The woman had tried to flush her baby down the toilet in a motel. She deserved my ire.

I immediately dismissed her as less-than for not, at least, leaving the baby in a warm blanket. Why try to kill him– a near-term boy who probably cried as he hit the cold toilet water.  There was just no state of mind that would justify such a heinous act.

I didn’t want to see her, didn’t want to force myself to smile, and didn’t want to be empathic. That’s just not how I felt. And, I would have to walk past the police standing outside her door, which only added to my discomfort.

I sat at the computer in the middle of the nursing station and reviewed her labs and read the notes written on the previous shift. “She’s fine. She’s ready to go to jail now,” I scoffed.

“Please be kind. She has been through a lot.” Bridget’s hand reached toward me as she spoke. She had been a nurse at this hospital for 25 years. Bridget was a white nurse who carried a toughness that belied her small frame and olive complexion. The type of nurse that every doctor wants around in the midst of an emergency. She has a keen clinical eye and calmly executes her duties.

“Are you kidding me?” I thought without responding to Bridget’s plea. The hotel maid heard the baby crying when she came in the clean the room. Who would do such a thing?

As I walked down the hall, a swarm of emotions filled my head. I was embarrassed by the admonishment. It was my role to exhibit professionalism and forgiveness. Confusion and surprise also visited my mind. In 25 years I have never heard a labor and delivery nurse defend an abusive mother. Not once. I have worked in six different hospital systems in the Northeast. Yet, today I was alone in my wrath because my negative emotions were not aligned with that of the clinicians around me.

Walking towards the patient’s room, I tried to cool my disgust: maybe she was raped and felt nothing but hatred for the baby; maybe she was a prostitute and was under duress; maybe she was homeless; maybe mentally ill, etc.

I said good morning to the police officers as I entered the room.

At first I saw a pair of slender feet that managed to escape the cover of the blanket. The room was too warm.  I was thinking about the temperature when the room, slowly, came into focus. The shades were drawn. A glance down at my notepad gave me a few seconds to put on my “doctor face.” I took a deep breath and managed a closed-lipped smile. It took a few minutes more for the scene to register.

The patient was white. She was not a Black mother.

I had to consciously un-wrinkle my face as I took in the blue eyes and light brown hair sitting up in the bed. He faced displayed no emotion whatsoever.

Wow.

I, a black physician, had assumed that she, the patient I deemed horrible, was a black mother. The picture of the crack mom is so inked into my mind. It’s a story printed there by decades of imagery that consistently delivered negative images of black mothers. It never occurred to me that the baby who was found bloodied, screaming, cold, abandoned in the toilet of a hotel room, came from a white woman. And, of this I am almost certain, Bridget would have never had come to her aide had she been a black woman.

Unconscious bias is all around.

it’s like the gleeful swimmer who is unaware that a shark is close by, until the shark bites. Or, like the fisherman who merrily gets his fish having never appreciated the harm done to the beings in the ocean by tactics that are harmful. We’re both guilty—Bridget and I. But I thank her still, for holding up the mirror.

I’m a sorry, Black mother, for my participation in the processes that contribute to your deaths. Alia McCants died after giving birth to her twins: implicit bias was responsible for her death. We can train our doctors and clinicians to do better. 

I was kind to the patient when I spoke, as I recovered from my fugue. Every patient deserves professionalism and respect. Every person deserves a chance to explain, or at least to ask for forgiveness. This should be the expectation of every clinician, no matter his or her creed or color, sex, gender—whatever the type of PRIDE celebrated. Certainly, Covid had made getting care even more difficult for women in general. As we emerge from the pandemic, we need to keep our attention steadfast on the issue of racism in healthcare in America.

~Juliet_MD~

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Every part of life has to be considered before one decides to have a baby. This is true, even if you believe in God.

Who best to make that decision? Even if she is in a partnership with another adult—her physical, emotional and financial wellbeing will be tested.

Does the right of a fetus matter? When does it start to matter? Or does the life of the mother matter more? And, does the life of the mother always matter more. Life here is defined wholly—the physical life, the financial life, and the intellectual life.

Raising a baby is hard work. There is nothing to be said that can ever prepare one for the sacrifices one will have to make. Nor will one ever be contain the willingness to literally die, to protect and safeguard this new being.

It’s OK to yes. It’s OK to say no.

Speeches and law will not show up in the middle of the night when you are tired. Skillful oration will not help you pay for childcare. Debates will not support you in those moments when you are forced to choose being your job and your baby—this will happen. They will not babysit so you can fulfill your dream of traveling to Paris.

And that’s just fine—for some. For some, life is meaningless without motherhood. Any perceived strife is the natural order of things and will never overshadow or trample real, almost palpable, joy.

Everybody deserves to chart their own path, define their own strengths and determine which sacrifices they hold dear.

This, I believe, is the meaning of choice.

There you have it. Now spread the word.

Juliet MD

“Right and wrong, wisdom, justice and goodness, were nothing but names, even though it might be argued that it was sometimes prudent to act as if they were more.”

~W.K.C Guthrie, The Greek Philosophers

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I am afraid.

Children. That is what they are–although they think that they are prepared and ready to face the world–often suffer one of the most traumatic and life altering events early in life and away from the protection that the watchful eyes of parents could provide.

Ross Duthat, a prolific writer on matters of politics and policy, wrote a thoughtful opinion piece in the New York Times about the dire state of college campuses with respect to the sexual assault. http://nyti.ms/1mrBNtZ  “In the debate over sexual violence on college campuses, two things are reasonably clear. First, campus rape is a grave, persistent problem, shadowing rowdy state schools and cozy liberal-arts campuses alike.”

Many parents focus on paying expenses and parting from beings who, for many, have given meaning to their lives. But, we have more to prepare for. Do we adequately give our young women the tools they need to protect themselves? Do we talk to them about drinking to the point of oblivion; falling down drunk in the presence of strangers; or the need to pay close attention to their surroundings? Have we taught our sons that to treat women with respect and not as objects is a true manifestation of manhood? Have we taught them about consequences?

Institutions need to do more. But, more work needs to be undertaken before we unload the laptop and dorm room supplies.

There you have it. Now spread the word.

Tweet @JulietMB_BTBB

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From the American Sexual Health Association

HPV affects men and women.

Ask your doctor is you are a candidate for the vaccine.

There you have it!  Now spread the word. @JulietMD_BTBB

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 This article was reposted from BlackandBrownNews.com

(Video) Fat. Just Fat: 5 Basic Tips to Lose Weight

One of the most miserable state of being—is being fat. The constant tugging at clothes that shift out of place; the closet filled with attire that we hope will soon fit; the frantic routine of changing into different outfits until we find one that…works; and of course, the abject despair when the number on the scale does not budge, or worse, moves further to the right. And yet the desire to be thinner and healthier persists, sometimes this unfulfilled hope can lead to self-loathing and low self esteem.

Photo Art by Jason Herdigein

The people who say that they are happy being “big”, i.e. Mama June, are not being honest with the world or, are in the minority when it comes to feelings about obesity.

One in every three Americans is overweight (BMI 25-29.9) or obese (BMI over 30).

How did this happen? It’s simple:

How we live has changed. We do our banking online instead of standing in line; we get our breakfast from Dunkin’ Donuts instead of at home; we drive, instead of walk; we play with iPhones instead of tag and tennis. We don’t move our bodies. Interestingly, of all the sedentary behaviors associated with weight gain, prolonged television watching is most associated with weight gain and most associated with the risk of becoming diabetic, more so than sitting at work.

 We also sleep less. One third of all Americans get less than seven hours of sleep per night. Studies have shown that sleep deprivation changes the hormone levels that control hunger, leading to increased appetite, especially for high carbohydrate foods. And, sleep deprivation makes the body less responsive to diets that aim to limit caloric intake.

We have overweight/obese friends and family. The risk of becoming obese is increased by 57 per cent if your social circle includes an obese friend, 40 per cent if it includes an obese sibling and 37 per cent if you have an obese spouse. Note also that he effect of the weight of the members in one’s social circle does not diminish or change based on social class. Your fat friend may encourage you to eat the kind and amount of food that will make you gain weight!

By now it is well understood those who are obese are more likely to become diagnosed with a chronic illness or a terminal disease: heart disease, respiratory disease and cancer (breast, prostate and colon).

Note also, people who are obese are harder to care for and are at higher risk of medical complications. Pregnant women who are obese are twice as likely to deliver by c-section. In emergent situations, obese patients are harder to intubate (breathing tube placement) and when they need surgery they are more likely to develop post-operative complications, including pneumonia and wound breakdown. Further, those who are overweight will die three years earlier than those who are not. Those who are obese will forfeit seven years of life. (And those who are obese and who also smoke will sacrifice fourteen years of life.)

The AMA has adopted a new policy whereby obesity is now considered a disease. By categorizing obesity as a disease, the AMA hopes to spur insurance companies to provide more coverage for medications, surgery and counseling.

In a June article published in the  New York Times, Dr. Patrice A. Harris said, “Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans.” Dr. Harris is the Chair of the Council on Legislation for the American Medical Association (AMA).

Dr. Patrice Harris said the obesity definition would help in the fight against heart disease.

But many physicians disagree with this tactic (myself included), in that categorizing obesity as a disease, may lead to more fervent dependence on medications and surgery as a remedy. Another argument is that obesity is a disease, in the same way that lung cancer is a disease caused by smoking. Both sides would agree, however, that weight maintenance/loss is challenging.Losing weight is hard.

Many of us—overweight and obese people (myself included)—suffer from the False Hope Syndrome…we start out fast and furious, falter and then fail.

Translation: I want to lose forty pounds now, not five pounds at a time. I’ll do it in time for my high school reunion next month. And, I will do it on my own, sheer will power is all I need, no need for counting calories and signing up for expensive programs. Once I’m skinny, the man/woman of my dreams will appear and I will win the lottery.

Losing weight is also simple.

Lifestyle intervention (diet, exercise and behavioral modification) is the most important strategy in weight loss.

1. Write it down, folks! Self monitoring–the use of food diaries and activity records has been shown over and over to result is short term weight loss and long term maintenance of weight loss.

2. Eat more often — A five meal a day pattern is associated with a significantly lower risk of becoming overweight and obese. Moreover, eating breakfast is associated with less weight

3. Stimulus control — Place healthier options in close proximity, prepare easy to eat low calorie foods, use smaller containers, plan ahead to have fresh fruit and vegetables in the refrigerator and do not eat mindlessly (don’t eat while watching television or reading.

4. Increase physical activity.

5. Set realistic goals.

Good Luck!

Juliet M Nevins is a board certified obstetrician/gynecologist, a medical director at Aetna and the author of belowthebellybutton.com

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