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The police lights flashed, and the 2012 Yukon Denali immediately pulled over.

The police officer got out, and began to walk to the vehicle.  As he approached the driver’s side of the vehicle, he saw the large black man behind the steering wheel and moved to put his hand on the butt of his gun.  The driver, sensing the change in dynamic, immediately shoved both hands out through the open window and called out it was okay for the officer to approach the car.

That “large black man” is my husband.

I was just featured in an article in Forbes, and I was chiding Americans for not discussing end of life topics with their loved ones just because it is uncomfortable.  However, I am ashamed to admit that I have fallen victim to this myself.  Dr. Brian Williams, a friend and colleague of mine, recently had an interview on CNN that reminded me of my own failure, because I have not addressed this aspect of my life before now.  And this was consciously done because I found it to be uncomfortable… But no more.

The situation occurring in America now can not tolerate any more non-discussion because the topic is “uncomfortable”… So here we go.

As a trauma surgeon, I have a wonderful and unique relationship with law enforcement. We work side by side, and a day never goes by without some interaction between myself and an officer or detective. We testify at trials and all too often we take care of them when they are injured. I treasure this relationship with the people who keep us safe. It is important to me, and one that I enjoy immensely. However, I know that I live in conflict.

I am married to an amazing man who has been my best friend for the past 16 years.  He happens to be black, and I happen to be white.  Although I know him to be the wonderful husband and father that he is, that he has so many accomplishments both from the football field and now in law school, I also know he is “just” a black man to the police.

I fear for him.  

Right after the shootings occurred in Dallas, I called him with tears in my eyes, and reminded him to be careful.  To make sure his tail lights always work.  To not go a single mile per hour over the speed limit.  To do everything in his power to prevent any encounter with law enforcement…  Because I know that his 6’6″ 300 pound frame makes people, and especially the police, nervous.

When we were in college together, I got sick with a terrible stomach flu, and he took me to the emergency department.  It was 3:00 in the morning because he was in 2 a days for football and we needed to get home before his early morning run.  Shortly after we arrived, another black man, approximately 5’10” and 160 pounds, entered the emergency department with blood on his face and shirt.  Two police officers entered the emergency department about 15 minutes later… One white, and one black.  The white officer beelined to my then boyfriend, now husband and began to question him, while the black officer watched.

Which leads me to my point… How can we make this better?  How can we prevent more innocent lives from being lost-  regardless of gender, race, or occupation? Because yes, All Lives Matter.

It has been a campaign in inner city communities “If you see something, say something”.  This is an effort to encourage community members to tell the police if they see illegal activity, to make their community better.

Well, quite frankly this movement needs to move across not only racial lines, but the Blue Line.  Police shootings should be investigated by an agency other than their own.  When a police officer sees another officer acting in an inappropriate way, or begin to question clearly the wrong black man, they need to be able to say something- to that officer, to their superior, whomever.

Far too many young black men fit an unfortunate stereotype.  We need to educate, provide opportunities and invest in their future so this stereotype no longer exists.

We need to engage each other… Black, white, law enforcement officer and civilian.  We need to have these difficult and uncomfortable conversations, and even more importantly as Dr. Williams so eloquently stated, we need to start Listening to each other, really listening.

I not only see, hear, and understand both sides of the coin, I live them.  I am in pain over the losses that our law enforcement agencies have suffered, as I view them all as friends and colleagues.  I relive in my mind my own patients that I could not save-law enforcement and civilian alike.

And I also fear for my husband.  I fear that one day he will get pulled over, and won’t come home to me.  We have got to start listening to one another, trying to view this situation from a perspective other than our own, and most of all…

The Shooting Has to Stop.

I am the proud mother of 2 boys, who are biracial.  My 4 year old looooves police cars.  Recently we were in Chicago, and these amazing CPD officers (thank you!) happily engaged my child who was so excited to see their vehicle.  They invited him to not only sit in the car, but to turn on the lights.  My son still, over a month later, talks about this day.

It breaks my heart that if things don’t change dramatically in our country, that I will one day have to tell him some things that will change his love for those flashing lights.

Although I have never posted any personal pictures on this page before, and certainly not of my children, I am going to change that today, for a reason.  I want to leave all of us with some hope, an image of innocence…

The image of a little boy in love with a police car.

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To my friends and colleagues in Dallas, to the victims and their families- my thoughts and prayers are with you.

Now, let’s all get uncomfortable, and change the conversation.

Defining “Mommy Friendly”

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I had a familiar conversation the other day with yet another female medical student.

“I really loved surgery!” she said, “but I was concerned about the lifestyle so I decided on _______________.” 

Lifestyle, it turns out, almost always seems to be code for having a family (maybe it’s just the kind of students who are apt to seek me out as I have yet to encounter someone who is concerned that a surgical career will hamper their aspirations to compete in triathlons or become national fencing champions or write books for the general masses–I personally know surgeons who manage to work full time and do all of these).

The other day, I came across yet anther discussion board on what advice to give to women in search of “mommy friendly” medical specialties. There were lots and lots of suggestions, some were full time jobs with predictable hours and others were part-time jobs but not one of the suggestions was a surgical subspecialty. 

Not. A. Single. One.

Sigh. This makes me sad for my chosen specialty and for all the promising young women who will not go on to realize their potential as amazing surgeons.

I would be lying if I said that surgery is lifestyle friendly. In fact, anyone who has followed this blog for more than a millisecond knows that many of our daily woes outside of work arise from the demanding hours and high stress of our career choice. But the question is: What does mommy friendly even mean? This is not the same as the “mother’s hours” often noted as selling points in help wanted ads. There may be ways to go really part-time or certain very specific specialties that enable a woman to only have to be at work when her kids are at school I suppose. But I have to believe that mommy friendly is about more than just the hours.

I know, I know. You are just waiting for me to launch into the cliche of it’s quality, not quantity. But I won’t. 

Because the truth is I wrote all the words above nearly 500 days ago. It turns out I never finished because I don’t know what mommy friendly means when it’s used as an adjective for a career. 

Since I first wrote the beginning of this blog post, I have spent well over a year of my life as a surgeon and a mother. I even wrote an open letter to young women with the same opening line evidently having forgotten about this draft. That letter, now read more than 15 thousand times, doesn’t define mommy friendly either.  

Paid maternity leave. Private pumping rooms. Childcare. A promotion clock that doesn’t penalize for maternity leaves. 

To be sure any work place can provide these but do the amenities in and of themselves mean the associated profession is mommy friendly? Not if the backhanded comments or outright displays of resent persist. Often, the culture of the profession is at odds with these progressive work place policies. And these replies on what medical career to choose clearly indicate that the culture of medicine has not caught up to modern times. 

Luckily, however, not every one is reading the same message board. And so this week across the country a whole new crop of women begin training as surgeons. They are less a minority and more just reflective of the demographic of modern surgery. Hopefully, they will all become surgeons (there is still some attrition in our programs nationally) and some will become mothers. And my hope is that, together with the men they are training with, they will foster a culture in which is it no longer necessary to ask if surgery is a mommy friendly. 

Liza & Stu: A fit & flare romance 

This past week was filled with glorious days and fun events. To celebrate I paired a series of Eliza J dresses with Stuart Wietzman shoes. The social media fanfare was so robust that I carried it forward into the work week. These were the results.  And also dresses with pockets are absolutely sublime. 

  

 

  

 
And for a few close ups of the shoes:

   
    
 

Here’s to all the Lead Parents, the co-Parents, and the Village it takes to Raise a Child.

I get the working mom dilemma. I am a mother and I work the hourly equivalent of 3 full time jobs. I get it. It’s hard to do it all. And sometimes the tasks involved in either or both are just not that much fun. Though I have never been a stay at home mom I suppose this is why many call this the hardest “job” of them all.  It’s not all coos and snuggles. Parenting can be onerous.

But every time I hear a working mom athem or a stay-at-home mom  anthem I feel sad for everyone who is left out, or worse, by implication, accused of not being able to or interested in parenting. As far as I can tell, other than gestating and breastfeeding, men can do every bit of parenting – the good and the bad, the fun and the tasking, the easy and the hard – that women can. And, just ask any adoptive mom or mom through surrogacy or step-mom and she’ll  probably tell you that those to bio/physiological processes aren’t requisite either. 

To be sure,  I too am guilty of getting caught up in the mob mentality of the “moms have the hardest job in world” even though my husband does the vast majority of parenting in our household.

But, it’s 2016.

We do nothing but reinforce old stereotypes about gender roles with tales of the plights of moms. These are plights shared by all parents. Single parents. Gay parents. Heterosexual parents. Widowed parents. Each person’s role in the day to day tasks of parenting will vary. Sure there are deadbeat dads (and moms!) out there and, without congratulating them on their parenting failures, let’s just agree that the definition of an involved parent will vary based on a number of complex, overlapping factors ranging from natural affinity for children to income potential.

I understand that statistically the bulk of childrearing in our society is provided by women. Social norms, cultural discourse, and possibly some biology are at play in determining this statistic. But, as a woman whose children have been well-reared by a devoted lead parent (who happens to be my male heterosexual partner), four healthy-able bodied grandparents, and a neighborhood of friends who I trust to nurture and admonish my children, it just makes me cringe when a mixed audience of dedicated parents is subjected to a “The Hardest Job is Being a Mom” mantra.

Parenting is hard no matter who does the parenting. It’s also filled with incomparable joys. So hats of to to all the lead parents, to the co-parents, to the moms and the dads, and to the various villages who are doing their best amidst the ups and downs to raise a child in our modern world.

Here is my village. 

  

We don’t need data, we need to ban semi-automatic assault rifles

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I am on call today. It’s been an average day for this trauma surgeon. 1250 miles away, it has been a day of extraordinary carnage at a trauma center in Orlando, and that was for the 53 people who survived the incident. Another 50 were left dead at the scene, all shot by a single person.

Yes, a single gunman.

This tragedy brought up a lot of issues that torment and divide us Americans today.

Anti-gay bigotry.

Islamophobia.

Gun control.

No doubt the perpetrator was a horrible, soul-less person. While whether he was driven by hatred for gays or misappropriation of Islam or an obsession with ISIL are issues worth considering, the fact of the matter is that, regardless of what drove him to do this, his impact would have been far less severe if he had not been in possession of an AR-15 semi-automatic rifle.

In the hours since news of the horrific event emerged, several friends shared a clip of President Obama on the PBS Newshour responding to a query on gun control where he discusses how the reduction of automobile-related mortality was data driven and how we are hamstrung by the NRA and those who are backed by the NRA when it comes to finding data-driven solutions to the gun problem. The President assured his audience that no one is going to take away guns from “lawful, responsible gun owners [who use them] for sporting, hunting, protecting yourself.” In fact, it appears that Moms Demand Action (an organization that emerged after the Sandy Hook tragedy) used data to change its focus from a ban on assault weapons to a focus on background checks and common sense use of firearms. Evidently, the data showed that the 1994 assault weapon ban, which existed for a decade before it was allowed to expire in 2004, did not save that many lives, and the organization wants its efforts to save as many lives as possible.

But let me ask you this:

Did the lives of the 50 people killed and 52 wounded in the Pulse night club not matter?

Did the lives of the 26 people killed and the 2 wounded in Sandyhook Elementary School not matter?

Did the lives of the 12 people killed and 70 wounded inside the Century 16 Theater not matter?

In his PBS town hall, the President also commented on restrictions on background checks which some believe may have prevented this man in Orlando from becoming a gunman. Many people posted the list of the 45 senators who blocked legislation that would have kept someone on a terror watch list, a person of concern to the FBI, from getting any gun legally. However, when there is not a legal way, someone truly intent on killing will find an illegal way. An so this single person who killed so many instantly in such rapid succession would have found a way.

He might have built as bomb as we saw in Oklahoma City and at the Boston Marathon. But, fertilizer, diesel fuel, pressure cookers, and ball bearings have other purposes.

He might have flown a plane into the building as was done in a calculated, multi-person, multi-year scheme set up by a worldwide terror group on 9/11/2001. But planes are intended for transport.

I could go on and on. And I often hear these myriad ways that others can kill cited when people state “Guns don’t kill; People kill.” Heck, I see them daily in my job: beer bottles, baseball bats, ice picks, kitchen knives, pipes, motorized vehicles…These all can be used to commit murder but are nowhere near as efficient as a semi-automatic rifle.

And for these reasons, yes it is worth discussing what motivated this man to commit mass murder. It’s worth trying to understand how he became this venomous monster. It’s worth examining our processes of surveillance by law enforcement of those whom we suspect might become venomous monsters. But come on, do we really need to amass any quantity of data on semi-automatic rifles? A single magazine can hold 20 to 100 rounds of military grade bullets and fire up to 60 times a minute. Do we need really need study if this kind of weapon is necessary for decent law-abiding folks to shoot tin cans in their back yards, or take down deer for sport, or protect themselves from home intruders?

Don’t get me wrong. I am both a surgeon and a health services researcher. I thrive on studying vexing issues through data collection and robust statistical analysis. I believe evidence-based approaches. Like many trauma surgeons and injury prevention researchers, I too want to know if biometric locks would reduce accidental deaths due to handguns. I wonder what psychometric tools might be used to optimize background checks if we ever could effectively implement them. I just don’t think we need data on this particular kind of weapon.

In case you missed it before, the kind of weapon that was used to kill 50 people nearly instantly and injure 52 more in Orlando overnight, was also used to killed 12 and wound 70 in Aurora, CO and was used to kill 20 children and 6 adults while injuring 2 more in Newtown, CT.

I was recently attended a talk by Dr. Lenworth Jacobs, a renowned surgeon at Hartford Hospital. He spoke of what steps they took on the day of the Sandy Hook massacre to ready their trauma center. Alas, no one was transported there because the vast majority were dead at the scene. Dr. Jacobs had the difficult task of reviewing every single autopsy while preparing a consensus statement on how to handle active shooter events. The air went cold as he described to a room full of surgeons what the military grade ammunition did to those poor kids’ bodies. They never had a chance.

The Hartford Consensus statements that would emerge from this review of Sandy Hook and other mass shooting focused on how to prepare civilians, first responders, and trauma centers to save as many lives as possible in the face of such horrific events. Nothing was said about the weapons themselves. When asked about this, the Dr. Jacobs responded that it’s too politically charged; and since active shooter events will presumably continue to happen, our role [as surgeons] was to identify a problem that is addressable (people dying of possibly preventable hemorrhage) and address it (education on hemorrhage control within the context of active shooter events). The logical person in me who understands that the right to bear arms in part of the fabric of US society admired the pragmatism and ingenuity regarding active shooter events described in Dr. Jacob’s talk.

Less than 3 weeks later there was the deadliest ever active shooter event in Orlando. To be sure, some of the 53 who lived must have benefited from the data reviewed for the Hartford statements. But please don’t tell me that you need data or that data is the reason why you won’t stand up and say “no, not ever” to a type of gun that can rip holes in the aorta, pierce through the brain, pummel through the heart, and break strong bones into bits and pieces in an instant up to 60 fucking shots a minute. There is no need for civilians to ever have this kind of a weapon. Not ever.

And while it’s true that people will continue to die because those intent on killing will do so with criminally acquired firearms or by weaponizing everyday objects, because law-abiding gun owners will continue to be careless with their hunting rifles and handguns, and because those suffering from depression will commit suicide by firearm, we simply cannot stand behind this veil of data in not calling for a ban on semi-automatic assault rifles.

The overall number of people killed by the AR-15 and similar military grade firearms might pale in comparison to the aggregate numbers of lives lost through other forms of gun violence but lets not devalue the lives of those killed and injured with these heinously destructive weapons by pretending we need data to ban them.

We don’t need data. We need to stand up and do the right thing. We need to put an end to the ‘single shooter able to kill multiple victims in just a few minutes’ phenomenon made possible by the deadly combination of soul-less perpetrators and powerful semi-automatic assault rifles.

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Since this post was first shared a number of people have posted petitions regarding a ban on assault rifles. I don’t know what if any impact any of these will have but I am sharing them below.

https://petitions.whitehouse.gov/petition/ban-ar-15-civilian-ownership

http://csgv.org/action/pass-a-ban-on-assault-weapons/

http://petitions.moveon.org/sign/ban-assault-weapons?source=s.fb&r_by=15891390

https://www.change.org/p/tell-congress-the-president-reinstate-the-assault-weapons-ban

What Brock Turner, his asshole dad, and a biased judge make me want to scream at my daughter (and my son)!

The internet has been consumed this week with outrage regarding the trial of Brock Turner a varsity swimmer at Stanford University who was convicted of 3 counts felony sexual assault and only sentenced to 6 months in the county jail for a crime punishable by upwards of a decade in the state penitentiary.

Evidently the trial was a classic blame the victim set up by the well compensated attorney hired by Turner’s family who was painted to be an all-American good guy. The jury didn’t fall for it and he was convicted. The judge, however, himself a former Stanford varsity athlete with seemingly similar racial and socioeconomic background, worried about the impact of a longer sentence on the convicted rapist. And so, the extraordinarily light sentence followed was in sharp contrast to what a young man of a different racial and socioeconomic background might expect from our judicial system.

Now twice victimized, first when she was raped and second when her behavior on the night she was raped and her character were drawn into question in a court, the young woman who was assaulted by Turner wrote a powerful letter that galvanized social media followers who were soon calling for the judge’s recall. The convicted rapist’s father countered the letter noting how just ‘20 minutes‘ of his son’s life had resulted in such a detriment to his well-being. He went on to suggest that his upstanding progeny take up motivational speaking on the the topic of alcohol and promiscuity on college campuses rather than taking up space in a jail cell. Not surprisingly, this sent the twitterati into an uproar.

‘Rape Culture’ and ‘White Privilege’ have been hashtagged repeatedly these last few days and I too am enraged. But, I am not here to talk to you about my rage. There are plenty of others who have expressed my thoughts on this brave victim, the entitled brat who victimized her, his piece of shit father, and a judge (no matter how neutral his prior rulings might be) who clearly was woefully imperceptive of his own unconscious bias in favor of affluent white males in rendering a sentence in this case.

I am here to express my grave concern about what to say to my children in response to this.

I don’t want my daughter to have to go through what this young woman went through. I don’t ever want to see her spirit wiped away by the most gruesome of personal violations and to have her reputation destroyed in the process of seeking justice. I want to provide her with wise counsel to protect herself from ever being raped. And by this I don’t mean the scary bogeyman rapist who lurks in the bushes preying on unknown victims; for that she will have a black belt in Krav Maga.  Since the vast majority of rapes are perpetrated by known assailants upon known victims, be they long-term intimate partners or recent encounters on a dance floor, my daughter needs solid advice on how to avoid the Brock Turner types now and in the future.

Wharton Professor and author Adam Grant’s post on Facebook (pictured below) sums up the causes of rape exceptionally well.

 And if these are it, then what can I say to my daughter to not play into the blame the victim stance that is so common in our society? I want to scream at her:

“Don’t ever, not ever, drink a single drop of alcohol, ever no matter what! I don’t care how safe the social scene appears to you. I don’t care how solid a crew your girlfriends promise to be. I don’t care if you are the legal age. You have no idea if and when you judgment will be compromised; and, since the Brock Turners of this world can’t be relied upon to exercise any judgment even when you are sloppy drunk to the point of unconsciousness just don’t let yourself to be vulnerable to the likes of him due to intoxication so JUST. DON’T. DRINK!”

“Ditto for drugs. Don’t expect anyone around you to exercise good judgment on your behalf. They won’t, especially if they are Brock Turner. Got it? NO DRUGS!”

“Don’t dress provocatively. No cleavage. No short skirts. Nothing that accentuates your femininity, NOT EVER! You can read about how rape is about violence, aggression and power rather than about sexual arousal, pleasure, and sex in the text books but in real life I beg you not to do anything that could possibly make you more attractive to the Brock Turners of this world. They are incapable of exercising control over their sexual urges and they will lash out violently and aggressively to satisfy these urges with bodies that are simply more powerful than yours so NOTHING SEXY on that body!”

“Ditto for flirty behavior. I wish a coy remark here or a sideways glance there could be just a fun, arm’s length interaction but to someone like Brock Turner it is like an invitation for sex even if it takes violent aggression to get it. So please DO NOT ACT LIKE YOU ARE ASKING FOR IT!”

“Don’t walk alone. You never know when a stranger is going to assault you. Wait you have Krav Maga for that. What I really mean to scream is DON’T GO ANYWHERE ALONE WITH SOMEONE LIKE BROCK TURNER! Especially if you have not obeyed my prior four rants about drinking, drugs, dressing, and flirting. If you do, you better hope that the non-Brock Turners are randomly riding by on their bikes or their skate boards to save you.”

And here I am seriously teetering on the edge of an unprovoked screaming fit at my daughter because my first reaction is not to scream at my son:

“DON’T BE LIKE FUCKING BROCK TURNER!!!!!!!!!!!”

“Nope. Not ever. I don’t care how she dressed or behaved, or how compromised her judgment may have been for whatever reason, or whatever fantasies have been imprinted in your brain from the media, or how our society tends to treat men and women differently when it comes to matters of power and sex and everything in between. You are better than that. You treat women-all humans for that matter-with respect. You protect those who might be vulnerable, be they male or female, young or old, drunk or sober, black or white, whatever their potential vulnerability may be. You stand up for what’s right and you squash all that is morally reprehensible. You be the guys on the bikes or the boards. You help. And unlike Brock Turner, his asshole dad, and this biased Judge you be the one who sets a good example for all the little boys that follow.”

Who do you save? The emotional impact of mass casualties.

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A 6 year old boy with abnormal pupils and gasping for breath.

A 26 year old pregnant woman with a gunshot wound to her abdomen.

A 54 year old male with blood pouring from a wound in his thigh.

Now add 43 more patients.

Imagine you are the paramedic at this scene.  Who do you take to the hospital first?  Who do you have to choose to walk past and leave at the scene while you take your patient to the hospital?

Now imagine you are the surgeon.  You walk into an emergency room with blood everywhere – covering faces, limbs, the floors.  There is a cacophony of sound – screams, cries, gasps, whimpers.  Where do you start?  Which room and which patient gets your attention first?  How many patients, calling out to you for help, do you have to pass by?  What operation will you perform and how will you perform it knowing there are nearly 50 other patients needing your attention at that very same moment?  Will you be right?  Will you save everyone you could?

As a trauma surgeon, these are the real types of questions that we are given when training for mass casualty situations.  And although the patient specifics listed above are not from the shooting, these are still the same thoughts that every single healthcare worker and all six trauma surgeons in Orlando right now have had and will continue to have for months to come.

26 operations in 12 hours.  I wish I could adequately describe the inhuman and superhuman effort that this represents from the trauma surgeons at Orlando Health, one of whom has been a friend of mine since high school.  When I first heard the news I immediately contacted him, letting him know I was thinking of him and his team, knowing exactly that this day will never leave him, or any of them.  I have written before describing the multitude of feelings involved when losing a patient… but this is just the tip of the iceberg when discussing a situation of this magnitude.

After the adrenaline surge, after the floors are mopped, the scrubs are changed, and the patients sorted through, they will pick apart this day – every last detail, decision, and action will be analyzed, examined, and questioned – and never forgotten by a single person who touched a patient on June 12th, 2016.

These six trauma surgeons have made a thousand decisions in the past 24 hours – the types of decisions that no one should ever have to make, but are unfortunately faced more and more by those of us in this field.

To the surgeons at Orlando Health – I know you haven’t slept.  I know you haven’t eaten.  I know you haven’t sat down in close to 30 hours.  I know you are mad, I know you are sad.  Stay strong my friends, we are all with you.

My thoughts and prayers go out to the victims, their families, the first responders and healthcare workers in Orlando – #lovewins.

 

 

 

A reunion, a wedding, & a race: Chapter 8 (Game Time Brunching)

So we lucked out with a a major temp drop and cloudy skies on race day. This allowed us a bit of extra time post race than we had expected since we ran a bit faster and we decided to celebrate by dropping in at reunion brunch. It gave us a chance to mingle with a few friends we missed these last couple of days. I hadn’t planned an outfit and it was way cooler than expected so I didn’t even have a cute cardigan or hoodie handy. I had to pull my emergency rain jacket out of the trunk! So just a pair of Athleta capris, Vince mixed media top, and a better look at mu favorite causal sneakers from Bernie Mev.