What a year this has been. It has been one punctuated by anxiety and many moments of feeling hopeless. I feel like this year brought out the worst in people. It brought out the racists, it brought out the naysayers, it brought out those who would put themselves over their neighbor and do so loudly over something as silly as wearing a mask. This year brought out many who would spew hate over political affiliations and many who would deny the problems in this country be they medical or social. It was at times infuriating and exhausting, often in the same breath.
Before 2020 even began, I was already restless. I was dissatisfied with my job and felt that medicine as a whole needed to change. We had lost something. For me, that something was the very thing that led me to the practice of medicine in the first place…love. It felt like I was so busy checking boxes that I was losing touch with the people I was entrusted to treat. Rather than languish hopelessly in a large system that felt like it would never change, I took my future and my patients’ experience of the medical system into my own hands and I started Pure Family Medicine. It has been a joy to create a place that feels like practicing medicine the way it should be - personal and rooted in love for humanity.
And there it was…HOPE…this little emotion that changes everything. It was growing alongside Pure Family Medicine. Hope for myself and my own career and hope for medicine as a whole to move back toward the art of caring for humanity.
Then there was George Floyd. His death opened my eyes to a problem that has long been boiling under the surface of American life. I will honestly say I had no idea the degree to which racism plagues our society. I am learning. I admit, I was initially overwhelmed by the weight of it all. It felt too heavy, too huge to be able to do anything about it. And yet, people did do something. The people in my community came together in a way I have never seen before. We reached out and stood up for one another. We raised money to keep our neighbors’ lights from being turned off. We stood peacefully on the street together in solidarity.
And there it was again…HOPE. Hope for my community, hope for my children’s future and for an end to the plague of racism in this country.
In the midst of all this, there was a global pandemic. Oh, the many ways that Coronavirus has changed our way of life. There were long periods of isolation. There were many with severe illness. There were many, too many, who died. It has overshadowed everything else about this year. In my lifetime, Covid has had a bigger impact on our day to day lives than any other single event. I went to work a second job in the hospital to feel like I was contributing where I could. I missed seeing my friends and my family and I struggled with distance learning with my children. We have grasped at things that feel “normal” but I doubt life will ever look quite like it did before.
And yet, rising up over all of the issues of this year, there is hope. For me and for many of my physician colleagues, that hope came in the form of a vaccine signaling what we hope will be the end of this pandemic. I got my vaccine on Christmas Eve and I celebrated with an almond croissant and a hot cup of coffee. It felt fitting that while I contemplated the greatest hope of my life, hope found in Jesus, I was able to receive the symbol of hope for the current crisis. It made me reflect on this year, and on the many times that unexpected hope rose above the troubles of the world. As 2020 draws to a close and I consider all of the words that could be used to describe this year…unprecedented, unknown, scary, angry, polarizing, anxiety, isolation, sickness, death, and at the same time creative, compassionate, inventive…the word that I choose to remember for 2020 is...
HOPE, that little emotion that changes everything.
I got married during a hurricane, Tropical Storm Allison to be exact. It hit Houston with full force causing massive flooding the day before my wedding in 2001. It was the definition of a disaster. We had planned this day for a year and had put all the details in place. We had chosen dresses and flowers and musicians and food for the reception and cake designs. Our family had traveled to help us celebrate. It was going to be perfect....until it wasn't. Nothing went quite as planned. Phone lines were down all over town and it took hours for my husband and I to even reach each other to confirm that we were going to try to get married despite the flooding. Roads were closed and it took several hours through back streets to even get to the church. Once we got to the church, there was no power and the whole ceremony happened under generator run flood lights and candles. All the planning went out the window and we were forced to adapt or postpone the wedding. We adapted, and it makes for a great and memorable story now, but it was not without some loss. Loss of the vision we had for our wedding, loss of some important people who should have been there but couldn't get there (my grandmother), loss of hours spent planning...it was nothing like what we had planned and that came with a little grief.
So many people think of grief only in the face of death. That is perhaps when it is most deeply felt and most profoundly visible to others, but that is definitely not the only time that humans grieve. We grieve when we have lost something, and we have all lost something in this pandemic. In the face of coronavirus, some people have lost everything; their most beloved person, or even their own life. Because of this, I see that many of us do not feel that we should acknowledge all the things that we each have lost, because they seem minor in comparison to what others are going through. The problem with this though, is that it is untrue. Failing to acknowledge loss does not erase loss. We have lost things. Humanity has lost things because of this pandemic:
Our sense of safety
Our financial stability
Our ability to congregate and worship together as church communities
The traditional end of the school year with awards and farewells and proms and graduations
The connections we had before social distancing
The freedom to travel and gather together as we have always done
Our role in our own lives - moving from executive or creator or manager to simply provider of education, entertainment, conflict management, and snacks for the children who are stuck at home
Yes, these are minor when compared to the loss of life that some have had to endure and that makes us excuse them as not important or as something that we should just accept and move on from. The problem with this is that loss causes grief and unrecognized or unresolved grief rears it's head in other ways. When we as humans fail to grieve our emotional losses, we can find ourselves dealing with repercussions for months or years, and the further we get from the loss the harder it gets to connect the dots. The ripple effects of unresolved grief are:
Irritability or anger - at everyone, for everything, without a clear reason
Obsession - hours spent reading and poring over the news and every theory out there
Hyper alertness or fear - hand washing, sanitizing, isolating at home
Addiction - food, alcohol, Netflix, yes even TikTok
Anxiety and Depression - mild to severe, this has been a very common theme in my practice lately
So....what do we do about it? First and foremost, we need to give ourselves permission to grieve. To grieve the big and the small things that we have lost during this time. Simply acknowledging the loss and giving yourself permission to feel however you feel takes away some of the power. Journal, talk about it, pray about it, commiserate with friends or family because there is an excellent chance they are feeling the same way you are. Secondly, move away from problem behaviors; if you have become apathetic, set a schedule and stick to it. If you are eating or drinking too much, set some limits. Finally, don't minimize your feelings. Don't pretend that things are normal - they definitely are not - and don't just say you are OK and move on. Grief takes time. It cannot be rushed and it should not be ignored. Take some time to examine your losses, large or small, and give yourself permission to grieve.
Everyone in the world has spent a lot of time recently focused on it. How to protect it with masks and ventilators. How to preserve it with medications and treatments. In ways that are more savage than other illnesses of recent memory, COVID-19 seeks to rob us of it. Both literally, for those patients who are ill; and figuratively, for the rest of society as a whole.
I met recently with my dearest friends to discuss and process what we have all experienced in recent weeks. We talked about a lot, which makes sense because we've all experienced things that are foreign and frightening, and that makes for a lot of subject matter. But what fascinated me and what I hope resonates with you, is that we all felt a collective need to exhale. To breathe. That reconnecting with each other somehow gave us permission to let go of the breath we had each been holding for the last several weeks. Have you ever held your breath for a very long time? After a while, it hurts. And there are complicated medical reasons why it hurts but those are not important. When you come up from being under water and you can exhale fully and inhale again it feels amazing. It feels life giving...because it is.
I have spent much of the last several weeks focused on the idea of breath. It has been in my work, of course. But what was interesting to me it that it has been in my thoughts and my prayer life as well. Many years ago, I learned a simple breath exercise that I have employed almost subconsciously since then. It has to do with simply focusing on your breath as it enters and leaves your lungs and then setting an intention for each inhale and exhale. It goes something like this:
Breathe in Peace and Breathe out Worry
Breathe in Calm and Breathe out Fear
Breathe in Light and Breathe out Darkness
Breathe in Energy and Breathe out Pain
Breathe in Connection and Breathe out Loneliness
Breathe in Unity and Breathe out Hatred
Using the power of our mind and our breath to change our emotions. It has been a go to technique for me for many years when I'm feeling overwhelmed with big things, but especially during this time. Coronavirus is not over, by any means, but we are navigating our way through what will be our new normal, and we are doing it together. I invite you to join me as we all start to breathe a little more deeply together.
Everyone has experienced it at one time or another. We have all felt it when anticipating a big event or facing down a tough decision. I even see it in my children as they bite their nails or can't sleep before a test or major athletic competition. In some ways, it sharpens us, makes us hyperaware of the consequences of our actions, and pushes us to perform at our best. A little bit of anxiety causes a rush of chemicals in our bodies that makes us run faster, jump higher, and do better. Fight or Flight. But... a lot of anxiety paralyzes us. It casts doubt and fear and keeps us from even getting started, much less doing our best. In some cases, more commonly than is talked about, it keeps us from even getting out of bed.
Many times, we naturally manage it using techniques we have learned from our youth. We pray. We take a deep breath. We go for a jog. We hit a punching bag. We call a friend. We take steps to resolve the situation causing our anxiety - we study for the test, work out harder for the competition, mend the relationship.
But what happens when we can't "fix it"? What happens in the time of a global pandemic where a blanket of anxiety is laid upon everything and everyone. We are suspicious of the person in the grocery store, are they infected, will I catch it? We are distancing from our closest of friends, and while it is necessary right now it is also one of the ways humans manage anxiety the best, by leaning on our loved ones.
So what do we do? The same thing we always do. Pray. Breathe deeply. Exercise. Call your mom, your sister, your best friend. It is normal to feel uneasy in a time like this. Give yourself permission to feel the way you do. And if it is so bad that you need more help, ask for it! There are medicines and therapies that can make a difference. We are all in this together and I am here for you.
I woke up this morning before my family and I got ready to do my second shift in the hospital. Amid the chaos of the COVID-19 pandemic, my hospital system has called on primary care doctors as reinforcements. I normally spend most of my time in the outpatient setting other than delivering babies, so spending all day in the hospital caring for the very ill is not something I have done since residency (a long time ago). As I was preparing to leave the house today I had a strong sense I was going to war. This enemy, coronavirus, is relentless. It is not kind. It is not just. It is not merciful. It seeks to destroy for destruction's sake. I am not a soldier, so I really have no reference for what battle preparations look like, but for me in the early hours while my house was dark and my children were asleep this is what my preparations looked like: a large cup of strong coffee, my N95 mask, Holy Water from Lourdes (known for healing), blessed healing oil, and prayers for protection. I prayed for myself and my family, for the nurses and other staff at the hospital. I prayed for the patients and their families, from whom they would be separated at the ER doors and not reunited until (and if) they went home. I prayed for the world. And in that still, dark, quiet moment I found peace. I hope you do as well.
What is Direct Primary Care?
DPC is a model of healthcare delivery that puts the patient first. At its core, it is a simplified payment model where you become a member of a practice with a simple, affordable monthly membership fee, like joining a gym. In return, you get personalized medical care and unlimited access to your personal doctor. After many years of frustration in the traditional medical system, I looked for ways to return to a simpler, more relationship driven method of caring for my patients. DPC is just that. It allows me to really be present to my patients in a way that makes sense.
How does DPC put patients first?
Being a member gives you unparalleled access to your doctor, me. If you need an appointment you can get one the same day. If you have a question, you can text or email anytime and get a quick answer. It is like having a doctor in the family, and I view my patients as my extended family. A healthy relationship with your doctor is exactly that...a relationship. It is not feeling like a number or cattle in an impersonal system. Here at Pure Family Med you matter and you will always feel that way.
What about insurance?
I do not accept insurance because it complicates the way I am able to care for my patients. If you have ever been told that a test or a medication is not covered or needs some sort of authorization, then you know what I mean. With DPC, traditional insurance and its high cost, is no longer needed. Anything and everything that can be done in the clinic is covered under your membership fee. Additional things like labs or imaging are negotiated for a much lower price than you can get with insurance. It is still a good idea to have some sort of catastrophic coverage or health-share in case you need to go to the hospital or have surgery.