I sent you a jeep, a boat and a chopper… Health care musings in the midst of Hurricane Sandy


10/29/12. We are in the early hours of Hurricane Sandy. Our town’s electricity went out about an hour ago; trees have fallen on nearby power lines. Just prior, my husband and I checked the Internet for storm updates. We were astonished to discover that some people in areas predicted to be hit hard – even by 12-foot waves and severe floods – were refusing to evacuate. Local officials and the Red Cross were issuing warnings and making statements such as “Do you want to be someone that an aid worker has to risk their life to save?” and “Do you want to be someone whose family cannot reach and is worried sick about your safety?” Sometimes home is just where the heart is; sometimes fear keeps us from taking help, moving to higher ground, or leaving our comfort zones.

This storm reminds me of the old parable about the man who refuses to evacuate in the face of an encroaching flood. A first attempt is made to evacuate him before the storm hits. Soldiers in a jeep offer to get him to higher ground. He refuses, saying, “God will save me.” Soon the waters are up to the second floor of his house and another group of soldiers come by, this time in a boat, offering to bring him to safe land. Again he refuses, saying, “God will save me.” Finally, the man is on the roof of his house, cold floodwaters surrounding him. A chopper flies over. Soldiers call down to him by bullhorn, offering, for the last time, to save him. And again he refuses, repeating, for his last time, “God will save me.” The man drowns. He goes to heaven.

When he is before God he says forlornly,‘God, I had faith in you, I believed you would save me, but you let me die.” To which God replied, “I sent you a jeep, I sent you a boat, and I sent you a helicopter; what more did you want?”

While I am not part of a religious faith, as a midwife and physician, this story has long resonated with me powerfully. It’s consistent with a saying I learned from a Muslim midwife when I was in the early years of my practice, “ Have faith in Allah and tether your camel.” The spirit of this adage has never failed me.

As a radical health care activist I believe in taking our health into our own hands. I also believe in using medical technologies appropriately and responsibly. I am not one who will, pardon another metaphor, throw the baby out with the bath water.

This storm and the evacuation refusals got me thinking of this woman I knew long ago. Jennifer. A chiropractor and the mother of young children, Jennifer was rabidly anti-medical. So much so that she actively discouraged women planning homebirths from utilizing the services of midwives, insisting that if they “really had faith” in their bodies, they’d birth at home alone. She once convinced an 18 year-old first time mother to deliver her baby – who was in a breech position – at home, alone, instead of working with the local OB who supported vaginal breech delivery, or even having a midwife experienced in breech births with her. Thankfully the birth went ok. Most births do, most of the time. It’s just when they don’t that…

Now here’s the thing, the body does have seemingly infinite wisdom and self-healing capacity. Many conditions, left alone, are self-limiting and will heal given simply the tincture of time.

Aviva doing a newborn exam after a home birth, circa 1995

Birth, which is not a medical condition at all (for most women), but a natural process, has been entirely usurped by the medical industry – over-medicalized and pathologized to the extent that the national cesarean section rate is over 30%. This is leading a growing cadre of women to take extreme measures to completely avoid all medical intervention.

The truth is that left alone, even quite literally, most women will birth spontaneously and without complications. I gave birth to my 4 children at home – naturally and easily. I am also aware of what can go wrong with birth, and the jeopardy into which birth complications can place the lives of mothers and babies. I prefer to have an understanding of when medical intervention is appropriate and necessary, and use it judiciously in those circumstances.

Let’s return to Jennifer’s story. About ten years ago, several years after I’d last had contact with Jennifer, I received a late night phone call from her husband. I barely knew him. He was reaching out in despair and loneliness. He told me Jennifer had died a few months prior, leaving him a widower with 3 children, all under 10 years old.

Jennifer had developed an ear infection. In spite of getting progressively sicker over ten days, with fevers and delirium for several, she adamantly refused medical care. Finally, her brother, who had been informed she was sick, came to her bedside. He hoped to convince her to go to the hospital. When he arrived, she was barely coherent. He lifted her up and took her to the hospital. But it was too late. She died shortly after arrival. The cause of death was fulminant sepsis. She had an ear infection and she’d refused to get treated.

I know this is a terrifying story. And extreme. I don’t mean to be scary. But it is entirely true without embellishment or exaggeration. And it illustrates a point.

Searching for meaning and lessons in his wife’s death, Jennifer’s husband reached out, thinking I might somehow make sense of Jennifer’s choice, somehow make it seem less insane. My heart flooded with empathy and sadness for him, my voice offered him consolation, but my mind was reeling with horror that this happened and I initially felt angry at Jennifer. I recalled the number of women she’d encouraged to take unnecessary risks. Strangely, though I then felt a peculiar flood of empathy for her. Her death was, needless to say, horribly tragic. But she was terrified – to an extreme – of being a victim of unnecessary medical interventions, so she avoided medical care – at all costs. And the ultimate price was paid.

A deeper question this all begs is what do we need to do to change the entire health care system so it is patient friendly and not a system in which people afraid to lose their autonomy and choice. Medicine should be that way: it is predicated on 4 essential rights of patients, patient choice and autonomy being amongst these.

As a midwife and medical doctor, I spend my life exploring the proper role of medical interventions in our lives – when we can treat with natural approaches, when medical care is needed, and when we need to say enough is enough to over-medicalization.

I’ve seen far too many patients unnecessarily or over-treated to the point of iatrogenic (doctor-caused) complications. I recently witnessed a life threatening complication in a woman in labor, and her unborn baby, because of a poorly chosen obstetric intervention. This was in a major hospital. And because the laboring mother had HIV, the medical team was also placed at risk as a rushed emergency cesarean section ensued.

The fact is that the cesarean section rate IS over 30% nationally and this is a major problem. Unnecessary cesareans significantly increase maternal morbidity and mortality. We know that midwives reduce cesarean numbers, as does homebirth, and yet there aren’t enough midwives to go around. This is entirely due the obstetric medical hegemony that prevents midwives from practicing legally in many states, makes medical back-up for home birth nearly impossible to obtain, and so constrains the definition of normal that many women can’t meet criteria for birthing at home or in birthing centers.

As one of my readers astutely commented to me, much of what is happening in the do-it-yourself birth movement is a natural reaction to an extremely prohibitive situation. It is not always optimal or ideal (though it is for some women); it is often an all or nothing choice.

Unlike the man who refused the jeep, boat, and plane, I prefer to accept reasonable life-saving assistance. Unlike Jennifer, I would prefer to take an antibiotic and be there for my kids’ birthdays rather than holding to extreme and restrictive ideologies. Like those of you who are making difficult health care choices every day, I, too, have had times when I have been uncertain of when medical interventions are appropriate. I have tremendous faith in my body, in all of our bodies’ abilities to heal. But my pragmatic side always reminds me to tie my camel!

I became a physician to better support and guide my patients – and you, my readers – through difficult health care choices, armed with information on the pros and cons of both medical and natural health options, and a deep understanding of when medical interventions are – and are not – necessary. While I do emphasize natural approaches whenever possible, which is most of the time, it is important to know when a medical intervention is the most appropriate. That is a significant part of what this website is dedicated to – giving you accurate information and insight into making wise health care choices.

And another homebirth…Katia’s newborn exam, 1988

Please let me hear your thoughts and struggles over medical intervention choices – and what kind of information you need on health care. On this stormy day in New England I invite you to ‘flood’ my inbox with your heart’s concerns. And if you are reading this post, my electricity has been restored – at least temporarily! I hope you are safe and dry wherever you are!

Love, Aviva

 

 

 

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Becky Webb

Thank you so much for this post. I am the daughter of a Chiropractor and have done research on natural health most of my adult life. I love natural health and healing and love it that the body is created to be healed. I am also a Christian a believe that God is the great physician and ultimately does heal but in many ways we do have to take charge of our health in order to find healing. I love this post because I struggle with this almost on a daily basis. I have found so much disappointment in the health care system that I often struggle with when to take my children to the doctor. Our family history is such that my grandfather died at a fairly young age (in his 50's) trying to heal himself as well. I'm not really sure of all the details, but it sounds as though if he would have gone to a hospital he may still be with us today. Although I love natural health and feel as it can do so much good this makes me so sad. I want to have a good balance of when to take advantage of natural medicine and when to take advantage of western medicine. My daughter 5 month old daughter, Piper just had a major surgery on her head. Without the use of allopathic medicine she could be plagued later in life with developmental delays or even brain damage. I am thankful for the nuro surgeon and plastic surgeon that did her surgery and I know that God provided them to do so. As I spent time at the hospital, I realized how I wanted to preach more integrated medicine. I wish there were more like you who comes from an integrated approach. At the age of almost 32 I don't know if I could ever see myself attending medical school, but I would love to aid people in this way someday if I can or at least as a natural health advocate help people approach health in a balanced way. I love this story that you used here. I feel like it is so true. We can really miss out on God's blessings if we are seeing them all from a one sided direction. Thanks so much for you approach on health. I really appreciate you knowledge and love reading your blog.

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Lauren Fries

I love that old parable about the man who refused a jeep, boat and plane.. I think you touch on something deeply profound in our psyches, where often the way to remedy an extreme (ie medical intervention when unnecessary, fear-based or for profit) is to go to the other extreme.. The boundary often comes from tragedy and there we learn to tether the camel.. It seems very much so that this is our lesson as humans.. we are indeed all part of the same family, and when hurricanes and life threatening situations arise, it shows how our choices affect everyone.. from the red cross having to risk their lives for those who wont risk their comfort zone, to families worried sick around the world for their loved ones, and the loveliest part, the kindness of strangers. Thank you for a very thoughtful post!

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Chara

Thanks for your nuanced thoughts, Aviva, on a topic that I, too, consider both for myself and my children. In a world in which allopathic and "natural" medicine are still often viewed as opposites, it can be hard to pick which side is the right one for a given problem. But I do see a rapidly increasing detente and even open dialogue between the sides, and this makes me hopeful. On a related but slightly different topic, I'm wondering if you might share with your followers what you do for yourself in terms of regular health maintenance, especially as regards exercise, diet, supplements, mental well-being, etc. You look so fantastically youthful, beautiful, and vibrant that I would really like to know what is working for you. As a working mom of three children, I find it really challenging to find exercise and personal care routines that fit into a busy week and are financially feasible, so I'm always curious about the choices made by women whom I know also are busy, yet somehow manage to keep their glow, as you do!

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Shannon

I too struggle with this delicate balance. When to go to the doctor. When to treat at home. Personally, without medical insurance, whenever I become sick I treat at home. (I've never gotten anything more than a regular cold). I use food and herbs as my medicine. And I just pray to never have real cause to go to a doctor or hospital (ie. broken limbs/freak accidents). With my daughter however who is covered through medical assistance, when she gets sick, I have a choice. My mothers response is always the same. Take her to the doctor and administer whatever medications are prescribed. My heart tells me to assess the situation and only IF it doesn't improve in time, give the prescribed medication. I do usually take her in for diagnostic purposes. The other day she had a fever and my mom was adamant that I give her Motrin to reduce the fever. I instead chose to go the herbal route and nurse her body as let the fever do its job with the assistance of herbs and while keeping an eye on her fever not letting it spoke past 102. Within 2 days her fever broke and she was back to normal. I continued to administer herbs until her symptoms were completely gone. This has been how I've always done it with her since she was a baby (I started my schooling as an herbalist when she was 1). All this to say that the line is still blurry for me. For instance, she was sick many times as a baby and I chose sometimes to use the drs remedies and other times to make my own. Last year at the age of 3 she was diagnosed with type 1 diabetes. For the life of me I wonder if it could possibly be the result of one of those times when I didn't... (Link between coxsackie cirus and autoimmune diabetes) Or if it was from one of the vaccines that I did allow. Or if it was something else I did or didn't do... Or if it was... But there is no real way to know. That's scary.

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Michelle

Yes! So true..all of it. Struggle for me too...I have 2 children who have medical conditions I believe were caused /exacerbated by conventional medicine, but also whose lives have been saved by conventional medicine. I am blessed with a great family doctor and also a naturopth/midwife who has an approach like yours. I live in Canada where our basic health coverage is subsidized, so I use both systems. I typically get diagnostic tests and recommendations from conventional system (which is paid for), then bring my results and questions to my ND out of pocket). Sometimes they advise the same way; sometimes differently. I will usually try my naturpaths recommendations first, but resort to conventional stuff if it doea not seem to be working. NDs have prescriptive rights here and I know that if they really feel it necessry they will use them. The biggest struggle for me is vaccines!! And affording it all. It would be much cheaper for me to use drugs and medications instead of holistic healing.

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Sandy Cox

We are going through very tough medical decisions. My youngest daughter, Cassie, was diagnosed with a brain tumor over 8 years ago at the age of 4. We did tons of research, but because the tumor was threatening her very life, we eventually chose chemo and later, radiation. Thankfully her tumor (which is inoperable) is now stable. But the treatments have destroyed her pituitarygland's ability to produce growth hormone and cortisol. This has caused her to be much shorter than normal. We have just decided to get her started on growth hormone replacement. Before all of this, we pretty much self-treated illnesses etc. with herbs, oils, and nutrition. During her treatments, we continued using alternative healing proticals, in addition to the chemo and radiation. Cassie went through these (basically toxic) treatments with very little negative side effects. Her counts were never dangerous, she retained her hair, and she is very healthy and strong. I truly believe that, even though we used conventional cancer treatments, because we also maintained a healthy, holistic healing process, she was and is able to come through so amazingly. I believe, as you do, that there is a need to carefully consider and use, when necessary, a variety of health care options. I also believe that parents MUST be the advocates for their children's health care. We need to be as educated as possible, asking questions and pushing for logical, understandable answers from every health care professional.

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Katerina

This is a wonderful article! As a student of Chinese medicine, I find that there often seems to be an argument between the "alternative" and "conventional" medicine worlds, each trying to prove that they are right and the other is wrong. But when I think about what I want my practice to be, I'd like to help people learn the gentle remedies, the preventative strategies, the healthy lifestyle choices they can make, and when there is a real emergency and the traditional methods fail I also like to know that there is a hospital I can send them to to utilize the incredible technology and science we have available today. I don't think it should be so much as question of which is better, but an exploration of each modality's strengths and weaknesses. If we could have this discussion more often everyone would be better off.

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aviva

Dear Friends, Thank you so much for your deeply personal and profound comments. I am honored that you shared your stories with me today. In my experience, parents who have gone through an illness in their child are some of the most spiritually evolved amongst us, having gained strength, compassion, insight and patience in the face of what most of us can hardly bare to imagine. Your stories also give me insight into specifics I can share with you in future posts: how to be an informed patient and have conversations with your physician (or your child’s), how and when to treat various health conditions with natural therapies and when medical care is needed, and of course, I am happy to share my own personal health routines with you –but I must admit, these are more basic than you might imagine! Thank you for your support of this post– I took a risk in publishing it– and am so grateful for your kind and thoughtful responses. Lovingly, Aviva

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Brooke Downing

Hi Aviva, I love this post. I hope that you and your readers are safe and warm, my heart really goes out to everyone on the east coast. I wonder your opinion on birth for women with controlled type I diabetes? Should it be medically managed? I had been diabetic for 12 years when I became pregnant with my daughter. I was terrified of not providing her with the strongest, healthiest body and the most gentle, tender birth into this world. I did not want to birth in a hospital, but I understood that was "safest" for us. I fought hard to be allowed to go into spontaneous labor, with the condition that NST results were satisfactory and that my blood sugar levels were still maintained in the A1C range of 5-5.5, as they had the entire pregnancy. My ob had a planned vacation the week before I was due and at our last visit she told me that she would induce me once she got back if I hadn't already birthed my baby. I told her we would see how things went and I know she wasn't happy with me. I trusted in my ability to birth her, and I trusted in my daughters ability to let me know once she was ready to join us. As it turned out, I went into spontaneous labor at home, two days before my ob returned. I labored at home for a day until I was ready to go into the hospital. I arrived at the hospital and was dilated to a 7 and my daughter was born 6 hours later, without medication or complication. I should say, without pain medication, they did force me to detach my insulin pump and they put me on IV insulin, after which my sugars shot up to 300+ and I was incredibly frustrated, that even with my own disease they didn't trust me to care for myself. I had worked so hard to keep my blood sugars as close to 100 from the moment I found out I was pregnant and now, as I labored I was dealing with the sensation of such a high blood sugar. I understand liability is their concern but I was doing everything I could to responsibly care for my body. And how serious and determined I was to allow my daughter what each and every human being deserves and that is a peaceful transition through a potentially traumatic experience. So, do you believe you would have supported me with the birth of my daughter? I searched for the first 4 months of my pregnancy for a midwife to support me and none were willing to take on a 'high risk' pregnancy. I have never felt so marginalized and not human, but instead like a walking disease. I am now studying to become a midwife and have yet to answer the question for myself, will I assist women with controlled diabetes to have the birth they're determined to have?

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Lora

Aviva, One of the reasons I so appreciate your work is that you see the benefit in all approaches to health. I am a registered nurse specialized in critical care,emergency and flight medicine. We have made tremendous advances in healthcare saving lives that we never could have before and yet we fail in long-term chronic illness. There is a place in healthcare for both "traditional" and allopathic care. In my opinion, healthcare has become as polarized as our political system, you either use all traditional or all allopathic and those that use the best of both often are chastised by the other. My father was in the hospital 9 weeks last year and surly would have died had I not used the best of both in our decisions for care. Patients need to be educated they are no longer seen in healthcare as patients but actually customers! You have all the rights and privileges that come with the title but many do not know how to use them. I would like to hear how we can better educate customers/patients to be their own advocates. All the information we give them will do no good if we do not tell they how to use it. I send good thoughts to all of you on the east coast. I have been through 2 natural disasters as a nurse and the road ahead will be long. Blessings to all Lora

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YE

I wish I had heard about you sooner. I would have ,without a doubt, had at least my first baby, at home with the help of a midwife. When I had my first, full term, healthy baby the doctors did a C-section after being in a hospital bed(literally) for over 12 hours. The whole time I was in the hospital , I only saw a doctor once. He came in once to put something in my body, never said a word to me and left. When the new sihft started, the new doctor came in and said labor was not progressing. According to doctors and nurses I only made it to 4 cm. I am confident that a lot could have been done to help labor progress but I just don't think they were interested. Eighteen months later when my second child was born at 25 weeks, a second C-section was needed.This time it was an emergency C-section was needed because not only was she too early and little( 2 pounds) but she was breech.

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Julia Mannes

Hi Aviva, First I should say I am a major fan. You will be teaching at a childbirth educator training I attend in a few months and I registered right away, even though it will be a repeat of that class for me! Thank you for this post. As a person who was not very holistic for a good part of my past, and doula, childbirth educator, and yogi, I have wrestled with finding the right balance for a long while now. My mother was sick for most of my life, and she passed away when she was 52. I felt that the issues she had (chronic infections, cancer, MS, bipolar) were largely either caused or exacerbated by allopathic medicine or toxic environmental substances. I'd say my biggest challenge with health care is finding a practitioner. My daughter was born at home 3 years ago, and it was an incredible experience in general, and one where I felt supported and clear about the process behind the scenes too (such as insurance, when to call my midwife, etc). After the birth, finding well-woman care was completely opposite. When I get ill, I have a number of holistic practitioners that I could call, but it's hard to know who to call first. I've at least gotten to a point that I know I relate more to herbs than homeopathy, more to food as medicine than lots of pills. But it's hard on the rare occasions that things go quickly out of balance and not knowing who to call. I used to think a doc could be a good diagnostician even if not the healer I am looking for, until I had an acupuncturist let me know that she doesn't even agree there anymore. She said that as an example, strep throat doesn't exist in chinese medicine, so the diagnosis more often than not feels skewed to me too now. It's like "when the spirit catches you and you fall down." - so so much gets lost in translation. These days, i've just been learning more and more about healing myself and my family, but I agree that I would not want to throw the baby out with the bathwater. I just find myself feeling 99% of the time at odds with what the medical model tells me. My daughter has never needed an antibiotic... Though I took an antibiotic twice myself in the past 2 years, once for a splinter in my hand that got infected, and once for another infected little lump. It felt obvious to me that I wasn't healing fast enough to be commensurate with the risk of not getting it healed quickly. I'm always urging my pregnant clients to figure out, when an intervention is suggested to them: what are the present risks? how likely are the risks to manifest and how serious would they be? How likely is the treatment to fix what we are concerned about? How quickly do we need a solution on this particular issue (based on how serious it is and what else is going on in our lives)? what are the risks of the treatment? how likely are the treatment's risks to manifest and how serious would they be? what are the alternatives? have we considered doing nothing as an alternative? What do we stand to gain by going the unintervened path? Because if we only ask the one question, "what is the risk," we'll just be told what to be afraid of, but we won't get dynamic answers about the nuances, or get an answer about what will nourish wellness as much as heal sickness. It’s easy to hear one compelling concern and get focused on it, but considering the rest of this context helps you get out of a frozen place of fear and into a dynamic place of thoughtfulness and trust. I ask these questions on both holistic and allopathic treatments because sometimes we can get very strict and dogmatic about our austere natural stuff too. I've always loved Susun Weed's concept of the Wise Woman path, as juxtaposed to either the allopathic or heroic path. A big place this has come up lately is in my circle of mama friends who are encountering dentists for children for the first time. Many of these mamas are so natural when it comes to so many other things, but are in unchartered waters and can't seem to get a middle ground view on this issue. Anyway these are the musings you inspired on my hurricane afternoon. Thank you for your post. Look forward to meeting you in March. Julia Mannes CD(DONA), CLC, RYT, and MOM Childbirth Educator, Doula, Certified Lactation Counselor, and yoga instructor 917.216.1991 www.juliamannes.com

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Meg

Thank you so much for this post. I am right there with you and I'm working to learn more about both ends of the spectrum: I'm in nursing school with the ultimate goal to be a CNM (possibly someday a NP or DNP) and I work to learn more about herbs and natural interventions. I appreciate what you are doing to bridge the gap between the medical establishment and natural remedies. During your training, how did you manage to hold on to your natural wisdom in the midst of (forgive me) medical indoctrination?

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Mary McMullin

Hi Aviva, Thank you so much for all the information you share. I have referred your website to my younger family members. I am an RN, and an herbalist, as I have studied with David Winston.I am an active member of the NHG. When my daughter was born, we chose not to have her vaccinated. I was studying with a homeopath at the time, but I later took a distance learning course with Sherri Nakken, all about vaccines. I was empowered by that knowledge to make the decisions necessary through my daughter's childhood with confidence. Melanie is now 20 years old, and although I have talked to her about her not being vaccinated, I feel that there is a lot more she needs to know, and understand about the implications for her. Do you know of any reference, either book or article that I can go over with her? I feel as if she is now ready to make her own decisions, but needs the information to understand the implications. I have the reference materials from the class about the diseases, etc. Thank you, Mary McMullin, RN

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