Big D, little d, what begins with D?

Happy things starting with D:

Discrimination, death, delight.

I am happy that slowly, slowly, it feels as if there is change in the world and a decrease in discrimination. It is NOT gone by any means, but I think it is slowly being eroded.

My parents had a party when I was two and they were both in college. The party was raided in Knoxville, Tennessee in 1963 and my father was taken to jail. My mother and I were left alone and she was afraid we would be lynched by the neighbors. The next morning the paper wrote about a MIXED RACE COLLEGE STUDENT PARTY possibly with orgies. My parents were both suspended from the University of Tennessee.

They were both reinstated after a hearing, because there were no drugs, no underage drinkers, and it was not illegal to have a mixed race party. My parents never touched marijuana ever and I think it was because of that party. I don’t remember it, but I still feel cautious at parties and in crowds. My mother refused to return to the U. of TN and eventually finished her undergraduate degree at Cornell. My parents were so notorious that we left Knoxville as soon as my father graduated.

I grew up learning protest songs and work songs and joke songs. My mother joked about the party and it was years before I found out how terrifying it was. My mother joked that they sat at the one liberal table at the University of Tennessee. I hate discrimination and I do not understand it.

Death: is death a happy thing? Death is as much a mystery as life, and we cannot have one without the other. How could we value life if it were eternal? And we’d also get awfully crowded. I have the privilege of caring for all ages in clinic, all genders, any race that comes in the door, age newborn to 104, what joy! I get to be present when someone is dying and try to help the person and the family. There is no single idea about death or about how to “do it right” and often families struggle with multiple opinions and ideas and feelings. Death is as intense as birth and I have had the privilege to attend both.

Delight: there are many things that I find difficult and depressing, but I find delight too! The latest morbidity and mortality report from the CDC on overdose deaths, up from 52K in the US in 2015 to 62K in the US in 2016: Overdose deaths involving opioids, cocaine and psychostimulents — United States, 2015-2016. We have to work harder to prevent addiction, why do we choose addictive substances, why do people think it won’t happen to THEM?

And yet, I still find delight, taking photographs of bird, seeing patients that I know well in clinic, we laugh often, finding joy walking outside, my family and friends.

D

The photograph is from Mauna Loa last week. It is not a giant dinosaur nest, it’s a cinder cone. At least, that’s what a geologist claims….

 

I shall leave you

My poems start with a problem, an idea, a worry. I never know where it will go when I start. This poem started with wanting to leave in a positive way and started with the title. So how could I leave but leave with kindness? And what would I leave?

So it is a song. And should include sign language, I think….

I shall leave you

I shall leave you with a song
I shall leave you with music
I shall leave you with a picture
I shall leave you with voice upraised

I leave you with a song
I leave you with music
I leave you with a picture
I leave you with voice upraised

I leave you a song
I leave you music
I leave you a picture
I leave you voice upraised

I leave a song
I leave music
I leave a picture
I leave voice upraised

leave a song
leave music
leave a picture
leave a voice upraised

a song
music
a picture
a voice upraised

song
music
picture
voice

song

inherit

For the Daily Prompt: inheritance.

Such soft colors. I am trying to capture the ferry wake color in the sunrise.

The news this morning and I am thinking of girls who are not believed and predators who are after them. And boys too. I am thinking of medical school, this essay.

I am thinking of the comment from a fellow male medical student, about the statistics of one girl in five sexually abused:  “I never believed it. I didn’t think women could be okay after that.”

There is still the idea in our culture of a woman “ruined”. Women are still not believed. Boys are assaulted, too. One in twenty. Here: http://victimsofcrime.org/media/reporting-on-child-sexual-abuse/child-sexual-abuse-statistics.

And in the end, I wonder, what are the adults thinking? It’s the woman’s fault for being pretty? It’s the girl’s fault for being vulnerable? The devil made me do it? I was tempted by evil? It isn’t my fault. I have money and power and therefore I can do whatever I want. Women and children aren’t people, I can buy and sell and use them.

I am so relieved to hear the news from Alabama this morning.

 

 

 

teens high risk for addiction

What teens are at high risk for addiction?

Would you say inner city, poor, abused, homeless?

This study : Adolescents from upper middle class communities: Substance misuse and addiction across early adulthood. which I first saw in WebMd, says that the privileged upper middle and rich children are at higher risk  for addiction than many of their peers.

350+ teens in New England were studied.

Drug and alcohol use was higher than across country norms, including inner city.

Rates of addiction diagnosis by age 26 were
19%-24% for girls
23%-40% for boys
These rates are two to three times the norms across the country.

Rates for addiction diagnosis by age 22 were
11%-16% for girls
19%-27% for boys
These rates are close to the same in girls, but twice as high in boys as peers across the country.

The teens were often popular high achievers who are A students. Parents tended to drink more in those cohorts than the norms.

Also: “Findings also showed the protective power of parents’ containment (anticipated stringency of repercussions for substance use) at age 18; this was inversely associated with frequency of drunkenness and marijuana and stimulant use in adulthood.” That is, parents who sent a clear message that consequences for illegal and underage substance use including alcohol and marijuana would be serious, provided protection for their teens.

A second article: Children of the Affluent: Challenges to Well-Being says this:

“Results also revealed the surprising unique significance of children’s eating dinner with at least one parent on most nights. Even after the other six parenting dimensions (including emotional closeness both to mothers and to fathers) were taken into account, this simple family routine was linked not only to children’s self-reported adjustment, but also to their performance at school. Striking, too, were the similarities of links involving family dining among families ostensibly easily able to arrange for shared leisure time and those who had to cope with the sundry exigencies of everyday life in poverty.”

Other children’s perception of parenting examined included:

felt closeness to mothers
felt closeness to fathers
parental values emphasizing integrity
regularity of eating dinner with parents
parental criticism
lack of after-school supervision
parental expectations

This aligns with my observations both in my town and with patients. I see parents “check out” sometimes when their children are in their teens. “I can’t control him/her. They are going to use drugs and alcohol.” I told my children that if they partied I would NOT be the parent who says, “Oh, he needs to play football anyhow.” I would be the parent who would be yelling “Throw the book at him/her. Bench them.” And I saw parents of teens going out to the parking lot to smoke marijuana at a church fundraiser when it was still illegal. And saying “Oh, our kids don’t know.” I thought, “Your kids are not that dumb.” They invited me along. I said, “No.” And I really lost respect for that group of parents. What example and message are they sending to their teens? Yeah, cool, do illegal things in the parking lot, nod, nod, wink, wink.

Meanwhile, my children keep me honest. “You are speeding, mom.”

“Yeah,” I say. “You are right. Sometimes I do.” And I slow down.

Make a difference

In medical school I made a difference.

I was with two women and two men from class. We’d had a lecture on rape that day. One of the guys piped up, “If I were a woman and I was raped, I’d never tell anyone.”

“Man, I don’t feel that way.” I said, “I would have the legal evidence done, have the police on his ass so fast his head would spin and I would nail his hide to the wall.”

He looked at me in surprise. “Um, wow. Why?”

I took a deep breath and decided to answer. “You are assuming that you would be ashamed and that as a woman, it is somehow your fault if you were raped. I was abused by a neighbor at age 7. At age 7 I thought it was my fault. I thought I might be pregnant, because I was a bit clueless about puberty. I made it stop and tried to keep my sister away from the guy. When I went to the pediatrician the next time with my mother, I decided that since he didn’t say I was pregnant, I probably wasn’t. When I started school that year, second grade, I thought sadly that I was probably the only girl on the bus who wasn’t a virgin.

In college, I heard a radio show about rape victims, how they blame themselves, often think they did something to cause it, are often treated badly by the police or the emergency room, and feel guilty. All of the feelings that I had at age 7. I realized that I was 7, for Christ’s sake, I wasn’t an adult. It was NOT my fault.

If I walk down the street naked, I’m ok with being arrested for indecency, but rape is violence against me and no one has that right no matter WHAT is happening.

And child sexual abuse is one in four women.”

The two guys looked at the three of us. After a long pause, one of the other women shook her head no, and the other nodded yes.

The guy shook his head. “I never believed it. I didn’t think women could be okay after that.”

“Oh, we can survive and we can heal and thrive.”

We had the lecture on child sexual abuse a few months later. My fellow student talked to me later. “I thought about you and — during the lecture. I thought about it completely differently than before you talked about it. I would deal with a patient in a completely different way than I would have before. Thank you.”

 

previously posted on everything2.com in 2009

for the Daily Prompt: release

Adverse Childhood Experiences 9: crisis wiring

I spoke to a patient recently about ACE scores. A veteran. Who has had trouble sleeping since childhood.

“What was your childhood like?” I say. “Was sleeping safe?”

“No, it wasn’t. We were in (one of the major cities) in a very bad part of town.”

“So not sleeping well may have been appropriate. To keep you safe. To survive.”

We both think this veteran has PTSD.

“I think I had PTSD as a child. And then the military made it worse.”

I show the veteran the CDC website and ACE pyramid: https://www.cdc.gov/violenceprevention/acestudy/about.html.

Adverse childhood experiences. Leading to disrupted neurodevelopment. Leading to a higher risk of mental health disorders, addiction, high risk behavior, medical disorders and early death.

Ugly, eh? Damaged children.

“But I don’t agree with it.” I say.

My veteran looks at me.

“Disrupted neurodevelopment.” I say. “I don’t agree with that. Different neurodevelopment. Crisis neurodevelopment. We have to have it as a species in order to survive. Think of the Syrian children escaping in boats, parents or sibling drowning. We have to have crisis wiring. It isn’t wrong, it’s different. The problem is really that our culture does not support this wiring.”

“You can say that again.”

“Our culture wants everyone to be raised by the Waltons. Or Leave it to Beaver. But the reality is that things can happen to any child. So we MUST have crisis wiring. Our culture needs to change to support and heal and not outcast those of us with high ACE Scores.”

My Veteran is quiet, thinking that over.

I say, “You may read more about ACE scores but you do not have to. And we can work more on the sleep. And we do believe more and more that the brain can heal and can rewire. But you were wired to survive your childhood and there is no shame in that.”

 

I took the picture in Wisconsin in August.

 

loyal

For the Daily Prompt: loyal.

I am thinking of the men working with the Weinstiens and the Cosbys. They might have heard a rumor, but they ignored it? Women are free to speak up if there is a problem?

No, gentlemen, actually women are only “free” to speak up if they are rich and in massive groups.

Otherwise, we are dismissed, silenced, disbelieved and ignored.

For me, it was at age 7. Are you going to say I was dressed wrong? I was too sexy? I should not have been alone with him? It’s my fault?

The water is beautiful and reflects the sky. What do you think is there beneath the surface in the depths?