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Continued Thoughts of a Fat Physician...

1/14/2021

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WARNING:
This is a very vulnerable post for me.  I truly have debated whether or not to post it because I was worried about triggering some sensitive areas for others.  So if discussing weight and weight loss is a trigger please do not read further.  

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During my pregnancy I understood the implications of not only being a geriatric mother but also an overweight mother and while physically I had trouble being as active as I was before the pregnancy I become vigilant about the foods and portion sizes I ate to make sure that I did not gain weight unnecessarily.  After my pregnancy my weight has since picked up because my activity level became, well to be truthfully non existent, while the food habits I engaged in during pregnancy did not change. 
All my life I have struggled with my weight. I’ve always been bigger than others in my class as a child. Over the years I have struggled with acceptance of my weight. During my medics school years I finally reached acceptance and love of my body size at the age of 27. For me that acceptance and love came in the realization that my focus should be less on the number on a scale but more on the way I feel and what physical activity my body could do.
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Four years into motherhood I am finally figuring out not only the importance of my mantra “Creating Space Girl and Thrive” but how to make it work for me. I have realized that in order to be the best mom for my son I must take care of myself and my health first.  As I have begun to thrive and get back into being more physically active my body has hit a brick wall.   Just as I have started to find my footing my body has begun to fail me just when I needed it most.
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I remember taking a walk with my son to the mail box and back to the house which is just 1/4 of a mile round trip and I almost did not make it back to the house due to a severe pain in my lower back.  As my son raced ahead of me I panicked as I realized that if a car or something  happened and I needed to get to him quickly I couldn’t.  Work up of my back pain revealed the beginning of back issues that directly tied into my weight.  In that moment I realized that I needed to make some tough decisions about my health quickly.  While I was working on being more active pain in my back and my knee began to limit my ability to be more active and therefore limit a key component of my journey to thriving.

I had casually thought about undergoing a bariatric procedure years ago.  Countless times and multitude of frustrations of exercising and “eating healthy” but never attaining the coveted ideal BMI goal left me frustrated and hating myself and my body.  At times I thought about undergoing a bariatric procedure for what I thought was an “easy fix”.   However, in pursuing my dream of becoming a physician I realized that bariatric surgery is NOT an “easy fix”.  The more I learned the more  I realized that even with all the frustrations that I have endured in my pursuit to be the idea BMI the idea of going under the knife was not something that I was willing to do for a shallow goal to achieve a targeted number that never took into account my ethnicity and its impact on my body structure and weight.
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I learned to focus not on my weight and to focus instead on healthy practices and a healthy lifestyle.  Which I carried with me.  I began to accept my body and appreciate it for the wonderful things it could do and the shape I was in.  The birth of my son, while a joy, changed my focus from myself to him and I put myself and my health on a cold back burner.
As I began my process of evaluating my own feelings about the new state of my body and health I realized that I had to consider bariatric options.  Not for the goal of a number but to put my body in a different position to be more active and address some of the health implications that genetics has in store for me as I get older.  I realized that my goal was a return of function and ability to move with less pain. 
As I started this journey it became clear that I needed to address issues that I may not be aware of in my relationship with food.  I started by taking a close look at what foods I eat and why.  I started having hard conversations with myself and decided to also work with my therapist to determine  if there is any components of comfort or stress eating that needed to be addressed.  Determining what behavior, triggers, and patterns impact my eating negatively and developing ways to rethink and address those triggers and patterns.
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This is a journey that I am on and one that I am fully committed to not only for me but for my family.  I’ll keep you updated with my process and progress.  If you have any questions please leave them below and I’ll try to answer them directly or in upcoming posts.
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3 Must Do's for January to Start Your New Year Right!

1/7/2021

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January is a time for starting new things.  It’s also a semblance of a fresh start a new beginning.  The key to a fresh start is a good foundation.  There are 3 things that I find help lay a good foundation for the year and I invite you to do with me to get your New Year off on the right foot!

Get a New Toothbrush!!!

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Photo by Paweł Czerwiński on Unsplash
The ADA recommends changing your tooth brush every 3-4 months (sooner if damaged).  If fined starting out January with a clean and new toothbrush just makes me smile in the morning  and evening and is a small tangible symbol of freshness.

Do a Quick Purge!!!

Christmas usually comes with great gifts; clothes, shoes, jewelry, makeup, body sprays etc.  As I find places to put my presents I also take a moment to look and see what I haven’t used or have not attachment to and I put them in a bag to prepare for donation.  I also use this time to go through my sons clothes and shoes to find things that not longer fit and add those to the collection.
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Photo by Priscilla Du Preez on Unsplash

Create a Mantra!!!

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Photo by Aleksander Vlad on Unsplash
One of the things I am working on this year is setting boundaries and putting myself and needs first.  One of the self destructive behaviors I realized, through therapy, is that I allow myself to be overextended to help others but then have no one to replenish and take care of me.  Going into 2021 I am working on putting myself first so I created a mantra that I recite to myself every morning to help me stay focused.  I think having a mantra helps encourage oneself for the year and also serves as a great motivator.
Everyday is a fresh start but there is something hopeful in society at large about the start of a New Year.  It’s like shedding a layer of skin and having a newness in the world.  Laying a good foundation is important and I hope that these 3 things will help you as we start 2021!
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My Glow Up Process

11/10/2020

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Earlier this year I had to let go of a relationship that I had invested my heart and soul into.  It was one of the hardest things I have had to do.  My track record with men is not the best I have the tendency to give my all to someone and am left being in a committed relationship on my own.  At the age of 42, most of my close friends are either in a relationship, married, or divorced.  In my family I am the only cousin who is not married and the only one that has had a child out of wedlock (my mom has been noting that point is a bit of a trigger for me—Geechi see’s all).  While 2020 has not been the year that I anticipated it has in an odd turn of events been the year that I have needed.
2020 has oddly been about introspection and addressing areas of my life that have been consistently ignored.  During this time I have focused on my mantra of “CST—Create Space girl and Thrive”.  During the last 8 months there are 3 things that I am proud of doing:

Self Care

Taking time away from things is hard when you are trying to serve others, build a brand (if you will), or build on a project.  It can feel selfish to care for yourself when you are responsible for so many things and others in your life.  Listening to bloggers and those who are experts on brand building; consistency is important in building an audience and building a social media following and brand. However, I learned this year that I needed to be consistent to myself and carve out consistent time for myself care
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Until I could do that fully and routinely I was no good to anyone and my desire to help others would be nothing but hollow and empty.  I have also been learning that self-care can look like many different things.  My narrow view of selfceare involved a period of significant uninterrupted time to rest, relax, pamper myself.  As a single working mom it’s hard to carve out a big chunk of time to devote to just myself.  Even so when I would carve out that time I would feel guilty and often that I was imposing on others to handle my responsibility.  This resulted in me feeling run down, overwhelmed and depressed.  So often as a women of color I felt I was failing others.  It was a hard realization that in actuality I was failing myself.  So now selfceare looks different than what I envisioned.  Self-care takes the form of journaling, blogging, working out, meditating, reading a book even if it’s only for 2-3 minutes at a time.  I make it a priority to get some time in every day just for myself, my goals, and my dreams.
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Chasing My Dreams

I grew up wanting to be a lot of things.  One passion other than medicine that has been a consistent part of my life is to be an author.  I have written poetry when I was in college (I even performed some for several open mic’s).  It brought me such joy to express myself through that medium.  I wrote a novel when I was in my late 20’s early 30’s that I found satisfying; however never felt confident enough to attempt to even seek publication. 
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After the birth of my son the feeling that I had repressed began to resurface.  I started my blog seeking to write about my experiences as a single working mother as a way to satisfy that passion.  The more I wrote the more I have longed and now have decided to invest in my passion to bring authorship to fruition.  The more I denied the the passion to seek authorship the quieter my voice became for my blog.  I finally decided the listen.  The further I have come in the process my voice has become louder.  Stay turned for my newest project that I can’t wait to announce soon!

Honoring My Worth

Love for another human being can be a beautiful part of life however when lost it can be hurtful.  It’s so easy for someone to tell you they know your worth however when their actions do not match their words it’s time to take another look at the situation.  Personally for me it was a challenge to honor my worth.  I know what I have to offer in any relationship.  I know I am far from perfect. ​The challenge for me was in
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walking away from a situation where I had invested my time, my hopes, and had invested dreams in a situation where I was not valued fully.  In addition to that feeling pressure not from others but from myself to have what I saw others have.  Not in a “Keeping up with the Jonses” manner but more of falling wedded to the dream that I came close to settling for less than what I deserve.  Often we focus on others not valuing our worth that sometimes we neglect that we must value our worth as well and walk away from situations that no longer serve or honor our worth despite the investment of time and feelings.
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My Second Black Wake-Up Call

10/2/2020

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Dear Diary...

All my life I’ve realized that I was black.  Well, not all my life however when I think back there is not a moment where I do not recall being aware of my skin color.  Even at a young age I remember kids in my class telling me that I couldn’t drink white milk because I was not white I had to drink chocolate milk.  Growing up I have realized that my country views me differently and that there is a second set of rules that applies to me; a set of rules that has nothing to do with fairness or equality.  Growing up I have always been told that I must be twice as smart, twice as talented, and twice as successful to get half of what my white counterparts had.  Through my years of living I have realized it as a harsh truth.   


Being black I learned about our history of enslavement, lynchings, rapes,  beatings, etc.  I have learned about the “war of northern aggression”.  I have learned about the constant attempt to subjugate my race.  I have learned about Tulsa, race riots  Jim Crow.  I have even learned about the civil rights movement.  I have never been deluded in thinking that I was somehow considered equal with my white counterparts.  I have always known that inequality was still present, that racism was still an ugly abscess that festered in America hidden and indurated under its lily white skin.


In my family we talk about people getting their black wake up call.  A call to awaken them from a deluded dream of mistakingly thinking that somehow they were viewed as equal with their white counterparts.  Being as “woke” as I thought I was I received mine for a second time as a 42 yr old woman when I realized through the murder and lack of justice for Breonna Taylor that I am not safe in my own home.   Erroneously I  believed that in America the days of whites breaking into the homes of blacks unannounced and killing them was no longer tolerated.  I never was delusional in the believing that it did not occur; but imprudently  I assumed that in my home I was safe.   Misguidedly I believed that those that would choose to  violate the sanctity of my home would be brought to justice.  I foolishly felt that in America at least in my home I had nothing to fear.  As a mother I believed that if my child if my son could just make it home he could be protected. 
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I Will No Longer Just Say Their Names...

9/4/2020

 
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"Nina Scott, a graduate of Carrboro High School and an incoming UNC first-year, painted a mural on Sunday, July 12, 2020 honoring some of the Black women who have been killed." ~Alexandra Smith From The Daily Tar Heel
 I can not bear to say their names any longer they haunt my dreams.  Dreams turning into nightmares stealing into the day causing me to jump at shadows.  Through my pregnancy I hoped that would have a daughter and prayed that I would not have a son.  My son was born and my heart was elated but my worry began.  As he grows my worry grows and I am left helpless and powerless.
A war was waged in response to the outcry of the Jewish Community due to the atrocities waged by the Nazi population.  From 1941-1945.  What war has been waged to address the 400+ years of enslavement, lynchings, rape, marginalization, discrimination, unfair imprisonment, ‘recommended’ sterilization of blacks for sentence reduction, financial imprisonment, substandard schools and access to food, tainted water sources, sanctioned murder guised as police arrest tactics, sanctioned murder under the stench of “stand your ground” rights, approved assassination poorly camouflaged as “no knock warrants”, ad nauseam.
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I grow weary and tired.  I am weary and tired.  I am done in.
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So instead of saying their names I say the names of my elected officials.  I say their names as they come up for election.  Instead of miring in fields of hopelessness I entrench in the evidence of my elected officials—what policies they support, what record have they produced, what do they stand and fall for.  Instead of saying their names I will write to the leaders that I elect requesting action on behalf of those that have been lost.  I will write their names to those I elect to protect me and my family.  Instead of saying their names I will say the names of those that say they are my “friend” but remain silent as I live in fear.  Those “friends” who do not understand why I cry, why I am afraid, what it means to be an ally—I will talk with them educate them have the difficult conversations.  I will say the names of those who feel that they are too busy to vote, those who do not understand the value of voting. 
I will voice the names of those who are supposed to protect my family and call them to act.  I will voice the names of those who fail to act, who fail to enact, who fail to heed the call to action.  I will voice their names for those names that I cannot bear to say anymore. 

I'm a Black Mom and I Do Spank My Child

2/24/2020

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The time after that is merely guiding, shaping, and helping the seeds I plant grow.  Every child is different and every child learns differently.  As a child I was spanked however I do not use that as justification as to why I may spank my son.  I mention it because it’s important to know and acknowledge ones background.
I would like to start off by stating that there is a difference between spanking your child and beating/abusing your child just like there is a difference between art and pornography.  My approach differs from that of my parents which focused (as I remember) mostly on spanking as the prime deterrent after verbal correction failed. 

MY METHODS:

As my son became of the age where discipline tools where needed I initially started with counting. 

COUNTING

Counting initially didn’t work.  I remember when it began to have significance was when I popped him on his hand.  Before you get alarmed let me apprise you of the situation…he was about to touch something hot that could have burned him and I popped his hand away—instinctively to keep him from hurting himself.  He cried, I cried, and apologized profusely because I had not intended to pop him but it was an instinctive reaction and because of that instinct I had caused him harm.  I cried because at the time I felt he was afraid and that the source of his fees was me.  That was never my intention, never my goal, never my aim.  
I read an article back in 2019 that caused me to pause and think about my parenting style; “I’m A Black Mom And I Don’t Spank My Children”
While I appreciate the article because I think as parents it’s important that we hear all sides, consider all opinions when it comes to something so sensitive and personal as disciplining our children; the article left me frustrated because in it she failed to expound on her methods of disciplining her children without spanking them.  Truly a lot of articles I have read about the “evils of corporal punishment” or spanking (as I term it) as a method of disciplining your child fail to provide parents with alternative solutions. 
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​I am a firm believer that as a parent I have about the first seven years to instill in my child the morals, beliefs, discipline, etc that I want him to have. {According to Geechi it's 6! 🧑🏾‍🦳}
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​After that, I went into a slight depression and began to indulge him in everything that he wanted, to try and make up for my “error”.  My apologizing just didn’t seem enough to me and I fell into the trap of trying to use things to buy my son’s affection/forgiveness.  Luckily, my mom educated me that I was not going to be a perfect parent but that I was a perfect parent for Jeremy and I needed to remember that!

TIME OUT

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So I moved to including Time Out.  Because I live with my parents this was a double challenge because it requires consistency and buy in from the grandparents.  The first time I tried it it seemed to have an impact.  I accidentally thought that his requests to go “potty” was a stall tactic so we had a slight accident 🤦🏾‍♀️.  After I cleaned him up we talked about appropriate behavior and what mommy expects.  We hugged and then he went back to playing a little wiser.  This methods has become a great addition to my arsenal as he gets older.
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THINGS TO CONSIDER

I realize that while my child is not an adult he do have feelings and desires 🤯.  Go figure!  Just like there are days when  I don’t want to go to work or times I don’t want to clean or wash the dishes; he feels that way too so I need to take that into consideration.  Now, I’m not saying that if he doesn’t feel like picking up his toys it’s okay to not do it; but acknowledging that feeling verbally to him and explaining that it still has to be done has helped. 
In the hustle of life it’s easy to discipline but what about praising?  When I see Jeremy doing things correctly or displaying good behavior I praise him for it.  I try to set a goal that for every time I discipline incorrect behavior I praise good behavior.  It can get a little tricky when you have others who correct your child (aunts, uncles, grandparents, friends, heck even strangers) but it’s important to try.  My goal no matter what is to praise him 3x a day for good behavior at the very least. 
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What’s your posture?  Are you standing over your child or are you eye to eye with them.  Getting “on his level” helps him pay attention and focus.  It also changes the dynamics and imparts a shared goal or feeling; and air of mutual respect.  I leaned this trick in medical school when talking with patients.  If I’m talking about serious health issues or engaging in a discussion; I always sit down.  No one wants to be lectured over,  not even me!
Anyone who knows me knows I despise repeating myself.  Raising a toddler I find that repeating myself raises my frustration level which is not his fault.  As a toddler his attention span is smaller than a gnat 😝.  So my patience must my grow.  If I find myself getting more frustrated than the situation calls for I stop and evaluate is this a battle I’m willing to fight.  Not every battle is worth fighting, trust me.  Geechi (my mom for new readers) asked me once if Jeremy wanted to wear a black shoe and a red shoe would I let him do that.  I thought for a moment and asked are the shoes on the correct foot. She looked at me surprised and said “Yes”.  Then I said "Yep" I would.  It’s not a battle worth fighting.  I’d rather spend my energy elsewhere like getting him to eat foods he doesn’t like but are nutritious for him.  So take a moment, is the situation worth the escalation?  Also taking a moment helps me cool down a bit and remember that my frustration is heightened not by him but by my frustration at having to repeat myself which I need to put in check. 

SPANKING

Is spanking off the table completely for me?  No, it’s not.  Is it my first go to method of discipline?  No, it’s not.  Do I think hitting my child in anger teaches them that it’s okay to hit in anger?  Yes!  Should you ever hit your child in anger? No!  But here’s the crux that gets a lot of parents I’ve talked to—you shouldn’t discipline your child in anger either.  Time out, counting down, plucking, antagonizing, ignoring bad behavior, removing children from the situation techniques should NEVER be used in anger.  So when would I use spanking as a mode of discipline?  In short; willful disobedience.
So have I had to spank my 3 year old?  Not yet.  Do I think I ever will?  I hope not but if I do here are my rules:
  1. Never in anger
  2. Never in front of others unless immediate action is required to prevent serious injury 
  3. Never spank above the waist
  4. Never without warning(s) with clear understanding of the consequences. 
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While I aim to be my son’s friend I also realize that my job as a parent is to love him, affirm him, and discipline him.  Bell Hooks, in All About Love, states that “Abuse and neglect negate love”.  Earlier in the same chapter she denounced hitting and draws no differentiation between disciplining and punishing.  However, there is a difference.  Punishment is focused on the past and is rooted in anger.  Discipline however is focused on the future and is rooted in love and care.  Even God disciplines. 
“At the time, discipline isn’t much fun. It always feels like it’s going against the grain. Later, of course, it pays off handsomely, for it’s the well-trained who find themselves mature in their relationship with God.”
Hebrews 12:11 MSG
I write this not to change your mind but to be a voice of those who spank our children but in the current climate feel that we must hide in the shadows for fear of judgment.  I speak out to voice that there is a difference between spanking and abuse and when we really honestly and openly talk about it we know the difference. 
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5 Ways To Handle Heartache And Not Be Bitter!

2/10/2020

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Photo by Nick Fewings on Unsplash
It’s hard out here!  Let me tell you!  For those that have found their mates and are in happy relationships…CONGRATULATIONS!  However for those of us who are still kissing frogs, worms, slugs, pugs, and so on the end of a relationship can be hard.
I recently ended a relationship that had been on and off again for the last 2 years.  It left me heartbroken to end it because I was in love.  Suffering repeated heartbreak and disappointment can leave one feeling jaded, unloved, and defeated.  In my 42 years I have been unlucky in my search but I still remain optimistic and a hopeless romantic by doing these 5 things.

BEING HONEST

There is always one side another side and somewhere in the middle lies the truth.  This is the hardest step for me to really look back and be honest about things in any relationship that I could have done differently or better.  It easy to remember and recall the faults or errors of others but so difficult sometimes to acknowledge our own.  Sometimes there is not fault to be laid at your feet and sometimes there is.
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Photo by Leighann Blackwood on Unsplash

Forgive

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Photo by Gus Moretta on Unsplash
You don’t have to go to the person and say I forgive you; that isn’t always possible or advisable.  But the act of purposefully and fully forgiving the other person and yourself is key.  The act of forgiving opens you up and frees you from the baggage of past hurts

​Know your worth!  Acknowledge your worth!  Declare your worth!

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Photo by Kevar Whilby on Unsplash
Sometimes in relationships that end others can try and tear your down mentally and emotionally.  Sometimes we can begin to doubt our self worth.  Our confidence can get hammered; especially when we look at our friends who have found their special someone.  We can turn inward and wonder “why not me” “what’s wrong with me”?  Well nothing is!  If you have fully addressed and been honest with yourself about your part or lack of let in your relationships end then you can quickly see that there is nothing wrong with you.  The act of comparison can be a foothold for your self worth to be annihilated.  So stop comparing!  If you know your worth, acknowledge your worth and declare your worth then there is no reason to compare yourself to anyone else.

Care for your heart

It’s easy to go into full wall up and protective mode when your heart is broken.  It’s a naturally reaction.  However there is a difference between caring and protecting your heart and walling yourself and your heart off.  Protect yourself,  pay attention to the red flags, your inner “woman” sense, your knowledge from past experiences in your life.  Be knowledgeable and wise in your actions, be careful but do not wall yourself off in loneliness.  By forgiving the other person it’s easier to trust.
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Photo by Leighann Blackwood on Unsplash

Love yourself first

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Photo by DESIGNECOLOGIST on Unsplash
If you love yourself first you are never without love.  If you love yourself first and fully then the love of another is extra and becomes a treat not a necessity.  Falling steadily in love with ones self is the best love affair.  It's a love affair to remember!
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What's Bumping...

2/3/2020

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Have you ever heard a song or even a whole album that takes you down memory lane?  Well a few weeks ago I was riding in the car with Geechi and The Temptations album Truly For You circa 1984 started playing and I was immediately teleported back in time.  I can remember listening to the album on tape in my parents car as we went up the road to visit family in the country.  I love that music has that ability to transport you in time; it’s like ones own time machine.
I remember listening to the album and being mesmerized by the harmonies and vocals.  While the album in total is great I have my favorite tracks that instantly bring a smile to my face. 

​Treat Her Like A Lady:

I can remember this song crooning through the speakers and my dad singing parts of the song and looking at my mom and my mom grinning.  I remember thinking that I wanted to be treated like a lady; it seemed nice.  Something to aim for.  “Now I like opening doors—Picking up her hanky off the floor—Treat her like a lady”
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​How Can You Say That It’s Over:

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Growing up and being watched by my grandmother I grew up watching soap operas. One of my favorites was Santa Barbra (oooo I’m showing my age). I remember watching soap operas where love was found on romantic beaches and islands. This song reminds me of those island episodes with its percussion and synthesizer melodies. Love being lost on the beach as the sunsets.

​I’ll Keep My Light In My Window:

This last song with its syncopated rhythm and synthesizers is a great song to uplift and encourage everyone to lend a help to others in need.  “I wanna ease the pain, (that life can bring)/Help them find a peace, mmm (their spirit needs)/Have been chosen for (a work to do)/To make this world a much better place/For me and you”. Looking for a song to get you started look no further than this song particularly this month—the months of love and the dedicated month to celebrate a history that is 366 days a year Black History!
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If you are looking for an album of love this month and don’t mind a “retro” sound.  Check out Truly For You by the Temptations.
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A NEW YEAR...A NEW JOB...

1/27/2020

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As I get ready to go back full time into the work force my emotions are mixed.  Nervous because I’m starting with a new practice; excited because I miss my patient interactions and interactions with colleagues. 

​As a physician part of my role is to get my patients to talk.  It’s hard at times for patients to open up to strangers and so establishing rapport is vital.  I always feel that when my patients view me as a friend, confident, or even as family that I’ve done this job well.
 Some of my colleagues may disagree but we all practice differently.

​As my self imposed sabbatical has been dwindling down my thoughts wonder to the many pleasant conversations I’ve had with my patients and the life stories that we have shared.  The crazy things we have said, the tears we have cried, the hugs that have transpired, the care that we have given to each other.  
I have had patients pray over me, for me, and give their advice.  I’ve had patient ask me to pray for them, ask me to celebrate in their triumphs and cry with them in their sorrow.  It is a truly an honor this vocation to which we have been called.
I look forward to new conversations, new atmosphere, new stories, new interactions.  I look forward!
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Pushing Past A Test Yet Feeling Like A Fraud

1/13/2020

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For 7 years I have been living a life of shame.  I have been fearful that  that I would be discovered and called a fraud.  Constantly feeling inadequate and not worthy of my initials M.D.  “Why,” you may ask?  Because for almost 7 years I had not attained the title of “Board Certified”.  I have taken the Medical College Admissions Test (aka  MCAT).  I have been to medical school for 4 years and graduated.  I took the required Step 1, Step 2, Step 2CK, and Step 3 and passed those exams without difficulty.  I successfully matched into a residency program.  I completed my internship year and 2 years of residency.  I even did a fellowship in geriatrics.  So why was this test my unicorn?
​As I began to practice medicine I learned that I was well prepared thanks not only due to my medical school education but also my training from internship and residency.  Of course there was a steep learning curve in becoming confident in practicing on my own and developing my own style.  However, after practicing for 2 years I felt I was ready to take the exam.  To be honest I didn’t really take time to study ??‍♀️ because in my mind after practicing for 2 years I had covered most of what I thought was going to be covered.   Needless to say I failed ?. 
Okay!  So I took a step back and of course chastised myself...how could I be so naive to think that I didn’t need to put forth effort!  I had erroneously assumed that all the training and testing I had done up to now was enough to prepare me for this exam.  *cue Denice Williams Silly of Me*.  Picking myself up and brushing myself off I formulated a plan to study and work at the same time; however as life would have it I became pregnant!  I put off taking the test for a year using the time to enjoy my pregnancy and the birth of my son.  After a year I prepared to take it again this time opting to work full time and care for my son full time.  And again I failed!

Options for non-board certified physicians

Feeling defeated and broken I started looking at what my options were for practicing as a non-board certified physician. To my surprise and chagrin there wasn’t much information about options and what I did find seemed to suggest that I was up a creek without a paddle.  I finally opened up to a colleague and found that they too had struggled with their initial certification.  They encouraged me not to give up and recommended some techniques that had helped them in their preparation.   Could we be the only ones that struggled with this exam?  Carefully I opened up to a few select people and found out that I was not alone.  When I asked why they had not said something they replied “why hadn’t I?”  When I answered them embarrassment” and “shame” where my reasons.  Where had this feeling come from?  Where had the notion that struggle at this level was somehow a weakness or something to be ashamed of come from?
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Still unempowered, I kept my secret to myself and the chosen few I had opened up to and prepared to take the exam again.  I partnered with others who like me had not passed and we studied together and supported each other during the lows of doubt and insecurity.   I worked full time, studied when I could, and was a mother the whole way through; and I failed.  

Wow, that word even now as I type it hurts.  I had taken this test a total of 3 times and had yet to pass.  I began to spiral down a dark hole.  How was I going to support my family?  How was I going to pay back my massive student loan debt?  As a single parent, I am the sole provider for me and my son.  In one year I would lose my board eligibility; essentially my career as a physician was on the brink of being over as well as my means of supporting my family!

There are few options now a days for physicians who do not have the desired title of Board Certified.  Hospitals privileges are unattainable, insurance companies unwilling too “allow” you to be a provider for their patients.  Practices refrain from wanting you if you are not BC/BE.  Four years of medical school, 3 years of residency, MCAT, USMLE exams all completed, state licensure obtained, DEA license purchased, and still one exam preventing me from the career I long desired, dreamed, and dedicated my early youth for.   There was no other choice—something had to change.  I contacted the ABIM to see what my options were as this was my last year of eligibility.   My prime question centered around my options if I didn’t pass this year.  On the website there was a statement:
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“A candidate who is no longer Board Eligible may nevertheless apply for a certifying examination, but only if the candidate has: (i) completed at least one year of retraining in the relevant specialty after the expiry of the candidate’s period of Board Eligibility, but no more than seven years before the application; and (ii) met all other requirements for Board Certification in effect at that time. Retraining will require the successful completion of at least one year of additional residency/fellowship training in an ACGME-accredited U.S. training program or an RCPSC-accredited Canadian training program and an attestation from the program that the candidate has demonstrated the requisite competency for unsupervised practice. Candidates and diplomates remain subject to other ABIM policies and requirements for certification, such as the Re-examination policy.”

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What is retraining?

​When I called to get more information about what a retraining year would entail there was no available information and I was referred back to my residency program director.  How absurd and frustrating that the organization who developed the rules and policies had no information to offer!  No guidance about what the required retraining year would look like.  
I nevertheless followed their instructions because I had no choice and reached out to my former director.  She to her dismay had no concrete information about what a retraining year looked like either.  She assured me she would contact the ABIM and see what she could learn but advised me not to give up; since I had one last year to take the exam.  She suggested that I get in touch with the Testing Center on campus to see if I had a testing or learning disability.  Could that be it?  Did I have an undiagnosed learning or testing disability that evaded me for years only now to rear its head?  She doubted it but it needed to be evaluated.  Speaking with the counselor it became clear that she agreed; it was highly unlikely that I had a learning or testing disability that had not previously shown up.  So what was the issue? Well one of the pieces that the counselor helped me discover was that I have a hard time trusting myself and taking a leap of faith in myself.  Another issue was that I have a tendency to answer the question that I think I’m being asked not the question that is being asked. 

​So armed with this I decided I needed to take a step back and focus solely on this exam and being a mom.  So I did.  I quit my job, neglected my friends and devoted myself to my son and my exam.  I fought through self-doubt constantly.  I second guessed myself on every question.  Thinking I was missing something.  Fearing that I somehow did not learn what I needed to in 8 years of training.  Why did I feel this way; because others before me had seemingly passed this test with ease.  Here I was on the brink of failure with no safety net; nothing to fall back on.  Despite years of caring for patients and living my dream I was in jeopardy of loosing it all.  I doubted my calling.  I never doubted God, but I doubted that I heard Him correctly.  I doubted that I was on His path for my life.  I was ashamed and alone.  I bore this shame in secret because to do otherwise was considered taboo and a marker of weakness.

Test Anxiety

As the exam grew closer my anxiety increased and my confidence dwindled.  In the last month of the exam I lived and breathed nothing else.  My parents looked after my son while I studied.  With each question I answered correctly my confidence grew and with each question I missed it was shattered into a million pieces.  The few people that I opened up to about my failure would ask how the studying was going...others would offer prayers and well wishes.  I felt inadequate, fraudulent I couldn’t figure out how I was able to take care of patients but still was not deemed worthy based on a test.  I then came across three quotes from Michelle Obama:
“When you are struggling, and you start thinking about giving up, I want you to remember something that my husband and I have talked about since we first started this journey nearly a decade ago—something that has carried us through every moment in this White House and every moment of our lives—and that is the power of hope. The belief that something better is always possible if you’re willing to work for it and fight for it.” – Michelle Obama


“Am I good enough? Yes I am.”– Michelle Obama


“If my future were determined just by my performance on a standardized test, I wouldn’t be here. I guarantee you that.”― Michelle Obama
The day came and I sat for the exam and as I was logged in by the proctor I prayed.  I thanked God for my calling and vocation and began my exam.  When I finished I felt spent; I truly had done all that I could.  If this was not enough I had no idea what the next step was and apparently neither did those at the ABIM.  But what I knew for sure was that no matter what the test said I was enough.  While I seemingly had to pass this test in order to continue on the traditional path of medicine I would not let it determine or limit my future.  I am a doctor and I always will be. 
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Written By: Kharia J. Holmes

This article was originally published on WomenInWhiteCoats.com

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