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Change can be scary and is almost always difficult. Change can force us to question both the reasons we stayed and the reasons we left. Learning to begin again has been challenging but life-giving, even more so as I settle into midlife. This list may resonate with some of you, so I thought I would share several scenarios in which I have learned to begin again.
While so many of the circumstances in my list above are quite personal, I know many of you can relate. In fact, just reaching a decision to begin again can feel overwhelming. I will link a resource below of a book that really helped me make some hard decisions in my life. I love this author's work, her podcast, and her platform. Her words have provided both comfort and fuel for my body and soul. She writes from a Christian perspective, so if that is not a fit for you, you may not enjoy her work. Let's take a deeper dive into a few of the life scenarios that forced me to begin again as I share anecdotes and resources that helped me get through the muck of starting over.
These real-life examples are very personal and may not apply to your life. I do hope they give you some insight, however, either for your own life or for someone that you love. Connection is the entire reason I started pouring my heart out over the internet, so please leave a comment below if any of this resonates with you. I see you and you are not alone. I love interacting with my readers. For more of an inside look into my days, you can follow me on TikTok, Instagram, or Facebook. Please support my fellow hope*writers by reading their works inspired by the prompt word BEGIN: Begin Moving Toward Your Soul’s Lifework by Lisa Crowder https://lisacrowder.substack.com/p/begin-moving-toward-your-souls-lifework The Beginning of Stories from the Supper Table Series by Jessica Haberman http://www.storytellerfarm.com/beginning-of-stories-from-the-supper-table-series How To Begin a New Career by Ashley Olivine https://ashleyolivine.com/how-to-begin-a-new-career/
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What do we say when we don't know what to say? We have good intentions of encouraging our loved ones, but we have no idea how to do so. Encouragement can feel obligatory on the sending end and inauthentic on the receiving end. And that FEELS BAD for both parties. We have all been there. Someone dies unexpectedly. Someone receives a terrible diagnosis. A divorce comes out of nowhere. A tragic accident. Our partner says something cruel or doesn't meet our emotional needs. A friend is struggling with infertility or has a miscarriage. Our friend is venting about a difficult situation. Here are some tips for what to say and what not to say:
Do/say this:
Don't do/say this:
Encouragement should feel good for the giver and the recipient. It takes practice on BOTH ends to make it work. At times, we are simply in too much pain to receive any encouragement and that is okay. Other times, we as givers are not in the best mental head space and must take care of ourselves before we can expend energy dolling out encouragement to friends or family members. In those situations, communication is key. Boundaries are vital. And reassurance that your person is important to you is paramount.
I love interacting with my readers. For more of an inside look into my days, you can follow me on TikTok, Instagram, or Facebook. Please support my fellow hope*writers by reading their works inspired by the prompt word ENCOURAGE: 4 Ways to Encourage Yourself in the Lord by Sharla Hallett https://sharlahallett.com/4-ways-to-encourage-yourself-in-the-lord/ Simple Is Better – Never Underestimate the Power of Encouragement by Dianne Vielhuber https://simplewordsoffaith.com/2023/08/01/simple-is-better-never-underestimate-the-power-of-encouragement/ Encouragement to Bloom by Lisa Crowder https://lisacrowder.substack.com/p/encouragement-to-bloom How Can Parents Encourage Emotional Development? By Ashley Olivine https://www.ashleyolivine.com/how-can-parents-encourage-emotional-development/ As of today, I have read 64 books in 2023. That is more than I have read in the past 3 years COMBINED (thanks to my new job and some life changes). While I have given over 20 five-star ratings and reviews, there are 10 books that are still following me around and dancing in my soul. I think about the characters or the story or the emotions they evoked and THAT is why I love to read. These 10 books have all taken up residence in my heart for 2023:
If you want to feel sad or reflective:
I hope these recommendations have come to you at the exact time you needed them. Please comment below if you have read any of these! I also review books regularly on TikTok and would love to connect with you there! Hijacked. Triggered. On Alert. On Edge. Uneasy. Icky. These are all words that describe how I feel when I am leaving my body as a result to some stimulus. And while I hate that my body has a physical response to certain triggers, my therapist has helped me realize that my body is doing its job. It is trying to keep me safe. It is sounding an alarm, and that is a good thing in the end. Whether you have been to therapy or not, you may recognize similar feelings and wonder how you can get back into your body and out of that fight, flight, or freeze response. Below I have listed some concrete ways to do so: 5 ways to get back into your body:
I hope these techniques have given you some concrete tools you can readily adapt the next time you are feeling a fight, flight, or freeze response. They have certainly helped me get back into my body. May you find more peace and belonging through my words. Please know that you are not alone. Godspeed.
Dear God, show me the way I am on this road Lord Do I exit or do I stay? I was once a little girl Learning the Apostle's Creed and the Lord’s Prayer Now I am a grown woman And I have seen far too much despair I have healed some I have broken some Bodies and hearts and souls And as I travel down this road Lord I reach desperately for your hand to hold There are nights I feel so lonely I know you are there but I can’t find you There is an emptiness that can control me I try to fight it but it obscures you There is beauty in the absence Sometimes I see it and sometimes I feel it A tree that has shed its leaves A body beyond Earth's healing A notebook blank and waiting for a pen A shared glance between strangers where love will soon begin A happy baby waiting for his first tooth A hopeful high school senior full of ambition and youth My Mammaw’s vase waiting for its perfect bouquet My middle schooler’s energy as he starts every single day Do I notice the widow alone on the bench? Do I dwell on her grief - Do I absorb her heart-wrench? Or do I peek in the bird’s nest that comes every spring? And await its perfect eggs Soon baby birds with tiny wings There is beauty in the absence God For even sorrow and loss is proof of love I will travel the road you paved for me Gently nudge me in those quiet corners Lord Help me remember I am enough Amen. I recently finished The Four Winds by Kristin Hannah. As I listen to books on my commute, I often pause the recording when I hear a lovely or heart-wrenching quote and voice text it into my iPhone notes. With The Four Winds, I captured 11 quotes. One that has settled into me is this:
"You're wearing your worried face"
said the daughter to her mother. "It's my love face" said the mother to her daughter.
*** I chose mother and daughter instead of character names for context
As I reflect upon ALL THE THINGS (#overanalyzersunite), I cannot get those words out of my head. I am embarrassed (or not?) to tell you the number of times one of my 3 boys has asked "are you okay mom? Your face looks funny like you're mad at me or worried." All the while, I'm thinking "I am cooking supper, I have just folded a million tiny boxer briefs, I signed your agenda, AND I am making a conscious effort to smile ever so slightly." I realize as I pass the hall mirror that my forced smile is only on the bottom half of my face and that the top half is riddled with the heavy and the unknown that I am carrying that day. In my previous post on motherhood, I mention that I sing my children awake. It is quirky and I don't know how it started, but it is ritual in this house. If ever a morning passes without music in the house, the boys know "mommy ain't right." (sidebar: the writer in me abhors "ain't" while the Kentucky in me knows it infers just another level of wrong that the word "not" misses). Laugh if you agree. As my boys get older, and as my therapy bill reaches the thousands of dollars, I am learning that pretending everything is okay:
With boys ages 19, 11, and 9, my Worried / Love Face has rested above my shoulders on so many different days and in so many different ways.
So what next? Is there a moral to this story? I think of my own Mama and both my grandmothers. I remember seeing their Worried / Love faces too and not knowing what they meant. I remember telling both grandmothers goodbye when they BOTH knew they were dying from lung cancer, one as a spitfire 60 year old and the other as a content great-grandmother in her 80s. Even if you are not a mother as you read these words, you have or had a mother. She may be a great mother, or she may be one of the worst. She may not be here to show you her Worried / Love face anymore, and for that my heart aches for you.
I will leave you with this. Another The Four Winds quote.
"Believe me Elsa, this little girl (or boy) will love you as no one ever has and make you crazy and try your soul. Often. And all at the same time." You either have a little girl or boy or you were a little girl or boy. If you have seen any parent figure's Worried Face, then just KNOW that you are or were or will always be LOVED beyond measure and without end. My pledge going forward is to tell my boys as much truth as they can handle at that moment about my Worried Face so that they will KNOW that it really just means that I love them. Forever and Always. Godspeed. I see it every year. It starts around the first week of November and it lasts through the middle of January. The holiday blues. As I’ve gotten older, I’ve actually slowed down enough to think about trends in my practice. Sure there is an actual diagnosis of seasonal affective disorder, but this is different. This is deeper. This is hard. And here’s how I see it every day for two months straight in my exam rooms: Me: Hey Mrs. Jones - it is so good to see you. I know we had to zoom for our last visit. What’s new in your life? Are you ready for Christmas? Do you have to cook for Thanksgiving? Are y’all going anywhere? Mrs Jones: oh you know, I will be cooking for the family for Thanksgiving. And the children and the grandchildren may stop by for Christmas. No... I don’t go anywhere. I’m ready as I’ll ever be. Blank stare. Obvious reflection. Anyway how are your boys? Are they ready for Christmas? Do you have to cook for Thanksgiving? Me: oh yes I will be making my Mammaw’s dressing, sweet potato casserole from an old Birmingham recipe from one of my mother’s friend’s mothers, my layered salad that a nurse I used to work with taught me how to make. Gosh that was over 25 years ago now. Blank stare. Obvious reflection. Daddy will fry the turkey and my husband will fix the ham and a peanut butter pie. Mama will make the deviled eggs and the Waldorf salad. I will make my mother-in-law‘s corn bean casserole and some homemade mashed potatoes. Of course we will have rolls and cranberry sauce. Another blank stare. I haven’t seen my mother-in-law in over five years. The boys? Oh yes, they are more than ready for Christmas. We got them a matchbox Advent calendar they can’t wait to get started on. They’re growing up so fast. Blank stare. Obvious reflection. The oldest will be home from the Air Force. He and his girlfriend will be together the whole time I’m sure. I smile. But I’m nearly in tears. What is going on? And we sit for a moment. Two women born of different decades and sometimes different skin colors who have lived two very different lives at the outsider’s glance, but are so alike on the inside that it’s haunting. Her daughter is sitting beside her. They look and act so much alike it makes me smile from the inside out. I’m sure that’s what people say when they see me with my mother. I don’t have a daughter. Will my boys take care of me? Alright, get it together Amy. We finish out our actual medical visit and say our go-to goodbyes: Happy Holidays. Y’all be safe. Call me if you need me. And now, after ALL these years, I often hear “you know I love you.” And I believe it’s true. It’s not forced. It’s been earned. Is it against the rules? No, not my rules it’s not. Truth be told, I love her too. Maybe because I see myself in her and I’m cheering for myself in my old age. I’m giving myself a head start and saving myself a seat. I’ve practiced in Kentucky and in Georgia. I worked in a nursing home for six years and then made rounds as a nurse practitioner in that very same nursing home. I’m an old soul myself so I think I draw my elderly patients in and they stick. I stick to them too, and I think they know it. I’ve had so many Mrs. Jones over my 17 years. I’ve had Mr. Jones and Little Johnny Jones or Little Sally Jones as well, but I am so connected to Mrs. Jones that I can almost finish her sentence. Now I’m driving home and this 2 Lane Highway surrounded by trees and cows and horses makes me feel like I could be in any of the four states I’ve lived. It’s familiar and so are these thoughts. I’m a little girl in my childhood home with my brother and my parents and we just came home from candlelight Christmas Eve service and mama made lasagna. I haven’t really been hurt yet. I don’t know what it feels like to love somebody besides my family. I feel safe and secure and like I can do anything in this world. How did Mrs. Jones feel at this age? How did you feel at 10 years old? Now I’m driving home from Tuscaloosa with Delta Zeta on my back windshield. My finals are over. I get to see my boyfriend. I’m taking pre-med classes as well as a full nursing load, but I’ve been hurt by now. I’ve been disappointed and lied to by some people I trusted. But it’s the holidays you see, and I still feel like I’ve got a handle on things. I wonder what Mrs. Jones was doing at 20 years old? Had you been hurt by then? Oh wow. I didn’t really see this coming. Or did I? I’m sitting alone in my first marital home. Half my furniture is gone. Someone I love deeply told me I don't really need a Christmas tree this year because "it's just you." Am I not enough for a tree? Who am I by myself anyway? I’m driving to Georgia for Christmas. I don’t think I’ve ever been this sad in my life. I wonder what Mrs. Jones was doing when she was 30 years old? Was her heart broken like mine? Was yours? Gather around now. It’s time to eat. My baby boy is four years old and can’t seem to stop smiling. God gave him to me for sure. The first one I carried is six and almost as smart as I am. The one I didn’t carry but I’ve fed and loved now for seven years is sitting right next to me. Is he thinking about his mama? Will he ever see her again? Tiny pieces of my heart crumble for him. I just started taking prednisone for an incurable autoimmune disease I had to look up on the Internet. Lord have mercy and I really do mean "please Lord have some mercy." I’m only about 3 1/2 weeks into a lifelong diagnosis and I don’t know what the future holds. I’m scared. I’m sad. Merry Christmas y’all. It’s the holidays, right? I wonder how old Mrs. Jones was when she first questioned her mortality? How old were you? Were you 40 years old like me with a child in pre-K, one in first grade, and one silently falling apart right in front of you? You see that’s what the holiday blues are. They are every heartbreak and broken promise. They are all the fears and all the lost relationships. They are that empty seat at the table. The phone that barely rings. They are the one that got away and the one that stayed too long. They are your mother, your father, and your children. They are every husband you’ve ever had. How can they not be? We can’t erase our memories. I don’t have a cure for the holiday blues. I think they’re part of life. Mrs. Jones might tell me they get better with each decade or she might tell me they grow and take up more space than we should allow. I’m scared to ask her. None of us even talk about it really. We just say Merry Christmas, Happy Holidays, y’all be safe. So this is my letter to you at age 45. Some heartaches of mine have healed and some are still there. I don’t think we should only remember the good times because that’s not what made us. It’s certainly not what made me today sitting right here baring my soul and giving you the permission to bare yours. Acknowledge the things that built you. Godspeed. This goes out to every Mrs. Jones that has ever allowed me to know her. She is me and I am her. And I thank God for that. A recent blog reader commented on my pandemic lessons post with the comment "we are not all scared and trying to stay alive." I have had to sit with that for a few days. I am not scared of death... for many reasons... but a lot of it does have to do with my blood, sweat, and tears I have poured into countless patients for decades now... as well as my faith, but the two seem very intertwined when I think of my own mortality. I think another reason is that I have a chronic illness and I know end-stage pulmonary fibrosis (how my disease usually pans out) is not a cake walk, so if God calls me home at another time for another reason, I am okay with that. But, I think it's her last little bit of commentary that hasn't settled well in my soul. "We are not all trying to stay alive." We are not all trying to stay alive. 🤔 🤷♀️ 🧐 But aren't we, though? Isn't that why all of these scenarios insight fear, panic, palpitations, stomach-drops, sweaty palms, and often tears?
This post is not meant to be a Debbie Downer. It's meant to be a reality check for myself, and perhaps for you too. Every SINGLE day in my work, I encounter people I hold dear now after all these years that are FIGHTING to stay alive. Whether it is cancer, chronic disease, renal failure requiring dialysis, congenital or acquired physical disability (think MS, cerebral palsy, and paraplegia to name a few), OR they are in an unsafe home environment OR they are mentally on the brink of self-harm. they are each FIGHTING to stay alive. The following examples have all taken place in the past 2 years along with countless other patient deaths (some covid, some not), but these have rocked me. I lost my first patient to suicide this year and I am not the same. I always worried about him. I would leave our visits thinking about him. Did I do enough? I lost a close friend my age, someone I admired- so many admired- this past year to a 6-year battle with colon cancer, and I have tried to help my friend of 27 years keep herself and her children together during and after that loss. I am still learning - we all are. This is new territory for us. I lost a patient my age that was so much like me health-wise and personality-wise that it was like looking in the mirror every time we had our visits. We just happened to have different colored skin, but our hearts, fears, loves, and passions were so aligned. I was the one her son called while the nurses were "pounding on mama's chest" and I was the one weeping in my parents' backyard looking to the heavens begging God "please don't take her, she's not ready. Please don't take her, she's not ready. Please, please, please Lord don't take her yet." As I attended her funeral, it was like I was attending my own. I still think of her so very often. So yes, dear reader, I can agree that most of the time I choose not to live in fear. I have a "crappy" (it's my blog and I will almost-cuss if I want to) autoimmune disease that makes me feel lousy some days and fine other days. I take mouthfuls of medicine twice a day and my Humira costs could house a small family (thank you Aetna for your coverage). Occasionally, I "fear" not ever seeing my 2 youngest sons graduate high school or college. I "fear" never meeting my grandchildren, and sometimes I "fear" my precious boys having to take care of dear old Mom. I'm afraid I won't get to tell them everything I want them to know about me, about love, about God, about marriage, about friendship, about what truly matters, and about how to navigate the good days and the bad days. How to forgive, how to keep moving forward, and how to love themselves. Honestly, I think it is part of why I felt this huge push to write. They don't read my words now, but they might one day. But as for not trying to stay alive? I will disagree with every hair on my head, bone in my body, and adjective in my razor-sharp vocabulary on that friend. I AM TRYING EVERY SECOND OF EVERY DAY TO STAY ALIVE. And I stand witness and hold space for every other person I have cared for during my career in nursing and medicine who were all and are all still trying to do the same. I learned a new term today during a visit to Little Havana in Miami. It was made for the patriots who were anti-Castro who often became political prisoners. They were named "Plantados" - they stood planted, strong, unmoving, unwilling to step down. I am a Plantado for life, sister who made that comment. I shall never budge on that. I am here, showing up, every single day- trying to stay alive. I welcome my fellow Lifers. Let us make this world a little better each day. 🌎 Please help support my fellow Hope*Writers
by reading their work 🥰 Does Fear Have a Place in the Life of a Christian? By Regina Marcazzo-Skarka https://reginamarcazzoskarka.wordpress.com/?p=90 Living Fearless By Sharla Hallett www.sharlahallett.com/living-fearless/ I ain't afraid: Reflections on turning 50 By Jessica Weaver www.rootedunrooted.com/blog/i-aint-afraid When Hidden Fear Creeps Out By Dianne Vielhuber https://simplewordsoffaith.com/2021/10/31/when-hidden-fear-creeps-out/ How to Help Kids with Anxiety and Fear By Ashley Olivine https://louvaria.com/how-to-help-kids-with-anxiety-and-fear/
Before deciding if you love me or hate me, let's look at each of these in a little more detail. If you are reading this and you don't work in healthcare, I encourage you to close your eyes. Imagine driving to work where patients are very sick and you are responsible for their health. Imagine being extremely exhausted - mentally, physically, and emotionally. Imagine having the same conversations day in and day out. Imagine wearing a mask and face shield all day every day AND if you work in certain healthcare settings, full plastic gowns (sweaty and HOT) with even more restrictive masks (n95). Think about having heart-wrenching conversations about death and dying with families and patients that you have come to love over many years. Consider praying on your drive in and your drive home because you've worked in healthcare since you were 19 years old, but you've never seen anything as dark and dangerous, cold and pointless, savage and destructive as THIS. Imagine that you, like everyone else, have also been unable to see loved ones, travel, send your kids to school without a mask, and that you- like everyone else- have your own political and religious beliefs but you cannot mention those since ALL eyes and ears are on you. Now imagine doing that every single day for 20 months in a row.
I usually wrap up my posts with some heart-swelling, tear-jerking, or funny concluding thoughts. I try to connect us as humans, mothers, fathers, daughters, sons, sisters, brothers, neighbors, and friends. I find a way to touch you, soften you, move you even if it’s only for a moment. I don’t know how to do that with this post. I’m tired. I’m sad. I’m frustrated. I’m still hopeful. I still believe. I guess I will end by asking all of us to consider the division we have all felt over the past 2 years. Consider the lost lives and energy we have all spent to prove we are right. And hug your family. Hug your loved ones. And look your “enemy” in the eye before you judge their choices. We really are all the same. Imperfect. Scared. And trying to stay alive. 🌎 What's in a name? I have been married twice. I dated my first husband six years before we got married, and we were married 7 years. We didn't have any children. I've been married to my current husband for 12 years now and we have raised 3 children together. My step-son was 7 when we got married (19 now and out of the house), and our boys are 9 and 11. What is bizarre is that neither of my husbands have a very close relationship with their fathers. In fact, I have never met either of their fathers. To take that even further, I have never met a SINGLE person on either of their father's side of the family. So... to put that into practical terms, I have had a last name for 19 of my 45 years that really had no "meaning" to me. My first husband was the only "Smith" (not his name, but just using as an example) I knew but then I carried that name. My second husband is the only Cobb I know other than our 3 children. Let that sink in for a moment. This has made for some very awkward life moments:
Since I'm really into family in general, and I love old family names and family history, I bought my parents an Ancestry.com kit for Mother's or Father's Day one year. I also bought one for myself and my husband. I love looking back at all of our relatives and heritage, but building my husband's family tree has been difficult. This has led me into some deep thought (doesn't take much for me to go deep 😜).
In my opinion, a name carries weight. Identity matters. Having always worked in the medical field, my name is something I sign every single day. I prescribe medicine so it appears on prescription bottles and insurance claims and lab and imaging orders. Nurses answer the phone "Amy Cobb's office, how may I help you?" I am listed as a primary care provider for about 2000 people. I don't mention this as if I am anything special. I most certainly am not. But do I feel odd having a last name plastered all over HealthGrades and pill bottles when I have no physical, emotional, or spiritual connection to the name? Yes, I am married to a Cobb. But what makes him a "Cobb?" I can't grin at my husband and say "you laugh just like your daddy." I can't look at my boys and tell them they have the Cobb nose or the Cobb stubborn streak. I can't say "boys, your grandfather would have loved to see you hit that ball, march that field, fix that jet." I don't know any Cobb recipes or Cobb traditions. I don't know if or where they went to church, what music they loved, or how they earned a living. And so again, is this how fatherless children feel? What about the motherless child? Is it the name that carries the weight or the connection itself with a parent, a heritage, a history? For my adopted friends and patients, what does their adopted name mean to them? Is it a name filled with love, hope, and acceptance or is it a daily reminder of what could have been and what may never be? Not knowing anyone else with my name is a first-world problem. I realize that. But it is a thing. I'm learning to acknowledge my "things." I'm learning to feel those feelings, name what's missing or hurting, and process what thoughts can do to my body. Is this shame I am feeling? Regret? Did I even do anything wrong? Who is to blame - or is blame even required? Another ebb and flow in the circle of life, the jagged bonds of connectedness that barely keep us together - sometimes by one single strand of a lineage. I reached out to my writing group to see if any adopted writers had a perspective about the meaning of a name. Ann C. Averill wrote a beautiful piece about her experience with her name, and I am happy to feature it as a guest post on 10/12/21. Thank you, Ann, for your bravery and vulnerability to share with my readers. ❤️
Who knew a pen and paper ✍️ could save a life? I wasn’t actively suicidal. But I was having frequent daydreams of having a wreck that was “bad enough” to keep me in the hospital a few days, off work at least a month, and unable to help anyone else for a while. 😳 I wanted it to be a single-car accident and of course I wanted to be alone. I wasn’t looking forward to the injuries and was praying nothing would require surgery, but I couldn’t wait to have a respite from work, life, and motherhood. Does that sound crazy? Selfish? Or similar to thoughts you’ve had? Caregiver fatigue 😴 is a real thing, even if you’re paid to care for others. Motherhood fatigue 😴and lemme just say it, full-time step-motherhood 🤷🏼♀️ fatigue is a real thing even if you love your children 🚶♂️👬🏼 dearly. Today’s world 🌎 for women is exhausting:
Toss in a pandemic 😷 and virtual school 📚and BAM, all the therapists are booked! Fortunately, my mental "breakdown" was pre-pandemic. Thank the heavens I already had a therapist when my regular job got flipped upside down in March of 2020. My crazy started when I was in the throes of motherhood, working full-time and commuting with kids age 2, 4, and 12. I was crying regularly on my way home from work, wondering how I was going to get everything done and actually sleep too...😴 I’ve always had pen and paper near me, but I didn’t start regularly journaling ✍️ until I started feeling that OVERWHELM on a regular basis. I had so many thoughts racing through my head and I didn’t have a system to capture them. I was using a planner, but I might think of something while driving or in the shower and I would lose the idea 💡 or thought before I captured it. Some internet scrolling led me to David Allen’s Getting Things Done method. By this point I had played around with bullet journaling and list making (List Maker 4 Life right here now!), but again, I felt like my thoughts were fleeting and scattered. I will link the GTD method below, and I do think it's a good system, but that's not the point of this post. Once I started decluttering my mind from all the racing thoughts, then I had to face my actual thoughts. This was not a good look. I couldn't remember the last time I had laughed with abandon or woken up with a passion for life. I felt like I was on a treadmill with no way off. Someone was going to have to pull me off, and I didn't have the time or energy to ask anyone to pull me off. I never felt relaxed. I was in a constant state of fight or flight (or so it seemed). I was alive. But was I living? Enter the JOURNAL. ✍️ A journal can be so many things:
When a patient presents with hair loss, I obtain a thorough history:
I then perform a thorough physical exam and order the following tests:
That may not “answer” your question but I hope it helps you know what a clinician will be looking for with this presentation of hair loss. 🩺👩⚕️ Personally, I have dealt with hair loss from taking Methotrexate for my sarcoidosis.
It started coming out in clumps in the shower and then in my brush. I soon had very patchy areas of hair loss all over my scalp. My hairdresser advised me to stop applying heat to my hair when possible, to wash my hair less frequently, to avoid ponytail holders when possible, and to avoid any hair color or harsh chemicals. I usually got some blonde highlights in the spring put in my naturally red hair, but I went without those for 4 years while I was on Methotrexate. My rheumatologist increased my Folic Acid dose from 1 mg to 2 mg daily, and I ordered Biotin off Amazon Subscribe and Save. I took the Biotin daily to help with hair growth. I am finally off Methotrexate and on Humira and am seeing hair growth again. Losing my hair was very emotional for me. My bright red hair has defined me for so long. I now knew what all of my patients struggling with hair loss from chemo or other medical reasons were feeling, and boy was it a wake up call. My heart goes out to anyone struggling with hair loss. Much love to you and I hope this helps. Reflection is a beautiful thing. It is often overlooked, but when we slow down and DO IT, we can learn and grow. Now that I'm in my forties, I sometimes look back at times in my teens and twenties and try to "hold on" to that feeling. We really can't do that, though, can we? Frequent reflection allows us to "hold on" right now. To really "feel it" right now... before it passes. Reflection gives us room to take note, consider future improvements, and relish in current joy. I'm hoping to start reflecting every quarter here. A public diary entry of sorts. A record of the good and the bad. A glimpse in time.
This is what I'm learning right now, September 2021:
Throughout my career, I have had to deliver hard news to my patients. I have had to deliver even worse news to their families. It is the LEAST favorite part of my job, but I have found some comfort knowing I am delivering the news with compassion and empathy. I usually know the patient and family very well, and I think that means a lot. These suggestions may be helpful when faced with a difficult diagnosis.
Let's look at each suggestion in detail:
I am in a unique position in that I have both delivered and received hard news. At the age of 40, when my youngest son was 4, I was told I probably have lymphoma AND multiple sclerosis over the phone by a nurse. I was told to get an appointment with an oncologist and a neurologist as soon as possible. Many blood tests, imaging tests, and biopsies later, I was finally told that "you don't have cancer! And I don't think you have MS but I'm not sure. What you do have is a lifelong incurable autoimmune disease that can attack any organ and can be difficult to treat. And by the way, nobody has really heard of it and even us doctors have to google it when we see it on a chart."
So maybe those weren't his exact words, but it was close. And there will be a lot more to that story to come in my posts. I wish someone had used tip #3 with me when delivering my news. What do we say when we don't know what to say? We have all been there. Someone dies unexpectedly. Someone receives a terrible diagnosis. A divorce comes out of nowhere. A tragic accident. Our partner says something cruel or doesn't meet our emotional needs. A friend is struggling with infertility or has a miscarriage. Our friend is venting about a difficult situation. Here are some tips for what to say and what not to say: Do / say this:
Don't do / say this:
CHECK OUT THE BOOK "I HEAR YOU" BY MICHAEL SORENSON FOR AN IN-DEPTH DISCUSSION ON ACTIVE AND EFFECTIVE LISTENING. WORTH THE READ!
She had legs as long as her cars (she always drove a Lincoln or a Ford). She loved cigarettes and an evening toddy. She never went to college, but she was sharp as a tack. She was good with money, and she wanted me to be able to take care of myself. She loved to dance, and she loved to have fun.
Every summer she would take me to an expensive swimsuit store in Gulf Shores and let me pick out whatever swimsuit I wanted, sometimes two. On her back porch, we sat together and shucked corn, shelled peas, and snapped beans. She loved my brother and me so much that she put an in-ground pool in her backyard and kept it crystal clean. She could call me out on my smart mouth or eye rolls in a hot second, and I will admit, I did not want to cross her. She and her third husband drove to see us in their RV which was the absolute coolest thing my friends and I had ever seen. No one in small-town Kentucky had an RV. One summer she flew a friend and me down to see her and we were able to fly without an adult. We thought we were movie stars! I was only thirteen when she was diagnosed with lung cancer and died 3 months later. When I went to “say goodbye” before she died, she told me to only cry 2 tears for her. She told me she had known love and loss and had a fulfilling career and raised her babies and got to meet her grandbabies. She told me she had traveled and had fun and danced weekly at the local spot. She had run a business and built a home (like literally picked out the plans which not all people get to do in their lifetime) and that she was okay to go. I had not known anything she had known at that time. No romantic love or loss (she was the first person I really lost as a child and boy was it a whammy!). No career or babies or grandbabies. No travel or weekly dance dates with my husband or businesses run or houses built. I sit here today, and I’ve done almost all of those things now. Because of her, I’ve even saved a dollar or two. Because of her, I laugh more, sing more, dance more, and love more. I forgive easier and dream more. Maya Angelou is famous for saying we don’t forget how people make us feel. Martha Louise Merrigan Taylor Rouse Taylor (yes, you read that right, she married 2 different Taylors of no relation) made me feel like I was special and important. When I was with her, I felt loved and cherished. Not perfect, she never let me think that, but close. Early morning in a hotel room in Birmingham, AL and it’s already scorching outside. The boys are asleep, but I’m still basking in the glory of seeing an old friend last night. We picked up as if we were just sitting next to each other in AP English, but in reality, it has been TEN years since I’ve seen her face and hugged her tightly.
With social media, one can “feel” like we know what’s going on in each other’s lives, but nothing replaces uninterrupted conversation and rehashing old memories. When you’re 45 and you see someone who knew you at 11 in that awkward braces-for-her, round-thick-glasses-for-me phase, any ego or feeling of adultness goes out the window. We saw each other’s hearts get broken and dreams get lived out. I twirled a flag in a band she led onto the field, and she had to witness all my annoying academic dominance in high school. Can you believe she actually apologized for something she said that was cruel to me 30 years ago? She is one of the most beautiful loving souls I have ever known! Her faith and love for God has always brought me to her like a moth to a flame; she has been a safe space for me to express my faith. Why do we all hold onto old garbage? I do it too! We all do. This time our conversation covered motherhood, marriage, aging parents, losing parents, our nursing careers, and each of our unwanted entrances into the world of rheumatology. Just like in high school, we laughed and smiled about our daily quest to do the best we can and survive the icky parts of relationships, parenting, and work. Both a little wiser, and me definitely a lot humbler (her too, I’m sure), it was refreshing to be REAL for a few hours with my friend who saw me with 2” high bangs and overalls with one strap unbuttoned. You can’t lie to a friend who has seen all that. |