Happy 2016


This has been an unsettling year.  We have the elections with the cast of clowns. Really, they all just need a red nose and a clown car.  The news media is no better. Then there is the cast of characters who are in charge of our government. It is truly not the statesmen we grew up admiring even when we disagreed with them.  There is no eloquence in the speeches or great land mark legislation passed.

We have seen what racism has produced in our over the top policing that has led to a record number of shooting deaths of unarmed black males.  The shoot to kill approach rather just arrest.  I watched a video of the London Police take down the subway attacker and there was no gunfire even though he had a knife.  There have been so many revealing and brilliant  NYT Op-eds written and I have posted them all on my Facebook page.

I don’t make New Year’s resolutions.  I am preparing to take a new position by returning to graduate medical education. This has allowed me the opportunity to review my career by putting together a credentialing application. I had to provide licenses, education history, documentation of competency regarding specific procedures and get letters of support from former colleagues.  I am reviewing evidence-based guidelines for the treatment of acute and chronic diseases.  Another requirement is completing modules and reviewing corporate compliance and learning about the culture of the organization I am joining. There is a review of the vision, mission, and values of the organization.

When I see the widespread use of deadly force by our police, I  can only ask if this is the culture and part of the training.  Is there any review of skills and competency documentation? Does it go beyond the firing range?  Is there any cultural awareness training? What is the vision, mission and values statement of the police force? Is it written and reviewed?

This also can be applied to our politicians.  Their vision, mission and values are not clearly stated and they have not shared their plan of including all Americans. The issues of gun violence especially looking at not only police shooting, but acts of terror and black-on-black murders.  Women’s reproductive rights are under attack and we cannot forget the wage gap. The issue of racism is real and as one of my colleagues has stated, must be addressed.  Racism is leading to a wealth and education gap. In the medical community, racism affects patient care, medical school admission and matriculation, and the number of medical educators that are from underrepresented minorities (URM). The definition of URM is African Americans, Mexican-Americans, Native Americans (American Indians, Alaska Natives, and Native Hawaiians), Pacific Islanders, and mainland Puerto Ricans. This is very important because of the cost of medical education and the issue of work-force diversity.

I am looking forward to 2016. I am energized by all that I (we) have to accomplish.   Happy New Year!!!

Caring for Patients: The Holiday Season


I love the holiday season.  Being a physician has changed some aspects of holidays and the way I celebrate them.  All holidays were defined as being “on-call” or “off-call” and it was that way always.  My first year in residency, I was on-call for Christmas.  I had a wonderful potluck dinner with the hospital staff who were working in the ICU.  All through my training, I was mostly on-call and not able to make it home to Birmingham. When my son was born, it did not change.  We were adopted by my friend Elaine (my senior resident) and we spent many holidays with her family in Montclair.  Her father was my hero.  He was the first African American physician to be allowed to join the Medical Staff at Mountainside Hospital.

When we moved to the Eastern Shore, for the first few years, I was on-call.  We were showered with gifts from patients and their families. At first, I was overwhelmed by the kindness.  I was always just being a physician and caring for each patient in the manner I was trained.  That is what Meharry Medical college taught me.  I had to learn to be a good receiver.  I was always taught it is better to give. So I always found it easier to give.

I usually performed my Christmas hospital rounds early in the morning while our kids were sleeping.  My husband made waffles and sausage and they opened gifts after breakfast.  I would hold my breath hoping not to get a call from the hospital, ER or a patient until after I saw their faces light up. The holiday season was a mixture of happiness and sadness.  I had several patients who each died around the holiday season.  One of my patients with AIDS who was suffering from a serious infection died.  I had mixed emotions. I was sad for his family but relieved that he was free from the suffering.  Another patient had a massive heart attack on Christmas day and died in the front yard of his home.  His family was devastated.  I had to be in the ER after the resuscitation.  One year, we had an influenza outbreak that almost closed the school system.  It stopped when the school let out for the holiday break.  The hospital had special treats and dinner for patients who were hospitalized. They each had small decorated trees in their rooms.  One year I was treated to the beautiful voice of a patient singing Christmas carols.  She had an infected bone in her foot (osteomyelitis) and needed IV antibiotics.  She had no family so we could not set-up home therapy for her. I loved rounding at the Nursing Home.  The decorations in the lobby and the patient areas were beautiful. The patients families would be visiting and always thanked us for the care we gave their loved ones.

One year, we received three turkeys, a ham, a large tin of assorted fresh fruit and Omaha Steaks.  That did not include the boxes of cookies.  We had to donate it to the Salvation Army and the AIDS Hospice.  Everyone benefitted from the love that my patients and colleagues showered on us.  I loved to make pies.  So I would make them and deliver them to my colleagues. One colleague was asleep so I left the pie on the top of her car.  She was thrilled.  It was one of my sweet potato pies.

Living in a small town, afforded me the opportunity to be invited to so many holiday events. Each year, I had to purchase several outfits for the party season. The selection was always from Nordstrom’s Half Yearly Sale. I would go to the sale with my shopping buddy Ann. The season began with the Hospital holiday party for the medical staff. The next was our office party.  I loved the Secret Santa gifts.  I had to find the best gifts for each person.   One year, I was awarded the “Doctor of the Year.”  There was the holiday party at the Country Club.  That invitation was courtesy of my office manager and her husband who owned a local bar. One patient was an organist and music director at the Episcopal Church.  We had the pleasure of being invited to the annual performance of “The Messiah.”  The husband of my nurse was a noted tenor and he was the highlight of the performance. My colleague Ann was a cardiologist and an accomplished musician.  She performed in the Bell Choir at her church.  I loved their annual Christmas Concert.  Afterwards, we had a wonderful dinner at her home.  She was an exceptional hostess.  We had many dinners in her home which included Easter dinner for several years.

When I left after six years, I received so many Christmas card.  I started a tradition with so many former patients. Over the years many of them died.  The return card would be from a family member.  The first year, the husband of a patient I had treated a chronic infection died and he sent me a long letter and her Funeral program.  He said, “She loved receiving me card each year. I regret having to inform you of her death.”   We continued to send each other cards until his daughter sent me a card informing me of his death. To paraphrase, “My father was heart-broken over the death of my mother. He has now joined her.”  One year, the wife of my former patient sent me his funeral program and copy of his picture.  He always brought me fresh kale from his garden.  He was known as an excellent cook and baker.  He always brought us baked goods.

Now, I  work for the state of NJ and in our ethics policy; we are unable to receive any holiday gifts except small ones from colleagues.  If a patient gave me a gift, I would have to take it their office and it would be donated to the appropriate charity.  The past two years, I have not been on call.  This year, we spent a few days in NYC.  I saw the Radio City Music Hall Christmas Spectacular with the Rockettes, looked at all the holiday decorations and pushed through the crowd to see the tree at Rockefeller Center.

Merry Christmas to all

Sisterhood of the World Bloggers Award

I started blogging at the encouragement of my friend Lisa Winkler who is a writer, teacher and cycling enthusiast.  Lisa paid me the compliment of awarding me the “Sisterhood of the World Bloggers Award.”


I enjoy reading her blog Cyclingrandma http://cyclingrandma.wordpress.com/

With the award there is a caveat, that the nominee may or may not choose to follow. The first is that you pass on the award to other bloggers.  The second is to answer a total of 10 questions.  So let me comply with answering the questions first.

1. What is your favorite color?  If you looked in my closet, you would think my favorite color is black or gray.  However, I really love the color magenta.  I wear it a lot over black. I also like orange.
2. What is your favorite animal?     I am fascinated by elephants, though you would not cuddle up with one. I am always amazed how something so big can be such loving. I would own a collie if I had the time.  I always loved Lassie.
3. What is your favorite non-alcoholic drink?   I love the taste of coffee.  I drink it without sugar just a little cream.  I stopped drinking sugar years ago so water and a twist of lemon is my mainstay.
4. Facebook, Twitter or both?  I do both.  However, I found out I am too wordy for twitter.  There is an art to a meaningful tweet. I honed my skills on a medical advice site called HealthTap.
5. What is your favorite pattern? I love floral patterns.  They look best on me now, especially with my natural hair.  However, I love geometric patterns for pillows and dresses.
6. Do you prefer getting or giving presents? Well, I prefer both.  I just read on Oprah.com that to be truly happy, you have to learn to give. So, I will be working on increasing my happiness by giving. It really looked at the small things we can do.
7. What is your favorite number? So, it is the number 1 because I always tried to be first because I am the oldest.  After going through Medical School, 10 was OK, meaning second 10% of class.
8.What is your favorite day of the week? I love Sunday morning.  It has always been a day to relax.  When I was younger, it was church.  Now it is a cup of coffee, breakfast and the New York Times.
9. What is your favorite flower? I have an allergy to flowers but if I didn’t, I would fill the house with roses.  I had a rose garden when I lived on the Eastern Shore.  My husband managed to save it after it was neglected by the previous owner.  I always had them in the house despite my allergy. It was beautiful.
10. What is your passion? I really enjoy caring for patients.  Every time I think about what else I could do, it all comes back to medicine.  I am a Family Physician and I love it. Yoga is my next passion.  I would be a yoga instructor.  I think it has much in common with medicine and caring for people.

Here are my answers to your questions Lisa. I promise to get back with my nominees for this award.

December 1

December 1 was my husband’s 70th birthday.  It marked 30 birthdays that we have celebrated together.  That is hard to believe.  December 1 is his birthday but it is also World Aids Day. The first World Aids Day was Dec 1, 1988 which was 25 years ago.  I witnessed the first documented case in our hospital in 1983 when I was a resident.  Five years later during my Family Medicine Residency, we would diagnose many cases in men, women and children.  My residency and pediatrics rotation provided an opportunity to unfortunately hospitalize several children who had AIDS.  I provided care to many patients with AIDS and watched too many of them die over a period of 12 years.

It is hard to believe that with all the new information that there are a rising number of new HIV infections in young African- American and Hispanic males.  The irony is that we relaxed the push to get information out there to these at risk groups.  According to the Centers for Disease Control (CDC), African-Americans represent approximately 12% of the U.S. population, but accounted for an estimated 44% of new HIV infections in 2010. Also, Hispanics/Latinos represented 16% of the population but accounted for 21% of new HIV infections in 2010.  Of those living with HIV in 2009, Hispanics/Latinos accounted for 19% and Blacks accounted for 44%. Sadly in 2010, the greatest number of new HIV infections (4,800) among MSM (men who have sex with men) occurred in young black/African-American MSM aged 13–24. Young black MSM accounted for 45% of new HIV infections among black MSM and 55% of new HIV infections among young MSM overall.  These are alarming statistics http://www.cdc.gov/hiv/basics/statistics.html


I am no longer providing direct care to patients who have AIDS but I do know that I will be diagnosing and referring new patients for treatment.  I am recommitted by these statistics to get the news out to a new generation.  Safe sex through use of condoms is essential to prevention.   However, the sad truth is that 1 in 6 people with HIV do not know they have been infected.  Getting tested is important.  Let’s get the information out there. For more information http://www.itsyoursexlife.com/gyt/hiv-aids/

Caring for the Ladies: Adolescent Females

Being the mother of an adolescent female can be difficult. Being the physician for both can be challenging but rewarding.  I have been amazed over the years as my patients asked me to talk with their daughters about safe sex and contraception.  They gave me permission to do what as necessary knowing I could never reveal any details of the encounter.  It was a very special trust they had in me.

Often their fears were unfounded.  Many of them had been teen mothers and had to marry because of an unintended pregnancy.  The truth is all mothers want the best life for their daughters. That includes a good education and the opportunity to be independent.  However, in some cases this was not true. These encounters made my encounters difficult.

One of my teens was in a very abusive relationship.  Her mother and family were not supportive. I found myself involved in her life more than I should have been.  One unintended pregnancy was ended with my assistance but the second was not.  I had to find the best obstetrician and arranged prenatal care in the next town.  She had several ER visits due to trauma. Her pregnancy was complicated by a seizure due to Eclampsia. She had an emergency cesarean section. Being a teenager, she did not understand that the seriousness of the situation.  Thankfully, the obstetrician was an experienced provider and he and the staff acted quickly to save her life and that of her son. She was a very good student with so many strikes against her but she managed to be successful as an athlete and a mother. She achieved awards in her sport and should have gone on to a 4-year college.  With support, she did go onto first community college and then on to further success.  Her grandmother was her rock.

Sometimes, I discovered my teens were having sex only when one of them presented with a serious infection.  I admitted several for Pelvic Inflammatory Disease or severe genital herpes Infections.  This was one of those difficult times.  I could not reveal the diagnosis to the mother who was my patient.  I had to leave that to the daughter.  Most gave me permission to talk with their mothers.  As a college Health doctor, I only have to deal with the female student.   They are naïve and still not comfortable negotiating the issue of safe sex.  Still not confident enough to demand their partner use a condom.  The idea that birth control is to prevent pregnancy and condoms prevent infection is still not a concept women embrace.

In my private office back then, my encounters for contraception were made a little less complicated because I had an unlimited supply of the latest oral contraceptive samples.  I just kept my teens supplied.  I even gave them out as a morning after pill regimen.  The most enjoyable encounters were sending my teens off to college.  I performed a physical examination, discussed safe sex and gave enough birth controls refills or samples to get them through the first semester, most did very well and came back home only to visit.

Now as a college health physician, I see times have changed. I have the same opportunity now to talk to my female students about safe sex, contraception, the HPV vaccine and prescribe the new generation of Emergency Contraception. But now, my female students are from all over the world.  I don’t have the same relationship but I do have a chance to dispel myths and fears about contraception.  Many are struggling with the stress of education, family pressures, cultural expectations, and sexuality.  Not easy.  In between, diagnosing viral syndromes, managing implementation of an electronic health record; I have to be sensitive to their concerns.

I am now going to make a plug for the Affordable Care Act.  I have an easier time prescribing for my college students because they have health insurance.  They are covered by their parents, work or through our Student Health Plan.  Thankfully it covers contraception because that is part of the law.  I am starting a campaign to push emergency contraception because that is covered too.  With all the talk over what is not working, let’s take the time to be thankful for what is working.  As women and mothers, that is a lot less worry for all of us.

Rude Awakening


The last few months have been very emotionally difficult.  I have in a sense of the word lost close friends and family.  These are people who without a doubt I just knew would be in my corner through thick and thin.  But then reality hit me because when I need them the most they are nowhere to be found……  Everyone I talk to tells me not to take it personal but how am I suppose to take it??  This is my LIFE I am fighting for.  Everyone loves you and wants to be there for you until you truly need them and then they just disappear.  They find every excuse in the book to why they all of a sudden can’t or are not willing to help you.  (It’s because of this or because this came up or my Dr. said this could happen)  The part that hurts the most is that if the…

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