Do I Contradict Myself?

 Do I Contradict Myself?

My interiority is expansive.

I contain multitudes, each as vast as a galaxy.

They swirl within, each with its own unique characteristics and structure.

They dance around and with one another, peaceful and harmonious, irrespective of their contradictions.

Until they collide unexpectedly with the force of a nuclear explosion.

I believe in G-d.

I do not know who or what G-d is.

Or if G-d even exists.

I believe in the inherent goodness of all people.

And so many keep working to prove me wrong.

And I want so desperately to be right.

About this one thing only.

I’m happy to be wrong about 

the height of the Empire State Building 

or the length of the Mississippi River

or how many feet are in a mile

or why the earth spins 

and the age of the universe 

or the exact shade of the color of your eyes.

I find questions more interesting and satisfying than answers.

Except for the terrible, unanswerable questions.

I want answers.

Why?  How?  If G-d is love, then, what?

I have soundly rejected your god, the one you handed me, who was too small and mean to find space within me.  The one who, when asked, “How much more will you take from me?” replied, “I will take everything until you realize that I am enough.”

Fuck.  That.

Such a god is not loving.  This is a god whose name sounds like “power over” and “control.”

My G-d is not made of moving goalposts 

and tit-for-tat blessings 

doled out only to the pure and holy

which, in the places where you tried to teach me, meant

white

conservative 

virginal

straight (or convincingly pretending to be).

My G-d loves everyone 

and most especially 

the widow, the orphan, the poor and marginalized.

My G-d even loves those who are cruelest, 

most especially when I cannot.

My G-d empowers,

loves unconditionally,

is patient,

kind,

gentle,

and the only form of control is 

self-control.

When I sit in silence,

desperate for more 

softness 

love 

compassion 

and sounds of children’s laughter in this world,

I know that G-d is with me in the unbroken silence.

G-d is the unanswerable question: why?

A Hungry, Hungry Ocean

David handed me a cup of coffee and as I sipped it slowly, trying to make sense of things as tears rolled down my cheeks and I struggled to find breath, he continued on with making breakfast.  When it was ready, I sat at the dining room table as he set the plate of eggs before me.  After several minutes he said, “I know it’s hard, but you still have to eat.”

“I know,” I tell him, “I will.”  And I will.  “I’m just working on my coffee.”  It rolls over my tongue and slides down my throat and fills me with some kind of warm that isn’t comfort at all.  Eventually, my cup is empty and I look at the cold eggs and mushrooms on my plate.  I push them around with my fork and try to remember how to eat them.  But nothing is the same and everything is different.

 

I take a bite and it feels wrong in my mouth, but I force myself to chew, chew, chew until it’s a soft, small, ball of mush.  And as I swallow, it sticks in my throat before settling like a rock in my stomach.  How will I get through the rest of this breakfast?  How will I get through the rest of this day?  This week?  This life?

 

“It feels so wrong,” I tell him, “that I have to carry on with life as usual.  But what else is there to do?  As I try to make sense of this?”

 

It hurts.  My heart, my soul, my head after sobbing and reminding myself to breathe, the tender skin beneath my eyes, despite the gentle dabbing motion I’ve used to dry my tears.

 

Pour in; dump out.  That’s what they say about managing grief and supporting the grieving.  Pour into those who are closer to the pain; dump out to those who are further away from it.

 

But how do I pour in?  When time and distance and life has left our connection, mine and my baby brother’s, fragile and tenuous and as thin as the finest filament and somehow named “hope.”  Hope for some time in the indeterminate future when I feel more prepared or maybe stronger or maybe less overwhelmed by the requisite work of holding boundaries that matter only to me in that fine dance of relationship, when I’m trying to step nimbly and lightly and graciously with someone who barrels through life at 177% all of the time.  How do I pour in support to someone I love, who has just experienced the most incomprehensible loss, when I’m not sure I even have a place in the dance anymore?

 

Does he know, my baby brother, how much I love him?  How much I have always loved him?  How I keep my distance and hold a boundary, perhaps more rigid than is truly essential, because it is the only way I know how to hold my love for him?

 

And when the unimaginable happens, a tiny child, just six and a half years old, is gone…. What now?

 

I know it sounds like I’m trying to justify myself, but I’m trying to make sense of something that makes no sense.  Not just in the microcosm of this horrible moment but in the larger something of life and I don’t know how the pieces fit together in this awful jigsaw.  I don’t know what the puzzle is even supposed to look like.  I do know that I want to rage and scream and throw the fucking thing at the wall.  I want to keen and wail with the pain and grief.  I want to do something, anything, to make my heart stop hurting.

 

I go to lunch with my spouse and I think about what it would mean to make my heart stop hurting.  Then, I think of Victoria Hutchins and her poem, “reasons to stick around for awhile” and though none of these reasons resonates with me, I find one of my own – as she suggests.  There is so much pain in the world, I want to not add to it.  That means sticking around for awhile.  Equally, however, I appreciate Victoria’s poem, “reasons to stick around for a night” and its opening line, “If sticking around for awhile is unfathomable, stick around for a night.”  Or maybe, it’s just stick around for one more meal – whatever that meal may be.

 

My spouse drives me back to my office after lunch and drops me off with the promise to pick me up at the end of the day.  Sitting in the drive of the parking lot, he says to me, “I cannot do anything to help with your sadness but I am so grateful that I still have you in my life.”

 

Do you know, Oprah Winfrey’s name was supposed to be Orpah.  From the biblical story of Ruth.  Orpah was sister-in-law to Ruth and tried followed Naomi when her, Orpah’s, husband had died.  Naomi encouraged both Orpah and Ruth to return to their people and their gods.  Ruth refused and followed Naomi.  Orpah returned to her people.  The hospital fucked that up when she was born, not knowing how to spell Orpah and transposing the “r” and the “p.”  Thus, Oprah was born into the world.

 

The same thing happened with Kairo.  (White people fuck up everything).  He was supposed to be named Kairu – Kikuyu for “black one,” a name of honor and respect, celebrating his strength, wisdom, resilience, and leadership.  But, the hospital fucked this one up when he was born.  They misunderstood the “u” for an “o” and thus, Kairo was born into the world.

 

There are a few things I actually love about this.  My brother is named Christopher, which means “Christ bearer.”  The Greek short-hand for Christ is XP (Chi Rho) and is pronounced Kai-ro.  Christ simply means “the anointed one” and is understood to be one who is chosen by God, who has a special calling on their life, and who is empowered to lead.  Not all that different from Kairu.

 

These are the things I wanted to tell Christopher when he first shared Kairo’s name with me, the mishap in the spelling, and the meaning behind the intended name.  As is often the case, I did not speak these words to anyone.  There are a lot of reasons why.  Probably none of them are good reasons.

 

Somehow, at the end of the day, I try to do better.  I try to say the things that matter, that are meaningful, that let people know that they are seen and loved and cherished.  I want Kairo to know that he was celebrated for all of who he was.  He is so loved.  He is so cherished.  He is God’s child, and we got to love him for such a brief time.  And it hurts more than I will ever be able to put words to – knowing he is gone, never having gotten a good-bye, and barely having had any hello-s in between.  Now, even the hoped for indeterminate future when there is more time, and more engagement, and more connection is gone.  The hoped for future has been extinguished.  And all that is left in wake of Kairo’s death is grief.  

 

And grief is a hungry, hungry ocean.  And I am on a beach.  Cautious of the sneaker waves that threaten to overwhelm me and carry me out to the abyss.  Will I see the bubbles of my breath as they rise to the surface?  Will I follow them?  Will I learn to float?  Will I know how to swim?  Of course.  But that knowledge does not make it easier. It does not, in any way, ameliorate the pain.  It does not make it less scary.  

 

So, I throw my arms wide open, embrace the waves, and live life afraid.

More Than Enough

"So, I am feeling some things" I text a friend of mine.

She responds pretty immediately with compassionate concern and an offer to talk by phone later in the weekend.

Turns out, trauma continues to live in my body.  Somewhere between the sinew and bones - only recently excavated as my body has shrunk.  Who'd've thunk it?

When Tim died, it was the pinnacle of terribleness.  There was so much that was wrapped up, connected to, falling apart at that time, but Tim's death was less "one more thing" and more "the thing."  It was the only thing for a very long time.  Because of the judgments of others and my disenfranchised grief, I tried to make it go away.  Except it stayed and it loomed larger and larger every day.  So, I tried very hard to make it very small and I locked it away and hid it deep inside of me and I never spoke his name and I never let others speak his name.  Except it wasn't gone and it wasn't well-hid, and it leaked out of me in the most awful ways.

Then, ten years ago, at my wits' end, I sat down and I wrote.  A lot.  About Tim's death, about what happened after Tim's death.  Somehow I managed to feel everything and it didn't kill me and then I figured out how to carry the grief lightly.

Somewhere in my brain, this seemed sufficient.  The trauma of Tim's death was so monumental that it overshadowed every other horrible thing that had happened that autumn.  Integrating the experience, if belatedly, had me thinking that everything else was okay, too.  I did a fair bit of writing and work - and oh, so much therapy - around Tim's death and the rape one week before.  Halloween is still uncomfortable for me, but the rest of it?  The rest of it didn't register.  Out of sight, out of mind.  The big thing was healed, so the rest of it was done, too, yes?  That's how it works, no?

And then last week, my pants slid down while I was walking from one location at work to another.  Not all the way down, thank goodness.  But far enough down on my hips that they would have made their way to the floor if I hadn't grabbed them, adjusted them, and removed everything from my pockets.  It was like that time in New York, back in 2007, when I was walking to the subway station at 116th, wearing a skirt, and I felt my panties start to slip.  I clenched my knee and waddled into Barnard Hall (quite the feat navigating a flight of stairs with my knees so tightly squeezed together), ducking into the first women's restroom I came to, relaxing my knees, and watching satin pool at my feet.  Today, my smallest clothes are comfortably loose and rather quickly becoming uncomfortably oversized.  I can easily see parts of my body I haven't seen in years.

Suddenly, I'm thinking about the lawyer, R.  Seventeen years later, and I'm thinking about the first time I ever had sex.  How horrified I was then by the decision.  How I spoke to Tim about it the next day and he said, "Oh, you lost your virginity!" and I practically shouted at him, "I didn't LOSE it!  It's not like I woke up this morning wondering where it went, scrambling around and looking under furniture for it, hoping to find it alongside my missing panties!  I GAVE IT AWAY!"

Except, that's also not entirely accurate.  I treated it less like a gift to be given and more like a bomb or hot potato, throwing it at the lawyer from across his apartment while yelling, "Just take it already!"  It's strange - I feel so much ambivalence when I remember this.  I was so ashamed then and I feel shame now when it pops into my head - shame that it still, sometimes, pops into my head - and I think about what sex with him was like.  And, seventeen years later, I'm super proud of how I handled it - clear, forthright, explicit about my boundaries.  I just baldly told him what I wanted, what I didn't want, and exactly where the boundaries were.  And he respected all of that.  I'm frankly in awe of this reality nearly two decades later, because honestly, having my boundaries respected was so freaking novel.  I was in no way emotionally ready for sex - hot fucking mess.  But, by any objective measure of how to negotiate sexual encounters ...?  I did everything right.

The thing that's hardest, though, is knowing how wrong everything I believed then was.  The hardest thing is knowing that I had been lied to, and I kind of think I might have known it was all a lie, but I was willing to swallow the lie whole in order to have something - community, belonging, validation.  Except it wasn't belonging.  I didn't fit in that place or that community and I was never going to fit in that place or that community.  Who I am, in my fullness, was never going to be validated.

I did not know then - and I now feel like I should have known - that this was the beginning of my faith deconstruction.  It was a seminal decision that changed everything.  It was the moment when I began my journey to ex-vangelicalism.  Still, it took far too long.

Because he, P, told me he loved me, he wanted a life with me, that I was “the only woman who fits the mold" of what he was looking for in a wife, and then he fucked the model-thin conventionally attractive woman.  So, I fucked R, the lawyer - his college friend, his frat brother, the first one he introduced me to.  Because P introduced me to them all - his friends, his colleagues, his college buddies, his family.  "Oh, you're her," she said to me, pulling me into a giant hug - unimaginable for such a small woman - when he took me home to meet his mom.  "P's told me all about you!  Welcome!"  And it felt like a "welcome to the family" as much as welcoming me into her home.

I remember sitting at the bar the night P introduced me to R, sipping French Martinis and thinking life was going to be beautiful from this moment forward.  "What are you looking for in a man?" R asked me.

"I want someone who loves Jesus," I said.

"Definitely not me," R interjected.

"And someone who can keep up with me intellectually," I finished.

"That's where you're going to run into problems," P informed me.  I've been described by men before as "scary smart."  I never understood.

So many years later, I don't even remember when and I don't remember if it was from a book I read or in a sermon I heard, but some evangelical Christian pastor was sharing the tale of his wife (having recently given birth) eating a chocolate donut for breakfast one morning.  He related how he was devastated by this because if she ate donuts for breakfast, she'd never get her pre-baby body back, she'd never again be the hot wife he married, she'd be sexually repulsive to him, and he wanted to want his wife and it was her job to be hot in order to make that happen.  This was the prevailing message of the evangelical church.  "Women: be hot and men will want you, will marry you, will protect you, will provide for you, will love you.  Men: get yourself a hot wife and then make sure she stays that way so you won't be tempted to cheat." 

Twenty-six and fresh-faced and oh so cute, but I would never be beautiful (except P told me that I was).  I had been fat my entire adolescence and young adulthood.  I would never be thin, but I still starved myself - eating a few hundred calories a day - and took up running and fasted two days a week until I was only overweight: heavy, rubenesque you might say, but no longer super fat.  I was still a far cry from "hot wife" material.

Still, the evangelical church promised the fulfillment of every juvenile wet dream for the men and Disney princess fantasy for the women.  I was killing myself to be (thin) enough, to be worthy - of love, of belonging, of validation, of being called good.  But my life was turning out to be more akin to Hans Christian Andersen's version of The Little Mermaid - voiceless, walking on sharp blades, and in the end utterly shattered, moving through the world like a sylph.  P set aside all of the things he'd said to me, all of the promises he made, and had sex with the pretty girl.

Still, he told me it was nothing.  Still, he told me that he loved me.  Still, when I dreamt I was at his engagement party and called him five days later to congratulate him, he said, "I'm not engaged to her.  I don't ever want to marry her.  I still want to fix this and make things right with you.  I just need time to figure out how to end it with her."  Two days later, when she told him she was pregnant, he proposed to her.  He did marry her.  

P had his hot wife.  And I believed, because it's what the church had told me my whole life, that the whole thing was my fault, that what P did was not just understandable, it was acceptable because the single most important thing to a man is sex and a woman's primary, nay sole, job in a marriage is to be fuckable and I had failed.  Even at my thinnest, cutest, closest-to-pretty stage in life, I was still failing to be the right kind of woman - the kind of woman who was wanted.  The kind of woman a Christian man wanted to fuck - and would be willing to marry first.

It's been seventeen years.  I never saw P or R again.  In the course of time, I finished my master's degree and left New York permanently.  I haven't been back for so much as a vacation.  This is the first time in eight years I've even thought about P or R.

Forty-three-year-old me sees all of this very differently.  I know now that it was never about me and that the failings were NOT mine.  What I knew then but couldn't see until now is that P was repeating the exact same pattern he'd laid in his first marriage (albeit without children the first time around).

Still, hiking in the Chehalem Mountains a week ago, my twenty-six-year-old self just showed up out of the blue, turned to my spouse, and cried out, "Are you going to leave me!?"  I know that he would never dream of it.  Still, my younger self that lives in the space between my sinew and bones remembers what we lost the last time we weighed this little, and how much it hurt.

"What!?" he asked.

"Terrible things happen when I'm thinner," I told him.  I know this is magical thinking.  I know that this is magical thinking, but knowing it's magical thinking does not, in any way, make it less terrifying or lessen the anxiety.

Surprise and confusion clouded my spouse’s face.  "Of course not," he told me in earnest.  "I'm just glad you like me because otherwise I'd have to worry about all the hot young guys that are going to be hitting on you."  Funny.  And true.  And then I remember R, who is forever thirty-six in my mind.

"I do like you," I tell my spouse.  "And you're super lucky to have me," I tease.  He agrees whole-heartedly and remarks on my chef-ing skills.  "I'm extraordinary," I tell him, knowing that it's true.  "Beyond my abilities in the kitchen, I - who I am as a person - am extraordinary."

My spouse believes this.  More importantly, I believe it.

I grieve, deeply, that it took me forty-three years to figure it out.  I wonder how different things might have been if I had known at twenty-six how absolutely worthy I am and have always been.  It still hurts - the way P treated me, the lies and betrayal and broken promises.  While I know that it had nothing to do with me, I also know that I will never receive an apology from him.  Whatever his feelings concerning his choices, whatever regrets he may carry about how he treated me, I will never know.

I do know that I would not have been happy in the life that he so fleetingly offered me.  The life I have now is beyond anything I could have even imagined all those years ago.  I am thriving and I'm married to someone who loves, respects, and cherishes me quite as much as I love, respect, and cherish him.  I wish I could go back and tell twenty-six-year-old me what it's like - to be loved, respected, cherished, to truly belong.  

Because she has no idea and she believes that the half-life she wanted and was willing to settle for would be enough for her.  She believes that that life would make her enough.  I wish I could tell her - the fault, the problem, the sin does not reside in her.  I wish she could know how extraordinary and truly lovely she is - and that none of that has anything to do with the body in which she resides or who chooses to do life with her.

"You, my beloved," I would say, looking her in the eyes, "are so much more than enough."

Bread for the Journey

“What is this?” my spouse asks me, utterly horrified at what is unfolding before us on the screen.

“It’s The Hobbit,” I tell him. How does he not remember this. He queued it up on the streaming service when we were discussing what to watch and made the decision.

“That is NOT The Hobbit!” he declares with certainty.

“It’s Peter Jackson’s interpretation,” I explain patiently. “You know he takes liberties and is into gross overproduction.”

“This is not taking liberties and overproduction,” my spouse tells me. “He’s completely made it all up. You’ve read The Hobbit. Haven’t you?” he asks.

At this point in our marriage, I had not read The Hobbit. “I’ve started it a few times,” I tell him honestly, but I just couldn’t get into it. I’ve got my copy around here somewhere, I’ll give it another go.”

Ultimately, my spouse pulled out his copy and I read it the next weekend. “What the heck did we watch last weekend?” I asked my spouse as I finished the final page and closed the book.

“Right!?!?!?!?” he exclaimed.

“That movie bore NO RESEMBLANCE WHATSOEVER to the book. I mean, the book is 280 pages of Bilbo Baggins ignoring the promise of the journey he’s one while bemoaning the troubles of this journey while extoling comforts of his bed and a desire for bacon. Where was the bacon!?!?!?!?”

Last week found Moses standing on a mountain, observing the prints of their journey as they moved toward promised land with the knowledge he would never enter it. Terry did a wonderful job sharing with us the need to look back from whence we’ve come and continue moving forward, even if we never see the fruit of the seeds we’ve planted. This week, we find the same group of Israelites, led by the same Moses, looking a little too far back, bemoaning the difficulties of their current situation and extoling the virtues of the only home they’ve ever known – a place of brutality and oppression. The Israelites are calling for a return to their lives as enslaved people in the land of Egypt, forced to build cities, work in the fields beaten by their oppressors, and their sons killed at birth. Somehow, in this moment, the promise of the future in a land flowing with milk and honey seems less appealing than oppression of the past where at “we sat by the fleshpots and ate our fill of bread.”

Forgotten is so quickly is God’s safety and protection – bringing about ten plagues: turning the Nile to blood, frogs, flies, diseased livestock, boils, thunder and hail, locusts, darkness, and the death of every first born Egyptian. The Israelites saved from each plague. They fled into the desert, Moses raised his staff at the edge of the Red Sea, parted the waters, and they crossed on dry land; the pursuing Egyptian army drowning in their wake. In the desert, the bitter waters of Mara were purified and turned sweet to slake their thirst. Now…. Well, now they are hungry. And once again, they complain against Moses. And once again, God meets all their needs – exactly they need it. Just enough bread for today.

What do we do when we see more need than resources? When we feel needs greater than we can meet? Part of preaching is about making a several thousand-year-old text relevant to our world today. But how do we do that while remaining faithful to the history of the text and the culture in which it was produced? It’s a hard task and I don’t believe the answer is in claiming that there are perfect parallels between the Israelites’ flight to freedom and our experiences of oppression today. I don’t believe that the specific promises given to a particular people in a particular place at a particular time can be universalized to my person circumstances today.

Wonderful and terrible things happen to people every day. Wonderful things sometimes happen to terrible people. And terrible things sometimes happen to good people. I cannot stand before you and pretend otherwise. Nor am I so presumptuous as to believe that I can making meaning out of anyone’s experiences and claim “God has a purpose for this!” And so I’m left instead to wonder about the Israelites, wandering in the desert, thirsty, hungry, and longing for the familiar even if it means giving up the chance at something unimaginably better. And I think about the nature of the divine – and how the Israelites have been delivered out of oppression and slavery; how they have been promised a land of their own, flowing with milk and honey; how they’ve been spared plagues and death; how they’ve been given water to drink; how they’ve been led to an oasis for rest.

And I wonder – is God so capricious as to meet the Israelites needs only because they complain so loudly? Is that truly the God they worshipped? Is that truly the God of our faith today?

And I can’t help but think … that’s not my God, nor is it any kind of God I want in my life.

So, I look instead at my own life. There have certainly been times when I have cried out for deliverance. There have been times when I have wandered through a barren wilderness of my own. There have been times when the tenuous hope for an uncertain future feels too painful and I find myself longing for the comfort of a known, if awful, past. Then, I think about the shift that happened, about thirteen years ago, that changed everything.

It was November and on social media, folks were doing “30 Days of Gratitude.” Each day, they would name three things for which they were grateful. I joined in and when November came to an end, I decided to carry on, with intention, for an entire year. Every day for one year, I listed three things for which I was grateful. It wasn’t always easy and there occasion repeats from day to day. And at the end of a year, I quietly stopped publicly naming three things for which I am grateful every day.

But in that year, something happened to my brain. My intentional shift in focus seemed to train my brain to unconsciously shift my focus. Suddenly, I felt more resilient. I was able to face failures, stand up, dust myself off, and move ahead. I was able to more objectively view my past, identify patterns, and make changes. I felt stronger, more autonomous, and in control of my life in ways that defied logic. Despite the, not insignificant, challenges in my life, I knew deep inside that ultimately I would be okay – even if I didn’t know, in that moment, what okay looked like or how I’d get there. In choosing to be grateful for all I do have, the actual or perceived lack in my life somehow became less significant.

Now, I am well aware that correlation does not prove causation. Little in life is a straightforward cause and effect. But almost nine years after my gratitude practice began, my spouse received an email from a job recruiter, inquiring as to his interest in a job in the Portland metro area. Three weeks later, he had a job offer, resigned his then-current position, and five weeks after that began working remote. At that point, we had five weeks to buy a house, sell a house, pack our lives and our cats into boxes, moving trucks, and our car, quit my job, find a new job, and move everything to Oregon. Ten weeks between learning we were moving and the day we arrived.

I had a lovely and robust community in Minnesota. I miss folks daily. It was hard to say good-bye. You know what I don’t miss? The oppressive heat and humidity that sometimes starts in March (95 degree days) and ends in October. The oppressive cold and snow that starts in October and ends in May (multiple feet of snow that don’t completely melt before the next storm piles more on – months on end of frozen tundra, seeking to navigate a small car around corners and over snow berms on the side streets that are only plowed when at least 8” of snow has fallen). Do you know, I still sometimes wake up on hot nights in August from nightmares about the winter of 2018 – 30” of snow fell in the month of February and then in mid-April, the night before my birthday, another 14” fell overnight.

I wake up from these nightmares, heart racing, dread filling me, terror at the thought of another winter – and then I remember: I am in Oregon. I take a deep breath and relax knowing that I will not have to endure that kind of winter again. And even while living in Minnesota’s brutally cold and snowy winters and her unbearably hot and humid summers, I chose to be grateful every day. I had a home that was safe, a spouse who cherishes me, a community that encouraged me, a job that fulfilled me. All of these realities were carried forward to Oregon – a land flowing with milk and honey.

And I wonder – if we shift our focus from a fear of scarcity and obsessing about what we lack to a trust in abundance and gratitude for all that we have – might we also find that we have enough for today? Might we trust that the God who has carried us safe thus far is the same God who will provide us enough bread for the journey – and maybe a bit more? And when we believe that there is enough, might we also gather around the table and share, with each other, the good news that God’s abundant love is always more than we can hope for or imagine?

Advocating … Belatedly

 To whom it may concern:

I apologize in advance for the extremely long email you've received.  The information contained herein is, in my view, essential for a full and robust understanding of the issue I am bringing to your attention today.

I am newer to the Portland Metro area.  My spouse and I moved here in October 2022 for his work.  Initially, we had our care through Kaiser Permanente.  Owing to job change, our health insurance coverage changed on November 1, 2023.  In the process, I needed to establish a new primary care relationship and Tuality is in-network.  I made an appointment for the earliest possible time, which was Tuesday, November 28 at 2:40PM at Tuality Internal Medicine - 368 SE 8th Ave, Suite 301, Hillsboro, OR.  My appointment was with C.O., PA.  C asked me to address him as C and I will refer to him as such throughout this email out of respect for his stated presence in address.

Most recently, my spouse and I were living in St. Paul, Minnesota.  I had healthcare providers of all manner of degree - medical doctors, physician's assistances, nurse practitioners, and medical residents.  I was always treated with care, dignity, and respect.  At every single visit, I felt listened to, heard, acknowledged, and as though my provider was working with me to develop a plan of care that would move me forward in my healthcare goals and were manageable for me personally.  My experiences with C were none of these things.

My primary concerns in getting established with a provider right away were related to medication management of two health issues: PTSD for which I take a low dose SNRI and Hypertension for which I take a low dose calcium blocker.  My most recent prescription had expired and I wanted to new scripts before I ran out of medication at home.  C was asked the relevant questions regarding my history with the medication, side effects, and changes in efficacy.  He then wrote me new scripts and sent them to the pharmacy of my choice.  He performed routine checks (capillary refill, heart and lung sounds, etc.).  C then asked me if there was anything I'd like to discuss.

"Yes," I replied.  "I would like a referral to see a bariatric specialist."

"For weight loss surgery?" C asked.

"I'm open to the possibility of surgery, but my goal is not lose weight.  I enjoy being active and following a soft tissue injury this summer, I've not been able to be active the way I like.  My concern is longevity and quality of life - to have more vitality and be able to move my body in the ways that I enjoy.  I know that weight loss will likely be an important means to achieving that goal, but it is not the goal itself."

"What else have you done to try to lose weight?" C asked me.

I then explained to him that I have a long history of weight-cycling.  Some efforts have been less healthy than others, dating back to 2005 when I lived in New York.  At that point I weighed approximately 365 lbs.  This is my best guess based on body composition as home bathroom scales at that time topped out at 350 lbs and I 'errored' out the scale.  I began to severely restrict my caloric intake.  When I lost enough weight to move more comfortably, I took up running.  I was eating a few hundred calories a day, most days of the week, and fasting 1-2 days per week.  Eventually,  I weighed in at 208 lbs and was officially "overweight" (rather than "obese") for the first time in my entire adult life.  Perhaps unsurprisingly, this was not sustainable and I rebounded to 320 lbs.  I weight cycled another three times in the next eleven years.  By 2016, I came to a full understanding of the ways in which my weight cycling were neither helpful nor healthy and I gave up caring.  My weight remained at 320 lbs and I have never been much heavier than that.  I have never rebounded to, let alone beyond, my starting weight.  I bought a bicyle in 2017 and found that I absolutely LOVE cycling.

During this same time, I began working with an extraordinary trauma therapist.  My goals in life changed (from being thin and pretty to being healthy) and I began to thrive in other ways.

In early 2020, I was able to take a Mindful Eating course and began working with a dietitian (up to the limit my plan allowed which was 3 sessions owing to my lack of co-morbid conditions).  With my dietitian, we determined my resting metabolic rate (RMR) [2,800 calories/day] using the BodyGem, which calculates RMR based on oxygen consumption and energy expenditure.   For Valentine's Day, I purchased an indoor bicycle stand so that I could continue to ride comfortably during the brutally cold and snowy Minnesota winters.  By early May, I was riding 23 miles outdoor with ease.  An accident in late May (in which I sustained tears to my rotator cuff and labrum) was not able to keep me off of my bicylce for long.  My spouse and I were bicycling 20+ miles every weekend and I was bicycling 14-23 miles 2-3 days a week as I commuted to and from work.  By October, I had lost 80 lbs.  I was now down to 240 lbs.  I was also having other concerning side effects.  My hair was falling out by the fistful, I was sustaining pressure injuries on my elbows from resting them on a table, and I had significant hormonal changes.

By the time winter arrived in 2020, I left the acute care setting where I had been working in favor of home-based hospice work.  With the the necessity of driving, the change in weather, the shortening days, I could no longer ride my bike as avidly.  I set up the bike trainer in my basement again and I could not force myself to ride inside again.  My spouse and I continued to take walks regularly in spite of the cold and snow; I was fortunate to be able to walk 10,000+ steps per day in the climate controlled Mall of America 2-3 days a week.  Still, my weight rebounded to 320 lbs.

Our move to the Pacific Northwest has been an extraodinary opportunity in terms of year-round outdoor activities.  My spouse and I hike regularly.  We bicycle in fair weather.  We started slowly and worked our way up.  By the end of summer 2023, we were hiking 6-8 miles 1-2 times a week and bicycling 45 miles every other weekend.  My weight remained stable.  I developed plantar fasciitis.  I could not hike for two months.  Bicycling was gentler on my foot, but still extremely painful at times.  We made every effort to continue getting as much movement as possible.

To be clear, I didn't give C this much information.  I explained my history of weight-cycling, in brief; my work with a therapist; my work with a dietitian; my Mindful Eating course; my activity level; and I shared with him what my diet consists of.  My spouse and I eat scrambled eggs with a small amount of lean ham and cheddar cheese (2 eggs for him, 1 egg for me) or scrambled eggs with home-smoked salmon and chevre, and a small tangerine, for breakfast.  I eat greek yogurt, fresh fruit, and a little granola for a mid-morning snack.  I eat a couple ounces of arugula and a well drained can of sardines for lunch.  In the afternoon, I might eat some hummus and tortilla chips for a snack.  Dinner frequently consists of a 3x3" square of homemade lasagne (including homemade sauce) and a big salad using 2 tablespoons of homemade Caesar dressing (no croutons) or 5 ounces of lean meat (skinless chicken thighs, pork loin, or white fish) and a large serving of vegetables.  I would have a serving of dessert (a homemade cookie or a scoop of ice cream) 4-6 days a week.  I routinely weigh my portions and I began to track my caloric intake again in early November.

C's response to me was, "If nothing else worked for you, I don't see why you think surgery will work.  I'd like to try you on a new medication instead."

I expressed my hesitations about medication.  I asked if I would have to remain on medication for life to continue reaping the benefits.  C answered, "There is no reason you shouldn't be able to go off of medication after you've reached your goals so long as you make the necessary lifestyle changes."

When I asked what changes C felt were necessary, he said, "You need to maintain a healthy diet and exercise."

I explained, again, to C what my diet and exercise regimen look like and he said, "You're doing everything right."

When I explained to C the history of hair loss and pressure ulcers, he said, "You probably just need to drink more water."

"I drink between 128 and 164 ounces of water a day.  I'm not clear how much more water I can consume."

C responded, "You're doing everything right with your water intake."

To be clear, I rarely eat out.  I do not eat fast food.  I do not drink soda or other sugar sweetened beverages, though I do like plain seltzer on ocassion.  I consume less than one standard alcoholic drink per week.

Against my stated preferences and with much cajoling from C, I agreed to try the medication.

The impact of the medication has been significant.  As an appetite suppressant, it's very effective.  I now eat less than half of my breakfast.  Most days, I will take the remainder of my breakfast and one corn tortilla for lunch.  Dinner consists of 2 ounces of lean meat and a half a serving of vegetables or a half piece of lasagne and  a salad.  I didn't have a bowel movement the entire first week I was on the medication - and I consider a daily bowel movement an essential factor to quality of life.  I'm now supplementing with 30-40 grams of psyllium husk daily to produce one bowel movement a day.  My average daily caloric intake is now between 900-1,100 calories - of which 120-160 calories are from the psyllium fiber.  I am neither a dietitian nor a food scientist, but it seems many people do not count carbohydrates or calories from fiber and using that measure, my daily caloric intake is closer to 800-950.  

I am exhausted.  I am experiencing nausea all of the time.  I have less energy, less stamina, and less motivation to move my body at all.  I burp dozens of times after every single meal.  Much of the time, I regurgitate food/fluids when I burp.  When I raised these concerns with C at my follow-up appointment on Wednesday, December 27, his response to me was, "Have you lost weight?"

"Well, yes.  I've lost approximately 12 lbs," I told him.

"Excellent.  Then the medication is working," he told me.

"Again," I explained to him, "losing weight is not my goal.  I want to more energy and vitality."

"Do you weigh yourself regularly?" C asked me.

"Yes.  I weigh myself almost daily," I answered.

"And what was your starting weight and what do you weigh now?" C asked me.

"My starting weight in clinic was, if remember correctly, 324 (caveat - I remembered incorrectly; per records, my starting weight in clinic was 322).  That was afternoon and I was fully clothed.  At home, I weigh myself in the morning after voiding my bladder and while naked.  In that context, my starting weight was 318 and my current weight is now 300 or 301."

"Excellent.  So the medication is working.  I'd like to increase your dose.  Don't worry about the side effects.  I'll prescribe Zofran for the nausea and if that doesn't work, let me know.  It might not necessarily be related to the medication and if the Zofran doesn't work, we should rule out other causes.  Also, have you tried eating smaller meals more often?  What do your meals look like?"

I looked up my food log.

"I eat about half an egg, a quarter ounce of lean ham, and a quarter ounce of cheese for breakfast at 6:00am.  I eat the other half of my egg, ham, and cheese on a corn tortilla around noon.  Recently, because of the holiday, our dinners have been a bit richer.  I had 2 ounces of a prime rib and four Brussels sprouts for dinner last night."

"Okay, so you're eating small portions.  That's perfect.  Keep doing what you're doing.  I'll write that prescription for the dosage increase.  Make an appointment in three months to check back in."

C also ordered labs, as appropriate, and the orders appeared in MyChart.  It was in this context that I learned that there were multiple errors entered into my medical chart.

When I had my last Fasting Glucose Test, it was 2017.  Because of a slight elevation, my physician ordered an HbA1c, noting that the high fasting glucose result could be indicative of pre-diabetes OR a result of stress.  My HbA1c came back at 5.6.  While this is just under the line for pre-diabetes, it was within the normal range.  I was NOT pre-diabetic when I last had my fasting glucose checked more than six years ago.

Though I had regular annual exams between 2017 and 2022, this was not rechecked as no other health marker indicated it needed to be completed more frequently.  In 2022, having just moved to the Portland Metro area, the physician resident I saw at Kaiser-Permanente when establishing care ordered an HbA1C.  The result was 6.0.  I began to prioritize movement and changed some of my eating habits (more fish for lunch vs leftovers) and I attended a "Managing Pre-Diabetes" health seminar.  I began to prioritize movement in my work day (routinely adding long walks on my lunch and eating my lunch while driving between locations) and, as noted above, my spouse and I were able to be more active outdoors over the winter than when we lived in the Midwest.  In May 2023, I asked my physician to re-check my HbA1c.  The result was 5.9.  Still pre-diabetic, but trending down.

In my chart, C added two new diagnoses:  Diabetes Mellitus Type 2 and Impaired Fasting Glucose.  When I asked him how he came to the determination that I had both an impaired fasting glucose and T2DM, seeing as he never ordered a fasting plasma glucose test and my two most recent HbA1c levels were nowhere near diabetic ranges and trending down, he did note that he'd made a mistake and updated my records to indicate Pre-Diabetes.  I also asked several questions related to my diet and exercise regimen.

In each of my visits with C to date, he has stated that so long as I make "the necessary lifestyle changes," I should be able to stop taking the new medication and maintain my weight loss.  When I again shared with C what my diet and exercise includes and asked what lifestyle changes he believes are necessary in my efforts to achieve my goals of greater vitality, quality of life, and longevity, C noted "I usually recommend healthy diet and increase in physical activity."  I quite literally cannot conceive of any way I can improve my diet in healthy and sustainable ways beyond what I am already doing.  I quite literally cannot conceive of having time in life to do anything apart from working full time and working out if I'm going to reasonably get more exercise than I was getting prior to my injury.  He then offered to refer me to a dietitian to develop a plan for maintenance of caloric balance, noting that this is not his area of expertise.

I am frustrated.  I am angry.  More than angry, I am livid with the way I've been treated.  I am deeply disturbed by the experiences I have had with C.  C focused on his goal of decreasing my weight while ignoring my goal of increased vitality, manageable activity, and longevity.  When I noted the profound extent to which the medication he prescribed is impacting my ability to engage in exercise and the nausea, regurgitation, weakness, lightheadedness with exercise, and exhaustion, he declared that were "nothing severe" and stated his intention to increase my dose.  The extent to which these are impacting my quality of life is something I experience as quite severe and at direct odds with my health goals of more physical activity - in the safest possible way.  The fact that I have lost weight was the clearest proof that the medication was working to achieve C's goals for my health - which frankly seems to be a matter of making me a less-fat fat person.

My goals have been ignored, brushed aside, or dismissed.  I have been humiliated and degraded.  I have been told to "make lifestyle changes" and when I explain what my lifestyle entails, I've been told that I'm doing the right things.  When I have then pointed out that this has not been successful and I am concerned that the medication being prescribed would only work if I remained on it for the rest of my life (which could be several decades), I was told, "You shouldn't experience a weight rebound so long as you make the necessary lifestyle changes."  When I then follow-up and once again explain exactly what my lifestyle entails and ask specifically what changes to make, I'm told, "healthy diet and increase in physical exercise."  This circular conversation is absolutely mind-bobbling and infuriating.

I do not know what the root of this communication barrier is - and I have a number of theories that range from frank and explicit anti-fat bias, to a broken medical system that allots fifteen minutes for face-to-face medical appointments, to working in a system that treats individual human beings as population-level trends while plugging their data into a statistical model and prescribing a one-size-fits-all plan of care that delivers anything but actual care.  What I do know is that regardless of the root cause, how C presents himself to and treated me as a patient is completely unacceptable and I very sincerely hope that he's provided appropriate feedback and coaching so he does not treat any other patient with such callous disregard in the future.

Thank you so much for your time.

Sincerely,

Me