Twenty Five Countries in Thirty two Days

Once the travel bug bit, I had two halves to my life----the time I spent traveling, and the time I spent planning my next trip.  After my first year of college, spending my summer living in the dorms of Boston College, made me realize that I loved living away from my home, with other people my own age, making my own decisions, and not spending my life feeling like I was always explaining myself or always disappointing someone because my opinions did not agree with theirs.  I felt alienated from my family--like I had nothing in common with them, and it was their constant job to tell me all the things that were wrong with my actions and my decisions.  Of course it was no different when I told my family that I had decided to go to Europe for the summer, and I planned the trip myself.  NO ONE in my family thought that was a great idea.  They told me I was selfish, flighty, irresponsible, and tried to make me feel guilty by saying things like, "If something happened to you, what would we do?"  No one wished me luck, or was happy for me.  No one saw it as a learning experience, or as a good idea.  I saved my own money from my waitressing jobs and planned my own itinerary.  For my first experience in Europe, I decided to go on an organized group trip---one of those "25 countries in 32 days" experiences--designed to see a little of everything, but no details of any country.  That was fine with me---there were about 30 college-age students from various backgrounds and experiences, traveling on a luxury coach, with Wolfgang our tourguide, and Joe, our busdriver.  I drank beer in the Hoffbrauhaus in Munich, went to the red-light district in Amsterdam, gambled in Monte Carlo, and had an awesome time.  I knew that my travel experiences were just beginning, and the feeling of freedom that came along with being away from home could not be duplicated.  I decided that as soon as I returned, I would start planning my next trip....and that's what kept me going through another year of commuter college.

An Out Of Body Exoerience

I am not really sure if this is something that is very specific to ME, or if other doctors have the ability to do the same thing, but, when I see a person as a patient, something happens which allows me to look at, treat, and talk to, that person differently than I look at anyone else, or even differently than I look at that SAME person in any other circumstances.  It sort of causes a "distancing" of myself, socially  from that person---enabling me, for many years now, to take care of friends and family members as patients.  People ask, "Isn't is strange to take care of someone that you know, OUTSIDE the office, as a patient, INSIDE the office?"  (Especially in the field that I am in, Obstetrics and Gynecology).  I think it is exactly the opposite--I DO have the ability to see someone outside the office, talk to them, and even socialize with them, looking at them one way, talking to them as a friend, and then as soon as the conversation turns to their medical care, and especially once the office visit begins, it's like I "turn into" this other person, and look at them, and talk to them clinically, in a completely different way.  So far this has been successful, as I have taken care of many family members and friends, and it has never felt awkward to see them again on a social basis.  I guess I take it as a compliment that I have been able to continue to have these people feel comfortable enough to continue their care with me!

World Traveler

Starting in high school, I read voraciously about other places-- other cities and states in the U.S., other cities and countries around the world-- and I was determined that I would see as many of them as I could. For high school graduation I let my parents know hat the only present I was intereststed in Would be for them to send me on a trip. They finally agreed to send me on one, if it would be a chaperoned group trip and it was not too expensive. I did the research and we agreed on a trip which would fly a group of about thirty high school students to California and then drive by motorcoach down the coast, then to Nevada, Arizona and then fly back to NY. Knowing I was not going to leave my home for the four academic years that I was going to go to college, I thought this would be a great opportunity. It was a great trip and it definitely whet my appetite to get away from my house and do more traveling. When I got back to Ny and started college (still unfortunately with poor self-esteem and always seeking approval) I realized that the limitations of a "commuter college" were considerable, and if I was going to have ro stick t out for 4 years I would make t bearable by doing as much traveling in between semesters as I could. I got a job as a waitress in a diner near my home and saved every penny I could to go into my travel fund. I decided that I would at least try to have a "college experience" the summer after my Freahman year. I moved to Boston for two months and lived in the dorm at Boston College, taking some core curriculum courses. I loved it and wished I could go there all year, but my parents would not pay for it although my grades were great ( all A's). So I went back home to my commuter college
and my waitress job after the summer,and began planning my next trip.

Growing UP----and OUT

I grew up all through Junior High School, and High School, in Brooklyn, trying, from what I remember, desperately to fit in.  That is probably a common theme, but as I recall it now, my self-esteem was SO low, and I thought SO poorly of myself, that I looked everywhere and ANYwhere for approval and validation--from my teachers, from friends, of course from boys.  And THAT is a recipe for disaster.  I was easily led into behaviors and actions that were strictly to secure approval and friendship from others.  Any boy who paid attention to me became the object of my affections and focus.  And, since no one at home was talking to me about relationships, emotions, and self-esteem, I was kind of "on my own".  I was very smart in school---always had high grades and high praise from my teachers---but that really did not carry into my home life.  My parents were completely caught up with what was happening with my brother-who by this time was severely developmentally delayed,  in special schools, special programs and needing constant care. They had me stay home to baby-sit with him, and never saw fit to give me my "own" time with friends.  Consequently, I never invited friends over to my house, and I certainly never told them what I was doing when I wasn't home.  The disapproval at everything I did that involved my being out of the house was SO thick, that I became an expert at circumventing the questions and planning my next getaway.  When my parents wanted to send him to a day camp for special needs children, they got me a job (at age 14) as a camp counselor at that same camp, so I could "keep an eye on him".  What they did NOT know, was that by sending me into an adult environment, my being the youngest counselor there, they placed me in EXACTLY the situations that they would never have wanted me to be in. I was among older teenagers and twenty-somethings who were smoking, drinking and doing drugs (not while working at the camp), and they were only to happy to welcome me along.  My parents made it clear to me that if I was not thinking of going into one of the "noble professions", (medicine or law) then they certainly were not going to invest in an education for me that included going away to college.  Feeling hopeless, I continued to study,  & worked endless hours as a waitress( another adult environment with plenty of adult distractions), so I could save enough money to make my ultimate "getaway",  and travel the world.

With Great Power Comes Great Responsibility

I am often amazed that there are so SO many things that can go wrong during the birth of a baby, and yet, most deliveries happen without anything bad ever happening.  I would love to take credit for all the wonderful outcomes that occur in the delivery room....but the truth is, the birth process usually happens so perfectly, so automatically, that it is not really BECAUSE of what we do, but in SPITE of what we do that these babies are born so "normally".  Of course, we learn all the "what if's"....what to do if the patient does not go into labor by her due date?  What to do if the fluid is not clear when the water breaks?  What to do if there are contractions, but they are not strong enough to cause the delivery to happen?  We "manage" a patient's labor, but the REAL manager is the baby----the baby responds a certain way, or doesn't......the baby passes through the birth canal in a specified period of time........or not.  The baby knows how to take its first breath and "convert" its circulation over to "non-umbilical" circulation....or it can't.....and all we can do is help the process along.  There is so much we don't know.  People are always asking "What can I do to get myself to go into labor?"  but there is nothing, after studies and research, and testing...we still do not know what is the "trigger" that will make someone go in to labor.  (not in humans, anyway.)  We know how to INDUCE labor, how to AUGMENT labor---but not exactly what INITIATES labor.  Why can one woman's pelvis accommodate the passage of a 9 pound baby, but another woman cannot successfully give birth to a 6 pounder?  We are really not sure.  Why do some babies present with feet or butt first, but most try to enter the world head-down?  AND WHY ARE THERE SO MANY C SECTIONS??????  We have talk--we have speculation---we have discussion---but we really do not know.....we watch what the baby does---and we work around it.  I DO know that I have a lot of "sneaking suspicions"...that babies seem to mostly want to be born between the hours of 12 midnight and 6 am!  That when the moon is full, the delivery room is too.  And the biggest thing I have learned, after all these years is this------the baby is the boss.....and the sooner the parents and the doctor/birth attendant accept this, the better off we all will be.

Past, Present, Future

Although this blog is jumping around quite a bit, time-wise, I am realizing that there IS information to be gotten from things that happened in the past, and that many things in the past fuel the behaviors of the present and future. That seems to be a recurring theme here.  I find it interesting that I mentioned in a prior post that it is important to me, as an Obstetrician and Gynecologist, to explain the details of how a woman's body functions, TO the women that are experiencing these functions.  I am sure that at least in part, that is due to the sore lack of information that I was given, growing up.  I was uninformed, misinformed and ill-informed about my own bodily functions.  I am not sure if it was just "the way things were", that NO ONE discussed "those things", (although I doubt it, since some of my friends seemed to have a handle on what was going on), but the first time I knew anything about a "period" that had any meaning to me, was when I experienced one---On Christmas Day, shortly after I turned 13.  I had no idea what was going on, and must have thrown away about 4 pairs of underwear before my mother noticed I was running in and out of the bathroom, seemingly horrified.  But even then---no words, no explanation--no "congratulations"--she handed me a book--a paperback pamphlet that was supposed to "explain it all to me". Needless to say--I can see how that had quite the impact.  I vowed, as I was growing up, that if I ever had the opportunity to parent children, and those children turned into pre-teens, and then teenagers, I would have actual conversations with them; and my conversations with them would not be full of things like "sin" and "bad behavior". (things that I heard PLENTY about)..I would tell them about things that I would have wanted to hear at that age---- like the proper words for body parts, like the fact that sex is NOT "dirty"...I would use words like, "emotions", "safety", "normal", "protection" and "love".   Luckily, I have had the opportunity to educate not only my own children, but many scores of teenagers and young women (and quite a few older women who had a serious lack of knowledge as well), and it has always made me feel like this knowledge has helped them make major decisions, and take control and responsibility for their reproductive health.  The rewards with my own children have been great. Although I am not under any delusions that my teenage and young adult children tell me EVERYTHING, I do know that they feel quite comfortable discussing many things about their bodies, their relationships and their health with me.  Part of that is because I am a doctor, but part of it is because they feel comfortable enough with me to trust me with that information......How wonderful!

Brooklyn, continued

There is a quote that I once read that said "Something has to explain the disproportionately large space that childhood misery takes up in the adult psyche"..I thought about that a lot. I was a miserable child, a miserable teenager, and for some of my young adult life, a miserable adult. It was not until I was going through a divorce, with two young children, and had gone to lots of therapy that I really understood what kind of an impact my younger years had on my older ones; and that if I didn't consciously try to change things, the cycle would only perpetuate itself. My brother was about two years older than me, and from all accounts was a pretty normal kid until about the age of six (knowing what I know now about childhood development and milestones, it is obvious to me that things were not so okay before that but no ome seemed to notice). After age six he was diagnosed with intractable seizures and everything changed. From that time on, all my parents time and efforts were devoted to him, his treatments, his doctors appointments and his medications. Having children of my own, of course I can see how one would want to do everything in an effort to help a sick child. But my parents, who were ill-equipped (remember, my father never wanted more children--see previous posts)emotionally distant, and not interested in how I felt about anything, completely discounted the fact that I was a child, who also needed their time and attention and their answers. I was dragged around to the doctors appointments, regardless of anything else that was going on in my life. I was expected to watch my brother, to stay home with him-- essentially to "parent" him and be an adult, instead of having a childhood appropriate to my age.

My Body Myself---Maybe?

I am continually amazed at the myths, untruths and misunderstandings that women have about their own bodies and how they work.  I do a LOT of educating in my day-to-day office sessions, and I always feel good when people leave understanding much more than they did when they came.  I'm not really sure where these ideas come from,other than information incorrectly gleaned from the Internet, or from family and friends, or from TV shows and other media.  One of the least well-understood concepts is that of the menstrual cycle.  My typical "menstrual cycle 101" explanation goes something like this:
The reproductive cycle is sort of a closed loop, involving the brain, the ovaries and the uterus.  The brain signals the ovaries to produce Estrogen.  The ovaries make Estrogen, whose job it is to make a thick blood-filled lining form inside the uterus.  Once it gets nice and thick (ready for something to implant) the brain again signals the ovary. This signal occurs about 12 days after the first day of the last period.  This signal is to OVULATE, or release an egg.  Once the egg is released, it takes a trip in search of a sperm to join with (into the fallopian tube).  What is then "left over" in the ovary after that ovulation, makes Progesterone, another hormone.  Progesterone helps stabilize that lining that has been building up in the uterus.  IF that egg is not fertilized, the levels of Estrogen and Progesterone drop very low, and the uterus, realizing that there is nothing coming to be implanted in the uterine lining, sheds that lining, hence---the next period.  This is quite a delicate balance of signals and hormones (estrogen and progesterone) and organs.  If ANY part of this cycle is not functioning correctly, it will result in either irregular periods, missing periods, and/or possible difficulty getting pregnant.  Once women understand this concept, they have a MUCH better understanding of their own cycle, and will understand the various ways that I can help them manage the problems they may be having with it.  There are explanations like this for so many other bodily functions, and I believe understanding these concepts is important for women to take control of their own health care.  In the "olden days" of Gynecology, when women were not so autonomous, and "The Doctor Always Knew Best", (and that doctor was usually a man), it was not unusual to hear things like, "You're finished having babies, why not just take your uterus out?" at the hint of any problem with the menstrual cycle.  These days,  women should hear about and understand all of their options when it comes to reproductive care.  It is important, and one of the things I love best about my doctor-patient relationships.

The Olden Days Continued

When my parents got married, things were rough.  They came from two different worlds and two different religions.  He had just buried his young wife, and she had just gotten out of an abusive marriage which was annulled  (I always wonder about annulments- do those people REALLY believe that "it never happened"?  More likely they can just deny it and pretend it never happened...)  They met when they were both teaching English as a second language to foreigners...so they had THAT in common.  I guess they were just two broken souls, seeking solace in each other.  My mother came from a big Italian family, and they were very welcoming to my father. My father came from a small Jewish family, and they were for the most part, very UNwelcoming to my mother.  But marry they did,  and in spite of the fact that my mother promised she was not going to have kids, when her sisters all started having babies, she took back her promise.  She pouted, and cried, until my father gave in, saying, "I'm too old to take care of babies" (he was 45, but had many medical problems).  He told her that the burden of taking care of these kids was going to fall mostly on her.  She agreed.  They had my brother, and then me, 22 months apart.  They already had the two (now older---8 & 13 year olds) from my father's first marriage, but by all accounts, they didn't really consider them "their kids"....those older kids were dragged around from relative to relative, and were pushed out of the spotlight by the two new babies.  Parents of that generation for the most part believed that they were good parents if they fed you and put a roof over your head: there was none of this "anticipating my children's needs" or "providing emotional stability" for the kids.  Knowing how my parents were when I was growing up, I can only imaging how they were to these two "leftover" kids.  The good news is that I am close with my older half-siblings.  Although we actually are from different generations, I adore them, and we have a shared history and a lot in common that I can't say I have with anyone else.  We speak regularly although we live on different coasts, and we are genuinely happy when our families spend time together.  The story of what happened with my parents, my "real" (if we must call it that) brother, and me-----not such good news.

Days and nights on call

Being oncall as an Obstetrician and Gynecologist is a unique experience.  Anything can happen, from perfectly normal women having perfectly normal pregnancies going on to have perfectly normal deliveries...to life-threatening emergencies where life-saving decisions need to be made.  Luckily, most of what goes on tends more toward the "normal" categories.  Having had three pregnancies and deliveries myself, and having been at this job for many years now, it gets easier to deal with whatever may come.  Also luckily, I am a "list" person----I have a constant list in my head when dealing with on call activity----a list of all the things that ARE happening, and all the things that COULD happen, and what I should be doing about it, in order of liklihood and priority.  I find that a LOT of my time is spent teaching and explaining to patients and families what can happen, what our plans are, and how the bast of plans may change drastically through the process.  Labor and childbirth can be a scary thing, and explaining things can really help the situation and lessen the anxiety.  One of the things that has been harder as I have gotten older, though, is the loss of good sleep and what that can do to me.  I was a resident in the days where we were still allowed to work 80 hour weeks, stay up all night, and then see a whole clinic-full of patients the next day. (And RIGHT after I was finished with residency, those rules changed---for the better--quite a bit!)  I used to lose sleep and bounce back right away.  Now, the "bounce" is not so immediate.  This past week, I had not had a good night's sleep for 4 or 5 nights in a row....and by the last day I felt like death.  The only other time in life I can equate this to is when you have a newborn baby in the house---especially if you are exclusively breastfeeding......the extreme exhaustion that accompanies waking every two hours to feed the baby, and never REALLY getting the restful, REM sleep that you need....With a new baby that goes on and on. In my opinion, the baby thing got me ready for being an on call doctor, and being oncall got me ready for having a new baby.  I had the pleasure of both of those experiences, since I had two babies BEFORE residency, and one baby AFTER.  More on THOSE stories later.

In The Beginning.......

I guess I'm going to jump around quite a bit on this blog-----there are a lot of things I want to say about the present time,  about my day-to-day life, but in order to see how I got here, I also have a lot to say about where I came from.  The road to wine country was by no means a straight path.  Sometimes I am amazed that I ended up here.....but so happy about the twists and turns that brought me to this place.
I was born in Brooklyn, New York.  After meeting so many people in so many different cities and states, I am convinced that about a third of the population came from Brooklyn or the surrounding areas at some point in their lives.  It's like everyone somehow starts out there, and then takes a different path to their ultimate residence.  Growing up in Brooklyn was quite the experience. At the time I didn't think anything was so unusual about it.  We played on street corners, rode bicycles to the school yard, and ate at the corner "pizza place".  After high school, most of the people I knew dispersed and went in different directions.  I only realized when I became an adult how much the place I grew up and the family I grew up in so directly influenced my decisions and who I would become.  My parents were also from Brooklyn, although one generation back, my father's family came from Poland, my mother's from Italy.  My father was married before.  He was Jewish, and was married to a Jewish woman.  They had two children, my half-brother and half-sister.  Sadly, his wife passed away from cancer at a very young age.  (but no one talked about it in those days).  Having a mother die so young, and a father who probably was grieving, and drinking, and unavailable probably made those kids emotionally unstable and unable to cope.  My father later met and married my mother--a non-Jewish woman who had no idea what she was getting herself into.  His family objected and rejected, the kids were confused and unhappy, and I'm surprised they ended up staying together.  But stay together they did, and several years later had two children together, my brother and me.   I guess I can stop here because there is so much to say and so many more blog posts to say it.

The Noble Profession

I have been an Obstetrician and Gynecologist since 1993, if you include my four years of residency.  I think it is the best Medical Specialty, because about 90 percent of the time it's a "happy specialty". People having babies, getting pregnant, having sex, talking about sex....it is a window into the lives of women and their families that not many get the privilege to see.  But it is a difficult specialty as well.  The endless hours without sleep, the emergencies that can and do happen at any time--the sheer enormity of so many of the decisions that have to be made, and how these decisions can affect the lives of your patients---no wonder many people think I'm crazy for having chosen it.  I've never been a particularly religious or even a spiritual person, but I firmly believe that what I do is a "calling"....that there was a point in my decision making process that something "came to me", and I realized that this is what I SHOULD be doing, and I could do the most good if I joined the ranks of this particular specialty.  I have never been sorry.  There have been times when I felt challenged..exhausted....sad......overwhelmed....but  I have never thought I should have gone into a different specialty  (Not many dermatologic emergencies in the middle of the night!)  I always said that when I do not enjoy it anymore, that is when I will stop doing it----and so far I am nowhere close.

Well, I think I'll give this thing a try

I always thought that blogging would be ideal for me.  I have so many interests, so many life experiences (for good and for bad) and I really love to talk.  I'm nearly 50 (although I sometimes can't believe that, nor can I believe how that number doesn't bother me as much as I thought it would), I live in one of the most beautiful places in the world--The Napa Valley. I have a wonderful, mixed (and sometimes mixed-up) and extended family, and I've been working as an Obstetrician and Gynecologist for about 14 years.  I love to read, travel and exercise, and I do as much of all three as I can.  The journey of how I came to become a physician, how I came to live in Napa, and how my blended family came into existence is an interesting and sometimes unbelievable one.  I am not really sure if anyone is interested in reading about this journey. As a matter of fact, I am pretty sure that my family would NOT be interested in my discussing or describing the details of their past or present lives.  But I've decided to try to discuss and explain, to talk about my thoughts and, to share without revealing too many intimate details.  So we'll see where this goes.....