I know I have been neglectful of you, and even somewhat insensitive of your needs, but I have a great reason, I promise you will be so proud of me! I am nearly done with my second book, and my days and nights have been consumed with trying to put the final touches with editing and such, you know how it is…:)
Today, I would like to share a piece of the book with you!
So, first off, the book is called A Teen’s Life. It looks at the lives of 10 different teenagers from across the globe. They are sharing their stories and struggles with me in a Dear Dr. Lulu format. I respond to their letters as best I can, and then I discuss their situations. It is statistics-heavy, it is sad and deep, but it is real. The stories are all real, but fictitious at the same time. It is essentially about youth suicide in a sense, but it is also about life, teen life. I am hoping that it serves as an eye-opener to the struggles of these youth, and hoping its readers (teens, parents, caregivers, the government, everyone) will come away with a better sense of understanding of the plight of teens and some simple but not necessarily easy solutions to tackle them.
Here is an excerpt from it. This is the portion that deals with myths about suicide. I am really proud of this…enjoy!
Before we embark on what we can all do to prevent suicide in our teens and youth, I think it is only proper to discuss some of the myths about suicide that are floating around. Debunking them will help increase awareness of their falsehood and help fill in some critical knowledge gaps.
Suicide is not a real problem; As we all know, suicide is a real problem in our world today, it is now the second leading cause of death in our youth.
Asking or talking to your teen about suicide causes suicidal behavior; Talking about suicide not only increases awareness and puts an end to the shame and stigma, but it also helps teens explore other options and keeps open communication lines.
The person/family needs more prayers and more Jesus; while having a sense of belonging to a community or spiritual group is always encouraged and actually protective of suicide it does not in of itself prevent suicide. However many suicidal persons have been known to say that when they reached out for help, they were told they were being dramatic and selfish and needed to pray more.
Religious persons do not die by suicide; just this past summer we heard about the young American pastor who was active in the mental health arena, who actually lost his life to suicide, there have been many others including a Nigerian pastor as well.
Denial: It does not happen to our ethnicity or family (Blacks, Asians); this thought process as we know is erroneous, and Black kids were recently documented as attempting and dying by suicide at a higher rate than other races.
Only a professional can identify a child at risk for suicide; one of the reasons for this book and my work in the suicide arena is to increase awareness by educating everyone about the signs so we are all more empowered.
Once someone is suicidal, they will always be suicidal; for the most part, suicidal thoughts and behavior are situational and temporary. Most suicidal persons need to know that their feelings can and do pass once they are equipped with the right tools to deal with their thoughts, and have the necessary support they need.
Only people with mental illness are suicidal; When I was going through my suicidal stage, I had never been diagnosed with mental illness, I did, however, experience a lot of life challenges which shook my core and caused me to consider myself a failure and not worthy of life. During the financial crisis of 2008, there was a sharp rise in suicides as a result of the enormous financial losses these people had experienced.
Most suicides happen suddenly and without warning; we know that 4 out of 5 teens who attempt suicide leave a sign. The decision to suicide is hardly ever a one-off thing, it is usually a culmination of events over time leading to “overwhelmedness”, an inability to cope, and a perceived or real lack of support.
Someone who is suicidal wants to die; in all honesty, most suicidal people do not want to die. They simply want their pain, suffering and despair to end. They often feel like they have exhausted all their options and they also have the means to end their lives at that moment.
Someone who is threatening suicide is not going to carry it out; I like to say “do not underestimate the power of determination”. We can never be too sure that someone will not carry out their threat. We must, therefore, take every suicide threat seriously. Part of the reason suicide is on the rise is because these people don’t feel they have any support, they feel all alone.
People who die by suicide are selfish and taking the easy way out; because these people have been suffering for a while, majority of them actually feel like suicide not only puts an end to their suffering, it also frees them from being a burden. Many suicide attempt survivors say they feel their lives are a burden to those around them.
All in all, suicide is a complex issue, but suicide prevention must be front and center in everyone’s minds in today’s world. To find out more, you will have to wait a couple more weeks for the actual book!
I am sitting in my home office on a sunny Thursday afternoon, as I write this letter to you.
In the past year since I quit my full-time job as a pediatrician to start speaking on child, teen and young adult depression and suicide, (read about it here and here). I have discovered a different side of me. The side that loves to write, and speak. The side that is an activist for a cause. The side that was lying dormant until the passion to actively save the lives of children and teens through creating awareness was ignited when my then 7-year-old patient attempted to hang himself in May of 2018.
I have always known that medicine, pediatrics, in particular, is my life, and public speaking is second nature, so it was sort of a natural progression for me. I have never had any trouble speaking in public to air my opinion, so when this opportunity to practice medicine in the most preventative way picked me, I had no hesitation to say, a resounding…yes! As the good book says, “many are called, but only a few are chosen”.
Though I don’t know when it will get published, I couldn’t think of a better day to write this letter than today, the 12th day of September, two days after September 10, which is recognized as World Suicide Prevention Day. This week marks National Suicide Prevention Week 9/8 to 9/14. A week which eerily includes September 11, a day suicide bombers set our country on a never to be forgotten path, a day that will forever go down in infamy, in the month of September, suicide awareness and prevention month.
This letter is, however, not about suicide days and suicide bombers. It is about a path that has led me, a Nigerian-born mother of three, a board-certified pediatrician, to become a speaker, bestselling author, and activist on youth suicide. It is about how finding a new way to practice medicine is allowing me further my cause. Every time I tell people what I speak about, it never fails, they look up, and suddenly get interested, no matter what they were doing before I started speaking. Some look at me with concern, some look at me with disbelief, and yet some look at me with sorrow, especially when I tell them my story, my why, which you can read here. Usually, by the time I am done, a majority of my audience wants to know where they can find me, where I practice.
For the past year, my response to that line of questioning has been a combination of the following…” nowhere in particular”, “I don’t have a practice”, or “I quit medicine to speak publicly”. To which even more eyes look at me with a mix of wonder, pride, gratitude and amazement… and then after a brief thought, pretty much everyone says a combination of “that’s such an important topic” or “that’s so needed” or “wow, thank you for the work you are doing”, etc.
As I have continued to speak locally, around the country and internationally, and as the questions have continued to come in, I have had to finally admit to myself that I have missed practicing medicine. I have missed clinical practice, but most of all, I have missed having physical contact with my patients. Those who know me, know my patients are my “anti-kryptonite” (if that is a word). That been said, I have known in my heart that I did not want to go back to traditional medicine (what I call “assembly line” medicine). The kind that is run by CEOs with little or no knowledge of what it’s like to have boots on the ground. The kind that has enslaved us doctors and caused burnout to now become a household phrase. The kind that puts profit and the bottom line before patients and providers. The kind that you, me, we, did not sign up for. The kind we did not dream about in our days in medical school. The kind that has unfortunately driven too many of us (400 per year at last check) to early deaths through suicide.
I knew that kind of medical practice was definitely no longer for me. So, I tried out Locums, but with my son still being in grade school, I am unable to travel out of town as much as most locum gigs would require, plus, I am only licensed in Texas so that limits me as well. I know the hospitalist route is not for me. So, while I was still pondering my next move, I happened upon a facebook group called DPC Docs. A two-thousand strong community of doctors practicing medicine on their own terms. I had actually heard of DPC about 2 years ago. Direct Primary Care. Three words that are turning out to be life-changing for those of us who care to look closer, look further and farther, think outside the box, and dare to be bold enough to say “enough already” to the big bosses and take back our lives.
I happily jumped in with two feet. You see, Direct Primary Care is exactly what Dr. Universe ordered for me. A spin-off of Concierge Medicine, DPC seeks to allow doctors to practice medicine the way it was meant to be. I had heard about it through a podcast that featured one of the true pioneers in DPC practice Dr. Josh Umbehr of Atlas MD in Wichita, Kansas. I remember excitedly running to find my spouse to tell her all about it that evening. I was so intrigued by the model, I was immediately hooked. And even though I knew the traditional medicine model I was in as an employee at that time was toxic for me, it still took me nearly 2 years to act on it. Not because the process is hard, but because I needed the right mindset and star alignment to get over the voice in my head telling me to stay put.
As soon as I decided to start back clinical practice, I knew it had to be on my own terms. My first order of business was to call the Texas Medical Board and enquire about my idea to only attend to at-risk youth aged 8 years to 18 years who are the exact population that I speak and write about. When the lady on the telephone told me I could, that was one of the happiest days of my life! Her words were something like “ma’am, as long as you are licensed to practice in this state, you can see only those born on the 5th of May if you like”. That essentially spun off my dream to open my own youth health center that would cater to the children that had picked me those many moons ago!
Do you know that it took me less than 6 weeks and cost me less than $10,000 to set up? I have a micro DPC practice model, that means I have no front or back office, no fancy equipment, no staff, and an expected patient panel of less than 300, compared to nearly 2000 which I had at my last place of employment. The way my practice is set up, I shall see only 6-8 patients a day for up to 1hour or more per visit, three days a week, compared to 35-45 patients at my last multigroup practice employment. My monthly overhead is far less than I had when I owned a traditional practice, my EHR is user-friendly and convenient, my stress level is low, my patients are happy, and so am I 🙂
While this might not work for many, it works for me and others with a small niche. My friend, Dr. Amber Price of Willow Pediatrics up in Chicago, Illinois’s niche is only newborns. She incorporates home visits as part of her practice. Yet another friend, Dr. Sara Sultz of the DOC group up in College Station, Texas does home visits as well as telemedicine as part of her pediatric DPC practice. She even gives vaccines and IVF right there in the patient’s home! Such is the new way to practice medicine, and I am proud to be a part of it, and to announce that I am the first and only pediatrician in Texas and the US with my specific niche in this particular model.
So, what exactly is DPC? And why is #yourstruly so elated about it? Ironically, many of the doctors that I speak with have never heard about it. A few have heard about concierge medicine, but not many, much like I was a few short years ago.
In the Direct Primary Care practice model, the emphasis is on affordable care. In its purest form, no insurance or third-party payer is accepted. That right there puts the first nail in the burnout coffin! I was like “whaaat?” No insurance means; I. Get. To. See. My. Patients. For. As. Long. As. I. Want. To! Yassss!! We do encourage patients to keep their health insurance, and some practices will even generate invoices that might be reimbursed by the patient’s insurance after each visit. The model is based on a flat monthly fee in exchange for services, longer times spent with the patient, more intimate doctor-patient relationship, overall lower healthcare costs, direct access to patients both virtually and in person, improved work-life balance for physicians; thus drastically reducing burnout, reduced patient load, and reduced administrative costs and overhead burdens. The increased intimacy with patients is a huge win for me, especially with the niche I see. Like any business, the fees vary depending on location and market competition.
The key here is; it is a membership model, much like Netflix or your gym membership. My patients have access to my cell phone number to call, text, email or facetime me whenever they need to, and they can be seen, as many times as they like to, each month! My question to you is; when was the last time you had that kind of access to your doctor? Let’s take for instance a 14 year old who is experiencing a depressive crisis at 2pm in the afternoon while at school, they would have the ability to call or text me right away, and not have to wait until they get home, inform their parent, who calls the next day only to get an appointment for the next week, take time off from work and school to arrive at the appointment, only to wait for one hour in the waiting room, and the doctor spends all of 10 minutes seeing them. Then wait another 2-3 months to get an appointment with the psychiatrist who may or may not accept their insurance, or is very likely to charge them 2 or 3 times my monthly fee for only one visit! Get it? #aintnobodygottimefordat!
Some DPC doctors are set up like traditional practices with office staff, laboratories, X-ray equipment, EKGs, and whatever else they need. Depending on state laws some also dispense medication in their practices, (Texas aint one of them…:) all for the same flat monthly fee. It’s just like a gym membership or Netflix for your doctor! In my case, for less than a cup of coffee at #Starbuxx my patients can see me everyday. Oh, and they don’t need to live in San Antonio Texas, I also have telemedicine included in the practice, so I can consult with patients virtually. Other services I am so proud we offer are a teen-2-teen support group (because teens speak teen, they don’t speak adult) and parent coaching, both of which I facilitate.
For now, I am loving DPC. It affords me time in my week to “mother” my children the way I want, be an awesome spouse to my Beloved, make time in the week to blog, work on my speaking gigs, record and edit my podcast; Suicide Pages with Dr. Lulu, The Podcast, you can subscribe, download and listen to it here and everywhere you listen to podcasts. I am finishing up my second book, a chronicle about Teen Life (my first book; a Parenting Guide, can be bought here). I have many more tricks up my sleeves in the coming weeks, so #staytuned.
In conclusion, I believe I have found my happy place in medicine again. While DPC might not be for everyone, it is for me, and it might be for you too, think about it. You never know. Here’s what you do, first start by conquering, silencing or banishing that voice telling you you can’t do it, the rest will fall in place. Ultimately, Happy Patient: Happy Doctor is what we all seek, right? Keeping it simple is what our mom’s taught us, yes?
So, I ask this time, dear doctor, will you DPC?
“We can’t be afraid of change. You may feel very secure in the pond that you are in, but if you never venture out of it, you will never know that there is such a thing as the sea, or an ocean. Holding onto something that is good for you now, may be the very reason why you don’t have something that is better.”
― C. JoyBell C.
“Adult Ed is a Mother, but it’s also a Keeper!”… Dr. Lulu
Last Friday as I found myself finishing up the last day of the last week of my 27-month journey into the land of a Masters in Business Administration at UTSA, my heart was a mixture of all sorts of emotions, the strongest of which was joy! Since I couldn’t keep it to myself, I did an impromptu FB Live and literarily broke into song and dance on screen! I no longer have to stay up late studying and doing homework EVERY NIGHT. I can now stop using “school” as my excuse for everything (I really don’t want to do). I get to add those coveted three letters to the other two after my name. I can now get much-needed rest (umm, say what?) Let me rephrase that, I shall try going to bed at 11pm every night (yeah right!) I finally, realize my dream of walking on an American stage wearing the black gown and black “crown”, and as an added treat, I get to wear VA cords!
In September of 2016, my 4yr term as a Lt Col. in the United States AirForce came to an end. In deciding what to do next, I realized I had multiple options to pick from; join the Air Force Reserves, go back to school and get a Masters Degree, or get a regular job as a pediatrician. I decided to go for the last two options. And no, I had no specific “why”, I simply wanted to use the VA educational funds I was entitled to, it was more like a “why not?”. The decision was met with a combination of gasps, shock, surprise and some reluctant encouragement from friends and family. Never one to waste too much time chewing on a thought, I jumped in with two feet (before I lost my nerve) Coincidentally, my first son was about to go into college at the same time and my spouse had also decided to get her Masters degree as well…so, I was in good, no, great company! (That sh** just about cost us our union, but that’s another day’s blog, LOL)
Later that month, as I was walking out of my job interview at Communicare Health Centers, I remember wondering to myself how I would manage a full-time work schedule and a full-time school schedule. I had initially wanted to do the combined MPH/MBA program, but FEAR and its close friend DOUBT, proceeded to discourage me and talk me out of it, so I settled for just the MBA. I was as excited as I was anxious! My colleagues, (after getting over the initial disbelief) quickly got on board and started cheering me on. I still had no idea how I was going to “manage” it, but I put my best Naija Igbo Woman foot forward (as per we no de eva carray last) and started the regular MBA at UTSA. Not online, in person, albeit, nearly 30 years post graduation from medical school, owning my own private practice for nearly 15 of those years and doing a brief 4yr stint as a Lt. Col in the US Air Force! I was going about mine backwards.
The first semester went like a breeze (or did it?) I now only remember that I had a hard time getting used to not only going back to school but also going back to school in the tech age! Just like my initial shock when I first came to the USA which I shared here in this earlier blog, going back to school, in America, was FULL of new experiences…!
First off, I was one of, if not the oldest student in that regular MBA class! I was not happy about that at all. I hated the fact that I was in class with late teens and early twenty-something-year-olds. Their mannerisms were a total lack, they were disrespectful, noisy, lackadaisical, and sometimes rude to the professors(s). What struck me the most was their tendency to not do the work! They were very content with not showing up for class, joining in class discussions or even doing their portion of the school work at all… (I guess I am seriously old school) This bothered me so much that after that first semester, I went back to my student adviser and requested to disenroll. Luckily, she was kind enough to understand my position and suggested I sign up for the Executive MBA program instead. I was really lucky because I literally made the interview on the last day! Reminds me of a similar incident with Howard University Hospital Residency interview, I also talked about here. Thankfully, I got in! Since my paperwork was already in the school of business, all I needed was an intradepartmental transfer. She hit the jackpot with that suggestion because once I understood what an Executive MBA was, I TOTALLY LOVED the idea! However, a couple of my “friends” queried the “executiveness” of it all…”make sure it is not a watered down version of an MBA”, is it an E-MBA as in online/electronic? “are you going to have a real MBA degree when you get done?” and, “why de heck are you even going back to school, aren’t you tired?” Hmmm…how does one respond to all that love?
At the Executive MBA program, my cohort comprised of people closer to my age, adults. managers, business owners, entrepreneurs, vice presidents, CEOs, executives, parents, grandparents, wives, and husbands. A fair number of them were still younger than me, but the age gap was not nearly as much. The youngest in my class was 31 yrs old. They had all seen life and lived it a little. A lot of them were well-traveled. They were much more experienced and for the most part, wanted to do their school work. My kind of people. We were different, yet the same. A few were veterans like me, a few were foreigners like me, a few were mothers of kids in college like me, a few were divorced like me, and one was not only the other one Black person, he is also Nigerian like me! Awon Naija sha! I believe I lucked out!
In spite of all that, the school work was still a huge challenge for me. I had to get used to school the American way. Folks actually call their professors by their first names around here, huh? Not in Nigeria, tufiakwa! I went to medical school in the 80s, graduated in the very early 90s. We had real chalkboards, not smartboards. Our blackboards were not virtual, they were really black and physically present in the classroom. I had no concept of the word office-hours, luckily, my son who was then a freshman at Stanford University explained what that meant to me. I had no idea what it meant to access library books online, and be able to “check them out” virtually? What de? As shocking as these findings were to me, there was more to come.
As the only physician and one of 2 Blacks of the lot, 33 of us to be exact, I had no one else wearing my exact shoes, hmmmm. I had no one to hold on to when Statistics got tough (yea, I know, I did biostatistics in med school, so I recalled sensitivity and specificity, but certainly not Anova or Covariance Analysis) I had no one to hold on to when Accounting reared its ugly head, or when Finance got crazy (my poor mom, a retired accountant, who was visiting at that time, got a daily dose of complaints from me). As a self-proclaimed hater of numbers (except those on my paycheck and bank account) I loathe Excel…still do! First of all, I had never really heard about it, furthermore, I not only had to learn its basics, but I also had to learn to apply it to Accounting, and Finance, WHY!? All of which made for many a tear-filled day at the professors’ office. Every now and again, I did feel lonely and left out in my cohort, but my resilience and adaptability would kick in and I would win the little battles.
Economics was good as long as it was Macro Economics and the professor who worked for the FED was a kindly older gentleman with a thick Texan accent and a friendly smile. Still, I spent too many afternoons in his office at the high-security Federal Building downtown San Antonio. Corporate Restructuring was okay at the start until we got deeper into the mathematical aspects and calculations, then it ceased to be fun. Since I love words, Organizational Behavior was great, Ethics was a bit confusing. Marketing, Negotiations, Business Strategy, and International Business Studies were easy for me because I had no numbers to worry about, furthermore, I LOVE reading and discussions. Looking back now, one of my favorite subjects was Leadership. Not only was our professor really cool and soft-spoken, but the cases were also interesting, intriguing and thought-provoking. I enjoyed learning about exemplary leaders. I learned about myself and my own flavor of leadership. I thoroughly enjoyed the final TEDx talk we each had to give at the end of the class. Oh, my talk was on the power of the word, NO.
One of my favorite experiences during my business school was Executive Coaching. As a matter of fact, I owe my executive coach, my entire career journey today. She is one cool Chica. She used to work for NASA, so she is equal part brains, beauty, class, and control. I absolutely admire her poise and her presence. She exuded knowledge and she helped me figure out who I am/was, and what I wanted to do with my life after school. Truth be told, I only signed up for the MBA partially because the VA was footing the bill, and partially because I used to counsel my subordinates in the Air Force to take advantage of the GI Bill and Post 911 educational grants and go back to school and further their education. I never even thought I could do it, but I had to heed my own advice.
I must say the highlight of our entire MBA experience was the 12day international trip to South East Asia! A trip that cost me the attendance of my youngest brother’s wedding in Nigeria, which just happened to have been scheduled for the exact same day. We left San Antonio bright and early that January morning and went through LAX. The 17hour flight both ways was no match for the excitement I felt in finally seeing the world famous Singapore and Vietnam! I grew up in the 70s and 80s and remember listening to the song “Vietnam” by Jimmy Cliff, so, this was a sort of homecoming for me. Singapore, a country born with a golden spoon, is eating its cake and having it too. It is an example of how hard work pays off no matter what. Vietnam, a country that is well on its way back from the ashes of multiple wars, betrayals and “destruction of men in their prime, whose average age was 19” a la Paul Hardcastle in his Jazz Masters hit (one of my faves). After everything she has been through, her people still wake up every morning, practice Tai Chi, get on their motorcycles and ride!
I cannot put in words the excitement of Singapore! Its clean streets, ultramodern architecture, eclectic suburbs, fine dining, high-end shopping, educated minds, and multiracial indigenes all living harmoniously in spite of differences in religion, language, customs, cultures, etc. A hard lesson for all African countries to learn (sadly). Singapore welcomed me with open arms. I even got a chance to sing old Karaoke tunes with a local band at a local pub! Vietnam was different. More real, dirtier, noisier, almost “happier” than Singapore. Our class got to visit the Crocs factory, eat with the locals in a traditional Vietnamese home, and take a canoe ride on the river to the coconut village, where my sense of smell was completely mesmerized by the indescribable smells of coconut. Since my wife is part Island girl, and I am the quintessential Tropical Chic, this, was HOME! I was immediately taken back to my childhood, my grandmother’s hut…her smell, her heart, the essence of her being my Nne Akuobu. As unbelievable as the trip was, I topped it up, by finishing the final edits of my first of many Amazon bestsellers on the plane ride home! BTW, get your copy on Amazon or on my website, it is the best parenting book ever! 😉
I shall miss school. I have always been studious. I have always had a quest for knowledge. Though old age is setting in and my memory is not quite as good as it used to be. I am proud to say that I completed the MBA and can now print out my new business card with all five letters in their proper order MD/MBA 🙂 I earned it. Considering I got the degree after I have already been in private practice for nearly 30yrs, and considering I have no idea what I am going to do with it…yet, I am still thankful for all the potential doors it will open for me. I admit I had NO WHY, I simply did it because I could, because the funds were available through the VA, and because I might have needed to prove to myself that I still gat it after all these years, or simply because…
In ending, I would like to say; just like that, my 27month program is done. Was it hard? Yeah! Is it doable? Hell yeah! Can you do it? All day! So follow your heart, try something new, push yourself. No one ever died wishing they spent one more day playing a round of golf. This is my legacy, what is yours? What is holding you back from following and fulfilling your dreams? Work? Kids? Family? What are your priorities? Are they in proper order? Remember, life is what happens while you are busy planning…so get off your phone, get off your couch and just do it! If I could do it, with my schedule, you can do it too! Peace still.
My name is Uchenna Umeh, MD/MBA, and I approve this message.
Happy New Year…I only wish my heart was happy as I write these words this morning. The title of this blog literally pulled me up from bed, begging to be written, so here goes.
We see them on the news every day, we see them on social media every time we look at our handheld devices. Headlines: “X-year-old boy hangs himself, X year old girl found hanging in her closet” “X-year-old teen dies from self-inflicted injuries”. The headlines are not the problem though, read a few lines down and you will see them, the unmistakable words “after years or months or even weeks of being bullied” BEING BULLIED? by whom you ask yourself, then it never fails, the words, by his or her peers follows every time, and I am sick of it!
I am sick of the fact that small children are now more pre-occupied with bullying each other than playing in the sandbox or with their X-Box. Even when they do play in said sandbox or on the X-Box, they are bullying each other. They are teasing each other, they are making fun of each other, and not in a nice way, in the worst possible ways, saying the worst possible things to themselves. I often speak of how another 12-year-old child once told my then 12-year-old son “when God made you, He left you too long in the oven and you got burned” referring to his skin color. How does a 12-year-old come up with those words? Sadly, the vocabulary is now even worse, they have now progressed to calling names like “bitch” and “slut” and phrases like “go kill yourself”, and “die now” as in the case of McKenzie Adams, a 9-year-old child from Alabama who hung herself in her closet last December after months of bullying by other 9-year-olds. 9-year-olds? What do they know? How did they come up with so much meanness and hatred in their hearts and mouths and fingers? Where will a 9-year-old child find such racist statements as those that were repeatedly uttered to this poor little girl? Where are their parents when all of this is happening? Who are these people?
As if that were not bad enough, just yesterday, the news broke about little Seven Bridges, a 10-year-old boy who not only had a medical condition that required him to wear a colostomy bag (and need multiple surgeries to live) about which he was repeatedly teased, he was allegedly called the N-word and “choked” on the bus by his “bus-buddy” for simply being himself. Where do I start? Who are these 10-year-olds and who are their parents and family members? What examples are we setting for them? How are we handling our home environments? Where are they learning this hatred from? What exactly is going on in our homes, in their heads, in their hearts?
It is easy to blame the teachers and counselors and the school system for not “checking the bullying at school”, but what about at home? What is happening there? Are we as parents now simply having children and leaving them to be raised by others? As a part of the village it takes to raise children, I must say, it is not my primary responsibility to raise yours for you, just as it is not yours to raise mine. We MUST as parents, stop and retrace our steps. We MUST accept our own responsibilities and accept the roles we are playing or not playing when it comes to raising our kids right. We MUST accept our own fair share of blame and then, maybe, we can seek to rectify. We MUST as a matter of urgency resist the urge to play the blame game. Enough already.
Earlier this week, the news broke about the suicide streak in Australian teen girls, a total of 5 girls aged 12-15 years have taken their lives since the beginning of this year, 2019. Blaming everything from child abuse and neglect, to sexual abuse, to poverty and even poor governance, nowhere does this article mention bullying, however, Rochelle Pryor’s last Facebook post clearly stated: “once I’m gone, the bullying and racism will stop”. This shows that even when reported, the news can sometimes be skewed, further compounding the problem and delaying any solutions.
As a pediatrician, child advocate and teen expert, the least I can do is join my voice with others trying to make a difference, to put an end to bullying by our children, at school, at home, at work, and wherever else it might be. Here are five (5) things every parent must do, today, now, in order to help in the fight to end suicide from bullying.
TALK to yourself. Start at home. Check your life. It is the mirror through which your children look at life. How are you living it? What kind of language are you using when you refer to people of other races, or other convictions different from yours? Is there some domestic violence or abuse going on in the home? Is there name calling? Are you putting yourselves down in front of your children? Do you argue a lot? Should you be in counseling? Do you speak to your children about what they should not be doing or saying in school? Do you even know your children and who they hang out with at school or at play? We must realize that if our kids are the bullies, it might not all be their faults. They might be needing some love, we might be needing to change the way we are doing things at home. They might need counseling or therapy. I recommend we watch this 2006 movie about 5th graders called “how to eat fried worms“, it touches on bullying at home and some of its consequences.
TALK to your children. We are going to have to tackle these questions head-on. Ask them the question directly, “are you a bully at school, on the bus, at the playground, on the internet, in your group chat?” Explain in the simplest terms what you mean by those words. My youngest son was a member of a group chat where some name-calling was going on one time, I saw it when I looked through his phone. I addressed it, made him report it to the school authorities, and he lost his phone privileges. He had not participated in the name-calling, but he had said nothing in the child’s defense either. 70% of children are bystanders when bullying is going on. The child being picked on in the group chat has Tourette’s syndrome, a disability he cannot help. And my child’s behavior was not good enough for me. Ask your child if he or she is bullied, or if they are bystanders when bullying is going on. Ask them what they do if or when they observe bullying going on. Now, if your child is neither the victim nor the bystander, maybe he or she is the bully. Go through your child’s room and their things, see if they happen to have stuff that does not belong to them. This might be a sign.
TALK to their friends. This means we have to know their friends, and better yet, their friends’ parents. When my youngest son David, 14, had some issues with bullying at school, (he was having a hard time transitioning after his two brothers went off to college) one of his friends’ had told his mom, who in turn told me. He had taken someone else’s lunch and eaten it, and lied about it, among other things. Ask their friends directly if they are bullies, or if they know any bullies in the neighborhood, or if they themselves are bullies. We must be seen as part of the community when it comes to raising our children. I had to have a chit-chat with David’s friends a few weeks ago after I overheard him say to David, “if you don’t come out and play ball with me, then you are gay”. I was like, “what?” Apparently, the kid had wanted to play ball with him but David had made an excuse about having to finish up his homework and needed a rain check. After a little tet-a-tet with the young lad, we fist-bumped and I went along my way, content that at least for that moment, I had stopped that line of thinking.
TALK to the school. Yes, of course, the school is the extension of the home. After taking care of the home front, we must engage the school. Most of the parents of these children we read about had frequent engagements with their kids’ schools. We have to ensure that the school sees us as a present parent. You must be all about your child’s business. Get to know your child’s teachers, get to know the counselors. Get to know their coaches, their dance instructors, their tutors. Anyone who imparts any kind of knowledge on your child you should get to know. Believe me, that will make a huge difference in the end. Imagine your child was about to bully someone, the fact that they know – you know their teachers so well will put a bit of a hindrance on that tendency. Furthermore, the teachers will be your second set of eyes and ears when it comes to guidance and assistance with your child. Having an alliance with your child’s teacher can only be a good thing. Unfortunately, we hear lots of stories of how the schools in some cases claim they had no idea any bullying was going on. Like the case of 8-year-old Gabriel who was knocked out in the school bathroom by bullies a few days before he hung himself.
TALK to a healthcare provider. If you do find out that your child is the bully (and believe me, this happened to me) Talk to someone. Talk to someone right away. Get them counseling. That made a huge difference in my child. It helped us realize and understand the reasons behind his actions. There are licensed therapists, psychologists, psychiatrists and pediatricians like me waiting to help you and your child. I understand that we never want to believe our children are capable of such horrific acts we read about in the news, but, they are. We have to change our mindset about that. We must do the needful and help them because the bully often resorts to that behavior as a result of their own inside pain and stress and trauma and insecurities. They too sometimes may have been a victim and as such, need some love and understanding and care. Let us remember that babies are born, innocent, then life happens. We do not of all things want to be the parent of the child who was in any way responsible for the death of another. So, pick up the phone, make that appointment and speak to a healthcare provider about your child, the bully, you’d be glad you did.
An edited and truncated version of this blog was accepted as a guest blog post on Successful Black Parenting Magazine, check it out here.
In this cough, runny nose and colds season, I cannot find any more befitting time to publish this article, that I first wrote for kevinmd.com last month in honor of the National Antibiotic Awareness week here in the US (November 12-18) It has become such a huge problem, that I am planning a TEDx talk on this topic in 2019 (stay tuned). I feel helpless sometimes, worse still, I feel hopeless most times when I think about the future of our world, our universe with antibacterial resistant germs aka superbugs. As a pediatrician, I have continued to experience a huge pushback from parents, and it is mostly NOT their faults. WE, care providers (Doctors, Midlevels, Pharmacists, Nurses, Medical Students, Residents) have all played major roles in what I call “excessive antibiotic prescription syndrome, or excessiveantibioticprescriptionitis“, #ANOTHEROPIOID-LIKEEPIDEMICANYONE?
These days, no one waits for the body’s immune system to work anymore, no one waits to see if the child or adult for that matter, can fight the infection anymore, no wonder our generation is getting less and less able to fight even the most mundane of infections. We are ALL in a rush to get better, real fast, so we continue to perpetuate the behavior.
For those of you who have been following my story since this summer of 2018, you will remember that I quit my nine-to-five job to pursue a carrier in public speaking on a more semi-permanent basis. I started working part-time with a National Telemedicine company. I am extremely excited about the opportunity and I am very satisfied with the options it has given me to stay home, as I complete my Executive MBA, as well as spend time with the family, a rare opportunity that I have never had in my entire adult working life of almost 30 years. I have realized that there is more to life than working for the man. I have gotten to know my children again. For instance, my eldest son who is a junior at Stanford University came home for 2 weeks this summer and I was able to spend time with him one-on-one. I got to meet the man that he has become and got to know him on a totally different level. In essence, he left my home almost three years ago as a boy and came home this summer as a man. And I am eternally grateful for the opportunity, but I digress.
Unfortunately, this blog is not about me and my children, it is about the fact that in the last 16 weeks, with this new and fun experience of independence and a new way of practicing medicine (for me), has come a new revelation that is rather disturbing. The following, are 11 quotes from my telemedicine patient/parent encounters that have recurred pretty much since my days in private practice but more so in the past few weeks.
“Hello, doctor, my son has had a fever for 4 days now, is there a way we can get an antibiotic for that, please? Thank you.
“Ma’am, I know my body very well, and I know that when I get like this, the only thing that fixes it is an antibiotic”
“Her cough is really deep, and she has greenish-yellow mucus, I think she needs an antibiotic”.
“My children have been running fevers off and on for about 3 days now, the last time they were like this the other doctor gave us an antibiotic and it worked, can we have it again this time?”
“All the other doctors we have spoken to have given us antibiotics I don’t understand why you won’t”.
“Are you saying you’re not going to treat my child?”
“…and what if his stomach doesn’t get better in two days, does he now get an antibiotic at that time?”
“So, how long does he continue to cough before he gets an antibiotic?”
“Can my little girl get an antibiotic for a pink eye? I know it’s a virus but I feel like an antibiotic will help, it did the last time”
“Sir, simply look back at our records, you will see that she gets antibiotics every time she has a ‘sinus infection’, that is the only thing that works for her when she gets like this”
As doctors, we all know that antibiotics are good, but they can also cause life-threatening problems when used recklessly, or when used excessively. However, in my opinion, I do not believe that we have done our due diligence in educating our patients and their parents appropriately to this point, hence their constant reliance on antibiotics for improvement of symptoms regardless of etiology. Even if we have done a fair enough job so far, I believe there’s a need for persistence and insistence on daily teaching of ourselves, our mid levels, our patients, trainee residents, and the entire medical team about the dangers of antibiotics, and especially, the dangers of their over-prescription. At this point I feel like we have to proceed with reminding ourselves; one doctor at a time; one trainee at a time; one pharmacist at a time, and one midlevel provider at a time, about the need for hypervigilance in this matter. I dare add a quick reminder that Sir Alexander Flemming himself said “ The greatest possibility of evil in self-medication with penicillin is the use of too-small doses, so that instead of clearing up the infection, the microbes are educated to resist penicillin and a host of penicillin-fast organisms is bred out which can be passed onto others until they reach someone who gets a septicemia or pneumonia which penicillin cannot save. In such a case the thoughtless person playing with Penicillin treatment is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism. I hope this evil can be averted”.
I find this quote extremely inspiring, however, even though his original fear was for under-dosage of penicillin, our problem today entails both underdosing and overusing. As much as I worry about my patients who have confided that they “shared the Amoxicillin meant for one child among the three children” or they “used the left-over Omnicef from last time, this time, because little “Misty” had the exact same symptoms as little “Joe” did the when he was sick”, hence perpetuating underdosing behavior, this write-up is mainly about overuse of antibiotics, and not only in humans, but also in livestock (something I rarely think about) In a 2015 paper, Business Insider wrote that in her TED talk, Maryn McKenna, a journalist, had cried out about the excessive use of antibiotics to fatten farm animals and prevent them from getting sick, thus causing widespread presence of antibiotics in circulation, leading to bacterial exposure to inappropriate doses, and therefore, resistance.
In a recent article published by the Journal of Antimicrobial Chemotherapy titled “antibiotic treatments and use in hospitals and long-term care facilities” it was observed that 30% to 50% of antibiotics prescribed in hospitals are unnecessary or inappropriate”, thus underscoring our own contribution to the situation. In that article, they refer to the term “antibiotic stewardship” as a process of evaluation and optimization of antibiotic use. It is being increasingly promoted as a means to reduce antibiotic resistance, adverse events, treatment complications and costs within institutions. Unfortunately for us practicing physicians, the recent WIRED article from March 2018 titled; The Yelping of the American Doctor by Maryn Mckenna, indicates that 2 million Americans are sick yearly from antibiotic related issues, and calls out us doctors as being part of the problem, when we write antibiotics for viral infections and or we give low-doses, the wrong dose, the wrong directions for use, or the wrong antibiotics for the ailments. It further points out that all of these factors contribute to the patient being sick, and developing antibiotic resistance and that antibiotic resistance costs the US 2.2 billion dollars in medical expenses yearly. Pressure and fear of bad online patient satisfaction scores are the main reason given by doctors that were surveyed for writing unnecessary antibiotics, as evidenced by the just-released NPR article titled Patients Give Doctors High Marks for Prescribing Antibiotics for Common Sniffles which notes that patients felt more satisfied with their doctors’ visits when they received antibiotics for upper respiratory tract infections, whether they needed it or not. As a result, doctors are now writing prescriptions for the patients who for the most part do not know what they’re asking for or why. Some of the other reasons cited include physician fatigue at the end of the workday and “just-in-case” situations like those that arise at the urgent care settings or with a new patient in the office.
The struggle is real for us doctors. One time I found myself arguing with a patient’s mother on the phone, who according to her, knew her child’s body and knew that “only an antibiotic would fix the problem”. She got really upset because I essentially refused to give her 17-year-old daughter an antibiotic prescription for a maternally diagnosed “sinus infection” after 4 days of symptoms of nasal congestion and cough. She challenged me and actually threatened to lodge a complaint against me, to which I gingerly informed her that I would be glad to do the same, and I did. I stood my ground and refused to give her what she wanted, strictly because her child did not need it, prompting her to declare that she would simply call back and get another doctor and would get her way!
Luckily for me, these experiences have not deterred me, over time, I have persisted and continued on my mission to educate my patients, and more and more of them are now doing better with listening to me and trying to understand my reasoning. Many of them actually thank me, happy that someone took some time to explain the proper reasoning to them. On my part, I always end the talk by empowering them to take a moment next time their provider prescribes antibiotics for themselves or their children, to respectfully ask that burning question: “doctor, does my child really need those antibiotics?”
As a Nigerian-born physician, the plight of my people in the third world countries has not escaped my mind. In Nigeria, like in most developing countries, people still generally walk up to the chemist or pharmacy and purchase medications over-the-counter, antibiotics included. That behavior, in addition to the lack of effective government regulations amongst other issues with healthcare delivery, puts us all in even greater danger of antibiotic resistance and further underscores the fact that in September of 2017, the World Health Organization described antimicrobial resistance as “a global health emergency”.
Finally, I am writing this piece as a gentle reminder to each one of us to remember our Hippocratic oath “to first do no harm”, to educate the patients repeatedly until it sticks… and never tire in doing so. This, I say is one time we MUST all stick together and speak with one voice. Otherwise, it puts some of us who still do so, in a weird light. Sometimes it might be necessary to be firm and insist on doing what is right in order to practice good medicine. And in case you are thinking otherwise, always remember that never has it been known that a defendant told his defense attorney exactly how to defend him in court. Our patients should neither be telling us how to treat them, nor threatening us, nor grading us better, based primarily on antibiotic prescriptions.
“Widespread use of antibiotics promotes the spread of antibiotic resistance. Smart use of antibiotics is the key to controlling its spread” A. P. J. Abdul Kalam
“When antibiotics first came out, nobody could have imagined we’d have the resistance problem we face today. We didn’t give bacteria credit for being able to change and adapt so fast”. Bonnie Bassler
Howdy? Long time! Just wanted to touch base and check in with you. I am having a fabulous life, you? So, after about one month off from my Rideshare seat, I returned to it today, and as usual, I was pleasantly delighted to meet my clients. The beautiful thing about Rideshare is you never know who you might pick up next. My clients are often so different from each other. Each one teaches me a new and different lesson about life. Again, that is why I do this. The story goes like this… I am writing a book on teens, depression, and suicide. I woke up this morning and as usual, I worked on a couple of chapters, but I just didn’t feel like it was flowing the I wanted, I was having a hard time getting into my characters’ minds to tell their stories, so I declared to my mother “I NEED a depressed and suicidal teen in my life right now!”. I proceeded to explain why, when I saw the puzzled expression on her face. We both shrugged and concluded that-that was going to be a tough one to pull off. So, I go about my business for the day.
Later on, since my numéro très had a birthday party to attend for 2 whole hours, I decided to seize the opportunity, take a break from my preparation for my Executive MBA midterms next weekend, and go online on my UberXL/Lyft apps to see if anyone was interested in a fun ride with Dr. Lulu! Unbeknownst to me, the Good Lord was going to use my clients today to show me yet again that He alone is Lord and King and more importantly, the Author of the universe.
My first client, whom we shall call “Joe” was picked up less than a mile away, he was going in for his night shift at the “Howl at the Moon” downtown San Antonio. We exchange pleasantries, and I decide on a whim to give him one of my brand new business cards and inform him that I am a Public Speaker on Teen/Young Adult depression and suicide. He, in turn, gives me two free admission coupons to HATM, with discounts on happy hour drinks etc, and proceeds to sign me up for their email list for more (free) Happy Hour goodies! I am elated, accept my coupons graciously, thank him, and self-declared it would be a good shift for me today because I had started my day literarily touched by an angel. I inquire about his choice of music vs my audible book. He says he doesn’t really care, he would rather watch “Sex and The City” on his phone, and he would have his earbuds on. We both settle in for the ride downtown, and I proceed to continue listening to my “Four Hour Work Week, by Tim Ferris”. As we approach downtown, I shut the audible off to focus on the traffic and the people, I ask him if he heard about the 12yr-old boy who had committed suicide in a nearby town lately, his response almost knocked me off my seat! “Oh yes! my co-worker’s younger brother is his best friend, they are from Jourdanton” was his immediate response! I had never mentioned the name of the town, but he knew the right one… At this, I am completely speechless at the smallness of this world! What are the odds? How could it be? But it sure was. Sitting right behind me, in my car, was someone who knew someone, who knew someone, who knew the 12-year old that had been bullied on to taking his own life at a local middle school yesterday! Wow! I LOOOOVE doing this!
Next, I pick up a (two couple) party of 4 baby boomers at the Westin. One of them is disabled and has a wheelchair. Though my Sasha is a 7/8 seater UberXL-ready 2017 Toyota Highlander, they had the hardest time getting that wheelchair to fit in her trunk. They eventually did, and I sensed they were a bit flustered with the entire process. When I asked my usual icebreaker question “so how has everyone’s day been today?”, they all grunt and puff and reply “it has been a rough one”. Trying to cheer them up, I gingerly quip, “well, at least we are on our way to fun now”, to which one of the ladies retorted, “well, we are late to our event”. I think to myself, I had nada to do with it, then I hear myself say “well this Saturday evening downtown traffic is not going to help that”… an awkward silence follows. Then I change lanes and perk up by sharing a bit about what I do as I distribute my business cards. Front seat guy now informs me that they are from Florida, but he would certainly keep my card and keep me in mind…I am like, YES! We have some small talk about hurricane Michael and its toll. Things get a bit worse when the address that he had put in as their destination on the Uber Navigation, was in the middle of the nowhere! not Shuck Shack, on Grayson and Broadway as they had wanted. Turns out all that initial frustration I had sensed was because they were with a food tasting party and had missed their bus! A couple of phone calls and a couple more U-turns later, they are safely delivered to their destination. “Bon Appetit”, I think to myself as they say their thank yous and I drive off.
I hop over to Nueva Vista, an enchanted and quaint neighborhood tucked away next to the Pearl to pick up a couple who right away complement me on Sasha. I thank them and start my usual icebreaker questions. He quickly responds, “we are doing fine, but we are interested in this your car, we are looking for a multi-seater vehicle”. I happily tell them everything I can about my Sasha, as he tells me to ignore the Uber navigation system, and proceeds to guide me through their wonderful enchanted streets instead. I note the air is different there. I inform him that I am officially in love with his side of town. We make a right turn into San Pedro on our way to the movie theater on Route 410 and he points out Alta Vista a sister neighborhood on the left, another whimsical looking part of town. As I drop them off, I note to myself (be sure to bring the wifey here for a “romantical” drive someday) Ironically, his wife or rather, lady companion did not so much as utter a single word throughout the ride, and I can’t even remember if she said goodbye. But before I could process that thought, I got a chime to pick up my next client.
Handsome “Diego” joins my space at North Star Mall. He is an energetic, mid-to-late-twenties sweet smelly, colorful young man, getting off his shift at Michael Kors. He gets in the front seat, acknowledges my white LV Neverfull which I pick up and place on the floor in the middle row, thank him for the compliment, and tell him to get comfortable, as we start our ride. With a megawatt smile, he shares that he is “dog tired” because even though he had known he had to be at work this morning at 0900hrs, he had proceeded to go out last night, and got back really late. I go into mama-bird-mode and we talk a bit about growing up and taking responsibility for actions and such. We talk a bit more about his dreams and somehow get to the topic of his roommate with whom he had had a recent fight, he gently adds that he had bought him a small (make-up) gift from MK because he “hates the energy in their apartment when they argue and fuss”. I am full of admiration for this young man, who wants to make the world a better place, one gift at a time. I like him. We arrive at his apartments shortly thereafter, but he remains in the car because he is telling me all about the recent shooting at Pegasus downtown. Apparently, he had been there that night. He recounts how his mother had unusually texted him up to three times that night, the last text coming just minutes before the shooting. He says he suspects his mom somehow sensed something bad was going to happen and had been trying to reach him. I share my own mama-bird story about me and my son at Stanford, the night I had seen him in a dream reaching out to me, I had woken up with tears in my eyes, and when I called him, it turned out he was burning up in a fever and needed his Mama. An instant friendship is born. Diego left my car after earning one of my world famous warm hugs and promising to text me his employee discount code at MK…another satisfied client.
To pick up Ms. Megan, I had to make several U-turns, drive into the gated apartment complex, and wait for almost 2 minutes. As Uber starts charging her for my wait, I note a tall slim female approaching the car. As she walks up to me, wearing the latest millennial garb of a black mid-section-revealing-cropped-tee, on black double slashed jeans and tousled hair, I note that she is easy on the makeup and I think to myself with a corner smile… “that is exactly what my daughter would be wearing if I had one”. She greets me pleasantly, apologizes for her lateness, gets in the middle row, I move my Neverfull back up front, and she gets comfy. Right away I sense she has had a sad life. She has an ever so slight air of melancholy. I note that unlike most teens her age, she is not on her phone. She is not texting, she is not talking, she is looking straight ahead, both hands resting on her thighs and deep in thought. I remark on that, to break the ice, and she smiles ever so slightly. I know I am right. I start telling her about what I do, give her my business card. She asks for more cards and the next 23 minutes fill me with more awe than I could have ever imagined. She opens up and says the words that every parent of a teenager or everyone who is acquainted with one would give money to hear… “that is pretty cool that you are doing that”… I smile as I say, “thank you”. Then she not only proceeds to tell me that at her high school, they have had 7 suicides in the past 5 years, (the last two in the past year, one of which its anniversary is today!), but that she herself has had not one, or two, but three attempts at suicide! I CANNOT believe my ears! Earlier this morning, when I had asked the universe for a suicidal teen, I had absolutely NO IDEA this was in store for me. I thank the good Lord immensely, reach back with my right hand and take her right hand, she grabs it with both hands. and holds on, and I simply let her hold it as long as she needs to. I take a long deep breathe after she gets off at the LongHorn Steakhouse on I-35 South, shake my head slightly, and vow henceforth, to only speak out, that which I know I really want because it will come to pass.
Last stop for the evening was about a mile up the road on I-35 south. I pick up four Airmen from “the best tattoo place in town” according to front seat guy. They are young, late teens, early twenties-ish, full of life, and bright expectations for what the future has to offer in the best Air Force in the world, the United States Air Force, “first in flight”. After back row seat guy curses twice, I clear my throat and proceed to tell them I am a veteran of the USAF and ask how they were doing. Front seat guy tells me they are recent basic training grads from Lackland AFB, and currently at Camp Bullis for Security Forces training. Then comes a barrage of questions from all of them at the same time; “did you go through OTS?”, “did you ever get to deploy?”, “what do you think about Tyndall AFB?”, “would you do it again if given a chance?”, “what’s life like on the outside after a brief taste of the inside?” “did you do your 20yrs?” “what did you do while you were in?” etc. I smile and try my very best to address all of their concerns. One tells me he is from Kansas and would love to be stationed at McConnell AFB after I mention my brief manning-assist there. Another wants to know if I know anyone at Robbins AFB in Georgia, yet another asks me what I think about going in the reserves afterward, and then another wants to know about Alaska and if I could confirm that it is truly considered an overseas deployment. I marvel at all of this. It turns out to be such a fun trip, but I made sure I still got time to squeeze in a quick note on depression and suicide and the need to ensure they formulate good relationships and stick to the straight and narrow. By the time I drop them off at Top Golf I feel truly fulfilled and thankful for a fairly eventful and awesome shift. In a little under 3hours, I feel I have gained much more in knowledge than the nearly 80usd I have earned in cash today.
“if you want light to come into your life, you need to stand where it is shinning”
Last Friday, as I sat finishing up notes on the last of my almost 30 physicals (this number is never any surprise for us Pediatricians this time of the year, it’s back to school week, so every Thomason, Dickinson and Harrison is lining up for sports physicals and regular physicals and all sorts of clearance and medication forms that need to be filled out and turned in “yesterday”) I took a deep breath and exhaled, my mind filled with the events of the day. As is customary, my beloved patients often postpone their physicals all summer, in search of sandy beaches and clear blue vacation skies, so it’s usually a mad rush the first week of school.
I found myself reflecting on the patients I had seen that day as I often do at the end of my day. Most of them were mundane well baby and well child checkups, nothing really of note, a few of them had minor issues to clear up before returning to play…but one of them stood out clearly like a lily in a field of carnations…a 16year old we shall call “Maya”. I have met Maya only a couple of times in the past and I have known her to be a troubled teen, plagued with depression and anguish, never really smiling, not much eye contact, not much of an affect…just sad. I have tried to manage her depression the best I can with counseling in the office, a referral for proper psychotherapy. My good friend, and child psychiatrist sees her regularly and has placed her on an appropriate dose of antidepressants, and she reportedly goes to counseling regularly, all with little or no change in her mood(s)
She came in that day in the company of her mother and her older 17yr old sister. I sensed something wrong right away, but I continued my usual intros and salutations and other little talk. Her mom could not stop fidgeting, with the characteristic continuous knee shaking. Her sister’s face was buried in her mobile device for pretty much the duration of the visit, except when I inquired about her. It turned out her sister was also to be seen that day. Both mother and child proceeded to explain to me that her sister needed to be seen for “stomach problems” that only happen at her high school, stemming from her “unique eating habits”, and her lunch time not being fixed at a particular time of the school day. This apparently never happens at home or during the holidays or vacation, when she reportedly “has her own eating schedule”. She wanted a note from me to the school nurse authorizing her to eat her lunch at the exact time she wanted, or she would develop abdominal cramps, nausea and headaches and “get so sick” she would end up being sent home from school. This story line and request stuck me as bizarre, I recognized a familiar thread of possible anxiety in her sister, and maybe some co-dependency in her mom, but I digress…
I somehow am a magnet for depressed and suicidal teens, and Maya, was no different. She made absolutely no attempt to engage with me, no eye contact, shoulders drooped over, melancholic and flat affected. She appeared pale, ashen and sullen, with dark circles around her eyes, she simply looked like she could use a looooong-warm-heart-filled-hug. During the physical exam, she hesitated to take off her sweat shirt, but I insisted, eventually, her mother ordered her to do so. She did so veeerrry-reluctantly, and immediately pronated both forearms…I gently supinated them, and to my horror, revealed numerous, clearly visible, freshly carved cuts all over her forearms, extending from her wrists all the way to her elbows, on her left and right forearms respectively. I said nothing, gently turned them back to her preferred position, completed her examination, and walked back to my seat. I then calmly asked her mom about Maya’s depression and how her cutting behavior was fairing. She hurriedly replied “oh, a lot better, she is receiving counseling, and has not cut in 2years. 2yrears?? I thought to myself, more like 2days!!… Her response immediately made me stop typing on my laptop EMR, I looked up at her, made sure my words came out clearly and as gently as my rapidly beating heart could muster, as I said, “No ma’am, I am afraid but I have to tell you that Maya has fresh cuts on her forearms and wrists, that are probably not more than 2 days old…”
The rest of the visit was a bit awkward. Her mom asked to see the cuts, Maya vehemently refused, and an uneasy silence set in after I explained to mom that, she would probably do better waiting until they got home to approach her alone in her bedroom. Meanwhile, we should probably revisit her counseling sessions, and explore the possibility of an in-house facility if possible, especially since her self-completed PHQ-9 score that day was a total of zero.
I write this story today to remind myself of my why. To urge each one of us doctors to remember our why(s) Never lose sight of the reason you went into medicine, no matter what. We are a special breed, a unique set of like-minded individuals who choose service to humanity above all. We choose to make a difference in our patients’ lives regardless of all the administrative, legislative, personal and sometimes insurmountable difficulties we face daily in the field. I was reminded that day of my reason for leaving my beloved 9-5 job to follow a passion of fighting to end teen depression and teen suicide. I was reminded to follow my heart and believe in my dream. I was reminded to stay the course, because, for every Maya in my office, there are a hundred or even a thousand more out there, so, I must go forth. “The harvest is plenty, the laborers, few…”, Luke 10:2
PS: My website dedicated to fighting teen depression and teen suicide, teenalive.com is LIVE, click the link to check it out!