Women, Work, and the Wish to be a Princess.

Like most little girls born in the 1980's...or ever...I wanted to be a Disney princess. I wish I was one of those cool girls that could claim she was a tomboy and grew up playing sports, but I wasn't. As much as I deny it now my favorite colors were purple and pink and glitter for many years.

I wanted to be a princess but my choices were limited.  Jasmine dressed too skanky. Pocahontas rolled around in the grass with John Smith and sang about the spirits in the wind (so I still haven't seen that movie). Ariel had a bad attitude and disobeyed her dad so my parents didn't like her, although I somehow still pulled off naming my first kitten after her.  Snow White seemed safe but REALLY boring. Does she even talk?

Belle was the best...let's be real.  She has the best songs, she was brunette, she actually got to ride the horse without the prince and the golden ball gown was awesome.  The tea parties weren't bad either.  So yeah, I'd pick Belle although my lifelong dream to own a large feline always drew me towards Jasmine. But since I wasn't allowed to dress like her for Halloween she was out.

I have resolved to finish a book every month this year.  I know that's no big deal for most but I'm someone who has started nearly all the books on my shelf and probably finished 25% of them.  Unlike Belle I'm not really a reader. If I could be a tomboy and reader then maybe my life would be complete or at least I'd feel a lot better about myself.

I did finish Lean In by Sheryl Sandberg in January.  It challenged my life.  While I will resist going on another feminist rant with this post I want to share some of the most memorable moments of the book.  If you haven't read it you should. Male or female, it is important.

1) Ban Bossy.
Personally I think this movement is a little extreme and I was the little girl who was told daily that she was too bossy.  It did hurt. It did make me feel like I shouldn't speak up and it did make me feel disliked by many of my peers. However, asking people to refrain from using the word "bossy" seems a little silly to me.  Instead I think we need to take ownership of our bossiness.  Sheryl was called bossy and now she's the boss of facebook (next to Mark of course). Even early in college Sheryl remembers that as one of five recipients for a scholarship at Harvard (and the only woman) being the top of the class made life easier for males and made it harder for females. Being smart is good in a lot of ways, but it doesn't make you particularly popular or attractive to men...our entrenched cultural ideas associate men with leadership qualities and put women with nurturing qualities...we believe not only that women are nurturing but that they should be nurturing above all else.  When a woman does anything that signals she might not be nice first and foremost, it creates a negative impression and makes us uncomfortable.

Solution? Suck it up and own your success. Sheryl argues that more women should be in leadership.  It's really easy to hate [bossy] senior women when there are only a few...but if 50% of the top jobs were held by women it would just be really difficult to dislike that many people. Powerful women must be less of an exception.

2) Forget Fear.
Women statistically do not speak up in meetings because they fear seeming like they are nagging or negative (story of my life). We fear that constructive criticism will come across as just plain old criticism. We fear that by speaking we will call attention to ourselves which will open us up to attack. We must speak with delicate honestly rather than brutal honesty. I am terrible at this but working on it.

3) Get Married.
The closer I get to thirty the clearer it becomes that single women my age tend to fall in to two categories 1: the OH MY GOD I'M GOING TO BE 35 AND SINGLE AND MY EGGS ARE DYING I MUST FIND A MAN TODAY TO BE TRULY HAPPY category or 2: the I'm INDEPENDENT and FREE and don't NEED a man and I'm not that interested in marriage because I'm career driven and kids are cool but I'm too selfish to have them right now category.  I have wavered through both categories but tend to fall into category 2 on most PMS-free days.

Sheryl would probably tell category 2 to humble yourself and get married. I truly believe that the single most important career decision that a woman makes is whether she will have a life partner and who that partner is. I don't know of one woman in a leadership position whose life partner is not fully supportive of her career. No exceptions. And contrary to the popular notion that only unmarried women can make it to the top, the majority of the most successful female business leaders have partners. 26/28 women who have served as CEOs of fortune 500 companies were married.

4) Discuss Role Definition and Ditch Divorce. 
Statistics show that the risk of divorce reduces by about 50% when a wife earns half the income and a husband does half the housework. Enough said. Or at least enough said by me.

5) Free yourself from Having It All.
It's a lie. It makes women (and men) feel like they are falling short. No one has it all. In a Tina Fey interview she stated that the single most offensive question she is asked as a woman is "how do you juggle it all?" People constantly ask me with that accusatory look in their eyes... 'You're really fucking it all up, aren't you?'

Remember that done is better than perfect. [Balancing a career with a family] will be a little messy, but embrace the mess. It will be complicated, but rejoice in the complications. It will not be anything like what you think it will be like, but surprises are good for you. And don't be frightened: YOU CAN ALWAYS CHANGE YOUR MIND."

6) You have a choice.
Career+family. Family. Career.  It's no ones choice but yours and there is not a wrong answer. Women have been subtly striving all our lives to prove that we have picked up the torch that feminism provided. That we haven't failed the mothers and grandmothers who made our ambitions possible. And yet, in a deep and profound way we are failing. Because feminism wasn't supposed to make us feel guilty, or prod us into constant competitions over who is raising children better, organizing more cooperative marriages, or getting less sleep.  It was supposed to make us free - to give us not only choices but the ability to make these choices without constantely feeling that we somehow got it wrong. ~Debora Spar

I chose not to be a princess. As I got older the castle seemed kind of restricting and I wanted  to try playing sports and riding horses without waiting for the prince to wake me up. For now I am career focused because I have to save enough pennies to purchase my own tiger and while my career is my pride, joy and main focus right now... I reserve the right that it may not be f o r e v e r.

For research studies and statistics please see Lean In by Sheryl Sandberg. 

Deal, listen to Georgia.

I do not claim to be an expert on the subject.  I haven’t even tried, but let’s face it…very few of us are.  I have decided I want to write my simplest thoughts about why I believe Georgia needs Medicaid expansion.  Some think that my Emory education has corrupted my once super conservative brain but I just believe that becoming a Nurse Practitioner has enlightened me.

When looking for jobs in the primary care setting, or even specialty offices like Infectious Disease or Cardiology it has become blatantly obvious that most doctors offices do not accept Medicaid.   I used to have it on my "non negotiable job list" that I would not work somewhere that does not accept Medicaid.  This has proven to be nearly impossible.

Why?  The easiest explanation is that Medicaid doesn’t pay.  A Physicians Assistant recently told me that he makes about $10 on a visit seeing one of his chronically ill HIV patients.  Medicaid reimburses physicians at about 59%of what Medicare pays them (some complicated policy has changed this temporarily in most states, thank God).  This is why it is fairly easy to find a physician seeing lots of old folks and zero poor folks. 

I had a renowned Infectious Disease doc sit with me in discussion recently and say, “Well, if Georgia was expanding Medicaid I’d have a job for you, but since Deal isn’t, I just don’t have the money or clientele” (because they don’t qualify for Medicaid they can’t come to his office). This doctor serves a huge number of low income HIV+ patients in Atlanta and if Medicaid was expanding many more of these AIDS patients would be funded through the (state+federal) government program and be able to see a primary care physician rather than an ER doc. I have yet to meet a physician in Atlanta that does not believe Medicaid should expand. 

So why should you care?  The arguments I hear are often are “why expand a broken system?” and “I don’t want my taxes to pay for them.”

Well, first of all the entire health care system is broken.  We can all agree to that, though none of us can agree on how to fix it. I believe expansion is a good step.

Secondly, let’s think of Calvin.  A 54 year old man who has lived on the street for most of his life, noticed that he has a large lump growing on his jaw.  He doesn’t think much about it because he doesn’t have insurance (or Medicaid…he doesn’t have an address).  He continues his life as the tumor grows.  He thinks about going to the doctor a few times but there are very few doctors in his area who would agree to see him even if he had Medicaid because the reimbursement rate is so low.  So the lump grows.

Eventually Calvin is in so much pain and discomfort from the now open, oozing tumor on his face he goes to the public hospital in the area that cannot turn patients away for lack of insurance.  By this time, two years later, he’s diagnosed with stage four cancer with metastasis to his brain.  The physician can’t live with himself doing nothing for Calvin so he is put through hundreds of thousands of dollars worth of chemo, radiation, ICU stays, intubation, life support and multiple physician consults to try to save what can no longer be saved. 

Who do we think is paying for this patient who now has a medical bill of at least six figures with no insurance to speak of? 

It is beyond the scope of this post for me to discuss how non-profit hospitals like this one survive and how your taxes pay for them to keep their doors open, but what I hope to help us remember is that all of this might have been prevented with primary care.

If Calvin had Medicaid, if primary care physicians in Atlanta took Medicaid as payment, and if he had been seen his first week rather than his second year he might still be alive. 

This is why movements such as Moral Monday make claims like, “If Georgia doesn't expand Medicaid 600 more Georgians will die this year.”

Our ER’s are overrun with patients like Calvin. Patients that come in during the last days of their lives because no one would accept them earlier.  Atlanta Magazine put an article out about a year ago about the story of a single mother who knew that she had breast cancer for nine years and came to Grady only when her breast had fallen off.  She couldn’t afford physician copays, couldn’t take time off work and feared the payment system as a whole. 

Hospital funding and politics is tricky.  I know very little.  But what I do know is that if primary care physicians don’t raise the bar and catch cancer and HIV and lung and heart disease early it becomes an astronomical hospital admission bill that the tax payers are left to settle.  It also becomes a lot of dead people that did not have to die.

Physicians must start accepting Medicaid and the only way that is going to happen is if it is expanded.  I used to be upset with physicians for not taking Medicaid, after all it is their choice, but now I realize that no one would choose to do something that will put her out of business. We have a frightening shortage of primary care physicians currently and this shortage is only expected to increase as other aspects of Obamacare go into affect this year. 

Why is there this shortage do you ask? Well clearly it’s because primary care physicians don’t want to pay taxes into a broken system either. 

japan y'all

My adorable friend Emily deemed "Japan y'all" the hashtag for our trip as four Georgia bred-if-not-born college friends got to spend 9 days and Thanksgiving together on the mainland.   Richard and I have been close since his freshman year of college.  I was his RA.  Somewhere along the way I introduced him to my friend Ashley and he introduced me to his lovely girlfriend-now-wife Emily.  That's the short version of the friendships.

I consider myself fairly cultured.  I've been to about 13 countries give or take the layovers and have seen most of the US.  Japan was my first exposure to anything Asian.  I realize that Asia is a massive place but when most of us think about Asian culture Japan, China, and likely the Koreas come to mind.  Or at least that's what comes to mind for me.

I've always enjoyed traveling, not only because I simply love learning how big the world is but I'm also baffled by how vastly different it is.  Other than traveling to Europe on four different occasions everywhere else I have been would be classified as a developing country.  This was somewhat of an adjustment for me in Japan as the wealth, classiness, safety, technology, the brillance of the people amazed me.  I guess in all honestly I don't think about Japan. My first desire to travel there arose when my friend Richard got stationed there 6 months ago and I can't say that it was in my top ten list of places I want to visit. (India is still #1 and has been since I was 16).

But how amazing it was. It took me three days to warm up to it.  The people are very quiet, reserved, almost cold.  They don't smile often and don't seem to talk to Americans except on rare occasions. They are always kind and helpful when approached but at first I was a little put off by how formal everything seemed.  Void of color.  Similar to NYC or Paris the people dress very well and almost entirely in black. It seems to blend in to their demeanor.

But then there are the cartoons!  Women dressed to the nines would have Hello Kitty iPhone cases and even teenage boys would have stuffed animals on their book bags. Every sign possible was illustrated in animation and color. It was mind boggling. Beautiful in its own way.

Perhaps I was most impressed by the tidiness.  There is no garbage anywhere...it's almost impossible to find a garbage can. Which.. I realize...makes no sense. Richard has a theory that every woman's purse is stuffed full of garbage. We went to a Japanese soccer game and every person cleans up after their self. They then stand in line to throw their garbage away when the game is over.  They sort it.  Similar to Whole Foods...into at least four different recycle bins.  They waste not. After having briefly lived in a country where it is the norm to eat your lunch out of a styrofoam to-go box and throw the box on the street when you're finished I found this very humorous.  Americans would also never take this kind of time!  Let's be real...I rarely throw my garbage away correctly the four times a year I enter a Whole Foods.

It's doubtful I will ever return to Japan.  I have an ambition to travel to a new country every year. I've been doing it for about six years now. Japan has been checked off of that list.

I am so thankful I went.  I got to spend Thanksgiving in a foreign country for a second time.  It makes one grateful for many things.  For diversity, for color, for new foods, for culture, for America, for creativity, for our wide world, for what makes us different, for what makes us the same and for a God who transcends it all.

2013 is coming to a close and I am more than thankful but my experiences in Japan will rank among its greatest memories.

fighting to be a feminist.

Three years ago I purchased a book at Perimeter Church's bookstore titled Recovering Biblical Manhood & Womanhood by Piper and Grudem. I was in a new promising relationship and I decided that maybe it was time for me to figure out what I was supposed to know.  I read about four pages and put it on my bookshelf. The book is over an inch thick, paperback.

I then progressed to thinking, well, I'm never gonna read that book but some(boy) is going to be super impressed that I have it on my shelf. I'll look cool when he comes over. Through the years my thoughts progressed to realizing that the kind of man that would find that book sitting on my shelf attractive is not one that would work for me. Oddly, the book still sits, receipt shoved in the cover, dog ear four pages in on my living room shelf. Maybe that's why my love life and my sister's (roommate's) seem cursed in 2013.

I'm not even sure what a feminist is but I want to be one. I have been learning lately that I am my own worst enemy in this endeavor. I disgust myself. 

For most of my life my best friends were boys. Especially in college, other than three great girlfriends almost every person who pulled me through was a male. Just to be clear, I did not date in college, these were platonic relationships. I've always been close to my (male) pastors and even my mother would agree that I'm a daddy's girl. It's taken me years to realize that I regard advice from men much more highly than I do from women. If I could choose a teacher, even for my French class, I'd pick a male every time. My best friend from my masters program is a 51 year old male and he is now my advisor on all things medical. If you've ever heard me talk about my future children you've probably heard me say that I'm only having boys. I realize that even genetically I don't get to contribute to that decision, but I'm still only having boys. 

Even as a nurse I have always preferred male patients. They are less complicated, easier to manage, are more fun to joke around with and at least in Georgia, they love the SEC. I'd sign up to care for the grumpy old man over anyone who possessed a vagina, every time.

Just a few months ago I again became disgusted with myself in my endeavor to become a feminist when I realized that the Tanzanian child whose tuition I pay is of course, MALE. I thought back to my experience visiting that school and would guess that about 65-70% of the children, supported by American money, are boys. 

You can see I'm an excellent feminist. What I have been wrestling through is why am I this way? Was it how I was raised in a evangelical christian southern community where I was taught that the best (though not only) model is for the mom to stay home with the kids, the dad to bring home the bacon and the preacher to wear a tie?  

Is it because in Georgia women still wear hose in the summer and too often stand behind their husbands or in the kitchen?  Is it because maybe the Bible really is misogynistic and I just never realized it?  I remember spending prayer meetings in college begging God to show me how to be a Proverbs 31 wife...ahem...woman.  While that passage is still quite valuable, is it all relevant?  Don't get me wrong, I actually know how to sew but I change the oil in my car and mow the grass more often. (Two things my father insisted his girls know how to do before we graduated from high school). 

"Women hold up half of the sky"...that's the proverb Half the Sky gets its name from. It's arguably the most influential thing I've read in the last year. It's where nearly every feminist thought in my head comes from. I learned that most African girls miss a week of school every month because they have no sanitary napkins. Five to seven days a month!?! That means that the small percentage of teenage girls who are in school in many developing countries are missing 25% of their education simply due to female bodily function.  This should cause outrage. 

Because of Half the Sky I follow nearly every facebook page that opposes child brides, supports votes and education for women and preaches against female genital mutilation.  I don't have enough feet for all the soap boxes I'd like to stand on. But is that enough?  What does a "like" on facebook mean anyway? 

An article this week in The Wall Street Journal said that women in 2012 are making 76.5 cents on the male dollar down from 77 in 2011.  My little sister understands this more than anyone as she works in a company where men with the same education and years of experience often outrank women by two or more levels and earn a 33% higher salary. Why are we still working for companies like this? Furthermore, why do they still exist?

I used to honestly believe that bit the church tells young women that men are supposed to be the leaders in companies and families because overall they are more level headed and make less emotional decisions. I used to believe the sermon saying the reason mankind fell was at least in part, because Adam didn't act like a man and Eve did. Since then I've actually dated a few men. I have usually been the less emotional, more level-headed member in the relationship. This is a personality type.  Not a gender description.  

Rachel who I have mentioned many times before stated, when I was a little girl, I knew I could be anything I wanted to be when I grew up, except a pastor...the whole thing bothered me a little bit because it made me feel like God had reserved all of the important, spiritual jobs for the boys, like he thought that girls are second best. As I've mentioned before I've never really thought that any job is second best, but I will say that as a girl who wanted to be a missionary from the time she was thirteen...I always thought I'd have to have a husband to be one. 

I am not sure where this frame of mind came from.  Was it my church, my family, my college ministry or my culture?  I don't even care.  All I know is that it exists in myself and I would argue that it also exists in many other women I know, especially Christian women. 

Feminism is a collection of movements and ideologies aimed at defining, establishing, and defending EQUAL political, economic and social rights for women. I am on board with that.  

My future daughters will be too. 

relating to the nakedness.

I have 14 students. As a part-time job between finishing my masters and getting a job as an NP I decided to teach.  I take seven first semester nursing students into the hospital for eight hours, two days a week.  For most it's their first experience in a hospital. It's been a little crazy.  It has been full of joy.

I did it for three reasons.  Mainly because I needed the money, but also because I loved precepting students when I worked in the ICU...watching them "get it" for the first time and understand what it's like to be responsible for another living body, a living soul.  It's remarkable.   I also did it because I had a terrible clinical instructor in nursing school.  For some unknown reason she hated me.  She hated me and I wasn't used to it.  I had always been the teachers-pet-my-parents-are-in-education kinda person.   My how that has changed.

Regardless of my reasons I am glad I took the job.  It has not all been easy.  There are the slackers and the strugglers and the know-it-alls but when I look at the whole experience I have been so blessed.  I often forget to write about the joy in my life because I don't need to process it like I do the sorrow and anger. However, I'm learning to take more time to process everything these days.

A few weeks ago a patient allowed me to perform a full head-to-toe assessment on him while my students watched.  He began to tell us his story and I tried not to look at my watch. He told us about his job with the CDC and how he's worked all over the world...I listened a little bit. He told us that healthcare providers are among the most important people on the planet.  He told us that he could not fully express his appreciation for nurses.

I was beginning to feel like I was in a Johnson & Johnson commercial when I noticed that at least three of the seven students in the room were in tears.  They were so moved by his affirmation that they were doing the right thing.

I had forgotten that part.  How terrifying it is to stick someone with a needle for the first time.  To inflict pain upon a body even for a good cause.  To see someone naked....their naked broken body and often their naked soul.  To be the one that is with them for twelve hours while they walk for the first time on a new joint or experience what it's like to function with the tumor gone.  To listen when a patient knows what they want to say but is unable to express it because of the blood sitting in their brain. I had forgotten what it's like to be that person and the whole time wonder if you're supposed to be.  If you're cut out for it.

My students are probably most afraid of waking patients up when they are sleeping and causing pain. These are two things that I don't even think about anymore. Almost never. At first it was adorable and now it's just annoying. But I'm realizing that even eight weeks later my students are still trying to figure out how they are supposed to relate.  As a friend, as a servant, as an enforcer, as helper, as a nurse.  It took me at least two years to get the patient/nurse relationship down.  To be in charge and yet always be the most sympathetic person in the room.  To negotiate the things the patient doesn't want to do and yet allow her to feel as if you are her biggest fan.

I probably tell my students ten times a day that patients are just people.  Just talk to them like they are people!  They aren't animals in a zoo. They are a lot more rationale than you think.  Unless of course they are 85 and demented and think that you're trying to kill them...but they'll learn that communication too.

It's been an incredible job to read my students' journals each week and see them progress from questioning what in the world they were thinking entering nursing to now being confident that they are right where they are supposed to be. Affirmation is such a vital part of moving forward. Their patients, their peers and hopefully their clinical instructor have helped them to see what it's like to work among the nakedness.

I know it's cliche to say that my students have taught me more than I have taught them...it's probably not even true. But they have reminded me what it's like to care in a different way.  To be touched by a patient's....a person's thankfulness and to be moved by their pain.  To take time to listen without looking at your watch. To approach their nakedness with a heart that still feels something.

Nurses need to be reminded of these things often. Maybe we all do. I'm glad my students have reminded me.