How do we keep going in a time of unprecedented uncertainty?
As you know, my own situation is layered with the fact that I was recently diagnosed with breast cancer and am undergoing chemotherapy. As the side effects of cancer treatment take hold, I add to them the very real worries of Coronoavirus infection to my immunocompromised body. I do not wish this burden to anyone.
But I worry less about myself than others: patients, our dear employees, my loved ones – many people fall into more than one of these groups – and we are all living with heavy burdens.
My heart hurts.
My brain hurts.
My body hurts.
Fertility treatment is literally on hold. We have been directed by the American Society of Reproductive Medicine and the Minnesota governor through a direct order that we must stop treatment. I will get into it later on whether fertility treatment is elective (it is not in my opinion), but our hands are tied. We can’t even do procedures that involve gloves. This effectively rules out almost everything we can do to help our patients build their families.
Super vulnerable: This morning I was feeling particularly hopeless. This is very unlike me; I am generally an optimistic person. I made a list of things I could not control. It was bleak.
I cannot control that there is a global pandemic. I cannot control that I have cancer. I cannot control that my life’s work and purpose have been – temporarily – taken away with an uncertain timeline to resume. I cannot control that patients whose own fertility timeline is limited are being forced to put their lives on hold. I cannot make this virus go away and get our lives back to normal.
And then I made a list of what I can control.
I can write in my gratitude journal every day; today’s entry was that I was safe for one more day. I can be present. I can show love to my family and pet. I can be kind. I can maintain relationships. I can eat nutritious foods when I am able due to my cancer side effects. I can hydrate as I am able. I can walk outside – alone – when energy allows. I can think and reflect. I can follow isolation guidelines to minimize my risk of infection. I can not give up hope.
And I can plan. Normally I do not have the luxury of time to think; I just do. Now I can plan. How to do better and be better. How to be a better physician, colleague, partner, parent, friend and human. As myself how I can help patients NOW. We may not be doing embryo transfers this week, but we will be back. And I can plan and be ready. We are finding ways to stay on top of the changing landscape and be able to nimbly slide back into our mission and work, only better.
To many, the pineapple has become symbolic of the fertility journey.
Here’s the science: For centuries, pineapple (Ananas comosus) has been used as a folk medicine by indigenous peoples of Central and South America.
Pineapple fruit, skin and stems can be extracted to yield bromelain, a mixture of proteolytic enzymes that can interact with pathways in the body involved in inflammation, blood clotting and the immune response.
But the link to fertility treatment – and specifically IVF – is weak.
The theory is that by ingesting pineapple – and hence its proteolytic enzymes – the uterine environment may have less inflammation, better blood flow and an altered immune response, one that favors implantation of an embryo.
The bottom line: Pineapple is unlikely to be harmful to an IVF cycle, but it’s also not likely to be the deciding factor for its success.
But patients, please keep wearing your lucky pineapple socks when you come for a transfer!
While I’m 99.999% Science, I’m also 0.001% Faith, Hope, Trust and Pixie Dust, and I still believe in the power of good luck – and good vibes.
So don’t worry, if you forget your lucky pineapple socks, I’ll probably still be wearing mine.
After that, I did 4 years of OBGYN residency and 3 more years of fellowship in Reproductive Endocrinology and Infertility.
That’s a lot.
Since then, I’ve been practicing medicine full time.
“Practicing medicine.” Think about that term. It implies that medicine always keeps us striving and learning, while never being perfected.
During my time as a physician, I’ve evolved. As I should.
These are my subjective observations after nearly two decades in medicine.
What is different for me:
I have experience under my belt. There are times in medicine where you can’t Fake It ‘til You Make It. I am Board Certified in OBGYN and my subspecialty, Reproductive Endocrinology and Infertility. I earned my stripes. More than 11 years into practicing my sub-specialty, I have seen a lot. When I quote you success rates about my practice, I am giving you facts about my practice. Mine. I have done thousands of egg retrievals and embryo transfers, not dozens or hundreds. Part of counseling patients is discussing the risks, benefits and alternatives to a procedure. We call this informed consent. Of course we do everything possible to minimize risks, recognize and treat any complications, but when you are doing something long enough and with sufficient volume, you will encounter complications and tough situations. I have. It’s humbling. But on the flip side, if you’re a patient, you want someone who can quickly and competently handle a problem, plus keep you out of trouble in the first place.
I work harder than ever to build relationships with patients. I am genuinely interested in where you grew up, how you met your partner (if you have one) and what your ideal family looks like. The reality is that while many patients will be successful, some will not. Investing in the relationship along the way pays multiple dividends. I have some patients who did not achieve pregnancy yet still express deep gratitude for their care and have transitioned from patients to friends.
I’ve aged into a new demographic. A whole generation of physicians has now come behind me. It is exciting to meet younger physicians or medical students who are the future of the field. They’re so bright and shiny! I love it. We’re in an age where women physicians get to be their authentic selves and I embrace it all. I love this army of Boss Lady Doctors.
I delegate more. I get it. Patients want access to their doctors, and we should be there for our patients. Should I personally answer every patient’s routine question or call with a non-urgent lab result? Maybe. But with a robust practice, it is impossible to sustain or scale this over the long term. When your patient load is building and time is less limited, I wholeheartedly agree that every patient would prefer to speak directly to her doctor with every question, problem or concern. As you get busier and time becomes your most precious resource, you *must* find a way to divide and conquer tasks. This is true for life at home, as well.
I am more skilled at having difficult conversations. My specialty requires a lot of them. Patients put their hopes, dreams and resources – emotional and financial – into our care and sometimes, it is not going to work out. It is never easy telling a patient that her eggs are not likely to create a baby. It is not easy telling a couple that none of their eggs fertilized in an IVF cycle and there are no embryos to transfer. While you should always bring your A Game to these conversations, I used to fear and dread them. Now I don’t. I might wish we were talking about something completely different, but I will be present for you and we will figure the next steps together.
I thank patients for letting me take care of them. This is something I have done for a long time, and I mean it. Thank you for letting me in. Being a physician is a unique profession; we care for others at their most vulnerable and in the end, it is mutually satisfying. A word about thanking patients: do not do this if you cannot be sincere. This isn’t a place for phonies. A healthcare provider I saw once for an acute issue with my daughter asked at the end of the visit what he could do to ensure a five star rating if we received a patient satisfaction survey. That left a bad taste in my mouth. Don’t be that guy.
I am better about recognizing when my tank is low. I’ve been burned out. Now I’m not. I’ve also come to think of my emotional reserve as a fuel tank: there are times when it is full and others where I am running on fumes. Now I’m better able to determine when I am down to my last quarter tank and then re-fueling prior to becoming completely dry. When I say “better,” I also do not mean perfect.
I remain a work in progress.
What is the same:
I will tell you “I’m sorry.” I’m sorry that your pregnancy test was negative. I’m sorry for your pregnancy loss. I’m sorry that you have to be my patient in the first place. I will acknowledge the Elephant in the Room. It isn’t a failing as a physician to say “I’m sorry.” Doctors aren’t gods, and I believe the “God Complex” stereotype is woefully outdated. I certainly don’t think of myself as anything other than deeply human, and part of being human is being honest and vulnerable with others. Saying “I’m sorry this happened to you” is often the humane thing to do.
I understand how much this matters to you. It matters to me, too. Every negative pregnancy test is hard. The one thing I have told myself over and over is that the day a negative pregnancy test stops being hard, I should quit the field. There isn’t room for ambivalence.
If you send me a birth announcement or a holiday card, I will save it. Not only will I keep it, I will look at it. Often. Especially on tough days.
If I ever get to meet your baby, I will cry. Probably ugly cry. They will be happy tears, though.
I earned the nickname “Fancy Lady Doctor” in medical school, even before getting the official MD letters behind my name in 2001.
Despite being tongue-in-cheek at its core, the concept of the Fancy Lady Doctor – or FLD – resonated with my classmates.
Several of them started developing their own mini-groups of FLDs in residency programs across the country, but nowhere did it take off like in my own OBGYN residency program at the University of Colorado.
Friends, they still give out a “Fancy Lady Doctor” award at the annual end of the year residency banquet.Idie with pride!
When I attended medical school in the late 1990s, there were a few attending physicians who qualified as FLDs, but not many. Ditto residency.
Don’t get me wrong, there were countless wonderful, smart and kind women who educated me, but not many were wearing heels in the OR at 3 A.M.
I have done this.
The culture of medicine has changed since then, too. More women than ever are entering medicine, and now that we are more than half of medical students – and emerging physicians – we can own the space in a way that our foresisters could not. I recognize the debt.
In the fertility world, the ASRM meeting is a big deal. Nearly 10,000 fertility professionals – doctors, nurses, embryologists, psychologists, scientists and more – meet to learn about cutting edge research and new techniques, tools or devices. There are opportunities to connect with old friends and colleagues, as well as industry leaders.
And there are parties.
Some of this has changed since my inaugural ASRM (it’s toned down a lot), but back then, I was blown away.
Everywhere I turned there was someone with near rock-star status in our field, walking around like a mere mortal. There were parties every night with multiple live bands, cocktails and embarrassingly extravagant displays of sushi. One party had enough jumbo shrimp and lobster tails to fill a bathtub.
And there were many, many FLDs.
Not only were these women smart, well-spoken and professionally accomplished, they looked great. They wore suits or dresses that fit perfectly. They had designer – real designer – shoes and bags. No knock-offs here. They had rings with diamonds large enough to choke a horse.
I had found my tribe.
Fast forward to now: Last week marked the 75th ASRM meeting in Philadelphia, PA. I went.
One day I wore these:
And I was delighted to connect with a whole new generation of FLDs in my field.
While it’s a surprising position to discover I’ve aged enough that a whole generation has come up behind me – How did I get here? – I really, really like these women.
It makes me happy for the future of our speciality and for women physicians in general.
And, so, a final message to my younger FLD colleagues: Keep it going.
Be amazing physicians.
And remember: diamonds are always the perfect accessory.