Caring for Patients: It’s medical not political

Thanks to the Affordable Care Act we now have coverage for contraception under all insurance plans. There are some exceptions. The rants of Mike Huckabee and other politicians were very upsetting. I did like Carly Fiorina’s take on the issue “Men should stop talking about women’s issues”. This really should be an issue discussed in the privacy of an examination room with a woman and her health care provider. Taking care of women has taught me some lessons. Women want reliable contraception with few side effects to prevent an unintended pregnancy and have the freedom to enjoy a sexual encounter with their partner. It has nothing to do with controlling our libido. It is about not worrying about a missed period. Another lesson I have learned is that caring men want their partners to have a reliable contraceptive with few side effects. They do not want their partner to have to suffer. They do recognize that they have to take responsibility and use a condom if they have to and feel very upset if they fail. Many of these of these offensive remarks sound like comments I have heard from abusive partners over the years.

The CDC website states that psychological/emotional abuse can “include, but is not limited to, humiliating the victim, controlling what the victim can and cannot do, withholding information from the victim, deliberately doing something to make the victim feel diminished or embarrassed, isolating the victim from friends and family, and denying the victim access to money or other basic resources. It is considered psychological/emotional violence when there has been prior physical or sexual violence or prior threat of physical or sexual violence”. If this sounds familiar, it should make you as upset as I am. If you go back and listen to every statement made by the outspoken politicians of late, you find elements of this definition in their statements.

For me, starting the pill after my son was born made residency much easier. My husband was a pharmaceutical company sales representative. The company launched its low dose oral contraceptive pill and I started taking it in 1987. After a few weeks of morning nausea, I was fine. I learned to stop my period even before it was common place with the new extended cycle pills. I would not have period during my hospital rotation months, during my vacation or on my weekends off. When I finished residency and started my private medical practice, I continued regulating my period. I also managed to save many honeymoons and vacations by using this method for my many female patients. I never had a period because I was too busy seeing patients or being on call. That was my freedom.

Now there are the new extended cycle pills that are being used by more women. Many women are not using them because of the higher insurance cost. The ACA will change that. The hormone dose in these oral contraceptive pills is even lower; one pill has only 10 micrograms if estrogen compared to 30 micrograms back when I started. Not only are the pills lower in dose, the new IUD’s are called Intrauterine Contraception (IUC’s). There are two types. The copper IUC which is non-hormonal which lasts for up to ten years and hormone containing IUC which is effective for five to seven years. paragardParagard mirena I really love the new FemCap which is an improved version of the diaphragm and cervical cap. It is non-hormonal. cervical capfemcap FemCap Another blast from the past is the new and improved contraceptive sponge. Renamed “Today Sponge.” We all remember the Seinfeld episodes with Elaine hoarding her supply of the Sponge. This is an over-the-counter product and not covered by insurance. sponge

Access to reliable and affordable contraception is our right and is medically necessary. The medical facts are being dismissed as we have to listen to the political rhetoric and the hysteria. Contraception decreases the risk of unintended pregnancy for women. Worldwide, women do not have this freedom. Contraception can reduce child-birth related deaths worldwide. In Nigeria, women are waiting in lines to obtain contraception. The facts are that using contraception is a safe option.

We made the decision together to have only one child to add to my husband’s two children. Every woman should have that freedom. It just takes a few clicks to be informed.

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


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

Caring for the Ladies

I have had the privilege to be the doctor for a magnificent collection of women of all races, age-groups, socio-economic status and professions.  Seeing the trailer for “Lee Daniel’s The Butler” triggered thoughts of some of these women. I think it was the character of the wife, Gloria, played by Oprah Winfrey.   So, I wanted to start with the elderly African-American females who paraded in and out of my office like characters from a fading Jonathan Green painting.  Each still elegant though they were well into their 80’s, 90’s and even over 100.  They came in dressed in hats, gloves, stockings and carrying old purses as if they were off to church.  A close look at these garments would show the fraying material or stains that come with age.  The fading of the once brilliant colors of these garments did not diminish their elegance.


These matriarchs were respected in the community as dedicated church members, retired teachers and sorority members (including my own).  Some had just worked in restaurants as cooks or been housewives. They were often widows or unmarried.  The widows had lost their husbands before I took over their care.  They were living proof of the shorter lifespan of the African-American male. They all had been my colleagues’ patients but they gravitated to me.

When I told them I had graduated from Meharry Medical College, they beamed with pride.  They too were graduates of Historically Black Colleges and Universities or had sent their children off to attend one of them.  Many were known as Teacher’s Colleges when they were attending them.  We shared stories because I had grown up in Birmingham and they had lived through the racial tension in their tiny community.  Most of them had children who had gone off to college and successful careers in cities from the West Coast to the East Coast and everywhere in between. When I had a problem or if they were concerned, I spoke with doctors, lawyers, college professors, business leaders and teachers.  Each one concerned about a parent, grandparent or an aunt.  Each frustrated at the refusal to leave the community and move closer to them.  When one of these ladies had an illness, they packed up and flew in to be by their side.  The reality was that they had a circle of friends and a social network; they were not willing to leave.

Each came to the office with a brown bag filled with bottles of pills from the medicine cabinet.  That was my request.  I reviewed them and they were shocked when I tossed out outdated bottles and made a new list.  I think they thought I was being wasteful when I tossed out pills but it was the safer option.  I had a group of three retired teachers who always came together.  The older one of the three was the driver.  One of the ladies experienced several episodes of blood in her urine. I had to do a vaginal examination first not easily accomplished but was necessary.  We thankfully diagnosed a benign tumor on her kidney.  She sailed through the entire ordeal. The other two cared for her and made sure she made every appointment. They were amazing.

One lovely woman came in for an examination.  I found a small mass in her breast.  It was a localized tumor.  She had no problems during surgery and recovery.  The surgeon was amazed because she had no medical problems. She too had a strong network of friends and family.  The nurses and all the staff in the hospital knew her and made sure she did well.

They were all addressed as “Miss.”  It was just what was done. Being from the south it was easy for me to continue this gesture of respect. Miss B was known for her biscuits.  She got up every morning and made the biscuits for a local restaurant.  I admit I had succumbed to the sausage biscuit sandwich which featured her biscuit.  It was a heavenly treat.  She unfortunately had a stroke and could not work.  It left her fortunately with a minor deficit.  The owner decided to keep her own just to supervise the new biscuit maker. Thankfully, she had the opportunity to pass on that skill. She was proud of her skills and proud to share.

One of my favorites was a retired nurse.  I removed several moles from her chest.  She formed a small keloid but some quick thinking by us both prevented it from being a problem. She had worked in the local hospital but before had been in a larger city.  She worked with residents and as she stated made them into good doctors.  I always knew even then that good nurses made good doctors.

Miss C had two daughters who always took her to specialist because she always complained of being sick.  They failed to see it was her way of getting them to come home to visit.  I had to intervene after several hospitalizations for medication side effects.  I called them and explained that she was just trying to get their attention.  I spoke with the Cardiologist and the Gastroenterologist.  I also required all medications to be approved by me before being taken.  I did such a good job that she begged my staff to get her brother in.  I was not taking new patients.  One of them came to me with a smile and said I had to take him.  When I asked “Why?” the answer left me nearly speechless.  I quote” All he has to do is touch the hem of her garment and I know he will be healed.  That woman was sent here by God to care for us.” A little embarrassed I said “Then I have to see him.”  They all laughed and so did I.  Unfortunately, I did not heal him but he did have good care.

Miss LR was over 100.  She always came in smiling and dressed for church.  She did make it past 102.  She developed an anemia after all those years that required blood transfusions but they caused Congestive Heart Failure.  The Hematologist just smiled and said he thought her bone marrow just “pooped out.”  A medical term for; “I do not know why but we better not try too hard to find out or we could really kill her.”  She eventually had to go to the local nursing home but she was cared for with love.  Everyone who worked there knew her and care for her with respect.  She was showered with hugs every day.  I think she made it to 103. It was a great day when her funeral was held.

Miss M  was another dear patient.  She was blind from glaucoma.  She lost her beloved husband and never recovered.  They were a cute little couple. She would call the answering service saying she woke up and couldn’t see.  These were panic attacks. I would take her calls and calm her down. One hot summer, we gave her an air conditioner.  We made her use it and had her utility bills taken care of.  There were funds for that back then.  She would die in the hospital.  She just stopped eating.  I even had a feeding tube placed and that was a decision I later regretted.

The church and community played an important role in their lives and their longevity. However, for each there was one illness that would lead to decline despite flu shots, pneumonia shots and careful monitoring of blood work and medications.  They each touched my life and shaped my medical career.  I was honored that they allowed me to be their doctor.

Reflecting on the SCOTUS Rulings: My Own Brush with Making History

The Supreme Court rulings on DOMA and Proposition 8 were a great moment in history.  When I lived on the eastern Shore, I had the privilege to care for a large number of patients infected with HIV.  Many were homosexual males. At that time I was among an elite group of doctors who were Family Physicians and “AIDS Doctors” as we were called then. I had trained in New Jersey. I had several patients with AIDS in my residency training.   They were both heterosexual males and females and homosexual males. Many of my patients had suffered in silence with being gay and then had the added stigma of AIDS.

I really did not choose to be the primary provider for these patients.  They found me.  I had gained a reputation because of my patients.  Word was spreading and patients were calling.  We scheduled each patient  so they could come to the office without fear of being found out.  This was not easy  in a small town.  Everyone prided themselves on knowing everyone one’s business.  I have forgotten many of the secrets I dared not write in my charts. That is a good thing.  One of my patients was openly gay and he contributed to my reputation.  He was flamboyant and so much fun.  My favorite encounter came was when I told him his CD4 count and he fainted.  We made a deal that I would only tell him if there was a change that was significant.  That made our lives a little easier.  My nurse was especially happy.

He met and fell in love with another patient of mine.  They were as different as night and day, a modern-day Rhett and Scarlet.  One was a tall African-American male who gave the appearance of being fearless and the other a White male who  fainted.  Together they contributed to changing AIDS care on the Eastern Shore.  They became tireless advocates for patients and families. The two of them dealt with their illness in such different ways. Like many African-Americans, the one patient was diagnosed after a major illness which left some neurological deficits. That did not matter.

They invited me to the blessing of their union.  The priest who performed the ceremony was later stripped of his position. He was accused of performing a marriage.    We were all there and the celebration was beautiful.  It was a blessing of two courageous men. Here is a link to the article: Fortunately when I left, they started seeing my colleague outside Philadelphia.  She is still a Family Physician who cares for patients living with HIV/AIDS.

The SCOTUS decisions on Wednesday July 26, 2013 made me reflect on that time.  We have come a long way.  Lisa Winkler’s blog entry  SCOTUS & I Am Harvey Milk: Perfect Timing was so moving; it caused me to reflect on my own moment in history.  At the time, I was just being a good doctor and an advocate for two courageous human beings.  I still at that time had to worry about my personal reputation and the practice.  I still had patients who would not have been supportive of our being there. When I attended the marriage of my two friends on Staten Island last year, in a beautiful marriage ceremony, I had no fear of loss of patients or revenue.  Thankfully, I may never have to experience that again.