<![CDATA[life of a doctor reinvented - Doctor Reinvented]]>Thu, 11 Feb 2016 12:27:20 -0800Weebly<![CDATA[seeing The Face of Love]]>Fri, 02 Jan 2015 03:04:09 GMThttp://www.doctorreinvented.com/doctor-reinvented/seeing-the-face-of-love
My family and I stumbled into church a few minutes late. It was a rare occasion that we were able to attend service since my baby was born 7 months ago. With my recovery from the recent flu well on its way  and naps seemingly miraculously well timed this morning, we actually made it. We took our agreed upon place in the last pew on the left while the other church goers, numbering maybe thirty or so, remained clustered in the front. Shortly after the start of the welcome prayer we all turned to a flurry of a woman entering from the center doors of the church.

She was somewhat petite in stature and bundled up in a pink fleece coat. She was carrying another woman in a blue hospital gown. I started slightly on seeing the very emaciated woman being held, eyes sunken into a face that seem too large for its very small body and I was immediately struck by the contrast of seeing her two rows ahead of my husband seated with my baby girl. The beginning of life, in its plumpness and bright face of my daughter next to the almost shrunken older woman, both in my field of vision, was humbling to see
. It reminded me at once how we are all human, and about the preciousness of life.

But there was much more to learn

I readied to nurse my daughter quietly in this back row, I saw the woman in the pink coat remove something from a bag and place it on the smaller, older woman's face. Everything else in the church faded when I realized she had placed an ambu bag over her face and begun to bag ventilate this woman in the blue hospital gown. She is dying, I thought. My husband and I looked each other, he with the serious look on his face that said, “Oh my." And we both looked at our two older children aged 9, standing between us in the pew and observing this interaction in front of us. What were they thinking of this? I wondered, and were they okay? One of my girls looked for a while then looked away seemingly unsure if she should continue to look at these women, a reaction I felt was appropriate and respectful. The other took small glances their way but did not stare. I was unsure of what they understood.

Woman in Blue is dying, I thought, and the Woman in Pink brought her here for the last rites. Those were my initial thoughts, and I felt both sad and awed at this act. As the service continued I looked closely at the face of the Woman in Blue and saw her blinking, staring at he face of the Woman in Pink in between shut and opened eyes.

The priest began his sermon on Mary as she was being celebrated today. He spoke of her life outside of the celebrated role as Mother of God, how her human everyday existence was most probably very difficult during those times, and how her entire life would have been challenging from what we knew. That she saw herself as a servant. I didn't know if my older daughters understood his message, or the juxtaposition of it against the interaction between the two women in the pew ahead of us. As I nursed my baby girl, I felt both a lightness and heaviness inside that reflected my acknowledgement of this, and later when we talked I learned my husband was deeply affected by this experience

see, the Woman in Pink not only brought the Woman in Blue to church, carrying her in her arms. She used that ambu bag to ventilate the older woman, for the entire service. The entire church service, pausing only for seconds at a time, then resuming. And every time I looked at the face of the Woman in Pink, she wore the softest expression, an almost smile. Looking then at the Woman in Blue who stared up at her, I thought, this is what she sees every time she opens her eyes, this soft look and smile that simply says, "I'm here.”

left shortly before the true end of the service because my baby girl began fussing, so we do not know why those two women were in church that day, sitting together in those pews ahead of us. In the car my husband turned to me and said,'That is the most amazing experience I have had in a long time. I am astounded by that Woman(in pink)." And I could see by his expression how deeply moved he was by being there, at that time, and witnessing what we all had together. 

We asked our daughters what they understood, what questions they had and how they felt. They asked a lot about why the Woman in Blue was so thin and what the plastic thing was making the funny air sound. We explained what we could and told them how tiring it was to use that
ambu bag. That their dad and I both in fact had used it for far shorter than we saw in church and it made my hands cramp up from fatigue. My husband and I are no strangers to the end of life. As a physician I have seen and been a part of many people's deaths, and been witness to many different versions of the universal departure from this life. Patients' deaths have made me cry, for many reasons. Both my husband I have seen one of our parents suffer from cancer, their bodies weaken and struggle, and we have seen them die. We know the grief that comes from witnessing that part of life. But we were still struck by this interaction between the Woman in Pink and the Woman in Blue.

As we told our daughters: what you saw today was one of the greatest acts of love between two human beings, one of the greatest you will ever see, because caring in this way, with gentleness and respect, for someone who is sick or dying takes a great deal of love
. It takes more love than you can comprehend until you are in that position yourself. Hours later my husband and I are still awed by what we witnessed. I feel blessed and honored to have seen the face of love, in this way, this morning.

<![CDATA[Is dressing "professionally" old fashioned?]]>Thu, 23 Oct 2014 16:04:52 GMThttp://www.doctorreinvented.com/doctor-reinvented/is-dressing-professionally-old-fashionedFor the past several months I have been working as a volunteer staffing physician at a clinic in town. Each clinic night sees several volunteers some of whom are medical students. Every now and then I stifle an eyebrow raise when I see a student, almost invariably female, wearing what I would say is "unprofessional clothing." This is subjective to be sure, but I think it is one of those things that you KNOW it when you see it.Examples include tight spandex dresses, jeans, and flip flops to name a few.  At first I told myself I was just being old fashioned, but it really bothered me seeing the women in particular dressing in a way I thought would make them seem less professional than their male counterparts.Then it bothered me because I thought perhaps I was having a double standard of sorts.But no, I realized this was an issue because atleast at this clinic the men never turned up in anything but professional clothing(pants, long sleeve shirt, sometimes a tie).
No, I have not said anything yet to the female students. A part of me doesn't want to have to say anything and let them see it for themselves. A part of me thinks this should not be an issue at all and as long as people are presentable and smart that should speak for themselves. But I know this is not true, especially for women in medicine. We are judged still, and sometimes more harshly than our male counterparts.I remember in residency we had an intern who always dressed in short dresses and flipflops.I recall hearing a senior resident tell her," If you keep dressing this way no one will know how smart you are." Is that fair? No, but it's the truth.Not a new thing either.In this essay in the NYT called "When young doctors strut too much of their stuff" the same issues are raised.

While the demographics of medical school has changed drastically over the past 50 years, societal expectations of how a doctor should present himself or herself has not changed that much. A JAMA study in 2013 showed that professional dress was one of the most influencial factors in determining how a doctor was perceived by family in the ICU setting. That said, as a lover of clothes myself, it is no fun feeling like you have to dress in a way that is contrary to how you enjoy dressing, especially if you work full time and thus end up wearing a 'work uniform' unlike your persona for the majority of your waking hours. Articles like this one talk about how to maintain professional air of dress while enjoying fashion to some degree, as a female physician. Nope it is not fluff, it's important to feel your best in all aspects, health and dress included.

Until the day when we truly are judged only on our abilities, and I don't see that day coming until we all dress in identical robes, we do need to pay attention to how we present ourselves especially as female professionals. It's a tough world out there, and we don't need any more chips stacked against us.I'll have to say something to those students next time I see the flip flops...

<![CDATA[Good Hair for women]]>Thu, 09 Oct 2014 12:53:50 GMThttp://www.doctorreinvented.com/doctor-reinvented/good-hair-for-womenA few weeks back Twitter exploded with comments when the Big Bang Theory's season opener aired, not only because of the script but because of Penny, the lead female character. Who had cut her hair. Oh dear.

Ever see that movie "Good Hair" by Chris Rock? It's pretty funny and eye opening in my opinion.It deals with the concept of what is "good hair" in the African American community, and in particular women's hair. Besides the important cultural issues raised by the movie's topic, there is a large underlying issue of the role a woman's hair plays in society. Remember about a year ago when there was a news story about an anchorwoman who received mail about her hairstyle? I am sure it exists somewhere but I don't se news stories about men receiving mail about their hairstyles...

Women's hair is wrapped up in all sorts of gender and cultural issues and norms. Long hair for many cultures is praised as a sign of femininity and beauty, of youth and possibly links to fertility. Perhaps some of those run so deep that even in today's modern society a woman's hair, including its length,texture and styling, swill still raise eyebrows when it is somehow perceived to be less than whatever the ideal is at the time.

As someone who has had her hair supershort and fairly long,and everything in between, I can speak to the length issue.I once had a customs officer, male, look at my passport picture with long hair then back at me and say AUDIBLY ,"I don't know why some women insist on cutting their hair short." At the time I was young enough to feel cowed by this and not say anything but simmered inside. Nowadays I would likely have some smart thing to say to this impolite officer, something that actually is true like: "probably because they like it short, like how you choose your own hairstyle, right?"

My young daughter recently wanted her air cut very short into a pixie.I went through months of talking to her about it, not because of what other people would say but because I wanted her to be READY for other people might say.I want my kids to be tough and do what they feel is right, especially concerning their own likes and dislikes.But my daughter is also quite young and sensitive so I didn't want unforeseen negative comments to hurt her.     I warned: some people won't like it, some of your friends may ask why you cut it, how will you feel if your best friend doesn't like it? By the time we headed to the hairdresser she was ready. And of course it came out wonderfully(I would never think it did not, she is my adorable daughter after all!). But if it had not, I would have wanted her to know that that's okay, it's just hair and not your soul, that you are no less smart or beautiful, and that judging based on hairstyle is not right. Ever.
<![CDATA[Parenting in the time of "fat shaming"]]>Thu, 07 Aug 2014 01:52:46 GMThttp://www.doctorreinvented.com/doctor-reinvented/parenting-in-the-time-of-fat-shamingPicture
It seems this new term "fat shaming" has taken off during the past year. I can rarely find a day without it popping up somewhere in a newsy article. This one was interesting, a cross between fat shaming and vandalism when unknowns took to altering a plastic surgery ad sign.

To be honest I am not quite sure what "fat shaming" is anymore. I used to think it was people outright making fun of those who were overweight, but recent articles makes me thing it encompasses saying anything at all about being overweight. That makes me a tad nervous to be honest, as a parent as well as a professional who at times needs to discuss weight issues with my patients. Will I be perceived as partaking in "fat shaming" myself if I bring this up in clinic? Many of you will say no, this is part of your job so as long as it is brought up respectfully and in context of health there is no problem.Well I can tell you that I have gotten some looks when I bring it up, and I assure you that I do it respectfully. But for this blog I would like to tackle the parenting side of this.

I started thinking about it way back when Michelle Obama took heat for talking about her daughter being overweight.For the record, I was in the camp of thinking maybe she should not have brought it up in wide public but surely talking about it with her daughter was appropriate. Many people did not think so, and the blogosphere blew up about how right or wrong it was for a parent to talk about weight with their child at that age. Perhaps for me this is in part a cultural thing because in the Caribbean the stress on being thin is not at all present like it is in the United States. There is no shortage of attention to appearance, just not a focus on being thin as an ideal. But beyond that I am still stymied why a parent could not, respectfully and appropriately, discuss a health issue such as weight if their child is becoming overweight.Talking about weight does not immediately make someone prone to eating disorders, which ultimately is the greatest fear I gather and not something to take lightly.

I once read about a father who  used a magic marker to draw circles around "fat" on his daughter's torso. All of us with a functioning brain and heart will know immediately this is scarring, abusive in fact and obviously not the way to address a concern about your daughter being overweight. I can see how that kind of behavior would destroy a child's trust in their parent and self esteem. On the other hand, ignoring your child's weight and consequent health problems can be argued as being negligent parenting. Childhood obesity is a problem in this country, and various health consequences will follow.Obviously there are approaches in between these extremes.

The hope all of us dedicated parents have is that every day we infuse our kids with healthy self esteem, and also are thus able to talk to them. Really TALK to them, with respect but as parents who are older and wiser than they are, and who love them. I need to be able to talk to my kids about weight concerns if and when they develop, because I think it is important, and because I love my children. Hopefully they will understand that, and not have this fall under yet another version of "fat shaming," no more than my discussions about avoiding early sex, smoking or drug use, risky driving etc imply anything about their personality or worth. Because in the end that is really what counts, a healthy life. Being able to talk about it openly with my kids helps us get there.

<![CDATA[Wearing it on our sleeves]]>Tue, 22 Jul 2014 02:25:44 GMThttp://www.doctorreinvented.com/doctor-reinvented/wearing-it-on-our-sleevesPicture
A  beauty queen found herself receiving some more attention than usual this week when a photo of her in her swimsuit at a pageant surfaced. Why? Miss Idaho is beautiful of course and her figure is killer, but that was not the reason.
She was strutting her stuff while wearing her insulin pump, visibly.
I was not entirely surprised when this garnered attention, and I myself applauded her choice to do this. I got to thinking further about her decision  to essentially share a very personal part of her life with the world.

Our health IS personal even though some people choose to divulge every detail to anyone they meet. I think for most, the details of their health are shared with specific people in specific circumstances, for a variety of reasons. One big reason is often that certain perceptions follow some disease states, and that can be difficult to overcome. For instance many people still do not share their history of mental illness willingly because of longstanding biases and preconceived notions about mental illness among the general public.

What Miss Idaho did however is another step forward and possibly indicative of our current state of technology as well, where medications/cures/treatments can be visible without us saying a word, and it is our decision whether or not we allow it to be more visible or not.This is obviously a choice each individual makes on his/her own. An insulin pump of course tells the world that you have diabetes. In this case of Miss Idaho it possibly is more admirable because of the circumstances where it was being worn, where this woman was being judged in part for her physical beauty/health, something not often associated in our societal thinking with a disease state of any kind. But is it not a new type of issue at all.

One of my medical school classmates who occasionally wore some low cut tops would be found discussing her quite visible anterior chest scar, a result of her having open heart surgery as a small child. A young woman in my family was considered at one point for having a pacemaker placed, something that would quite obvious on her thin frame, and it did cause her concern at the time("Am I really going to have this box sticking off my chest?"). Individuals with prosthetic limbs, people needing oxygen tanks, those with very visible scarring; they all bear highly visible external evidence of something that impacted their health at some point.

In some cases it is nearly impossible to hide if you wanted to do so, but when it IS possible, the choice is deeply personal whether or not that option is chosen. Devices are being made smaller and smaller, in part with the hope of not making anything easily visible, to ensure privacy of the wearer.It is also for convenience of course--insulin pumps used to be MUCH bigger than they are now for instance.Medical procedures have for some time been heading towards those that cause as little scarring as possible. The idea of standing out because of a health issue is not a small thing by any means. I had a patient refuse thyroid surgery because she had keloid type scarring and the idea of having a highly visible thick scar on her anterior neck was enough to deter her from having a thyroid mass removed. Patients of mine have refused consideration of an insulin pump because they did not want anyone to notice it.

I am not saying either decision path is "right" or "wrong". But given our inherent need to fit in as humans, I do find it admirable when someone does wear their heart on their sleeve in regard to his/her health. In this world of ours, we can sometimes be very judgmental of each other, especially when lacking in knowledge. Sharing our personal information always carries some degree of that risk to be seen as "other" in some way, and that is why Miss Idaho's decision was so admirable.

<![CDATA[Parenting opportunities lost?]]>Sun, 06 Jul 2014 13:33:37 GMThttp://www.doctorreinvented.com/doctor-reinvented/parenting-opportunities-lostPicture
It's always on my mind: am I doing the right thing as a parent? This includes not only doing the right thing, but NOT doing the wrong thing.
I've come to realize that every minute of every day is rife with opportunity to teach our kids something, sometimes big and sometimes small, but always a chance. Of course, it is also a chance for us to learn something ourselves. I am far from believing as many years as I have had on this earth that those make me an full expert in ANYTHING! I am on the lookout not only to teach but to learn.

This last week saw what I thought was a potential massive missed opportunity for kids to learn a lesson about sportsmanship. I will pause and say first that I have some of this information from the press, and I am well aware that we receive versions of the truth through the press, but it's what I have to go on. In my house we are currently overcome with World Cup fever--fever I tell you!!! We love us some football, and yes that is what we call soccer in my house. You can imagine my dismay when the now-infamous biting incident occurred involving Luis Suarez of Uruguay and Giorgio Chiellini from Italy. 

What has snowballed after that incident has been disturbing to behold, if indeed it is as reported.Suarez faces a hefty ban on future soccer activities, and whether or not you think that is fair is not the issue here. Sorry, that is not the minefield in which I plan to wade. The part of this story that is most bothersome to me has been the defense of Suarez, by teammates and country mates, and even political heads.


Does this man's talent, ability to win a game or bring in money overshadow the obvious truth here, that civilized adults simply don't bite one another? What does this teach our children for goodness sake? That if you are powerful enough it doesn't matter what you do?

This got me thinking about more everyday events where we as adults may make excuses of some kind for our own less-than-good behavior, even if not on par with a bite. I wondered how many times my kids heard me softly (or not so softly) berate someone in traffic when perhaps I should instead be showing them how to be patient. Or make a comment about a news item where my view trumps a more obvious point to be made. Hmm, food for thought.

None of us is infallible of course, but I do hope bringing this into my mind's forefront will prevent me as a parent from calling up paranoid theories rather than teach a lesson in acceptable behavior to my still impressionable kids.

<![CDATA[Time Off]]>Tue, 27 May 2014 21:31:59 GMThttp://www.doctorreinvented.com/doctor-reinvented/time-off
I'll be taking a little time off as my family transitions into a busy summer. There are new experiences for all of us, right around the corner. I look forward to enjoying even the seemingly mundane, which summer and newness make seem glorious.
See you in a few weeks!
<![CDATA[rebirth after early career crisis]]>Tue, 20 May 2014 12:26:17 GMThttp://www.doctorreinvented.com/doctor-reinvented/rebirth-after-early-career-crisisPicture
A good friend of mine shared some news this week about a colleague of hers switching career paths of sorts. In the academic setting where she worked, this colleague was successful by standard measures: she had publications, had secured grant money for the institution for her research, and was respected by her peers. But she was leaving research academics for a job in administration instead.

A recent edition of Endocrine News that came to my mailbox talked about a crisis in Endocrinology, where fewer trainees are entering my field of specialization.Plus, of those who did enter the field within the last several years, many are leaving the traditional academic or small private practices and moving to different versions like large multi-specialty groups, or entirely new ways to use those years of medical education such as medical-legal opinions or marketing.

During my last year of medical school we had a guest speaker visit to discuss contracts. I recall this person telling us that a large percentage of us would leave our first job within 2 years. WHAT? Some estimates put it at 65% of doctors leaving their first job within 5 years. All of us sitting there could only think one thing: after all THIS, there is a high chance we would walk away from our first paying job, you must be kidding!!!??? Ah, the innocence of the unknowing.We had no idea what was ahead in our professional lives. Since graduation, I would wager that indeed the vast majority of my classmates who signed job contracts at some point have indeed moved on from those initial jobs to others, sometimes several times, even outside of advanced training purposes. The reasons are many. Forbes magazine had a sad but interesting article discussing discontent among physicians and the myriad of some contributing reasons.

In my medical school class we had several "non-traditional students" including lawyers and pharmacy doctorates who left their previously chosen fields after years of study and practice to instead pursue medicine, starting from scratch like everyone else. A search for "academics leaving academia" will yield more results than you can imagine, including a first page full of articles and blogs written by individuals doing just that.  Interested in more resources? There are tons of books also talking about leaving the ivory tower, life after academics or life after PhD.

In "the old days" it was well accepted as the norm that you took on a career path(finance, government job, teaching,medicine,law etc) and stuck with it the rest of your life. These days it does not seem necessarily the case anymore, and for careers that take an initial investment of many years of study it can be jarring to witness someone make the leap from one career path to another. What is going on here? Are we now within a generation that has such different expectations of jobs and life that the old plan of finding a career you "stuck with" is no longer the norm? And if so, is that good, bad or just different? I remember thinking in medical school how incredible it was that someone would go through law school and all the way into practice only to change her mind and come back to another intense post graduate path of study.I didn't understand it at all really, not back then. But now I do, as do many of my friends and colleagues in medicine and other career paths.

I have found this is a topic that can be quite polarizing--the early professional career crisis and where it leads, or should lead. For some people the fact is simple: after you incur that much debt of time, effort, emotional and mental investment as well as financial debt, you stick this out and find a way to make it work for you. For some others, life is simply too short and filled with other important aspects to devote a large percentage of daily time( and years upon years of a lifetime) to a job you don't enjoy.

Nope, I can't tie up this blog simply and neatly. I don't have an answer and even if I claimed to, it obviously would not be right for everyone as all circumstances are so different. I think a big career leap should not be taken lightly, but I don't think many adults would take it lightly anyway. I do think being happy with your chosen career path/job is important as we can spend the majority of our waking lives at work. But I also accept that there is no perfect job, and that there will be days with bumps in the road or snags in the carpet that make some periods of time at work less than ideal.Or outright miserable. If those periods are relatively contained and brief, then you stick it out.If not, consider moving on. But again, this is my point of view, and unlike much of Endocrinology I have no numbers to specify when I would even make those decisions myself(what? An Endo not using numbers to explain something? Unheard of!). Leave after 2 years? 3 years? 6 months? I don't know.

What I have come to appreciate is that the early career crisis can be a good thing.It does not make you "flaky" or "indecisive" as some may think. Wanting to be happy at work is not entitlement, it is a reasonable goal for all of us. While I make some of those tough decisions myself, I have learned to keep an open mind and open eyes during these years of our productive working  life. That career path chosen years ago may take some turns you don't expect and off-roading(temporary or permanent) may be more fun that you thought.

<![CDATA[It's about the job, okay?]]>Fri, 16 May 2014 14:45:10 GMThttp://www.doctorreinvented.com/doctor-reinvented/its-about-the-job-okay
This week among the usual nonsense news about celebrities starting fights(who cares, really?) and serious pieces about wildfires in California was a major upheaval in the journalism world when Jill Abramson was removed from her position as Executive Editor of the New York Times.

Not surprisingly, given this being such a high level position, it drew lots of attention.And again not surprisingly, questions have been raised about whether or not this has anything to do with Abramson being a woman, and how her tenure as Executive Editor, leadership style and even her dismissal may have been interpreted/misinterpreted in light of her gender.


I will never say that giving consideration to the possibility that her being a woman unfairly set Abramson up for different judgement than her male counterparts because we all know that possibility exists, everyday, for women everywhere.  What I will say is this: let's not jump to that as the first thing.

It is a difficult balance to take into account known issues surrounding discrimination of any type(which can be quite subtle) and not making them the centerpiece of an honest assessment of a situation. Further complicating matters is the simple fact that there is no one "truth". There are versions of truth as seen through the eyes of all involved, and then further changed in the way they are communicated to others, who can in turn alter the perception of said truths. For instance decisions can be seen as either daring/forward thinking or foolhardy/risky depending on how they are communicated and who is listening to the information being shared.

Like many people, I will stay tuned to find out what is discovered about the circumstances of Abramson's dismissal. I would like to know why the decision was made and in such a seemingly hasty fashion. But unlike some, I am not going to first assume this has to do with her being a woman.Instead I will first assume it had to do with the actual job done. Maybe I am wrong, totally wrong. But for me, I don't first assume an issue/failure/misinterpretation has to do with something I can't control. Instead I think it IS something I have control over and can change, so I set out to do so. If all my efforts fail or somehow don't turn out the way I suspect, then I look at those issues outside my control.

Despite what some may say, most women I know WANT it all to be about the work.They don't want their gender being an issue at all, negatively or positively affecting the way their work is viewed. It's fine saying, "the first female executive editor" and marking that with an acknowledgement, but then let's move on and make it about the work, please. We want neither excessive accolades neither excuses being attributed to our gender.

There has to be a balance between scapegoating our gender and ignoring the fact that societal biases exist. The day we find that balance and truly make it about the work will be a great one indeed.

<![CDATA[child marriage and a mother's heart]]>Tue, 13 May 2014 13:31:08 GMThttp://www.doctorreinvented.com/doctor-reinvented/child-marriage-and-a-mothers-heart

How does a mother feel the night before she sends her 8 year old daughter to be married?
Married to a 40 year old man?

This question had plagued me after seeing the news article about an 8 year old Yemeni girl who died on her “wedding night”. The headline alone shook me so horribly that it took days for me to read the actual article. Even while accepting that I have read only one version of this story, and as an adult knowing that behind the reported news is often a more complicated version of the truth, I am still sure that the bare bones of this news story is exactly what it sounds like: a child being given to serve as a wife, in all its roles including sexual, to a grown man 5 times her age.  Initially, like many of you perhaps, my mind was riddled with the horrific idea of this poor child, being taken into this disgusting “relationship” ( a word that hugely misrepresents this situation). At some point my thoughts took a shift from this 8 year old who died of internal bleeding, suffering a death most of us should never ever have to face as a possibility. My thoughts turned to her mother and I did not know how to feel about her, or for her.

When I became a mother myself, and by that I mean within the first months of pregnancy, something changed for me in regard to priorities.  When my children were born, the biggest shift in my life occurred, and yes it sounds like a cliche but my life was truly changed forever. Even with all its stressful days and nights, fatigue and vexation, being a parent is a gift I would not ever refuse.  My husband recalls me struggling out of my wheelchair after my c-section that came after 12 hours of labor, still sick from a fever during delivery, struggling to see my children in their bassinet, and weeping, and weeping. I cannot describe entirely what I was feeling, but from that moment my number one priority in life has been to keep them safe, and happy. I do this without thinking, and 100% willingly.

Did this mother of the 8 year old Yemeni girl feel that same way? I of course assumed that she did and this article is not about a mother not loving her children, far from it. I do not think the vast majority of child marriage situations stem from lack of parental love for the child. What I have struggled with is understanding, and accepting, that different cultures will influence a mother’s instinctual protection of her child, even to the point of willingly sending her to this horrible situation of child marriage.

How does it feel for a mother sending her child off to a situation in which you know she is almost assured of suffering? I can only imagine how heart wrenching it would be and hope never to know a situation even close.  Even if this child did not die on her “wedding night” (a term so grotesquely inappropriate here that I cannot repeat it again), any person with even rudimentary knowledge of what typically happens between husband and wives would know this child would be suffering. They would know that if she survived the several years of what was essentially child sexual abuse, she would eventually become pregnant too early and have a high chance of dying in childbirth or experiencing complications of childbirth. And these say nothing about the other aspects of her life, her obviously low standing in society and in her marriage situation into which she had been given or traded.

But these are words coming from me, a woman born and raised in the western world, one whose mother infused in her the sense of you-can-do-anything from the day she was born.  I am a physician and a wife, respected at work and in a marriage where I am seen and appreciated as an equal. I expected nothing less growing up and sought out both of those situations with purpose. Largely I count my mother’s influence as the driving force, and perhaps some inherent stubbornness of personality on my part.
What if my mother was instead this Yemeni mother, who would be expected to yield to the decisions made by her husband and village/town, no matter the outcome for her children? What if my mother was made to know that she had no choice, no power, and that her daughters had to serve larger roles in terms of satisfying family debts or honor?

Questions only lead to more questions.

How much does your own personality play a role? Would I as a Yemeni woman send my daughter off to be married at 8, to a 40 year old man? I would like to say no, that no culture or threat could make me send my child off to a life of pain. But that is my westernized and independent mind talking. If I was taught I had no power, and my decision was worthless, would I somehow speak out anyway? How much does culture and ingrained societal status of being at the bottom of the rung match up against individual questioning/stubbornness/resistance? Did this Yemeni woman ever think, “this is wrong and I won’t send my daughter?” Did she even think there was a choice?  Maybe she cried the night before as she explained to her daughter what would happen the next day, and dressed her hair and kissed her goodnight, hoping maybe her daughter’s husband-to-be would be kind, and thoughtful and not touch this child until she was much, much older. Maybe the mother made herself believe in a miracle that frequently does not come to fruition in male dominated societies.

I need to believe that she did atleast consider fighting back. There are women all around the world who break that mold of subservience, and this is one big way to bring about cultural changes. Women and men refuse to accept the current state of things, question it, challenge it and sometimes suffer for their actions. Slave women have chosen death for themselves and their children rather than continue a line of slavery and suffering, a choice that can be seen as either heroic or cowardly depending on your point of view. Women have fled genital mutilation and arranged marriages, they have learned to drive, they have gone to school, they have run for office and spoken out in marriages, small groups and large meetings.  They have been shot at, beaten, abused, imprisoned and some killed. Where one falls, another one rises, sometimes immediately and sometimes years later.

Big changes start on relatively smaller scales, like my mother as a teen refusing to continue the rules of her father’s house that women not wear pants. Her mother, my grandmother also rebelled against her husband’s preferred family dress code, and the seed was planted.

Maybe those men who talk about women’s independence being a “disease” are right in a way: it is a genetic disease of the mind and of the soul that spreads, often from mother to daughter, like a gene amplified from generation to generation until one day we see the full expression of a female who stands up against something big. A husband. A village. A nation. A culture or a religion. A woman who says “no.”

Hopefully somewhere around the world, against all cultural expectations, a woman is whispering to her daughter that she will not be married off as a child, . She will instead get an education, and marriage, if and when it comes, will be at  a later time. Her daughter will be thoughtful and nod in agreement. And the gene amplification begins.