Dear Lawrence Tabas,
I am in awe of your many years of service and law experience. As a physician, I appreciate your work in healthcare law. We need good men like you on our team, ensuring compliance and justice.
Today, I'm writing about your role as an electoral college representative. It's clear that you have taken your positions seriously, and I'm sure December 19th won't be an entirely peaceful day for you and your fellow electors.
To be honest, I am terrified of what may be ahead of us as Americans if you cast your vote for Donald Trump. You are a level-headed, loyal and diplomatic attorney. In complete contrast, Donald Trump is a loose cannon with ever-changing positions who explodes at slight criticism. He name calls, he demeans, he encourages violence. I realize he is charismatic, but is that really a positive quality with his pathological instability?
I think allowing Trump to be our next American president is asking for unpredictability, aggressive behavior, thoughtless decisionmaking and terror for me and my loved ones.
Please consider this position as one of our precious Pennsylvania electors carefully. We are all counting on you and your fellow electors, as we are technically at your mercy for voting in our next president. I believe your years of experience have led you to this most powerful decision on December 19th. Please deliberate with your fellow electoral college members carefully, and lead your team to the right decision for us. It has to be someone other than Trump.
Thank you for your kind consideration.
Frances M Southwick, D.O.
Osteopathic Family Physician
Bling-bong, goes my phone.
A text from Jessie, a doctor friend, pops up. I click it open.
Hey, friend, can I ask you for your expertise on something?
Jessie is a friend who shares a diagnosis or two with me (Major Depressive Disorder and Post Traumatic Stress Disorder). This text could mean many things. I start to text back, then decide to call her, instead.
"Heeeeey, friend! How are you?" I ask.
"Yeah, I'm doing okay, but my doc wants to change my antidepressant. What do you think?"
I have many thoughts. I ask for more details. Interestingly, she and I happen to be taking the same drug, Wellbutrin. We discuss the possible efficacy / adverse effects, what to expect, we consider asking her physician to maximize the dose before swapping it out for Prozac.
The conversation meanders around to her sexual abuse history, spouse challenges, family relationships, psychotherapy, career choices, medical problems, and long-distance friendships.
"Can you hand me the dandelion picker?" Jude asks.
I am squatting in front of the hedges with leather gloves on, fingertips moistened with brown earth. I look to my left and reach for the new tool, a long-handled metal spire with a sort of back-of-the-hammer nail remover at the end. It's great for digging up deep-rooted weeds.
"Here you go babe," I smile and pivot toward her with the instrument.
"I can't believe you are out here WEEDING with me, honey!" she comments.
"Shhhh," I say, "It's not weeding, it's Green Time."
I explain that the new title has allowed me to more fully enjoy time outside with her.
"You know the annoying thing about depression?" I ask Jessie, pacing cheerfully in front of my house.
"No, what?" she asks.
"Therapy is amazing. Evaluating the causes is important. It's great to be aware of why we feel how we feel, and what patterns we are repeating. But sometimes, you just can't figure it out. And trying to figure it out makes it worse. Doing and feeling seems to work better than thinking, for me...when I'm sinking," I confide.
I lay on the couch thinking about what to do. Jude is out in the yard.
My leg hurts.
I want to go to sleep.
I remember the conversation with my buddy.
I roll off the couch and grab my gloves.
I hate weeding. Hm. What if I rebranded it...
Happy Weekend. <3
It was Elk Season.
I was fourteen.
The four of us hiked steadily into the Colorado wilderness:
1. Daryll, my natural-outdoorsman father who was once a hunting guide,
2. Brock, my 18-year-old (but quite experienced in hunting) brother,
3. Bill (a family friend of ours, also a hunter/fisherman), and
4. Me, Francie, a girl anxiously trying to please the men in her life through joining them today.
Each of us carried a rifle and our packs. Mine carried warm clothing, a sleeping bag, ear plugs for the anticipated gunshots, hunting knife, flashlight, sustenance for the next few days and a purple sleeping pad tied underneath. As we walked single-file toward our campsite that first day, I grimaced nervously. I had never killed an elk before. An antelope, yes. A deer, sort of - my dad had had to finish it off for me with a second shot in the head, as I shook and cried, standing there listening to it flop in the weeds. But not an elk.
We hiked for a few hours, full of energy for the trip. Once we arrived at the campsite, the four of us "made camp" by pounding stakes into the dusty ground to keep our tents steady, gathering sticks for the fire, eating canned sardines and sipping whiskey sitting in a ring around a campfire before sleep.
I shared a tent with my brother that night. He taught me to lay out my boots, socks, long johns, sweater, pants and coat carefully; we would dress awkwardly in this tiny space together in the cold dark before daylight.
I was awakened in the dark, as promised. Heart pounding from the abruptness and foreign terrain, I slipped my gear on, garment by garment. I stuffed the ear plugs, knife and flashlight into my jeans pocket. We gathered by the unanimated fire ring. Daryll decided we should split into pairs; my brother would hunt with him, and I would hunt with Bill. I agreed; the plan seemed reasonable.
I was small for my age, and Bill was only a few inches taller than me, which made for a comfortable and even pace. I walked, sometimes beside Bill and sometimes behind. We walked for probably three hours or so, rarely making small talk; after all, we were trying to stalk wild game. Just as my legs began to burn a bit from the hike, Bill stopped us in a sunny spot on a hillside. He turned to face me.
"Do you know how to use that gun?" he asked, nodding at the rifle hanging from my shoulder.
"Y - ye - I mean, sort of," I admitted. I had passed the required Hunter Safety course, and had worked on "target practice" (shooting targets pinned on hay bales and prairie dogs) with my family. But I wasn't sure if this was the same gun - my dad had always packed the weapons.
Bill smiled easily and held out his hand for the gun. I cautiously slid it off my shoulder and handed it to Bill.
"Yeah, see here - this is a double action rifle. Pretty neat little gun you got here. But it's not great for beginners. Look here," he pointed a finger at the top of the gun, at the bullet loading site.
"You see, you just - "
I struggled to stay steady and conscious.
I couldn't see anything.
I dropped to the ground from the force of the blast. I now understood the term 'ringing' in the ears; my whole head rang like an enormous tuning fork that had been struck against a steel beam. My eyes reverberated for a few seconds in my skull. It took me several (ten? sixty?) seconds to get my bearings and understand what had happened. It had been an explosion; an accidental shot fired and its impressive echo, millimeters from my right ear. Bill's eyes had been focused on the chamber of the gun as he had absentmindedly swung the barrel up toward my head. His hand had touched the trigger. He hadn't known it was loaded.
. . .
I consider Paul Kalanithi, the neurosurgeon who wrote an elegant account of his short life; he died of cancer in his late thirties. I finished his book this morning...its force is radiating from my chest and my fingers as I type this. His entire life, he had thought up until the last year, had been a preparation to become a surgeon.
I consider my mother's rare cancer - she simply lives on, and embraces each day with grace.
I consider that early morning on the hillside, trusting Bill, not thinking of my mortality, just standing there, eagerly receiving instruction.
This stuff about life being one moment at a time, unpredictable, fleeting, and soon to end -
I consider the things I would have missed had the gun barrel been pointing a few millimeters to the west. The things Paul cherished during his year of dying. The things my mom continues to do, to keep meaning and depth in her life. It is all about connection. With oneself, with nature, with other human beings.
How are you connecting today?
REPLY: "What about doctor self care?!" my patient laughed hysterically at me. I threw my head back and laughed along with her.
ORIGINAL STATEMENT: "In two days, I will have my first day off in four weeks."
Self Care is an elusive, ever-changing and never-ending goal for me. Clearly, I am not always an 'A' student in Self Care Class. But I do try, and I think I'm getting better at it.
Here are a few small examples of ways I have tried to implement good Self Care this week:
1. When given the choice between skipping lunch or drinking a giant chocolate milk from the gas station, I chose the giant chocolate milk.
2. When choosing between completing three more notes or sitting on the floor and talking with the office staff, I chose the sitting and talking.
3. When craving something that seemed like a good idea, but has proven over and over to lead to pain and guilt...I chose to avoid that activity.
4. Adding "write" and "coffee shop time" to my to do list (on par with "bills and "notes").
5. When I noticed I haven't had a day off in a month, I planned a "should-less" weekend for the first days off.
6. I reminded myself that Caring for Self is beautiful, feels good, and necessary for a rich life.
When my life is busy, it remains enjoyable if I keep perspective and care for myself.
Wish me luck for this weekend.
"What does 'BALINT' stand for?" asked Dustin, a bright-eyed third year family medicine resident. His earnestness shined straight through his white coat. His friend Matt looked just as purely interested, leaning onto the pressed wood cafeteria table in teal scrubs, listening for an answer.
I hung out with the residents and medical students from 8-9 AM at Greenbrier Valley Medical Center in Lewisburg, West Virginia yesterday. I was asked to speak 'off the cuff' with these trainees.
"I don't know what to talk about," I had confessed to my wife Judith, just two nights previous. We sat in our PJs, eyelids heavy.
"Why don't you run a Balint group?" she asked casually.
Judith is a genius.
I sat erect in my chair in the doctors dining room, sealed off from the rest of the cafeteria. I was kindly introduced to the group by my med school mentor, Bob Foster.
"Hi everyone, I'm Frances Southwick, and I'm an Osteopathic family doctor in Pittsburgh," I began. I looked into the eyes of each med student and resident around the large table. The room was a bit awkward and tense. I felt such warmth for them. I could feel their good will and eagerness pouring out, ready to talk.
"Balint is not an acronym, but it sounds like one!" I laughed. "It's actually a last name - Drs. Balint and Balint invented a way to reduce physician burnout in the 1960s," I explained. We would discuss an actual case they had been struggling with, and explore the doctor-patient relationship. I asked if anyone had a difficult patient case they would like to talk about. One resident's hand shot up in just three seconds, and we dove straight in.
The group of us talked our way through each character in the difficult medical predicament. (HIPAA, medical ethics and Balint confidentiality prevent more detail here). The patient. His partner. The nursing staff. The med student. The resident. The attending.
What would it like to be each of these players, day in and day out?
How frustrating...when no one knows the best thing to do, but all are pretending to know?
What should we do about the unexplainable abnormal physical examination findings?
What is acceptable to ask the patient, to demonstrate respect for him and simultaneously get accurate medical history?
How do we communicate with one another?
What do we do when we don't know what to do?
By the end of the Balint session, we were unified. We understood one another's roles even more clearly, now that we had meticulously empathized.
I thanked all for participating. The tension in the room had dissipated.
Maybe it's enough to admit we don't always know...
...But we care.
This is something that actually happened today.
Blasting Cake's "What's Now Is Now" in our 2007 Subaru Forester and bumping down our cobblestone road after a satisfying day's work, I begin to daydream about a shower. Wherever. It doesn't matter. As long as it's hot, wet and clean.
A shower sounds particularly special today because our basement now boasts a small mudpit. There is a kind older gentleman who has been sledge-hammering through our concrete floor in search of a broken pipe.
And this means...no showering at our house. Thankfully, the next-door neighbors are out of town and are gracious enough to allow us use of their bathroom.
I rush in through my front door, up the wooden steps and grab some clean clothes and bathroom supplies. Everything is trying to tumble out of my arms, but no matter. I'm about to have a shower. Without using my hands, I step into my giant snow boots and awkwardly carry everything to the sweetheart neighbor house. I could have put all this stuff in a bag.
Toss the clothes and keys onto a bed in a nearby spare room and head into the bathroom. As I set the shampoo and conditioner down on the showerside table, I realize I have forgotten a towel. Gr. Keys. Stairs. Door. Back into my house.
Again, I bumble up the steps and yank a clean purple towel from the bathroom, and I'm on my way! I'm back at the front door and I hear, "Crash. Crash. Jingle, jingle, jumble, clink. Clink clank. Pinkpank," from the basement. Oh, god there is an intruder. I've made it 11 years calming Judith down, telling her there will never be a break-in, and now I'm a liar. I pause and listen to the noises for awhile. And it slowly dawns on me...No one in their right mind would keep banging around in the basement if they wanted my stuff or my body; they would be up here with me, by now.
So, I walk down to the basement and greet Jim, the kindly sewer-smart gentleman. He has gentle eyes and rough, dirty hands and a capable mind. He stands in the mud in his work boots and we get to talking. Somehow, we manage to discuss his daughters, the twins due in April, how far ultrasound technology has come along, skiing in Colorado, gentrification in East Liberty, and the wonder of Western Pennsylvania. He grew up here, you know. He has seen all the changes for years. His mom is in her 90s, and she still gets around the kitchen.
Eventually, we wrap it up. How lovely, to spend half an hour gabbing with someone outside my culture zone. Comfortingly exhilarating.
I traipse back out into the now-quite-snowy evening and prepare for that blessed shower, boosted by this beautiful conversation. I walk upstairs to the neighbor bathroom, find the hot and cold shower knobs and enjoy the foreign claw-footed tub under the sprinkling water. I breathe deeply. Ahhhhh. Clean. I pull the showercurtain and reach for...
It's by my front door, abandoned during my intruder panic.
And so, I do what I have to do. I dress in the chilly house, soaked, and prepare for the weather.
Even though I know better, I wonder if that wive's tale is true about catching cold.
People are beautiful.
I'm at Biddle's Escape. That's a coffee, tea and art spot. I'm calm. My left forearm rests next to a doorknob sticking out of this table, which is...an old door. There is no more peppermint tea in my giant ceramic mug. This is a shared door table.
My laptop screen serves as a divider between me and a very thin woman. She wears a red puffy coat with a red paisley scarf. She has matching red puffy eyes and is talking on her cell phone, cradling it like a cup of cocoa. Due to emotion, her sad small voice sing/cries an octive higher than I expect. She sniffles and tells the phone that she can't commit to him right now. He knows what he wants, but she doesn't. And she loves him.
Over there - by the hip coffee shop garage door, are two people reading. One reads from a white Mac and one from a white thick book. They are bundled in black hoodies, and they look beautiful against the white snow peeking through the windows of the garage door behind them. They smoosh their hands onto their faces and into their laps absent-mindedly, engrossed in the material.
To my 10:00 (at the hinge of the door) sits a woman with blue round glasses in a blue long-sleeved tee shirt, sporting blue earbuds. She engages fully with her computer. She hums to the music from the earbuds. Though I can't hear the tune, her humming seems off-key. Like someone OM-ing while meditating. Slowly, she stands and wraps a gray and blue scarf around her neck and jaw to prepare for the cold.
And me. I am a small pink person in a pink hoodie. I chew on a cinnamon toothpick and allow the cursor of my mind to float from mental screen to mental screen, sometimes clicking on a link and reviewing a memory or expanding upon a musing.
I enjoy the dash of euphoria from these observations.
People are beautiful.
It's my day off.
I shift my legs again on the couch.
I'm uncomfortable. My skin kind of hurts. I want to hide, but I want to run, I want to be mindful in the moment, I want to feel satisfied, I want to feel a sense of accomplishment and connection.
I mentally flick through my categories: Judith/love. Job/notes. Friends. Family. Writing/reading. Body care. House to-dos. I have a large to-do list, but I see a stagnant moat between me and their completion. It feels impossible to get started.
I restlessly flip myself onto my belly and scan for 'likes' on my Facebook page on my phone. Maybe I should get a cup of tea. Ugh. My head hurts, now. I don't want to get up.
Or maybe a walk.
I roll myself off the ottoman and verticalize myself. I slide the keys off the shelf by the front door and cram my feet into my shoes without untying/retying them. Lock the door, squeeze the storm door closed. Now I let the cool, damp breeze into my nostrils.
One foot in front of the other at first, then it's automatic. Down the walk and up toward Farin's house. My legs blissfully tingle as I cruise steadily up the hill. The neighbor's home-made stone retaining wall is bowing. I smile and think of our own home-made retaining wall, still hanging tough.
RUSTLE. A cardinal surprises me, flapping in a bush, arm's length away. I am a little startled, but in a good way. My heart rate is comfortably climbing.
I round the block and pass the yard Judith always comments on, "I love their yard design. Look at that wheelbarrow, and those lights on the back deck. Can we do that?" She asks excitedly in my head.
I wind my way around the neighborhood and arrive back home. I stride over the new flagstone walk just installed in December. Cling/clang the keys and open the door. Return the keys to the shelf. I'm breathing deeper and a bit faster than before. I notice that my vision is slightly sharper. I collect the mugs and dishes from their lazy locations and carry them into the kitchen which then inspires me to unload the dishwasher.
I can get started with my day, now.
A simple walk energizes me more than a Youtube video or a Facebook scroll or a Netflix hunt. It's better than a nap, too. Bonus: my medical journal reminded me this morning: 20 minutes of daily brisk walking reduces risk of heart attack by 30-40%.
"Don't treat the trans ones oddly!"
Red Goblet, a young transsexual male, stands before the slightly uncomfortable audience. Red has a uniform to match his name - red topcoat with tails, black top hat, chunky boot heels. He and his stage band Sparkly Tampon have us locked and loaded.
He holds a glittering red-painted fake tampon in place of a microphone.
"Am I am boy, or a girl? Am I a boy or a girl?! I'm an EXPERIENCE!"
Red and his queer/allied teen colleagues wrote this line. They wrote the whole song Red is spouting. In fact, they wrote the entire play they are performing.
Dreams of Hope is a Pittsburgh-based organization that celebrates and fosters growth in LGBTQQAAIP teens through arts expression. Through their fall/winter project called "Theatriq," teens collaborate with adult arts supervisors (music director Judith Avers, performance director Adil Mansoor, playwright Paul Kruse and visual artist Katie Kaplan, along with Adrian Gordon, Jason Scattaregia, Luke Niebler, Pixie Colbert, Antoinette Weir and T.J. Hurt) to write and perform a brand new production every year. This year, the show is called "Webs." It explores myths and legends, including the Greek myth of Arachne and its modern connections to the queer community.
Why am I writing about teens putting on a play? Am I not a physician? What's happening, here?
My mind wanders to a thirty-something friend of mine. She is bright. She is kind. She is funny. She is a thoughtful friend, she is a hard worker, she is helpful to her community. She is also queer.
Last year, she attempted suicide.
I ache for her.
If she had had support like Dreams of Hope when she was a teen, would she have a more solid sense of self?
More self-kindness and comfort in her body?
I am struck by the gravity of the knowledge that health is more than pills and exercise.
It's about how we treat each other.
Thank you to Dreams of Hope for this. Although they cannot publicly agree, I consider Theatriq a community health program.
“How tiring is residency?
When Jude and I went out to eat, I avoided ordering salad; I didn’t have the energy to chew that much.”
My name is Frances Southwick. I am a practicing family medicine physician in Pittsburgh, Pennsylvania. I completed my medical residency two years ago, and I can’t believe my wife and I are still together.
When I was accepted to the West Virginia School of Osteopathic Medicine in 2005, my relationship with Judith was a bud; we had met only one year prior. We were just starting to trust and know one another. On a huge leap of faith, Jude left her family and friends in Greeley, Colorado for the unknown hills of Lewisburg, West Virginia. She hugged her therapist, her mom, her brother and sister, her nieces and nephews, and her best friend goodbye. She packed up her guitar (she’s a song-writer) and her cat, and off we drove.
Neither of us had any idea what we were doing.
The next eight years were the clumped chaos of medical school, then residency. For me, these were times of non-stop mental work coupled with physical and emotional fatigue. I stood for hours in surgery, spent sleepless hours answering pages in lonely call rooms, and learned, literally, to become a physician. I talk about how I was “reprogrammed,” which is not a joke (although laughing about it does seem to help). Becoming a doctor is brutal. It involves abandoning part of oneself. It takes every type of strength a person has. Jude watched me morph from a bright-eyed, artistic whippersnapper, always up for coffee and a conversation … into a disheveled, depressed indentured servant who fell asleep eating mozzarella sticks.
When I think of what Jude went through just to stay with me, my chest shrinks. Her life was transformed as a result of our relationship. She uprooted herself twice, built and re-built friendships, bought my family members’ birthday cards, put up with my sleep-deprived/empty conversations, walked the laundry to the coin-slot machine in the snow, cooked beautiful meals often uneaten, took care of herself when she had pneumonia, and patted herself on the back when she had successes in her own career. She became her own best friend while I was at the hospital. Though it killed/kills me to know and admit this, sometimes I just wasn’t there for her when she needed me.
Judith had not only the basic challenges of being partnered to a physician, but devastating loss during the training process. Her sister, father and mother all passed away during residency.
Take a moment to soak that in.
If you are a physician or family member of a physician, you might guess how much support Jude received from me during those arduous, draining, dark times. I did my best; I helped with the funerals and listened when I was around, but it was never enough. My work sometimes had to trump our relationship. I had to fly back and take call the night of Jude’s sister’s funeral.
Medical training is trying. Doctors and doctors-in-training undergo enormous stressors. These are facts. Medical training is also extremely burdensome for spouses and family members of trainees. This is a fact too often brushed aside.
In an attempt to reach out in solidarity to those in Jude’s/my position, I have recently published a book about my experience during medical training, and included snapshots of my marriage, as well. It is called Prognosis: Poor, One Doctor’s Personal Account of the Beauty and the Perils of Modern Medical Training.
One of the appendices is entitled: How Jude and I Stayed Together. I believe special attention should be given to the most cherished relationships in order to survive.
I gave all I had, and then a little more. And so did Jude.
So, here we are.
Published 12/16/15 on Physician Family Magazine's blog.