Diane, Author at Cherokee Women's Health - Page 58 of 59

Author name: Diane

Michael Litrel, MD, FACOG, FPMRS
Well Woman

A Scientific Name for Nonsense

By Michael Litrel, MD, FACOG, FPMRS My physics classmates and I were studying for freshman exams when our professor introduced a new subject. “Retrograde motion” is the term used to describe the motion of the planets in the night sky. The apparent backward-looping paths are due to the planets’ orbit positions around the sun. Because ancient peoples believed all heavenly bodies revolve around the earth, they devised convoluted reasons for what they could see in the sky. The math required was incredibly complicated – undoubtedly because the planets did not, in fact, revolve around the earth. Full of resentment, I returned to my dorm room to study my notes on abandoned explanations for “Retrograde Motion.” It seemed to me that college physics was hard enough without having to learn something somebody else had figured out wasn’t true. As a premedical student I needed to get an A in this class – and all my others. What was the purpose of making me learn nonsense? Science is a powerful tool that helps us make sense of the world. Every decision I make for my patients is based upon a foundation of scientific evidence. But years of medical practice have also shown me that science has its limitations. For one thing, medical understanding is continually evolving. A hundred years ago, bacteria and viruses were unknown to humans. Thirty years ago, minimally invasive surgery didn’t exist. The understanding of today will change tomorrow. Science describes and measures things in the physical world. Blood pressure or cholesterol can be measured, infections diagnosed, and tumors discovered. Science provides the medications or surgeries to help our bodies get well. But health is about more than just the body. How do you measure a person’s happiness or fulfillment? Can you weigh a person’s faith or how much they love their neighbors? Some argue you can. Diagnoses Outside the Realm of Medicine Jill had been on antidepressants for eight years when I first met her. Her doctor had first prescribed the medication in Jill’s last year of college. She had been distraught because her fiancé had cheated on her. A few years later, she had met someone else and was now happily married. They wanted to have children, but antidepressants are known to cause birth defects – and Jill was addicted. It took six months to safely wean Jill from her medication before it was safe to conceive. I wondered why medication had been started in the first place. She was confused about this herself. There are many drugs available to treat depression, anxiety, and diseases – with names like “attention deficit disorder” and “bipolar syndrome.“ Are these really problems of the body, classified along with high blood pressure and diabetes as medical problems to be treated with medication? When I recommend surgery for a tumor, or tell a woman she is pregnant, I can back up my diagnosis with observable facts and measurable lab results. Psychiatric diagnoses, like depression or anxiety or bipolar, are based upon opinions, not evidence. Pharmaceuticals are created that make us feel less sad or less anxious. These drugs can make us feel better for a while – but then again, so can cocaine. A Scientific Name Doesn’t Make It True A lot of money is made selling drugs, especially the legal kind. You can give grief and sadness a scientific name, call it a mood disorder, and quote well-funded scientific studies about imbalances of neurotransmitters in the brain and successful treatment with medication. But this is the same specious argument made by those who insisted the stars and planets revolved around the Earth. If you look in the night sky, you can see the celestial bodies moving around our planet’s sky, just as the ancients described a thousand years ago. But this doesn’t mean they understood what was going on. We suffer for a reason. Your hand hurts when you touch a hot stove. You can move your hand, or you can take pain medication. Medication will work for a while, but the burning will continue, and you will eventually need more drugs. This is the source of substance abuse. You take drugs for the wrong reason to make you feel better – and soon you need some more. We all suffer from terrible loss. This can be the death of one we love, or a heart breaking betrayal, or a crappy childhood. Grief is a feeling so deep and awful it can make us question whether we even want to live. This is spiritual suffering. The source of this suffering is not as obvious as when your hand or mine is on a hot stove. But what we can learn is even more important. The Physician for Spiritual Pain Spiritual pain is the only way we come to understand the eternal nature of ourselves. This is not an easy lesson. We come into the world as helpless newborns, only to die eight or ten decades later. In the course of that life, we gain – and then lose – everything and everyone that matters to us. We suffer terribly and we grieve along the way. But during these moments of pain, we can learn to reach out to a Higher Power – to God – for answers. And as we open ourselves to the source of Life, we come to recognize a greater truth. We are not mortal human beings suffering from spiritual problems. We are immortal spiritual beings, suffering from human problems. When we open our hearts to God our faith grows and we understand how to live. Taking a pill is easier than building a relationship with God. But this is what our world encourages; there is more money in selling drugs than in recommending spiritual growth. Anxiety and depression are not medical diagnoses. They are spiritual injuries. These are the signs pointing the path we must learn to travel. This is the path of Love. Learning this lesson is the only reason why we are here.

sad young woman
Well Woman

Fighting the Demons: the Right Antidepressant

by Michael Litrel, MD, FACOG, FPMRS Last year when Cindy came in for an annual exam, I was disheartened that her Internist had placed her on yet another antidepressant and she had gained another twenty pounds. Now she was even more depressed. Like all of us, Cindy has her demons. Her biggest goes by the name of “Donut.” A donut is just like an antidepressant; it makes you feel better immediately, but when your clothing becomes tight and the scale moves in the wrong direction you need yet another one to make you feel better. Excess fat on your body does not make you a bad person. The body is not who you are. It is only a temporary shell that houses your immortal self. But disliking what you see in the mirror is a lousy way to start the day. Negative feelings make it difficult to become the person God imagines. How can you love others when you have trouble even loving yourself? Poor Choices Map the Highway to Depression Skillful living boils down to one action at a time. Buy fresh fruit rather than a box of donuts. Pick up an apple instead of the donut. Eat the apple. Wise choices lead to happiness and fulfillment. Poor choices chart the highway to depression. Do I relax on the couch or go for a walk around the block? Do I watch mindless television or read a good book? Will I complain about my troubles – or thank God for my blessings? The decisions we make determine whether we have a healthy life or not, both physically and spiritually. I can tell you from knowing thousands of patients through the years that it’s the choices we make each moment that determine our happiness. The Prescription for Happiness I recommended to Cindy the book “Eat to Live” by Dr. Joel Fuhrman. His prescription boils down to this: Just add a pound of salad, a pound of cooked vegetables, and fresh fruit every day. Then watch your demons – and the cravings – gradually fade away. In fighting depression, our first line of defense must be against the countless chemicals and preservatives, and the dangerous fats and sugars, that permeate our food. A good diet is the first and best antidepressant. This year when Cindy came back for her annual, she had lost fifty pounds. As she explained she was off all her medications, a huge smile lit her face. It’s amazing what the right antidepressant can do.

Michael Litrel, MD, FACOG, FPMRS
Dr. Litrel's Blog

Passing the Test

I am blessed to be a doctor, the fulfillment of my childhood dream. It has sometimes been a steep climb, but the constant challenges of being a doctor still give my life its meaning every day. But there were times I almost gave up on my dream. The main reason I wanted to quit was that studying science was difficult. In high school I almost failed chemistry. The ideas were complicated, the language was strange. Even though I could quote my textbook like a parrot, I didn’t understand it. I floundered for months until I finally learned what was required: I had to understand each word, and grasp every concept, before moving forward. Studying science takes a lot of work. Knowing the Source of Health But there is a subject more complicated than science. It is the subject of the human spirit. Understanding God, our relationship to Him, and the purpose of our lives is the most important knowledge we can acquire. It impacts every segment of our lives: our health, our career, our relationships and happiness. In the same way we can get the answers wrong about a chemistry problem, we can get the answers wrong on the spiritual tests of life. But instead of just failing a high school class, we fail in life; and we suffer terrible unhappiness or anger. Jesus taught us that our task in life is to love and forgive. Yet so often we judge instead. “Why do you look at the speck of sawdust in your brother’s eye and pay no attention to the plank in your own eye? How can you say to your brother, ‘Let me take the speck out of your eye,” when all the time there is a plank in your own eye? You hypocrite, first take the plank out of your own eye, and then you will see clearly to remove the speck from your brother’s eye.’ ” Matthew 7:3-5 When we quote Bible verses in the name of Christ while judging others, we become modern day Pharisees – and persecutors of Him. We parrot the letter of the law without understanding the spirit. I see this truth in my patients every day. When we choose the path of love and acceptance, our lives become happy. And when we choose to improve not our neighbor, but the person we see in the mirror, we find the peace and meaning in life that form the foundation of real health. -Dr. Mike Litrel

Michael Litrel, MD, FACOG, FPMRS
Dr. Litrel's Blog

New Year’s Resolutions: Don’t Be a Spiritual Couch Potato

My office schedule was packed with patients one day when a colleague called me in to an exam room to see her patient. The situation was urgent, and I tried not to think about the delays our patients would experience because I was making time for someone else. This patient was a thirty year old woman who had been bleeding heavily for almost two years. Her pain had increasingly become worse, so severe that today that she had arrived at the office without an appointment, insisting on being seen. Our nurse practitioner had made time for her, but it turned out her problem was complicated, too complicated to be diagnosed without a surgical perspective. I could clearly feel the large mass in her pelvis: it was obvious she needed surgery. We performed the ultrasound and necessary biopsy to line her up for the help she needed. Unfortunately, the patient didn’t have health insurance. For a doctor or anyone in the healing profession, it’s heartbreaking to see patients who need help but can’t afford care. The patient glared at me with a mixture of pain and anger, and asked what she was supposed to do. I suggested going to the health department to see if she was eligible for Medicaid – or perhaps to the hospital, to see if she could get charity care. “I already tried that!” she snapped. “And it didn’t work!” She angrily held out her hands, in a gesture that seemed to offer up her problems for me to take on. The tone of voice clearly conveyed that this was someone else’s fault. I pointed out that she had been suffering with this problem for years – she needed to take some responsibility for not having health insurance. She was very capable. If she had begun looking for a job with benefits a year ago, instead of staying at home, she would not be in this situation, and we could perform the surgery. Whose Health Problem Is it? I try to be as honest and open with patients as possible about how I can help them – and how I can’t. Sometimes maybe I am too honest, and I began thinking this was one of those times. I’d tried to communicate in a non-judgmental way, but I wondered as I went back to my waiting patients if I had not just been a big jerk. About six months ago, a patient arrived at the office unannounced, with a plate full of home baked cookies. She asked if I remembered her. I didn’t. It was the same patient. She had come in to thank me. Three months after I had examined her, she had gotten health insurance, and one of my partners had performed her surgery. She felt better than she had in years. She just wanted me to know she had made changes. And she said thank you for my honest words. “All these years I felt like my problems were somebody else’s fault,” she said. “I think you were the first person to tell me I had to help take care of myself.” She said she felt feel better physically, but she was most surprised that she actually felt better spiritually and emotionally. “I feel like my life is finally on the right track.” Health is not what someone does for you, and it’s not just about your body. It’s about your soul, and what you do for yourself. To be healthy and happy, you have to assume responsibility for your life. And as we come to the time of year for making new resolutions, it’s important to know – God doesn’t smile on the Spiritual Couch Potato. -Dr. Mike Litrel

Michael Litrel, MD, FACOG, FPMRS
Dr. Litrel's Blog

My Children Will Have Faith

A single surgical clamp, placed on the bleeding vessels of a ruptured fallopian tube, can save a patient’s life. I know this because I have placed these clamps myself. Ten years ago, a patient arrived at the emergency room of Grady Hospital in shock from such a rupture and the resulting loss of blood. I was a fourth year Chief Resident on call for the surgical emergency. After placing the clamp, I instructed my pretty, wide-eyed junior resident to suction the half gallon of blood and clots from the patient’s abdomen and pelvis. I remember keeping my voice calm, to emphasize the achievement of total control—“Just another day in the operating room, ma’am.” I tried to limit my swagger as we walked to the waiting room to reassure the patient’s family and give them the good news. But afterward, alone in the call room in my blood-stained scrubs, I allowed myself to bask in the full power of my accumulated years of study and training. I felt a Cheshire cat smile of self-congratulation steal over my face. Always a mistake. A superb textbook on obstetrics and gynecology opens with Alexander Pope’s famous refrain, “A little learning is a dang’rous thing; Drink deep, or taste not the Pierian Spring; There shallow draughts intoxicate the brain, And drinking largely sobers us again.” Many times I had flipped to re-read that quote before diving into my studies. It was a warning to the overconfident. But on that day toward the end of my eighth year of training, I fell into the deep sleep of the self-satisfied. At last, I knew exactly what I was doing and what was going on in the world. A phone call the next day proved how wrong I was. The caller was Ife Sofola. Ife (pronounced Ee-fay) was one of my classmates from medical school. A tall, muscular Nigerian, Ife was not only a brilliant student, but a man of deep compassion and undeniable charisma. His easy smile, booming laugh, and lilting Nigerian accent were a comfort and delight to both friends and patients. At the time, he was a flight surgeon at the renowned Bethesda Naval Hospital, where our Presidents receive their medical care. Ife had called to let me know that his mother had died. But it wasn’t the sorrow he wanted to share. It was the miracle. Months earlier, Ife’s family learned that his mother was dying from liver failure. Brought to the Bethesda Naval Hospital, she fell into a coma. She was put under a DNR order—Do Not Resuscitate. Those orders are reserved for patients who cannot be saved. The words are a kind of final acknowledgement: that modern medicine has failed the patient, that we can do nothing, that Death is coming. But Ife and his siblings were not ready to let go of their mother. They had been already heartsick with the loss of their father, who had died earlier that year. The looming loss of their mother was too much to bear. Desperate to do something, Ife’s sister sought out a friend of a friend of a friend who was reputed to be a “healer”—someone who could save life where others had failed. Ife’s sister flew the healer to America from Nigeria, keeping it a secret from her family until the healer showed up at Bethesda. A student of medical science, Ife was dismayed and agitated by his arrival. But there was nothing to lose, so he and his siblings permitted the healer to stay. The healer directed them to hold hands around the dying woman’s bed. They prayed in silence for five minutes. Then the healer announced, “It is done.” With that he departed, taking a taxi back to the airport. Twenty minutes later, Ife’s mother awoke. She smiled and greeted her family and got out of bed to take a shower. Ife said there were no words to describe how dumbstruck her physicians were. Ife himself, exuberant, believing, brimming with unadulterated joy, raced and leaped down the hallways in his white coat, yelling so all could hear, “A miracle has occurred! Here, at Bethesda! A MIRACLE!” Within a few weeks, Ife’s mother succumbed to her disease and died. But not before she had left the hospital and spent precious days with her children at home saying good-bye. Her explanation of what had happened was simple and profound. “I came back,” she said to her children, “so you would have faith.” The power of modern medicine is an illusion. The physician’s sense of mastery, the gratitude of patients and their families—all these constitute a thin veneer which sometimes covers the truth. The source of the healing lies far beyond our earthly skills. It emanates from the realm of the Unknowable—from God, the Source of Life. The other day a patient told me she was confident about her upcoming surgery, “because I have faith in you.” A decade ago I would have enjoyed that kind of comment. The trust and respect of patients is a blessing. But the truth is that we are all participants—patients and physicians alike—holding hands in a circle of healing and praying for a miracle. And we are blessed with this miracle of healing every day we live. Ife concluded his call to me with his own revelation. His tone was not one of grief, but excitement. “Michael,” Ife said to me, his voice trembling, “how many hours did we spend in the lecture hall? How many books did we read? How many operations have we performed? We think we are doctors, so we must know something about life and death.” He paused for a long moment. “I tell you this, Michael—we know nothing. Nothing.” I fumbled for words. I said his story was just amazing, that it had changed my life. Ife laughed his large, unforgettable laugh. “And well it should, Michael—well it should.” -Dr. Mike Litrel

michael litrel, md, facog, fpmrs
Well Woman

I Gotta Hava Shrimp Piccata

By Michael Litrel, MD, FACOG, FPMRS We all know our bodies are gas tanks and what we put in them will either cause us to sputter through the day or make us feel like we can take on the world but for some reason, when a piece of pecan pie is staring me in the face, all that logic kind of goes out the window. And that’s how I came to be laid out on the couch the other night, so tired I could barely move. Was it a food sensitivity or just overload on sugar? Whatever the reason, I couldn’t help but wonder why oh why did I eat that darn pie? After getting off the couch from my near comatose state, I went dumpster diving to find out just how much sugar one piece of that sinfully good pie had. I knew it had to be up there but I was shocked when I looked at the back of the box. (Yes, I know. Packaged pecan pie at that!) Holy moly! 470 calories and 29 grams of sugar in one piece of pie! No wonder I felt horrible! Right then and there, I knew my love affair with pecan pie was over. Or, at least we wouldn’t be meeting nearly as often. I was determined to start making better choices so like any woman who’s experienced a break up, I went online in search for something better. When I looked for healthy food, I was overwhelmed with all the choices. This was pretty new territory for me so it was kind of confusing at first. But the more I looked, I narrowed it down to what I really liked and found tons of recipes that were not only easy to make but looked delicious. I made shrimp piccata that very night. I just replaced the pasta with rice and oh mama, it was soooo good. Did it taste as good as pecan pie? Well, that’s like comparing apples to oranges but I will say it tasted amazing. And more importantly, I felt great afterwards! So great in fact that I had enough energy to take my doggies for a brisk walk around the neighborhood. Now if I can just remember that awesome feeling the next time a piece of pecan pie stares me in the face. Oi.

leaky bladder-photo_128432701
GYN Problems, Urinary Incontinence Education

Tips for a Stronger Bladder

Following are tips for a stronger bladder. If you have a weak bladder, you are not alone. Many women suffer from leaky bladder symptoms. Urge Incontinence and Stress Incontinence Urge incontinence is when you feel a sudden urge to urinate and sometimes leak as a result. Stress incontinence is when you leak a bit of urine when you cough, sneeze, laugh or jump. One Diet Does Not Fit All While some diet tips may work for the average Jane, they might not work for you so try them on for size and keep what works and throw out the ones that don’t. Some foods and drinks are known to cause irritation to the bladder lining, which can result in more frequent urination or the urge to go. The best way to figure out what might be triggering your incontinence, try eliminating or cutting back on certain foods and beverages. Once you narrow down the culprits, you can start reintroducing them one by one to determine your tolerant level. Sneaky Little Culprits Water intake – For optimum health, we should drink at least six to eight glasses of water a day, right? But what if you have incontinence? Won’t that make matters worse? Well yes…and no. On one hand, if you drink too much, you might overtax your bladder and make matters worse. On the other hand, if you don’t drink enough, your urine may become concentrated and that’s when bacteria can grow.  Which can lead to infection. Which can lead to incontinence. So what’s a girl to do? If you’re already drinking six to eight glasses of water a day, you can start by trying to reduce that amount by 25%. A recent study showed this helped reduce episodes of urgency and frequency. Don’t want to put so much effort into it? Don’t worry. Your body is constantly talking to you (and not just after you eat a bean burrito) so pay attention and it’ll tell you if you’re getting enough or not, and then just adjust your intake accordingly. You can also try cutting off your fluid intake earlier in the evening, which will help reduce those middle-of-the-night potty breaks. Caffeinated beverages and foods – Caffeine can do a number on your bladder. It not only stimulates the bladder but it also acts as a diuretic, giving it a double whammy effect. To figure out how much caffeine your body can tolerate, it’s best to completely eliminate it from your diet. But, let’s look at this from a realistic standpoint. If you’ve been drinking coffee since the beginning of time, cutting it out completely probably isn’t an option. The point is, do what works for you. Even reducing the amount of caffeine can have a beneficial effect on incontinence. If you’re drinking four cups of coffee a day, try cutting down to one or two cups and see how your body responds! Acidic foods – Certain citrus foods and drinks are highly acidic and tend to irritate the bladder. Cranberry juice has a reputation for helping to clear up bladder infections but it doesn’t help with overactive bladder and urge incontinence so try to eliminate or reduce these culprits. Alcohol – Alcohol can interfere with your bladder. Here’s how: Your brain sends neurological signals to your bladder when it’s time to go but when there’s alcohol in your system, there’s less control over that signaling and this can make accidents more likely. So try to reduce or even eliminate alcohol altogether for a couple weeks to see how much control it has over your bladder. Spicy foods – Did you know your favorite Mexican restaurant may be wreaking havoc on your bladder? As much as we love them, spicy and hot foods can irritate the lining of your bladder, which can exacerbate incontinence. Foods like Mexican or hot Chinese dishes, chili peppers, chili, horseradish and other highly spiced foods should be greatly reduced or eliminated if at all possible. Again, this is trial and error so try cutting these foods out and slowly reintroducing them to determine their effect. Carbonated beverages – Even if your favorite carbonated drinks aren’t caffeinated, they can still irritate a sensitive bladder and once irritation sets in, you can have the urge to go. Other Culprits We Can Help Alleviate Your Urinary Incontinence If you’re suffering from incontinence, be kind to yourself and try giving these tips a whirl. If they get to be confusing, just tune in to your body and listen – really listen. To make an appointment with one of our double board-certified urogynecologists, call us at 770.720.7733 or schedule an appointment online.

Michael Litrel, MD, FACOG, FPMRS
Dr. Litrel's Blog

Endless Love

It was Saturday morning, and already my wife had been working for several hours at the computer, sitting ramrod straight in her chair. No doubt she was stressed out, with too many projects on her plate. It seemed like the perfect time for the surprise I had been planning. With a flourish, I invited Ann to come with me to my office. She raised her eyebrows. “Can’t it wait?” I said no. Reluctantly she accompanied me upstairs. Once in my office, I moved to my computer and selected a song I had recently added to my play list. The music began, and everything was ready. I asked Ann to dance. Lionel Richie and Diana Ross’s duet “Endless Love” was all the rage back in the day. I remember dancing to the song, feeling deeply in love. The piano played softly, and then the lyrics came… “My love…there’s only you in my life…the only thing that’s bright…” What a charming romantic I was! Ann rolled her eyes and reminded me she had been busy. Her reaction surprised me. I thought she would gaze adoringly into my eyes with the look I remembered from years before. But Ann’s body remained stiff. Instead of feeling like the star high school quarterback dancing with the head cheerleader, I began to feel like the nerd the girls feel sorry for but try to avoid anyway. I was annoyed. Fall in love with me again, why don’t you already? Tactfully I expressed my concern that our once special memories of dancing to our song meant nothing to her now. “Our song?” Ann pulled her head back to look me in the face. “We never danced to that song – I never even LIKED that song!” Oops. That was an unexpectedly awkward revelation. Well, at least that explained why she wasn’t exactly melting in my arms. I could feel Ann’s body tensing even more as the implication of my mistaken memory became clear to both of us. Our dance became more and more stilted until we were essentially standing still in the middle of my office. I could feel the question coming. “So Michael,” Ann opened, “which one of your ‘past loves’ did you enjoy this wonderful song with?” Funny you should ask my dear, I thought to myself, I was just wondered the same thing myself. A surgeon in the middle of an operation would call this “getting into unexpected bleeding.” It had seemed like the perfect plan – play a song of tender memories, and instantly transform Ann from the “I have too many things to do” stressed out woman to the “I am so lucky to have you as a husband” happy wife. A beautiful Saturday afternoon would follow, with Ann gazing at me adoringly whenever I walked by, even if I was just scratching myself. Now all I wanted was to get this angry hellion out of my office. The music continued to play as I held a now jealous wife in my arms. This was not “Endless Love.” This was “Endless Dance.” Would you please shut up already, Lionel? “It wasn’t that we ever danced to this song,” I explained disingenuously.“It’s just that whenever I hear it I think about you and how much I love you.” It was the right thing to say, a good line, really – but I delivered it half heartedly voice, in a perfunctory oh-let-me-just-say-it- and-get-it-over-with sort of way. Ann surprised me by laughing out loud. She seemed delighted by my obvious lack of candor. ”Oh really?” She betted her eyelashes batting coquettishly. “Do you really mean it?” “Oh yes,” I responded, smiling at her like used car salesman. “I would never lie to you, my darling.” Ann laughed again. And remarkably, she rested her face against my chest with a happy smile on her face. Her body relaxed. “I’m sorry I’ve been so stressed out lately,” she said a few moments later. My plan had worked after all! Ann had actually melted in my arms. Womanhood, what a remarkable mystery. Maybe it’s not choosing the right song that matters most. Sometimes you get credit just for the effort. -Dr. Mike Litrel

Michael Litrel, MD, FACOG, FPMRS
Dr. Litrel's Blog

The Night the Caterpillars Ate My Dinner

Many years have passed since the night I delivered my first baby and, in retrospect, it is clear that practicing obstetrics was the path the Creator intended me to take. But I confess that after a thousand deliveries, the blaze of emotions that once accompanied each one has subsided to a softer glow, flaring up again only at those times when danger, or joy, bring the world more sharply into focus. So it was with a recent difficult birth. The mother and her family were well known to me. Two years earlier I had delivered my patient’s second daughter. Her first daughter, then an irrepressible nine-year-old, had gleefully cut the cord. But with this labor, the third daughter, there were complications. The baby’s heart rate kept falling. It was obvious to my patient that I was worried. Every five minutes I came into the room, obsessing over the baby’s heart rate like an anxious stockbroker watching the ticker tape. I maintained a professional demeanor with my patient, trying to give her as much reassurance as I could. Her anxiety level was rising and, for a moment, I felt bad. When confronted with worrisome clinical circumstances, doctors tend to pull back emotionally. It helps us think clearly and, hopefully, make the right decisions. It’s a mistake to think that any physician knows exactly what he or she is doing at all times, and, at this moment, I was no exception. I was uncertain about what was wrong. But finally a routine procedure improved the baby’s heart rate, averting emergency surgery. The baby was born. My patient’s first daughter, now eleven, delightedly cut her second cord. Her little sister’s cry filled the room. My tension dissipated. I was a third year medical student discovering my destiny once again, and my soul hummed with the joy that swelled the room. When I arrived home that evening, my stomach was also humming—with hunger. I looked forward to a nourishing meal and sharing the stories of my day. My wife, Ann, is my soul mate. Well, she’s either my soul mate or just a very good listener. It doesn’t matter. Ann is a loving person, a supportive friend, a great mother to our children and, most importantly, an attentive audience. So even though she’s heard me talk about clinical cases hundreds of times, I knew she’d listen to me with polite fascination. And, she would feed me. But this night I was wrong. When I walked in the door my first clue was that supper was nowhere to be seen. My second was that Ann expressed no interest in the heroics of my day. Instead, she wanted to tell me all about her day. It was an outrage. Incredibly, Ann and the boys were actually ignoring me. They were engrossed in a large glass jar on the kitchen counter which contained, upon inspection, caterpillars. I groaned under my breath—the evening’s conversation was going to revolve around Ann’s butterfly garden, again. She shot me a dark look. My groan had apparently been less discreet than I intended. I gave myself a mental kick. Now I’d have to work even harder to feign interest. Last year, after months of research—otherwise known as shopping from gardening catalogs—Ann created a butterfly garden in our backyard. She told me all about it but the details escape me—something about attracting lots of bugs to our yard. In its execution, the project fell short of Ann’s expectations. Deer and rabbits showed their enthusiasm by chowing down on her plants. In the end, Ann counted a grand total of five butterflies the entire summer. She was depressed. So was I. All the plants she’d ordered had been a waste of money, and now I had to console her about it, to boot. Then, one morning, Ann returned from a visit to her garden practically skipping. Two monarch caterpillars were eating her milkweed plants. Several times a day, Ann took our two sons out to watch the bugs. After a few days, according to their frequent and detailed bulletins, the caterpillars had eaten all the milkweed. So, I came home this particular evening in a good mood after a delivery to find that Ann and the boys had spent two hours gathering food for the caterpillars. The air went out of my balloon. Ann enthusiastically badgered me into pressing my ear against the jar so I could hear the caterpillars munching on the milkweed leaf dinners she and the boys had so thoughtfully and painstakingly prepared. I took the subtle approach: “They sound really hungry. I know how they must feel.” “Boy, it must be nice to eat your fill.” “You’ve done a really nice job fixing dinner—for the caterpillars.” I tried to be a good sport. I’d heard that Monarch butterflies are endangered. Freezes in Mexico and genetically-engineered corn with poison pollen are said to be wiping them out. These are the facts you pick up when your wife has a butterfly garden. I proudly recited my extensive knowledge about Monarchs in an effort to show Ann that, in fact, I was listening to her all those months. But she informed me, to my surprise, that Monarchs may not be so endangered after all, just underestimated by butterfly experts. That was the final straw! A couple of bugs not even on the endangered species list were keeping me from my dinner. But Ann was so enchanted, she didn’t notice how annoyed I was. I adopted the guise of supportive husband and took the family out to the local pizza parlor. The caterpillars came along for the ride. My mouth was watering by the time the cheese breadsticks arrived. Joseph, our five-year-old, launched into a rambling grace, thanking God for the caterpillars who had come to our yard … who were going to grow into orange butterflies … and fly away into the sky …. As I half-listened to his thankful litany, my mind wandered back to the delivery. I gave silent thanks

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