cancer treatments.


I am not a Buddhist.  I belong to the Church of Jesus Christ of Latter-day Saints.  I am really very Christian.  Some might look at it and say, "Why would she have a heathen symbol in her yard?"  Or if they knew Brian put it up they may wonder why I didn't complain.  Complaining would be amazingly hypocritical of me, since I am the one who put the Buddha head statue back there several years ago.  Got that one from my Bishop; it was given to him by a good friend who had died but I think he felt a little uncomfortable having it in his yard.


So why do I have Buddhist things in my backyard?  To try to fit in with all my Buddhist neighbors?  (A lot of my neighborhood is Vietnamese.)  Because it is trendy and cool?  No.  Each item has its own reason.  I put the Buddha head there because I admire Buddhist philosophy - it's acceptance of life as it is and the belief one can bring change through changing ones self.  It resonates with my Christian beliefs of doing good because it is the right thing to do.  It resonates with my life experience that the only time I am truly happy is when I accept life is what it is and choose to be at peace with it.


Why did Brian put up the prayer flags?  I don't know, but I think it is a small way of reaching out to God.  As he watches the flags wave I imagine he thinks of prayers being said to God.  And I do believe that any thing which invites you to approach God is a good thing.  It is not the fullness of good, but it is good.


That is why Buddhist pray flags softly sway near a statue of Buddha in the back yard of this Christian house.


ALB

Dear Graduates - You Knew that Already

No surprise to you, all of your plans will not come to fruition.

It is graduation season so I've read a couple articles and speeches that were aimed at high school and college graduates.  One of the themes is, "Life doesn't turn out the way you dream and plan it will, so be prepared for failure and change."  Guess what - you already knew that.

Childhood is the time of biggest struggle for change.  Learning to walk takes a lot of effort and painful failed attempts.  As does learning to ride a bike.  As does learning to get along with other people.  And talk about failed dreams - you can't fly like superman, you won't make a ton of money with a lemonade stand, you can't collect the biggest ball of chewing gum because your mom said no way.  You struggle to balance  the profoundly differing stories about Santa that are told by your parents and by kids on the playground, or ponder the existential motives of a tooth fairy.

You struggle for separation from parents, yet desire their support and nurture.  You long to make an identity for yourself, and then long to re-invent it.

Here is my message to you - grown up life is not that hard compared to negotiating the minefield of childhood and adolescence.  The school room and play ground become the work place.  You turn from child to parent.  Your friends are ... maybe as immature as ever, maybe not.  You come to this place in your life having navigated a myriad of difficult mazes.

You already know that the only constant in life is change.  Keep on keepin' on.

ALB

What Not to Say

http://www.nytimes.com/2011/06/12/fashion/what-to-say-to-someone-whos-sick-this-life.html

This is a great article in the NYT about what not to say, and what to say, to someone who is seriously ill.  And, I would add, to their family members.  The author went through cancer treatment.  His suggestions are spot on.  All the things I want to say to people but feel too polite to say.

I recall a time when I was in the hospital quite ill and in a lot of pain.  Five days into the hospital stay a newly consulted specialist walked into the room and said, "You look miserable."  I wanted to cry and hug her.  That was what I really wanted to hear, an acknowledgement of how I felt.  If you had asked me how I felt I would have said, "I'm hanging in there."  Which I was.  But it was miserable.  I try to remember as a physician that if I can't do anything else, I can always acknowledge a patient's suffering.  "This is such a miserable experience, I am sorry you have to go through this."

Compassion is the best medicine.

Why Good Parents Make Their Children Cry

I heard screams coming from the shower.  When I went to investigate, there stood a child with a large amount of shampoo in her hair, crying that shampoo went in her eyes and now it burned.  I told her the best thing to do, which would make her feel better faster than anything else, is to put her head under the shower and let it rinse all of the shampoo off her head and out of her eyes.  She hates getting water on her face and refused.  I raised my voice - she refused and continued to cry.  I yelled - she refused and continued to cry.  So I took her screaming, wiggling body and shoved it under the running shower until all of the shampoo was out of her hair and off of her face.  As she stood wrapped in her towel after the experience she looked at me with scorn and said, "A good parent wouldn't make her child cry!"


Good parents do things all the time that make their kids cry.  Get them immunized.  Refuse to buy them toys they don't need or can't afford.  Reprimand them for bad choices in their behavior.  A parent's job is to see the big picture and do what is best for the child, even when it causes temporary pain and sorrow in the child.

Our Heavenly Father sees the big picture much better than we do.  I wonder how many times I have stood before him crying out for help and the answer I got was painful and made me cry.  How many times have I figuratively screamed in the shower and refused his gentle advice to put my head in the shower - only to have myself bodily pushed under the falling water.

At those times, when we are sputtering in the midst of hard times and sorrows, and we are tempted to yell at God, "A good parent wouldn't make his children cry!", we need to remember that he sees the big picture.  Bad things things happen because it gives us the chance to learn.  Whether we cry and become bitter, or consider the good that could come of each bad experience is up to us.

God lets bad things happen to us because he loves us.

ALB

My Beautiful State of Denial

Brian has a sore in his mouth.

For anyone else I would say, "Big deal, put some numbing medicine on it, it will go away."
Life after oral cancer, however, is a waiting game.  Will it come back?  If so, where?  Will we recognize it if it comes?  A simple mouth sore is a pit in my stomach.

I have been living in a beautiful world of denial since Brian ended radiation treatments.  The hard part is over, the long road of recovery ahead.  Long, slow, but upward ... positive in direction.  My brain wouldn't even let me consider the possibility of relapse.  It is a peaceful place, this world of denial.  Not easy and not joyful, yet not filled with anxiety.
All it takes to crack the walls of my peaceful world is a little mouth sore.  At his surgical margin.

He already has an appointment scheduled with the surgeon for a follow-up appointment in 4 days.  Will I be able to see in the surgeon's face how worried he is?  Will he try to reassure us, yet walk out of the room with a pit in his stomach and feeling that this will not end well?  Will he take one look and say, "That is completely normal for this stage of healing"?  Whatever his response, he will be blunt.  And my world of denial will have to create new boundaries.

ALB
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5/31/11 Update - saw the surgeon today.  He was cautious about the lesion.  Come back in 2 weeks, if it isn't gone by then he will biopsy it.  Seems fair enough.  Back to blissful denial.

6/14/11  Update - saw the surgeon again.  The spot looks better.  No biopsy, follow-up with the other surgeon at our regularly scheduled appointment in 4 weeks.  Back to blissful denial.

I Am a Child of God

Watch the whole thing, don't get overwhelmed if the beginning seems too sweet.  It gets even cuter when the big children appear!

And so are YOU!

ALB

Cooks Anonymous

Hi, my name is Angela and I just figured out how to cook rice at age 40.


Yes, the simple "one cup rice, two cups water, simmer covered for 20 minutes, voila perfectly fluffy rice."  I just gained confidence in doing this.  I have no idea why I have feared cooking rice so long.  Fear of burning or crunchiness maybe.
I could never remember the ratios (I realize how stupid that sounds).  It's like I had rice dyslexia.  I own a rice cooker, but that always produces an overcooked layer on the bottom.  Deliciously crunchy but not what I want on a regular basis.
This is a dumb post ... but I am proud of the fact that I managed to cook a perfect pot of rice without looking up instructions.  I will now slink off in embarrassment.

ALB

Why I Will Not Phone in Antibiotics

Dear Parent on the other end of the phone,


I am so sorry that your child is not feeling well and you are leaving on vacation tomorrow/out of town/can't afford another copayment/sick of coming in to the office.  I realize that having a miserable/feverish child makes your life hard and makes you feel stressed.  I know that you are sure the ear pain/sore throat/pain with peeing must be an ear infection/case of strep/urinary tract infection.  And I know you are very unhappy that I will not phone in a prescription for antibiotics for you.

Unfortunately not ever fever and ear pain is an ear infection - many of these kids have normal looking and functioning ear drums when I examine them in the office.  Most of the sore throats we see do not test positive for strep.  Most of the pain with peeing in young children is not a urinary tract infection.

I will not prescribe an antibiotic "just in case".  This makes your child more likely to have bacteria that are resistant to the antibiotics that we commonly use to treat infections.  And what if your child has a reaction to the medication?  Aside from a bad allergy, getting diarrhea or a yeast infection or a rash is still not a pleasant thing from a medication your child didn't need in the first place.

There is also the possibility that your child really has a bacterial infection and needs an antibiotic - it just isn't the infection you think.  What if that ear pain is a swimmers ear rather than a middle ear infection?  What if the ear pain is caused by a strep throat infection?  What if that pain with urination in your teen is a sexually transmitted infection, not a urinary tract infection?  I can only tell by talking to and examining the child.

I am sorry that your employer has contracted for a high co-payment insurance plan, or your insurance company doesn't cover out-of-area care.  I am happy to speak to you and problem solve, to suggest over the counter medications and other ways to make your child feel better.  I will even advocate for you with your insurance company the best I can.  But I will not phone in antibiotics.

I am used to the anger, the pleading, the threats to file a complaint.  I will try hard to be patient when I talk to you on the phone.  But I will not compromise my standards of giving your child the highest quality medical care I can provide.   If that means I need to examine your child to determine the best course of treatment then I will let you know that.  And I won't back down.

Sincerely,
Dr. Beeler


ALB

It takes time...

You know how I wrote that post about how the body heals itself?  And how miserable the radiation treatment's were?  Well, the treatments are all done for 2 months and the recovery is happening.  S-l-o-w-l-y.  He is talking well (I think).  Able to drink some by mouth and swallow medications rather than having to use the PEG tube for everything.  Walking without pain or walker.

As a physician I knew that progressive illnesses take a decline-plateau-decline-plateau pattern as they worsen.  I hadn't considered that healing takes the same pattern but in reverse: improve-plateau-improve-plateau.  But that is what is happening.  The improvement is great.  The plateau is freaky because it makes you wonder, "Is this it?  Is this as good as it gets??"

Statistics I have read say that only half of people feel back to normal 6 months after they end radiation and chemo.  This is reassuring since Brian is only 2 months out from treatment.  We will continue to watch and see how long the healing takes.

ALB

Motherhood

It wasn't until having children of my own that I realized I had been a Mom all along.


My oldest child is now eleven.  Reflecting on all the things I do for her, and my twins, that are considered "motherly duties", I realize these are things I have been doing for other people since I have been able.


A mother listens to others, even when what they say is ridiculous.  She corrects when appropriate.
A mother sacrifices her own desires to meet the needs, physical or emotional, of others.
A mother loves unconditionally.  She may be saddened by the actions of others, but she loves all the same.
A mother teaches.  She shares her knowledge, her enthusiasm and her determination to learn.
A mother cries for the pain of others.  And then she gets up and keeps going.


As women we bear the title of mother before we are even born.  Sometimes we refer to it as being a sister, a friend, a companion, a mentor, a servant.  All of this really just means being a mother.


To all the woman in my life who have been mothers to me - my physical mother, my sister, my friends, my teachers - thank you for the mothering you have given me.
To all the people in my life who are children to me - my biological children, my Primary children, my students, my friends, my family - thank you for your patience as I learn how to be a mother.


I do believe that the most meaningful name I can be called is Mother.


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I had been thinking about how much my motherhood means to me for a long time and really wanted to share that.  I am dissatisfied with how stiff and preachy this came out.  Because that is not how my motherhood feels!  It is warm and squishy (hmmmm, like me) and joyful.  So here are the mother moments I enjoy outside the confines of my own family:


-Primary children running up to hug me or tell me something, but also just grabbing a primary kid to give them a hug and a kiss.
-That I can now name all 60 of my Primary kids by sight!
-The fabulous, random things that kids tell me in the office.
-Giving advice to parents - makes me feel like a wise Abuela!
-Talking to my friends about what they have accomplished.
-Having my students tell me of their questions and concerns.
-Bearing testimony with my sister on the phone.
-Loving people without having to judge them or "fix" them.  What a relief!
-Cleaning up in the kitchen after activities, laughing and chatting with others.  (Half a gigantic cake with Oprah on it?  Whaaaaaahhhh?!!!)  Or even cleaning up without other people sometimes.
-Smiling at people randomly, just to let them know I see them.


Life is good.  To be a nurturer is good.


And when I say "confines of my own family" I of course mean that in the nicest way possible...


ALB

An Easter Post - Of bunnies and children and eternity

Yesterday I (or rather the Primary) put on a big brunch and Easter egg hunt for the ward.  It was great - 50 kids showed up with their families.  Everyone said it was a wonderful time.  The kids were writhing with excitement all through the brunch.  Peeking around the barriers to try to spy eggs as the rain prevented an outside hunt.  Then reveling in the finding of candy filled eggs.  Still, I feel a tug of guilt about making an official activity commemorating the most important religious event ever such a heathen activity.
(On a separate note, it is a fairly easy and quick activity - eat, quick egg hunt, clean up all done in under 2 hours.  Get in, party, get out.  I consider that a successful activity.)

I felt that I had to apologetically promise the parents that our Sunday lesson in Primary would be spiritual.  I promise, Bishop, I promise, parents - the children of this ward do know the true reason we celebrate Easter!  And tomorrow they will remember once more!

Today for sharing time I brought a big box with a bow on it and discussed the gifts our Heavenly Father has given us.  I told them the story of their lives.  How excited they were in Heaven to come to Earth and get a body (remember that next time you stub your toe).  I reminded them that when Jesus was born they were part of the "multitude of the heavenly host" (Luke 2:13) who sang for joy.  But this moment was just the beginning.  Like that moment you hold your breath because you know something good is coming - it has begun.

We reviewed the final evening of Christ's life, how he suffered in Gethsemane for the sins of everyone who ever has or will live.  He bled because I told lies and I was mean to other people.  How he was crucified and we all were part of the heavens that wept.

And then I told them that the happiest, most excited day of their whole existence happened before they were born, but when they feel excited about the story of Jesus they are remembering it.  How they heavens shouted for joy as Christ left the tomb - it is accomplished!  Physical and spiritual death are conquered, the way is prepared for all people to return to Heaven.  This was the moment we had held our breath for and it happened!

The best gift we have ever been given is an empty tomb.  (John 3:16)
Happy Easter!

ALB

Politics and Religion

I suspect I am a socialist.

The more I read the scriptures, the more I am struck that every time people were most devoted to living the Gospel of Jesus Christ, "there were no poor among them." (Moses 7:18)  In the book of Acts it describes how the saints sold their possessions and gave all they had to the church.  Or apparently were struck dead if they didn't.  (Acts 5:1-11)  Certainly the United Order asked similar things of the saints in these latter-days. (D&C 78:3-7)  Though I don't think death was on the line.  OK, spiritual death was on the line but not physical death.  The Nephites, after the resurrected Christ established this church among them, "had all things common among them."  (4 Nephi 1:2-3)
While the Nephites at the time of King Benjamin don't appear to be living the law of consecration, Mosiah 4:16-26 is a very powerful sermon on giving to those in need.

Given that the ideal society, in the eyes of God, involves us taking care of each other so that there are no poor, what is wrong with having a system of government that has that as its goal?


Some people say that the difference is in agency.  When the Lord asks you to do it you are free to say no.  When the government asks you to do it you are not so free to refuse.  But what if we use our agency to vote for a government that has taking care of the poor and needy as it's goal?  Many people live, quite happily, in socialist systems for which they have voted.  They are not evil and socialism is not evil.  I might even argue that if our goal is to produce a government that will be similar to what things will be like in the millennium then they are further along than we.

Go ahead, tell me that if I like socialism so much maybe I should leave America and move to a socialist country.  Tempting, very tempting.  Instead I will stay here to defend those who think government should be used to better the lives of it's people and be a safety net to get them back on their feet when they stumble.
I do not advocate lifetime government support and I do feel people need a path to success.  Don't get me started on how a system of education that allows 30% of it's children to enter adulthood without a high school diploma is dysfunctional!

OK, so I'm a socialist.  Though the more I think about it, the more I suspect I may be a communist libertarian.

His Radiation Was Worse Than Yours - My Whiny Post

I will try to keep my whiny venting brief.

When people find out that Brian is having radiation for cancer treatment, they sometimes share a personal or family story of radiation.  I understand the desire to share, to bond, to help us know we aren't alone, others have tread this way before.  Having watched Brian go through the side of effects of radiation to his lower jaw and neck, I feel irritated when people tell me how a loved one worked every day through it, or how it wasn't that bad.  Getting your breast or prostate irradiated is lousy, I'm sure.  Getting your mouth and neck irradiated is horrendous.

The radiation damage in the mouth and neck causes swelling and pain that begins a couple weeks in.  Over time the lining of the mouth begins to ulcerate.  The muscles of the jaw and neck become inflamed.  Every movement of the mouth to speak or chew causes pain.  Every bit of food into the mouth causes pain.  Every swallow of anything causes pain.  And the radiation damages the nerves of the tongue, causing loss of taste.

Brian loves to talk and Brian loves to cook and eat.  Radiation took both away.  He lays in bed exhausted and silent with the whir of the feeding pump in the back ground.  All I can do is look on and keep his medications renewed.

So forgive me if I am not uplifted by your story of radiation treatments being bad but manageable.  Here they are horrible.  But like everyone else, we will get through this too.

Rant off.

Heal Thyself - or rather, Just Let Thyself Heal

The human body has amazing powers of self restoration.

I have known that for years.  Little cuts don't bother me, I don't think every little cut needs a bandage.  (My kids on the other hand do.  Thus the rule fun band-aid if it is bleeding, plain brown band-aid if there is no blood.)  I'm not bothered when my kids eat stuff off the floor.  Or occasionally out of the trash can.  Coughs, colds - no big deal.  I have even refused to pick up a child from school who had fallen and bumped her head.  She sounded fine, I told the nurse to send her back to class.  More often than you realize your body has prevented horrible disaster through the efforts of the many healing substances in your blood.  And don't get me started on how much DNA your body repairs due to sun damage.

This is not at all to say I am opposed to modern medicine.  I am a physician, and I also marvel at what we can do.  Being a pediatrician, immunizations stand squarely above everything else as the most amazing medical advance.  They have saved millions of lives through preventive medicine - the best kind of medicine there is!  People don't even realize their life was saved because they never got sick in the first place.  Preventing infection through immunization is something that we take for granted these days, but something our grandparents marvel at, and something our great-grandparents would have begged to have the privilege of doing for their children.  But I digress.  I started this to talk about what the body can do for itself.

As part of my husband's cancer treatment he had bone, muscle and skin from his leg removed to rebuild the site where the tumor was removed.  It was painful.  I mean, really painful.  He was on large doses of pain medications and would cry in pain if they were allowed to wear off.  After a few weeks of this I became concerned.  Why is he not healing?  Why is this taking so long?  And why are his doctors not worried, just tell me to keep giving pain meds?  We could get the pain under control with large amounts of medication. (I always teased him they were Elvis amounts, but not up to Michael Jackson amounts of pain medication.  Sorry if I offended anyone but when you are at the pharmacy every few days picking up more opiates you have to take a step back and laugh a little.)  The doctors just said, "It takes time.  Sometimes months."  So just when I resigned myself to months of heavy duty painkillers and the long wean that would follow, the pain improved.  I'm not saying we could suddenly stop all medications.  I'm saying his pain could be controlled with long acting medication alone and didn't need break through medications.

Where a large piece of bone, muscle and skin were missing, healing was happening.  Whatever had been so irritated or swollen and painful before was quieted, returned to a more normal state.  He started to be able to walk, even walk faster than me, though off balance and needing a walker.  Skin grew over the large surgical site.  Red, bumpy skin, but none the less an effective barrier to keep out contamination and keep in moisture.  Even more amazing, the site where the bone, muscle and skin were grafter healed beautifully.  It was never really painful as the nerves to the area were severed in the surgery.  But the skin grew pink and healthy, well perfused.  It is amazing to see how the surgeons know how to connect things, then stand back and let the body heal.

It helps me remember that as a physician I can't heal anyone.  I can prescribe an antibiotic but the body still has to return the site of infection back to normal, removing dead tissue and rebuilding.  I can set a broken bone but the body has to reconnect and realign the pieces of bone.  All of my interventions are mere tinkering, pushing things in ways that allows the body to heal itself.

That low back pain, that cold that is 5 days along, even that little pus pocket you drained yourself - most of the time these will get better on their own.  So next time your physician tells you "This one just takes time to get better, there is nothing more we need to do", what she is really saying is, "All things are in alignment for your body to heal itself.  Just give it time."

Gifts Freely Given

Cast your bread upon the waters.  Then don't look back.


How many times have I heard one child yelling at another, "But you gave that to me, it was a gift!"  And the other yells back, "You don't play with it so I'm taking it back!"  Kids like to give old toys to each other, but rarely does it seem like a gift freely given.

In watching how people around me give of themselves, either through tangible or intangible means, I thought about the scripture that says "Cast thy bread upon the waters: for thou shalt find it after many days."  (Ecclesiastes 11:1)  Throwing bread out on the water makes me think of feeding ducks.  You just throw the bread and they eat.  You don't row out onto the pond, discuss with the ducks how much effort you put into making the bread and how you bought special flour just for them.  You don't come back the next day and ask if they liked the bread.  And you don't get angry if they left the bread to rot on the edge of the pond or let the geese eat instead of them.  You just throw the bread out for the joy of knowing that maybe the ducks will like it.  And then you let it go.


Many people have a hard time letting go when they give a gift.  They give more for the feeling of being appreciated than for the joy of giving.  How many of us have things we received that we feel we must display so that the giver knows we appreciate them?  How many have looked around the house of someone to whom we have gifted to see if what we gave is out for all to see?  I am guilting of looking through relatives' Christmas pictures to see if the gifts I sent made the grade of being included in pictures.  And opening up the mailbox, wondering if a thank-you note was sent.  (I'm much more guilty of being the one who didn't send the thank-you note.)


So I try to teach my children that the real joy of giving is just feeling good inside about giving a thoughtful gift.  Kids will break the birthday party gifts you give.  I won't even buy birthday cards for kid parties any more because those just end up right in the trash - I make my kids draw a card for the birthday child.  Adults will re-gift or exchange gifts.  If you give them money to pay a bill, they use it to buy designer sneakers.  It's OK.  You were generous and gave out of the goodness of your heart.  Let it go and start noticing the many gifts that people give you you.


Because the bread that comes back to you after you cast yours on the water was thrown by someone else.


ALB

The Third Chair - life on the other side of the stethescope

My husband was diagnosed with cancer 4 months ago.  With apologies to the Grateful Dead, what a long, strange trip it's been.

Since he is still in the throes of treatment I am not yet ready to process this experience into a thoughtful analysis.  Instead I will share with you a jumble of my impressions of life as the physician spouse of someone dealing with the medical system.  And just my impressions of life caring for someone with cancer.

• I felt guilty when the doctor said, "It looks like cancer" - did I miss something?  How could I have not caught this earlier?  I do feel that I pushed when I felt things were not being followed up when I thought they should.  In retrospect the diagnosis to surgery time was pretty fast, though it felt agonizingly slow when going through it.
• When we interact with health care personnel I feel a need to tell the history, even though I know I should let my husband speak.  He frequently defers to me when I do sit back and try to shut up -- but have I just trained him to do that by my eagerness to speak?
• I feel a little guilty when we are treated very nicely by the hospital staff, like getting a private room.  Part of me wonders if they are just doing that because I am a doctor, part of me knows I wouldn't refuse even if that was the reason we got the good treatment.  I do feel better when I look around and notice other people being treated as well.
• I can't stop being a doctor and just be a spouse.  I make recommendations for treatments - please put dextrose in the IV fluids, please give Reglan.  I question treatment options, especially if it seems no different than what we've already tried.
• And then when I reach the limits of my medical knowledge, and my husband still has that "Please help me" look on his face, I feel guilty and frustrated.  I feel like a failure sometimes when we have to go to the hospital for non-routine treatment because I feel it means I failed at management. Is that the "doctor as god" complex, having a hard time admitting that I can't do it all?
• When he is inpatient I have dichotomous feelings - frustrated by having to wait for other people to act (at home I give the meds when I feel they need to be given), yet safe because if something is not going right there is someone else to turn to (if he vomits the med someone else can figure out what else to give).
• One of the big surprises is how many employees I see in the hospital and clinics that are parents of my patients (did I mention I'm a pediatrician?).  I smiled when the Gastroenterologist came out of the OR to tell me that the PEG placement had gone well and mentioned that "half the endoscopy staff said to treat your husband well because you are their pediatrician."

The one big advantage I have over other people going through difficult medical treatments is that I feel at home.  The geography and language of the hospital are not foreign to me.  I understand the hierarchies - I'm not afraid to ask someone where they fit in the team.  The ebb and flow of shifts, the difference between what can be accomplished during a day shift and a night shift.  This allows me to act as an interpreter for my husband, to try to ease his anxiety.  No, the nurse can't just change that medication from oral to IV, you must wait for the night float resident to answer the page and give a new order.  Yes, they will still take you to the OR for that procedure, even at 6pm.  I know which alarms on an IV I can fix and which I can't.

I am still deep under water with my head down, swimming hard to get through this as I carry my husband along.  But now when I look up, sometimes I can see a bit of light dancing on the surface of the water.  Then I have hope that end of the hard times is near, we will come to the surface and enjoy a large gasp of fresh air that will wash over us with wonder.

1 more round of chemo, 13 more radiation treatments to go.

ALB

Love the Ones You're With

I hope this doesn't come as a surprise to anyone, but life doesn't turn out the way you think it will.

When I was growing up a good Mormon girl I had a view of what my life would be.  We were taught all about what our lives should be through Primary and Young Women.  I got my Gospel in Action award and my Young Womanhood Recognition award, graduated from seminary and got married in the temple.  A few weeks after we were married my husband's church attendance became spotty, and within a few months he was only attending Sacrament Meeting.  Within a year or so he was completely inactive.

I was heart broken, though I mostly kept that to myself.  What do you say to people - or really, what can they say to you?  I had a copy of Carlfred Broderick's book One Heart, One Flesh that the Bishop in our single's ward gave us when we got engaged, and that was very helpful.  I can't even remember why it was helpful because I've lost the book, I just recall that it gave me the spiritual strength to stay married.  (On the other hand I gave a copy to a young neighbor and later she thanked me because it gave her the courage to get a divorce - go figure.)

I didn't go to the temple for a couple years because in my mind that is something you do with your spouse and it was too upsetting to go alone.  Finally I did start going, and came to enjoy the peace and inspiration in the temple.  It was in the temple, as I prayed once more for the Lord to help me, that I got the answer that will probably last me for the rest of my life.  It was simply this - "Love and patience."  (It will last me for the rest of my life because it is not as easy to accomplish as it sounds.)

It's not earth shattering, is it?  It doesn't take your breath away or explode in your mind or reveal an untrodden path.  At this point in my life it feels like the most well worn path I can take.  And yet there is something comforting about going down the well trod road.

I laugh to myself when I hear people say that there is no sadness and there are no tears in heaven.  I am sure our heavenly parents weep on a regular basis for the poor choices we make.  To raise a child for half of eternity and then watch that child separate itself from you - how could you not be sad? To see that child use the gift you all fought to preserve - the gift of agency - to make choices that will forever separate that child from your presence?  How could there not be tears?  I feel my sadness to seem minor in comparison to this.

Love and patience.  It didn't take me long to see that Heavenly Father was only telling me to follow his example.  It is how He deals with the poor choices we make.  As I tell my Primary children, your Heavenly Father loves you, not matter what, there is not a thing you can do to make him stop loving you for ever and always. And he has eternal patience.  I suppose it helps to "know the end from the beginning."  Still, he patiently waits for us to turn to him and is never absent when we reach out.  Love and patience.

When someone I love makes a choice that breaks my heart, what choice do I have but to love them and patiently be there for them if and when they chose another way?  I have been down the sad road and shed a lot of tears - didn't get me anywhere but sad.  I have been down the angry road and yelled about my sorrows - didn't get me anywhere but angry.  I never chose the bitter road, but that is just me.  The love and patience road did get me somewhere -- peace.

This journey prepared me for the day when my brothers left the church for various reasons.  And when a friend was excommunicated.  It feels weird to say that I'm not sorrowful about these things, but I'm not.  I am filled with hope and peace that with time things will change.  I love them and care about them.  I am willing to patiently wait for them to use their agency to make better choices.  My open arms aren't waiting for them to turn around, though.  I am embracing them all along the way so they don't forget that the Lord loves them and there is peace in his path.  Love and patience.

Cast your burdens of anger and sorrow on the Lord, and take up his yoke of loving other people with him.  The burden is lighter.  And not every day, but some days, it is like having wings to fly.

ALB

Who am I? (A posting of introduction)

The name of my blog is taken from the back of a t-shirt.

Granted, it is a t-shirt that I made for myself before going to Girls Camp as a leader for the first time 11 years ago.  I wanted to put my name on the back of the shirt - but which name?  By that time I had already collected many names and couldn't pick just one that I felt summarized who I am.  So I put all of my names in a row.  When someone asked what to call me, I pointed to the back of my shirt and said, "Pick one."  Or combine a couple.  It's all good.

Sister for my place in the gospel of Jesus Christ.  A literal spirit sister to each and every human being who lives, has lived or ever will live.  But don't expect me to put you all on my Christmas gift list.

Doctor for the 4 years of medical school that got me the title.  I'm not stuffy about it, and I don't make a big deal when patients call me Angela ... or sweety ... or honey.  I do refer to myself as doctor when I introduce myself to patients because they need to know my role.  And I guess I was just raised to use titles with people.

Angela for the name given me by my parents.  Not Angie.  Not Ang.  Angela.  I can't really explain why, but I'm just not a nick-name person when it comes to myself.  Angela is the person I was growing up before I got the rest of these titles.  It's my go-to persona.

Beeler for the name I took with marriage.  It brought with it a wonderful family-in-law.  How many other people vacation with their in-laws and leave the spouse at home?  And it moved me up in the alphabet.

(I did not abandon my maiden name.  It sits in between my first and last names.  But not on this blog.  It is not my middle name.  It is my maiden name.)

Mom for the 3 little ones who call me that.  It is my best name.  It wasn't until having children of my own that I realized I had been a Mom all along.  I wanted to have kids for a long time, and even when I thought I couldn't I still knew I was a Mom.  Having kids just clarified what I was already doing.

Those are my titles.  How else am I defined?  Hopefully many of the entries to follow will answer that question.  In the meantime, here are a few more descriptors:

• The fat blob in the family pictures drawn by my son.  I can always tell which stick figure is me.
• Housecleaning is at the bottom of my priority list.  Seriously.  It's kinda sad.
• I am not 24601, but I do love a good musical.  I can sing but I don't advertise that, you have to find out for yourself.
• An iPad user who will not give up her unlimited data plan even though she doesn't come close to using enough 3G data to justify it most months.
• Meyers-Briggs introvert.  I have a vibrant inner life.
• Mamaroo100

OK, on with the show.  After a brief interlude to deal with the responsibilities that come with all these titles.