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

Talladega Time

One False Move Recently, my son Tyler and I went to Talladega Superspeedway in Alabama to drive a NASCAR race car, in celebration of his nineteenth birthday. Under the watchful eye of a professional driver in the passenger seat, we took turns driving a race car around the world’s fastest track. Standing five stories high and banked at 33 degrees, the Talladega track allowed us to reach speeds that topped 170 miles per hour. Driving that fast felt just like my early experiences in the operating room; I was both exhilarated and frightened. One false move would spell disaster. When I was a young doctor, the drama of life-and-death situations appealed to me. Adrenaline coursed through my body as I directed the operating room team, scalpel in hand, barking out orders like a sergeant to his troops under enemy fire. I think as a young man I enjoyed feeling important. I’ve never liked braggarts, so I hope I projected some modesty. But I was charged up by the drama and my role in it, and in retrospect, I suspect I swaggered around the operating room despite myself. Nowadays, I never swagger, and I don’t feel important, either. Mostly I am highly concerned to the point of being terrified. Racing To Save a Life This Wednesday morning, a call from the delivery room nurse woke me up at four. A laboring patient had just arrived at hospital. She was bleeding, nowhere close to delivering, and her baby’s heart rate was faltering. Her baby was dying. I told the nurse to set up the operating room for an emergency c-section. I ran to my car and screeched out of my driveway. It was Talladega time. I am careful when I drive fast. I gathered speed, hazard lights flashing, punching a few red lights along the empty road before finally opening up my engine. My speedometer crawled into some high numbers. Already this week I had witnessed the unexpected loss of an 18-week-old pregnancy, and the pain a mother and family experience when hope is shattered. I didn’t want to see any more. This wasn’t fun like a birthday lap around the racetrack with my son. When I reached the hospital, I ran up the stairs, arriving just as the patient was being placed on the operating room table. By the time I had washed my hands and caught my breath, the anesthesia team had done their job. I could make the incision. In less than a minute, the baby’s head could be lifted free. The baby’s arm, when I grasped it, had the muscle tone of a live baby, not the terrifying ragdoll floppiness that signifies unconsciousness, or even death. This baby was okay. I breathed a sigh of relief and profound thanks. However, my blood pressure remained elevated the rest of the day. Grief and Joy I became a doctor because I wanted to be in people’s lives in those moments I believe really matter. I was drawn to OB/GYN because I am awed to witness the miracle of birth, and drawn to help in the sudden emergencies that require my utmost concentration and ability. The moment when a baby is ready to leave his or her mother’s body, so much is at stake. Will we celebrate the miracle or grieve the tragedy? But as I have matured, I have come to understand this: every moment of our life hangs in the balance. We are just as much at the junction of life and death in this very moment as we are in any surgical emergency. We live biologically mortal lives, and none of us are promised tomorrow. We are racing around a track, always at that point of losing control, never knowing when our lives will be shattered. Life is fragile. The image of the baby’s death earlier in the week, and my patient’s grief, dogged my thoughts that day like a fragment of a song I couldn’t shake from my mind. How does a family survive the loss of a baby, just before the baby shower? As we endeavor to relieve our suffering, we reach out for answers. When we pay attention, God does answer, and the answer is always the same. Our lives are not biological accidents – they are spiritual inevitabilities. We are each a manifestation of God’s Love, and we are thus each blessed with spiritual immortality. Grief – no matter the pain – is a spiritual gift, once we understand. As we heal, we see this simple truth: the tears we shed at funerals are the confetti used in Heaven. -Dr. Mike Litrel

Michael Litrel, MD, FACOG, FPMRS
Well Woman

Fear Is Our Friend

By Michael Litrel, MD, FACOG, FPMRS Why Are We Afraid? It used to trouble me when a patient became nervous before surgery. Maybe she doesn’t think I will do a good job? Maybe I haven’t explained myself well enough? Maybe she doesn’t trust me? But after twenty years of being a surgeon, I now welcome a patient’s anxiety before she undergoes an operation. Fear can be good for your health. When my son Tyler was two years old, we took a family vacation to Jekyll Island, one of Georgia’s coastal isles that had been my wife Ann’s and my honeymoon spot a decade earlier. Tyler was thrilled at his first view of the ocean. The winter sun was warm as we slowly walked the sand to the water’s edge, and he grew more excited, pointing his chubby finger and saying “Water, water, water!!!” Tyler walked between Ann and me, and we each held one of his hands, swinging him high to prevent his feet from getting wet in the waves. But Tyler didn’t just want to get his feet wet. He fought to pull free of us, his intention clear: he wanted to walk into the ocean. At first, Ann and were laughing as we enjoyed Tyler’s insistence that he be allowed to walk freely. But a spectacular temper tantrum soon followed, and our morning family stroll was ruined. Tyler is now nineteen, finishing his first year of college, but in some ways things haven’t much changed. Three months ago, I taught him how to drive a manual transmission on my old 2004 silver Corvette; the car accelerates like a rocket ship. Tyler is a good driver. But when he asked to borrow the car to visit his buddies, my answer was an emphatic ‘no.’ There is no way I will put my son in a car that will go 160 MPH, so he can visit his teenage buddies. What good can come from that? I’d just as soon let a two-year-old walk into the ocean. Good Choices Can Cause Temporary Unhappiness The reason parenthood is difficult is because that inexperienced human being you love more than life itself will do stupid things and hurt himself, if given the opportunity. Not only that, but when you rightfully say ‘no,’ he will express his anger adamantly – no matter that your heart and mind are in the right place. The longer we are on this planet, the more we learn. If we look at the experiences we share as human beings, we see that each of us is born into this world as a helpless newborn, and a hundred years later – give or take – we die. In the process, we lose everything and everyone we love. The truth is actually brutal. Anyone paying attention has a right to be terrified. Surgery reminds us what we have to be afraid of. Every patient thinks about the same thing: “In a few moments I will be lying unconscious on a table while the surgeon cuts on my body! Who knows?!! I could die here today! ” Yesterday my patient gave me a big smile before her operation. But I saw right through her poker face: her eyes clearly telegraphed her fear. I smiled at her, shook her husband’s hand, and asked her and her husband if they had any questions or concerns. They did not. But it was obvious they did. We are all afraid of suffering. And although surgery always hurts, we know that when we wake up, there are narcotics and other drugs that will take care of the physical pain. Simply put, what we are really afraid of is not waking up. What We Care About I’ve had thousands of conversations with patients in the intense moments before an operation, and as I listen and try to comfort each patient before they go into the operating room, there is an additional truth my patients have shown me. We don’t want to say good-bye to the people we love. In the moments when we brush with death, what matters to us is not our money, our home, our job or possessions – it’s the people we know and experience life with. Admittedly, they may sometimes annoy us – but they make our lives worth living. Fear is good for our health because it serves as a spiritual reminder. God does not grant eternal biological life for any of us. As mortal beings, we lose all that is most important to us – our loved ones and our lives. So as experienced human beings who have suffered during our short time here, our spiritual lesson is fairly obvious – to love those around us more and more each day. This is the path of a healthy life. The more we love others, the more we understand the heart of God. This understanding brings us courage and comfort as we face the terrors of life. This courage is called faith. It is the understanding that true life is eternal. I held my patient’s hand and said a prayer of gratitude. Together we asked God to be with my patient and her husband so their hearts were at peace, and with me and the other doctors and nurses and staff, so once again we would be blessed to witness the miracle of healing grace. When I looked at my patient again, I noticed that now her eyes were smiling too. Already my prayer had been answered.

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

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

Dr. Litrel's Blog

Every Day is Father’s Day

Despite its lifetime warranty my bathroom scale is broken. No matter how many times, or how gingerly I step on it, it keeps telling me I weigh more than I do. Also, my clothes are all shrinking, despite labels which clearly state they are machine wash-and-wear. My problem is not weight gain. It’s defective merchandise. Okay, the concept of weight loss is not that difficult, just challenging. Eat less, exercise more. What could be so difficult? All I want now is to get back down to what I said I’d never get up to. So this past Father’s Day I decided to forgo the “all-the-donuts-I-can-eat” tradition and work out in the basement. Father’s Day Challenge #1: Health Years ago I made the unfortunate discovery about myself that I am less the natural athlete and more a natural couch potato. Thus I have developed my well-known personal interior decorating philosophy, which involves surrounding any and all television sets in the house with exercise equipment. My Schwinn Recumbent Cycle is the best piece of exercise equipment I own. The workout itself is not spectacular, But it’s very comfortable to sit in, and perfect for watching television. It’s like a lounge chair with pedals. So on the morning of my seventh Father’s Day, with the boys I love beside me, I began my First Annual Father’s Day Workout. Out of respect for the widely accepted traditions of fathers’ birthrights, I also commandeered the television remote. I chose something we could all enjoy – the CNN News Update. Regardless of Father’s Day tradition, it wasn’t long before Tyler and Joseph, sprawled on the floor in front of the screen, were complaining about my God-given right to choose the TV show. I capitulated and switched to the Cartoon Network, which was broadcasting some inane piece of animation I’d never heard of. Evidently the boys must have found it boring, too, because pretty soon they were arguing so loudly that the character dialogue was moot. My kids have me at a disadvantage when I’m working out, and they know it. When my breath gets short, I can’t yell at them so loud. Also, there’s always the chance that if I get up to discipline them and interrupt the workout, that will be the end of it. But this time the combat escalated to the point where I had to actually get off the bike to bring them into line. Which brings me to something ironic…. Father’s Day Challenge #2: Children I think it was George Bernard Shaw who said, “Never hit a child – except in anger.” Having gotten up, I was angry all right, angry enough to threaten bodily harm. But I’m not a fan of corporal punishment. My parents, if not big fans, were at least mildly enthusiastic camp followers. Back in those days, my father didn’t own any exercise equipment, so I think his major cardiovascular workouts consisted of the time he spent spanking my bottom. Ann and I don’t rule out spankings entirely, but more often we fall into the “Time Out” philosophy of our generation. In a burst of enthusiasm for parenting during the first six months of Tyler’s life, we listened to numerous tapes of experts with “parenting” advice. The main piece of wisdom we acquired from the hours we spent listening to these experts was the location of the perfect place in the house for “time out” — the bathroom. According to the experts, the bathroom is the most boring room in the house, the perfect place for quiet reflection. I suspect this to be true, because despite the inevitable first few minutes when my boys seize the opportunity of bathroom confinement to take care of essential bodily functions, they soon lapse into the crying and complaining that let us know the deterrent is working. Regardless of whether it works, it’s strangely satisfying. As I closed the bathroom door on my battling boys, a warm feeling came over me. Maybe I should have put them in separate bathrooms. But that particular nuance was not covered in the parenting tapes, and it’s easier to put them both in the closest one. After a while they seemed to quiet down into the appropriate reflective mood, so I let them out and resumed my workout. In a familiar routine which constitutes the classic defense for corporal punishment, Tyler and Joseph soon launched into another argument, which unfortunately coincided with my noticing that the pulleys on my Joe Weider weight set were broken again. That did it. I turned off the TV. “Stand up!” I ordered my boys. My face was dripping with perspiration, my teeth clenched in anger. “How many times do I have to tell you not to play on my weight set?” I demanded. It was a rhetorical question, but Joseph, my four-year-old, took me literally. “A million times,” he replied meekly. “You have to tell us a million times.” I smothered a smile and kicked them both out into the back yard. My decision was final. This Father’s Day, I wanted to spend my time as far away as possible from the two people who had made me a father. I told them in no uncertain terms not to interrupt my workout again – unless it was an emergency. Fifteen minutes later, Joseph came running into the basement. “It’s an emergency, it’s an emergency!” He pulled me into the back yard, and there, away at the bottom of the hill, were the bodies of Tyler and his friend Sami Leonard, lying prone on the ground. They didn’t appear to be moving. I fought my instinct to run down the hill. This was something you learn as a medical student at Grady Hospital. One night as I was urgently wheeling a gunshot victim toward the O.R., a surgical resident flagged me down. “Don’t rush when you are in a hurry,” I remember him saying. When I got to the bottom of the hill, I saw that the boys were

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

A Disappointing Tumor

I once removed a tumor that weighed nine pounds and twelve ounces. Before the operation I had told my patient that the mass on her ovary was at least ten pounds. So I was four ounces shy – and very disappointed. I asked Diane, the operating room nurse, to weigh it again, stressing to her that my expectation had been that the tumor be at least a ten pounder. “I’m sorry, Dr. Litrel – it weighs the exact same,” Diane assured me in her sweet southern voice. Diane is quiet and competent – one of my favorites – but her answer was annoying and I told her so. “Why couldn’t you just have said it was ten pounds!?” I asked incredulously. “It wouldn’t make any difference and I’d feel so much better!” Diane laughed like I was joking, and I joined in. But maybe I was serious. You see, surgeons can be megalomaniacs. Or at least this one can. And occasionally they don’t mind saying things like, “you should have seen the size of that incision,” or, “this morning I took out a ten pounder.” It’s a chest beating thing. But despite the four ounce shortfall, there was wonderful news, too, and much more important. Not a drop of cancer. The capsule of the tumor was smooth and glistening, unlike the surface of a malignant mass. In a few places it had become stuck to my patient’s intestines. But once the scar tissue had been cut, the large mass lifted easily and cleanly out of her body. And the patient was ten pounds lighter. Well, almost. The incision was more than a foot long, spread wide open by the retractor. Anywhere but in the operating room, this would have been a mortal wound. But here it was bloodless, opened layer by layer in a clean surgery. We had entered her abdominal cavity and removed the source of her pain. My patient would quickly recover. And she would no longer suffer from this tumor. Pain was the reason she had first come to my office. Her family practitioner had been treating her “menstrual pain” with stronger and stronger medications. She had finally appeared in my office because the medication wasn’t “holding her,” and she wanted a stronger pill. She hadn’t known about the tumor. Another patient, Pamela, visited that day and also wanted a pill to make her feel better. Her pain was even worse. But unfortunately, there was no tumor to account for it. In the end, it’s the lucky patient who has a tumor. Once the tumor is removed, the pain comes to an end. Since having her children over the past ten years, my patient Pamela had become increasingly depressed. She found herself turning forty, with a weight problem, low sex drive, and a profound sense of disappointment. Somehow life had not turned out as she once had imagined it. The long stretch of middle age ahead seemed barren of hope. Over the years, she had received treatment from several different physicians. Antidepressants had once helped her improve her mood, forget her suffering, and feel better about her life. But by and large, the years had brought no change, no new purpose, and finally, no hope of ever feeling really good. She had just seen a television commercial featuring a vibrant woman advocating the latest and greatest antidepressant. Maybe that was the pill for her, she said to me. No where in the anatomy textbooks I studied in medical school will you find a description of the soul. Yet the soul exists, just the same. And as the years go by, I see in my patients with more and more certainty: the process of life is biological – but its purpose is spiritual. We are not human beings with spiritual problems – we are spiritual beings with human problems. The disappointing tumor is the one that cannot be seen, cannot be cut out. I suspect that Pamela has a tumor on her soul. She can cover up the pain with medication, just as my first patient was masking the evidence of her tumor with stronger medicine. But this will not mean the tumor is not there. For Pamela I can prescribe pain medication, sleeping pills, or antidepressants. Or she can self prescribe in the usual ways – overeating or drinking. The more difficult but effective task is to locate the tumor on her soul. God puts suffering in our lives for a reason. Just as He has given us pain to signal a physical problem, depression can signal that there is dire spiritual work that needs to be done. My own drug of choice has always been food – sweets, in particular. In times of stress or upset, I have been guilty of imbibing a box of chocolate glazed or cream filled delights, a half dozen at a time. I quote one of my all time idols, Homer Simpson, when I say: “Mmmmmm… dohhhhnuts…Is there ANYTHING they can’t do?” In the end, though, that box of delights with ten thousand calories actually contributes more to my problems than it solves them. And the source of my suffering remains unexamined, untreated. Not all suffering is in vain. God has created us with the capacity to suffer, so that we will know when there is sickness in our spiritual lives. What is the spiritual work that Pamela needs? Only she can figure that out for herself. Prayer and counseling can be part of the surgery to remove it. But if she does not examine the source of that pain, she risks its growing presence for the rest of her life. She will continue to find her life disappointing. And who wants to be disappointed? -Dr. Mike Litrel

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