The Challenges of Treating ADHD as a Prescriber

I receive around two or three calls weekly for evaluation of ADHD in children and adults. Generally people have done some sort of questionnaire online and self diagnosed after answering six general questions. Or they have been receiving stimulants from their pediatrician, PCP, or other psychiatrist or APRN who is now requesting they transition care to psychiatry for whatever reason. They could have been on stimulants for years, having only completed a basic questionnaire at the time of the first prescription.

Diagnosing ADHD is hard. There are a lot of false positives because our brains and bodies are not supposed to sit for eight hours a day listening to lectures or working on a computer. So kids in high school and college who find lectures challenging often come to me stating they can’t pay attention to a three hour lecture. I’m thinking yeah but who can?

Depression is pretty straightforward. For a true severe depressive episode there is weight loss/gain, poor ability to function in daily life (decrease in showering, poorly groomed, missing work etc.), sleep increase or decrease, irritability…the list goes on. I’ve sat with enough depressed people on the spectrum from mild to severe with psychotic features that it in general fits a picture and there is overt evidence of impairment in functioning of the individual.

ADHD, especially in adults, is more subjective. Sometimes it takes a few sessions for me to see the full disorganization of their thought process. These are people who could be getting a 3.5 GPA telling me they can’t focus and can’t organize themselves. It’s hard for me to believe that when they are doing well academically. There’s also a lot to rule out. Anxiety disorders often present with difficulty focusing as do depressive disorders. Bipolar disorder has a high co-morbidity with ADHD and many times when bipolar patients are treated with mood stabilizers their focus improves. Trauma/abuse in children presents often as behavioral difficulties and difficulty focusing. I can’t tell you the number of kids I’ve assessed who have been diagnosed with ADHD but no one asked them about being sexually assaulted and how that is on their mind all the time making it impossible to focus.

I have adults who come to see me who are working two or three jobs, raising kids, getting maybe four hours of sleep per night telling me they have trouble concentrating and completing tasks. Chronic sleep deprivation can cause cognitive impairments. In other words without enough sleep you can’t think straight. Taking a stimulant would enhance anyone who is chronically tired. Taking a stimulant honestly would enhance anyone in general too.

What I look for in an assessment is thorough testing of some sort. Neuropsychiatric evaluation, or at the most basic a Conners Behavioral Rating Scale. Anything beyond a Vanderbilt really. Then I need to figure out how functioning is impaired. It needs to be impaired for me to offer medication. In the midst of all of this I have to assess for those who are drug seeking: those who would potentially sell their medications to others, and any other co-morbid substance abuse issues.

Then if I get through all of that and decide this person could benefit from some sort of medication for ADHD I have to warn about all the adverse effects. Because they exist. For real. I’ve seen stimulants make kids psychotic (visual hallucinations), more angry, irritable, lose weight due to decrease in appetite, stunt growth (yes I measure height and weight at every visit and rarely kids have needed Growth Hormone injections), and yes I’ve seen people who are addicted to stimulants. It’s a real thing.

Then we have to pick the stimulant to trial. There’s a bunch. I point blank don’t prescribe Adderall- it has a high, then a crash, and a wicked withdrawal, it also had a major street value and is the “most addicting”. Yet Adderall is the cheapest and the one all insurance companies want me to prescribe first. So for every stimulant prescription I write that’s a new prescription, new medication, I have to do a prior authorization. It’s a pain in the ass.

This is a side note. Adderall is supposedly the “cheapest” available. But Ritalin has been out on the market since 1952. So I’m confused as to why it is still wicked expensive. It’s generic now, yet pharmaceutical companies keep the price of stimulants jacked up. Read ADHD Nation. It’s a good book.

So, I do a thorough assessment, I provide drug education for my patient and/or their parents, I potentially send a urine toxicology screen, I fight the insurance company to cover the stimulant I feel is safest to prescribe. I call the pharmacy and the patient to tell them they can now pick up the stimulant. They try it. We do a follow-up. They don’t like it. “I just don’t feel like me.” “It makes me too tired.” “I have no appetite.” “It makes me angry.” “It makes me cloudy.” “My friends notice something’s not right.” The list goes on.

Round 2. We try another one. I have to do another prior authorization. I have to do more education. If it’s a college kid I have to make sure they get the old stimulant out of their dorm room and off the college campus to a place that destroys old medication.

Potential success with second medication trial. Or we go onto the third.

In my experience it can take 1-3 tries to find the right ADHD medication. I do prescribe non-stimulants as well.

We find the right medication. Then we have to taper to the right dose. Then it’s only lasting 6 hours they want it to last 8 or 10 or 16.

Then we have to have the discussion- my goals are to medicate someone to last a school day. My goal is not to have a person’s brain on a stimulant for sixteen hours a day. That’s not healthy. Then we may have to have the discussion of why they are running out of their medication early- because they are doubling their dose, or taking an added afternoon or evening dose to get through work or night classes. Then we have to revisit goals of treatment, misuse of medication….it goes on.

I don’t want people to think I don’t love treating ADHD. Because I do. When a thirteen or fourteen year old comes to me and is suffering and being made fun of at school and says the one thing they want to fix with medication “is to give me friends” well that just about breaks me and when I see them respond to ADHD medication and therapy and a year or two down the line they are functioning beautiful teenagers with friends and a social life and good grades, well that’s just about the best feeling in the world.

I’ve been in outpatient practice now for three and a half years. Some of the patient’s have been with me since day one. I started treating them as gangly and awkward thirteen year olds and they are now applying for college and asking me advice about sex and if they can smoke pot with their medications. It’s frightening watching these babies turn into men and women but it’s also amazing forging relationships with them and being a safe space for them to ask any question about anything. It’s also heart-melting to see them now have friends when a few years ago they felt like the most lonely kid in the world.

Those are my success stories and those are the reasons I still treat clients with ADHD. But there have been a lot of problems along the way too. I’ve seen clients who became irate and verbally aggressive because I wouldn’t prescribe them stimulants, specifically their Adderall. I now screen clients over the phone for intakes and am clear that I don’t prescribe that particular medication to weed out those issues.

Prescribing psychiatric medication is hard. Diagnosing psychiatric illness is hard. I take that responsibility very seriously and I try and be exceptionally thorough. Because for those suffering with ADHD I do want to help. But it can be exhausting and it is one of the few fields where patients come often thinking they know more than their healthcare provider about their diagnosis and course of treatment because of the tests they’ve taken online and subsequent research (many pharmaceutical companies are tricky and link ADHD questionnaires with websites about stimulants- you have a problem? Here’s the answer!).

For those truly suffering from ADHD I’m not trying to invalidate your experience. Because like I said, there are clients I treat with true ADHD who improve with therapy and medication and allowing me to be part of their journey is an honor. But to everyone else, you may not have ADHD- don’t jump to conclusions and please ask for a thorough evaluation before agreeing to the diagnosis. Also note that behavioral and cognitive therapy does help ADHD in addition to medication. Naturopath doctors also are around who treat ADHD if you are looking for an alternative approach.

Read legitimate sources and articles. ADHD Nation is great, the American Journal of Psychiatry has excellent articles about ADHD. Don’t depend on WebMD and pharmaceutical company websites. Be truly informed and don’t get mad when your healthcare provider recommends a thorough evaluation before jumping to a stimulant. Instead be thankful.



“You mean the sperm donor?” “Yes the biological dad.”

I am going to preface this blog post with the statement that I love my pediatrician group. They are very smart and very professional and I’ve met all of the doctors in the large group practice over the past two years. Twin boys in daycare catch just about everything and then we also have the physicals. We spend a lot of time at our pediatrician’s office. A lot.

At their two year physical we were asked for health history (and not for the first time) we were asked for information about their “biological dad” also stated as “bio father” throughout the dialogue. The first time it was asked my wife and I both kind of stopped and stared and then the dialogue went something like this….

I said, “You mean the sperm donor?”

“Yes, the bio father.”

“You mean the sperm donor?”

“Yes their biological dad.”

“You mean the sperm donor?”

“Yes, do you know any of the history of their biological father?”

“You mean the sperm donor?”

This all was said in less than thirty seconds. Then I said we don’t know much and we all moved on. I think by now you can see where I’m going with this.

Something about the term Dad or Father being placed into my children’s vocabulary when it really has no place there at all pissed me off. It also made me feel vulnerable and protective. Was this person messing with me? Were they being deliberately obtuse or worse deliberately hurtful? Or were they, as I suspect and my wife concurs, just not educated on caring for a two mom family?

My sons are two. They don’t know yet what a dad is. But at some point they will. I don’t want the anonymous sperm donor placed as a father figure in their lives. Because he’s not. We don’t know anything about him except his height, eye color, and age at the time that he donated the sperm. The boys have the option of contacting him when they turn eighteen. And that will be their choice. But I hope at that time it is not out of some longing for a father they never had.

When caring for a two-mom or two-dad or whatever kind of family is presenting in a healthcare provider’s office it would be polite if you ask how they refer to one another. Because there are some two-mom families who do know their sperm donor and do refer to him as the “biological Dad” or whatever. But that’s not my family.

Wherever we take the boys for healthcare we are going to face these vocabulary issues. We are going to have to answer potentially rude (intentionally or unintentionally) questions and we are going to have to do this all in front of our sons. We have to model behavior and vocabulary for them. Because I can’t freak out on every health care provider or secretary who makes assumptions. But I don’t want to sit back and not address the issue.

After that exchange in the pediatrician’s office I thought about my response. I was caught off guard, even though it’s happened there before, so I needed to think of my response next time. I need to overtly say, “We don’t refer to him as the dad or father, the sperm donor is our preferred term. Thanks.” Set the boundary in the moment instead of engaging in this back and forth with some one who thinks sperm donor is synonymous with biological dad. It’s not.

I also contacted their office and gave the feedback that perhaps with diverse families they could ask about preferred names and terms.

Entering a healthcare provider’s office is scary and vulnerable for any one. Add in that we are a minority with our young sons with our own narrative and it makes me instantly defensive mostly because I want my son’s protected and I want the people caring for them not to care for them differently because they have two mom’s.

Dad is a protected term to me. It depicts an individual who has a vested interest in a child’s development. I have a Dad. I know what it’s like. He was and is a good Dad. The boy’s don’t have a dad. They have a sperm donor. They also have two Mom’s. If I donated my eggs and never met the resulting child I would not expect to be referred to as the Mom. I would be the egg donor. The child would hopefully have either a Mom or Dad or two of each. But I would not have a vested interest in that egg’s development into a child, therefore would not presume to be named a parent.

The moral here is if you work in healthcare and care for diverse families, just ask how they want their roles to be referred to or defined as. It makes life for us much easier.


When therapists “don’t want to get involved”.

I’ve seen enough LGBT youth now in my private practice to unfortunately have heard many times, “Yeah my last therapist just didn’t want to get involved.”

Here’s the story.

I see people for therapy and/or medication management. When I see clients for medication management I still do a thorough assessment. I ask all the tough questions and find out why someone is really depressed or anxious or whatever. I poke and pry because I don’t want to prescribe medication if there is actually a deeper issue that just won’t respond to medication.

Case in point- every LGBT youth whose family is not accepting of their sexuality. That would make me depressed too. And anxious. Because they fear that if they are “out” their parents will kick them out, stop supporting them financially, but most of all they fear their parents will stop loving them.

I tell my patients that no amount of medication I prescribe will take that fear away. Then I ask how we can address this issue with their family. They usually look at me through tears and tell me no previous therapist wanted to insert themselves into this issue in the family.

For a little bit I started questioning if I was doing the right thing. But then I saw their relief, and I’ve met with parents and processed their fears and feelings around their children’s sexuality. I’ve never met with parents without extensive processing with the kids first, and I’ve never done it in a way that would out my client if they do not want me to do that. I am extremely respectful of their boundaries and where they are at in their own journeys.

But I can’t ignore the elephant in the room. I can’t continue to increase an anti-depressant dosage knowing the depression comes from feeling rejected and not address that in some way.

As a therapist and as a nurse I feel it is my duty to provide support not only to my client but to the family system. And my teens and young adults are grateful to have someone speak up for them and be heard in ways by their parents that maybe as “the kid” they cannot be. It’s a fine dance to be sure though. Balancing where my client is at and where their family is at and what each needs from the other in the moment.

Therapists are in a position to be incredible advocates for LGBT youths. Why would we not seize the opportunity? And if you are not comfortable for whatever reason to do the family work then refer them to someone who is.

Many clients come to me feeling stuck. The best part of the work is helping to unstick them from the fear and secrecy and move their whole family forward into the light.

It’s incredibly difficult and requires good supervision as a clinician and continuing education specific to the LGBT community. But it’s doable and as difficult as it is it’s the most rewarding aspect of my work. Too many LGBT youth face high rates of depression and higher rates of suicide to ignore this issue and to not insert ourselves.





I’ve counseled people through grief. Acutely and in the moment when I worked in the emergency department. Then working in psychiatry I treat it sometimes years later. It is remarkable to me how many people have not properly grieved. But now that I am going through it I understand why. Grief sucks.

Acutely in some cases death is a “blessing” or a “relief”. In other cases it is a tragedy.

As I face my Nana’s death…even writing those words being tears to my eyes…I reflect on all the times in my life that I have truly grieved. They are, thankfully, few and far between. They include the deaths of my Grandpa, other Grandma, and the death of my cat. The other time I truly and deeply grieved was during my year of fertility treatments.

I’m not a crier. It takes a lot to get me to that point (at least it did before pregnancy hormones, now it only takes anything having to do with children). Previous to pregnancy though I truly and deeply cried when my Grandpa passed, when my Grandma passed, and when my cat died.

My cat adopted my family when my mom was pregnant with me. He ran inside on a rainy Halloween night. I was born the following January. Cookie was black and white and quite possibly the smartest and most loving cat to exist. We put him to sleep when I was a month shy of 18. He was three when he adopted us. I grew up with him sleeping in my bed every night. He went outdoors and would follow me to neighbor’s houses and wait for me and escort me home. He sat with me as I cried when I was bullied daily in fifth grade. Some days he was the only reason I survived. He was big, and his fur was coarse, and he had a big sturdy head that loved to be scratched.

He was my best friend.

I remember knowing something was wrong with him. My mom brought him home from the vet that December day and I knew it would be my last afternoon with him. I held him as our vet injected him and he took his final breath. We ended his suffering. He let out a final meow with his last breath, and I shook as my body was wracked with sobs. That was ten years after my Grandpa passed, and seven after my Dad’s mom.

I remember seeing a therapist in college and he asked me when I truly cried. I told him about those three deaths, and he specifically asked me to describe the death of Cookie. I did. I looked up and he had tears streaming down his face. Like my Nana said, I do things big or not at all. That was my first time in therapy and I made my therapist cry.

Grief is so hard because it is elusive. I think I am fine with something, and then I light a fire and think my Nana would have liked this and it hits me like a ton of bricks. I think I’ve laid Cookie to rest and then I look at my two current cats, Rajha and Maddy, and it tears me up to think of living without them. Rajha also is obsessed with me, and I’ve always thought she is Cookie reincarnated.

For women in my practice the most common unresolved grief I see is due to miscarriages or infertility issues. I remember receiving the phone calls from my fertility doctor’s office after our pregnancy tests and it feeling like a punch in the gut when they would tell me it was negative. Then I would just carry on with my day. No time to grieve.

Grief is realizing I will never hear my Nana’s laugh again. Grief was my deep pain in thinking I might never be a Mom. Grief was holding my best furry friend so he would enter death knowing he was loved and that I would never abandon him. I had to give him at least a fraction of the comfort he provided me over the years.

Grief at the core is a sadness and a heaviness that almost defies description. It hits me in the pit of my stomach. I’ve had to sit with clients as they process grief. It’s an ugly process to bear witness to, but it is powerful to be trusted that much by others.

The best part about grief is that it passes. If you can sit with it, tolerate it, feel it, and let it go, then it will pass. But it sure does fucking hurt.

Death always puts life into sharp perspective. It serves as a reminder that our existence is fleeting. That we too will leave our loved ones one day and they will grieve us.

Grief reminds us to enjoy our lives and to love to live.



Coming out to Nana: “But I thought you were going to marry a doctor?”

My Nana was 81 when I told her I was dating a girl.

My Nana and I go way back. Obviously. She met me the day I was born. She lived close by when I was growing up. She came to my soccer games, she brought me to the aquarium (a lot) in our state, she brought me to a casino…thinking back on that I’m kinda like wow my Nana brought me to a casino….that’s weird. She loved the beach, and we spent a lot of time there also. She hosted Thanksgiving and Christmas when I was much younger, and my memories in her home are warm and comforting.

When I was in high school and I had my license I would drive to see her at least once a week, and I even made her dinner once a week for my entire senior year. We spent New Years Eve at her house with my cousins every year, and we vacationed together in New Hampshire every Summer. She was a major influence on my life.

She and I had fun together, but we also could just chill and watch movies together. We also could fight. We were both stubborn. When she started using her walker I remember I wouldn’t bring her to the movies unless she brought the walker, and she was pissed. But she brought it, and afterward she thanked me for making her bring it.

Watching her age and go from being so active to not, has been very difficult for me. Losing the relationship we had has also been hard. Because I’m not just losing my Nana; I’m losing a friend.

The older she got the less politically correct she became. Meaning she asked me regularly if I combed my hair (it’s very curly) and when I said no, just in the shower, she would kind of make a face like it was wrong to not comb my mane down. She grimaced loudly when I got a tattoo and asked repeatedly what I was thinking.

When I started dating my now-wife my sister was already in a relationship with a woman and out as a lesbian. My Nana seemed okay with it. But I remember being very nervous about telling her because I knew she would say whatever she felt. I was worried about being rejected because I don’t care about many people’s opinions. But I cared about hers.

I told her about my then-girlfriend and she said she understood what I was telling her but she didn’t understand why. She looked completely shocked. She said about five times that day, “But I thought you were going to marry a doctor?” I didn’t really understand that. I guess because I was a nurse she assumed I would marry a doctor. Weird. So I told her that my girlfriend was an EMT, not a doctor. My Nana was by nature very polite to everyone outside of her immediate family. So my then-girlfriend now-wife was welcomed with open arms and told to call her Nana.

For the first year or so if we were alone, she would ask if I met any doctors. I would remind her about my girlfriend. She would say “Oh yes, how is she doing?” Then after a year she stopped asking about doctors. Later, when I told her about our impending marriage she was thrilled for me. She loved my fiancee by then, and never asked about a doctor again.

One day in the Spring of 2015 we were sitting on my parents porch and I told my Nana I was pregnant with twins. She laughed and clasped her hands together, and said “Well you always do things big if you are going to do them, I’m so happy for you.” I remember the joy we all felt sitting together knowing the wonderful times that would come.

By the time our sons were born my Nana was declining cognitively. She might not remember what day it was or who people were- in fact she often called me by one of my Aunt’s names- but she always remembered she had six grandchildren and three great-grandchildren. And she never forgot their names.

She met the boys for the first time on Christmas 2015 and she held them and made up her own nicknames for them and as they grew into little toddlers she still loved to watch them play and try and hold them if they would stay still. Something that made it special was giving one of my son’s my Grandfather’s name as his middle name. As he grows we all can see the striking resemblance he bears to my Grandfather who passed in 1993. That meant so much to my Nana. When the boys were about six months we were visiting, and she held one at a time, and the one who looks like my Grandfather just calmly looked her right in the eye like he knew who she was and was at peace and content just sitting with her.

The last time I saw her when she was thinking clearly I told her stories about the boys and she laughed at their toddler antics. My sons turned two the day after she died. My Nana loved birthdays and cake. I knew she would want us to celebrate them and eat a lot of cake. So that’s what we did.

As I faced her impending passing I stepped back and looked at all she had been through. To have not one but two granddaughters identify as lesbians and to be able to accept that at her age and with her conservative background is nothing short of amazing. No one in my family made a big deal about us being lesbians because everyone just wanted to be accepting, but when I really examine it she pretty much kicked ass.

All my young LGBT clients fear coming out to their grandparents the most. They think they are the most conservative and the most rigid members of their families. I thought that way too, and was pleasantly surprised when she proved me wrong. Minus the whole asking about marrying a doctor for a year.

It’s sad that my sons won’t know her the way I knew her. It’s sad that I lost a dear friend. But I’m incredibly proud to have her blood run through my veins. Because she taught me that even age 82 is not too old to learn acceptance. Her demonstration of unconditional love for her two granddaughters will live in my heart forever.

I say the following sincerely and with much love and admiration; rest in peace Nana.


“What the F#%$ happened to your eye?”

This is off topic. Has nothing to do with being a lesbian.

Whenever I’m starting a blog post I think about starting it “This one time…” then I think about American Pie. Good movie.

Anyway. This one time a nurse I worked with came to work with a black eye. We had been working together in the emergency department literally since day one. And we were about four years in at this point. She looked up at me from her locker and I said, “What the fuck happened to your eye? Was it your husband because I will fucking end him.”

Now, I attended their wedding. Her husband was legitimately one of the sweetest men alive. I could not imagine him for a second laying a hand on her. So I was half joking. But also half not. Because how do people get black eyes? Especially married women in their late twenties. I had to lay out the possible though very unlikely reality as an opening in case it was true.

She laughed and told me a hilarious story that involved too much alcohol and a pile of ice in a parking lot. I myself had been victim to too much alcohol and icy parking lots that very winter but my bruises were luckily on my backside therefore hidden underneath my clothing. She unfortunately went face first. After we laughed about reality, she told me I was the only person to ask her about her eye.

She had been at work for four hours. In a place where we knew everything about everyone. Literally. We knew who was pooping regularly and who wasn’t. We knew who was having sex with who and who wasn’t. It wasn’t Gray’s Anatomy. Not even close. Gray’s Anatomy can’t compare. Can’t make it up.

I couldn’t believe that the people who ask regularly about our bowel regimens did not ask about her eye. She said patients and families also didn’t ask. She had been getting stares and side-eyes all day. People were making assumptions. Like I did. But I voiced it out loud because if there is a problem I’m not going to pretend it’s not there.

My friend and I talked more about how no one else said anything to her about her eye. How weird it was for her, because she felt that she had to then explain without being asked but also that she shouldn’t have to. She didn’t want people making assumptions about her husband though. The whole experience for her was weird, and at the end of our conversation in the emergency department locker room she said, “Thanks for asking though, but no we don’t need to kill him. Yet.” Then we laughed and walked out to the floor.

She came into contact with about fifty people before seeing me. Between staff and patients and families. Fifty people who all had the opportunity to act to intervene, and who chose not to. None of my business perhaps they thought. Don’t want to embarrass her or don’t want to get involved.

I honestly didn’t think twice before I opened my mouth. I have no filter obviously. It also would never occur to me to ignore the elephant in the room.

This whole #Metoo and #45 situation has gotten me thinking and reflecting a lot. I do individual therapy with rape victims and they carry so much guilt and shame. Part of the healing work is to help them put that guilt and shame onto the perpetrator. Why as a society are we more comfortable allowing a woman to walk around with a black eye instead of asking how she got it? Why are we more comfortable with a woman carrying the guilt and shame silently instead of stepping out with her story and placing it back onto the perpetrator?

Mental illness, rape, domestic violence- they all carry a stigma in our society. It runs deep. Shame. Guilt. Fear. How can we change this? To start with, if you see some one with a bruise ask how the fuck they got it. Look them in the eye and handle the truth.

You don’t have to save people. By asking doesn’t mean you have to be involved. But perhaps by asking you are opening a door for some one to tell the truth. To tell their story. If they tell their story once, maybe that will make them brave enough to tell it again.


What I consider a hard day as a nurse.

This day occurred two or three years ago.

I walked in at 7:30 AM to the inpatient psychiatric unit. I found out quickly I was the only provider for twenty-six patients. We were already short one, then one call out and one psychiatrist working in the interventional suite. I had a team of three residents and two medical students, and myself, so we all just buckled down and started seeing patients.

It was kind of wild in general on the unit that day. We had a run of manic/psychotic patients who were loud, up generally all day and night, refusing medication, and one out of all of them who was particularly rude and verbally aggressive in their unmedicated state.

The other part of the culture on that unit was there was a very anti-nurse practitioner view by patients. They always wanted to see the doctor. But that day they didn’t have a choice because there were no Attending physicians to be had. It was nice always having a resident with me because I could at least say there was a doctor with me, but I ultimately was the one making decisions. So, there were a lot of irrational unmedicated patients. Some were angry about being involuntarily hospitalized and they really had no time for me because they wanted to see the Doctor.

I was in the middle of a particularly trying interview with a patient who was becoming verbally threatening around not being discharged when I saw a nurse run out of a patient room. He looked frazzled. On impulse I got up and went out of the interview room mid-sentence and stopped the nurse who told me a patient was seizing.

I was now in charge of a medical emergency. We called for transport to the emergency department. I started an IV and we gave Lorazepam (an anti-seizure medication). The patient was large, and it was hard, and we were doing this all in a psychiatric room which is not at all equipped or set up for medical emergencies. I was literally holding the oxygen mask on the patient after just pushing in the IV Lorazepam when some one tapped on my shoulder. “What?” I asked with somewhat of an attitude, as I was clearly busy.

“Um, you need to come out to the front.” I heard the voice of a tech.

“Kinda busy here,” I replied irritated.

“Um, the Secret Service is here.”

I sort of stopped and turned my head.

“You’ve got to be fucking kidding me?” I said. But I knew they weren’t. Because at that point I worked there for a few years, and we had been visited by federal marshals, sheriff’s, and the FBI, so really all that was left was the Secret Service. Psychiatry is nuts.

The ambulance stretcher rolled in. Thank God for paramedics. I gladly gave over my patient and walked out the door to go talk to the goddamn Secret Service.

My day didn’t get better from there.

After all of that we still had to write twenty-six notes. We discharged four patients, and admitted four patients. We reviewed labwork, EKG’s, medication doses, changes, etc. etc. etc.

We had to do all the normal shit healthcare providers do on top of rescue a seizing patient and deal with the Secret Service while working with one provider on a unit where there was supposed to be four. We did all this while one of the patients yelled racial and religious slurs at all of us. All day.

It was a Friday.

I vividly remember this day. I remember thinking I don’t get paid enough to keep my brain sharp enough to deal with this shit. I remember thinking NFL players get paid way too much to get their brains turned to shit. I remember feeling thankful I had my colleagues: the nursing staff, the residents, the social workers, everyone was a team. That’s the benefit to working in a hospital setting. I remember feeling burnt out; physically and emotionally exhausted, and also gross because the seizing patient puked and I felt like I had flecks of vomit on me all day. I hope to God I didn’t. But it was a possibility.

I remember mostly though that whole day no one cared or thought to ask about my sexuality. It didn’t matter that I am a lesbian when I threw the IV into that patient’s arm and pushed the anti-seizure medication. The families I met with to review discharge plans for their family members, the patients who screamed and swore at me for not discharging them, and all the staff. No one could have given two shits that I was married to a woman. Because I was competent and I got the job done. I’d like to think I got it done well.

The religious right says the homosexual agenda is to “normalize” homosexuality. Well duh. Because my identity as a lesbian has nothing to do with the ability to perform my job as a nurse practitioner. It has nothing to do with my ability to be a wife or mother or daughter. Being homosexual is normal. For me. I am a normal person who happens to be gay. If that was your relative seizing, and I was the one running the response, would it really matter to you if I am a lesbian or not?

Would you want me to step back and let a straight person who might have less skills as a nurse step in because they are straight? Gotta be honest even if that’s what you want I wouldn’t let it happen. Because my duty as a nurse and a human being would not allow me to let someone potentially die because of some one else’s ignorance. I’d tell you to shut the hell up and get out of my way most likely.

My ability to function and to be a contributing member of society has nothing to do with my sexuality. And this debate over whether people have the right to refuse services to others based on sexual orientation or gender identity infuriates me.

Illness eventually touches everyone. Illness does not discriminate. Remember that every single person will at some point be in a hospital. Think long and hard about whether you want to give your nurse, doctor, tech, surgeon, anesthesiologist, the right to discriminate.





“I have two mom’s too.”

Today is Halloween. We do celebrate. Though this year has been a little sparse because we moved and I started a business. But we did dress the boys as little lumberjacks and brought them to their daycare parade. My three year old niece joined us for the day with my parents. My sons are obsessed with their cousin. They want to know what she’s doing and they want to be doing it to. They also start referring to my wife by her first name after spending time with her because she calls my wife by her first name. She calls me by my first name too but the boys still call me Mama. Weird.

Anyway, today my niece and the boys in their lumberjack costumes were playing and laughing in this big hall before the daycare Halloween parade. My wife arrived and my niece and boys said Hi then resumed playing together. My niece kept looking at my wife and I, and then yelled, “I have two mom’s too!” She said it to the boys but of course the entire room heard.

I think it was the first time she put together that she is connected to my boys in more than just a “cousin” way. They actually all have two mom’s. She was beaming when she said it.

My wife and I just smiled and said yup, you do. Then they all kept playing.

There are a lot of factors at work here. My niece recently started a preschool and maybe she’s been seeing a lot of mom/dad families. She loves Disney Princesses and all those movies are super heterosexual. She’s at an age where she’s realizing she doesn’t have a dad, but instead has two kick ass Moms. To be able to be connected by blood to two boys who will have a shared experience with her in terms of having two Moms.

That moment stuck out for me so much because she literally yelled her proclamation and was smiling ear to ear. She is young and innocent and while she’s figuring out that having two mom’s is not necessarily the “norm” she’s still naive to discrimination. So she yells it. I loved it. But it also made me want to cry. Because will all three of them yell it in five years? In ten years? When they are twelve and facing peer pressure and in the digital age pressure on social media will they be so forthcoming about their Two Mom status? Will they be taught subconsciously or consciously to hide it? Or at least not advertise it?

My heart aches when I think of how much I love those three kids.

Would I have it any other way if I could? Probably not. I’m a firm believer in fate and karma. These kids are going to be stronger for knowing adversity. They will be more open minded and more tolerant because unfortunately they will witness discrimination. Having two mom’s will shape them in ways I can only imagine.

There are moments in life I wish could be freeze-framed. Every time one of my sons spontaneously gives me a hug. The first time I saw my niece in a NICU incubator, fighting to breathe, fighting to live. The ultrasound tech shoving the monitor toward me when I didn’t believe her when she told me there were two fetal sacs both with heartbeats, and seeing those two beautiful circles with a little flutter in the middle. The night I knew I would marry my wife even before gay marriage was legal because I tried imagining living without her and physically couldn’t. The day my sister had a major surgery and we were reassured that all the cancer was gone. Every time my son’s reach for my Mom or Dad. These are pit in my stomach moments that I remember viscerally. Add to the list that time my niece shouted out proudly that she has two moms too.

These are moments that made me feel something. That made me connect with the world around me and see the past and future aligned perfectly. That may sound silly or whimsical but it’s true. Some moments are meant to be enjoyed because pure joy and pure wonder can be instantly knocked out with the next hand life has to deal.