4 Airmen, Diego and Megan

 

Dear Blog,

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.

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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. Photo by Pixabay on Pexels.comShe 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”

                                                                                             ~Guy Ginley~

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Physicians, never forget your WHY…

 

Dear Blog,

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)

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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…

Maya on the other hand, wore a thick black sweat shirt and jogging pants…mind you, it is 105F outdoors in San Antonio Texas in July! As I indicated in my first two Kevinmd articles https://www.kevinmd.com/blog/2018/07/a-pediatricians-healing-spirit-treating-depressed-anxious-and-suicidal-teens.html, and https://www.kevinmd.com/blog/2018/08/why-this-physician-quit-her-job.html

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…”Self-inflicted lacerations on arm of man : Stock Photo

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

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#endteendepression

#endteensuicide

#askdocotorlulu

BB

PS: My website dedicated to fighting teen depression and teen suicide, teenalive.com is LIVE, click the link to check it out!

My name is Dr. Uchenna Umeh and I am an immigrant (Physician)

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Dear Blog,

As far back as I can remember I’ve always wanted to be an architect. My journey to becoming a physician started somewhat as a dare. I was born in Nigeria, the first child of six children from middle class parents. My father served in the Nigerian Air Force, my mother, a Banker.

Towards the end of my secondary education (I attended an all-girls boarding secondary school, F.G.G.C Bakori, making me a Bakorian for life!) my father asked me the natural question, “So what are you going to study in the university?” I eagerly answered “Architecture!” He went on to say the words which hit me like bricks. “Nne, you are a woman, architecture? why don’t you study pharmacy like your (female) cousin? I was bewildered but not for too long, you see, in the Nigeria of my father’s and my childhood, certain professions were still “meant” for certain sexes. I gently and calmly explained to him that I would rather study medicine if I must do something in the “medical field”. Then he added, “But medicine is for men, why don’t you do something more feminine?” At this point, I promised him I would work really hard to prove to him that I could and would become a doctor, regardless of my sex. After completing medical school (I was one of a few females in my majority male graduating class) I decided I would like to go to the US for my residency, and I wanted none other than Howard University in Washington D.C. This decision was again met with “But you are a single female”, “America is so huge, and we really don’t know anyone there”, “How are you going to manage on your own?” “I hear that everyone uses drugs out there”, “You are not married yet”, “What about children?”, “Will you meet a nice Naija guy to marry?”, “Don’t forget your Igbo o”, on and on and on …

Foreign medical graduates take the ECFMG/USMLE exams to get into residency in the US. These exams are tough, they are expensive, and those of us from Nigeria, had to travel to Ghana to take them, because it was the only country with test centers in West Africa at that time. After scaling each exam with one try, I applied for residency. After my experience with the entire process, I became a believer in the power of speaking one’s destiny into existence. I applied (from my home in Nigeria) to a total of seventy-five different residency programs. Eight of them responded, six turned me down, and only two invited me for interviews. In the process of raising money for my trip, obtaining a visa from the US Embassy, and finally “coming to America”, I made it just in time for my interview at Miami Children’s Hospital, but I arrived at Washington D.C, one day late for my interview at Howard University Hospital.

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Now I need to explain to you that while I was in Nigeria, I somehow managed to keep and maintain a line of communication with the secretary of the department of pediatrics at Howard University Hospital. I called her frequently, closely following the progress of my application, and folks, that singular act, ended up saving the day. She amazingly recognized my voice, the lady that had been bugging her all the way from Nigeria! Thankfully, she was able to secure another spot for an interview for me, only by the good grace of God. I must mention here, what my odds were: I was a day late for my interview, there were over 4000 applicants, there were fourteen positions, and I got matched! How’s that for fulfilling my destiny?

As a “newbee” in America, I had many memorable firsts. My first greyhound bus ride from New York to the Nation’s Capital, the first Bratwurst hot dog I ate on the streets of New York, the sounds and smells of the subway stations of Washington D.C and New York, the sheer number of homeless people on the streets, the huge number of teen-aged mothers pushing baby strollers on every corner of the streets of Queens, my first encounter with a flasher on a Brooklyn-bound New York subway train, etc… but the cherry on top was undoubtedly the golden opportunity to train at Howard University, and to have matched at my very first try!

Residency itself, was not particularly difficult. The hospital had enough Nigerian residents and faculty for my comfort. However, as a recent immigrant, I had to adjust my ears to understand the American English, its many accent(s), and its unique vocabulary. I remember especially having a hard time with phrases like “glove compartment” not pigeon hole, “flash light” not torch light, and “diaper rash” not nappy rash. Never mind the new spellings of words like color not colour, tire not tyre, pediatrics, not paediatrics or estrogen, not oestrogen. I also had to re-learn old medications with new names like “Tylenol”, instead of Paracetamol/Panadol, “Amoxicillin” not Ampiclox, and the fact that there are absolutely no antimalarials, or typhoid medications being prescribed anywhere! I was puzzled by the fact that most people I met were impressed by my English language and vocabulary. “Where did you learn how to speak English?” they’d ask, “You ain’t gat no kids at twenty-seven years old?” and one of my favorites was “How did you get to America, did you fly? to which I would usually respond “No, I sailed on La Amistad to the shores of Georgia, and swam the rest of the way”(seriously??, rolling eyes emoji), and there was the occasional “So you are Nigerian, do you happen to know Hakeem Olajuwon?”, to which I would gladly say “No, but maybe you know Michael Jordan?”… I tell ya…! SMH

I eventually completed residency, got married, moved to South Carolina and started a private practice. With a J-1 VISA, I had to start up in a Health Professional Shortage Area (HPSA) in Lancaster county, South Carolina. I adjusted well. I had one son at the time, and my practice was doing okay, until one fateful day, a disgruntled mom reminded me that I was far away from home with the words, “Go back to your country and stop taking our jobs!” I’m like…what? These words came from an unemployed citizen who felt I had to give her child antibiotics for a cold or else…(…more eye rolling) Funny enough, these days, I sometimes ponder on her words, how she could have ever imagined I was taking her job? or how I could have been of any sort of threat to her source of livelihood? Other than that, and a few other interesting comments like “Ma’am, I love your accent”, or “Doc, I don’t want to mess up your name, so I will just spell it out”, or, “You have an accent, is it Jamaican?” life in these united states has for the most part, been good.

It has been nearly twenty-five years since I first came into this country, nervous, afraid, but bright-eyed and determined to get into residency, at none other than the Howard University Hospital.

H.U!

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“Obstacles do not block the path, they are the path”       -anonymous

 “I didn’t come this far, to only come this far”       -anonymous

“Believe in yourself and all that you are, and know that there is something inside you that is greater than any obstacle…”          – Christian D Larson

 

PS: My website dedicated to fighting teen depression and teen suicide, teenalive.com is LIVE, click the link to check it out!