Author Archives: gretchenlasalle@hotmail.com

A Hidden Epidemic

In my first job out of residency, I worked with another new physician.  Let’s call him Bill.  Bill was a warm, caring and generous, but highly anxious, person. He worried about everything: every patient he took on, every decision he made, every lab that was even remotely out of range.   My partners and I also suspected there were things going on in his personal life that were troubling him but we wanted to remain professional.  We didn’t want to pry or to make him feel uncomfortable.  We figured he was just like many of us… trying to sort out his new role as physician, finding a way to make it fit into his life.  Then one day Bill didn’t show up for work.  We contacted his family, who lived out of state, and they hadn’t heard from him.  Later that day, Bill’s body was discovered in the river.

In our last all provider meeting, we discussed the new regulations requiring health care providers to have a certain number of hours of training regarding suicide.  As the requirements and options for training were being laid out, I couldn’t help but think of Bill and of our medical profession as a whole.  The figures are frightening.  The equivalent of nearly 2-3 medical school classes of physicians die by suicide each year.  Male physicians are about 1.5 times and female physicians about 2.5 times more likely to die by suicide than the average person.  Not only do we need to undergo training for suicide risk detection and prevention for our patients, but, it seems, we desperately need it for ourselves as well.

The role we have chosen for ourselves is difficult.  It has many rewards, of course, but it also can take its toll on self and family.  As a group, we tend to be harder on ourselves than we are on others.  We hold ourselves to sometimes unrealistic and unhealthy standards.  We are excellent at delayed gratification and dedication to others before self.  We want to please and have a hard time saying no.  We put our lives and families and finances on hold to complete our training and to build a practice, only to be met with what sometimes feels like a lack of appreciation for our efforts.  And the ultimate goal of our calling, the development of a close and caring relationship between doctor and patient, is eroded by the seemingly endless administrative duties which are taking over our day-to-day lives.  And if we do ultimately feel like medicine is not the right place for us, we often feel stuck  – without other skills, saddled with huge debt, and lacking time to pursue other options.

We need to begin to care for ourselves as we care for our patients.  We would never suggest that our patients work 60-80 hour weeks, skip meals, get too little sleep, defer family time for more hours at work, take only a few weeks of maternity or paternity leave, etc.  This is not a humane way of living and it is unsustainable.  We need to support each other as coworkers and in an organizational capacity in pursuing quality of life in the workplace and at home.  Our emotions – all of our emotions – are not weaknesses.  They are part of what makes us human.  We need to acknowledge this as a profession and work to get rid of the stigma that surrounds mental health issues in healthcare providers.  And, finally, we need to be there for each other if one of us is struggling.

Some of us worry that reaching out for help would be an admission of weakness or would signal to others an inability to practice in the best interest and safety of our patients.  So we don’t reach out.  Many of us have long office hours and spend more hours after work completing charting and don’t see a time to be able to attend counseling sessions.  So we don’t reach out.  But we have to find a way to break down these barriers to care.  Below are some of the resources available to us that are confidential and will work around our hectic schedules, we just have to be willing to get started.

None of us can travel this road alone.  If you are struggling, please reach out and let someone help you.  After all, wouldn’t you do the same for another in need?

·        The Spokane County Medical Society (SCMS) Foundation offers a Wellness Program which is staffed by psychiatrists who specialize in treating medical professionals.  There is complete privacy and confidentiality (providers are referenced by number only and providers can either choose to go to the psychiatrist’s office or there is a separate room with a separate entrance at the SCMS offices that facilitates anonymity).  For SCMS members, the  1st 8 sessions are free.  Sessions are contracted at lower rates for non-members.  Mental health providers are available 24/7 by pager and can be reached at 509-720-6000 (if not immediately available, a message can be left which the recording states will be returned within 10 minutes).  You can find out more about the SCMS Foundation programs at www.spcms.org.

 

This Is Me

This is me.

I am Doctor, Mother, Wife, and More.

I am Confidence Keeper, Amateur Counselor, Health Promoter and Sickness Healer.                       I am Patient Protector, Part-time Teacher, Dream Inspirer and a Sometimes Friend.

I am Meal Maker, Homework Helper, Heart Healer and Expert Worrier.                                             I am Story Teller, Back Rubber, Booboo Kisser and a Tucker in Bed.

I am Travel Planner, Errand Runner, Special Maker and Photo Taker.                                                   I am Memory Maker, Party Planner, Love Giver and the Keeper of Kin.

I am Shower Singer, Daydreamer, Nature Lover and Wannabe Writer.                                                 I am Cause Fighter, Alone Time Hoarder, Age Defier, and the Fiercest of Friends.

This is me.

And who are you?

I Rise Early

I rise early, hoping to steal some time alone with my thoughts.  It’s quiet at the lake in the morning… except for the symphony of sound.  The honking of geese miles away bounces off the mountains.  Squirrels titter in the trees.  There are high-pitched squeaks and guttural whale-like sounds, forced from adjacent docks as they rise and fall with the lapping of the lake water.  The bees begin their gentle hum.  In the distance, a bird calls but there is no answer.  A car engine breaks the silence, then quickly fades away.  Even in the stillness there is motion. Nature is an early riser, just like me.

The lake smells of smoke this morning; like a thousand campfires left smoldering to ash.  Yet past the smoke, or maybe underneath it, there is a freshness, a clean smell; something subtle that you can’t quite put your finger on.  Had I a better nose, I might smell the sweetness of flowers growing in the planters below or the piney scent from the surrounding trees.  But the only thing wafting my way this morning is the smell of coffee.  Lights are on in the cabin. Someone has turned on the coffee pot.  My youngest son, now awake, snuggles up on the couch in a cozy blanket as I grab the few remaining moments of quiet… before the rest of the world awakes.

Even now the light is rising, as if on a dimmer switch in reverse.  The mountains become clearer on the horizon.  Smoke from distant fires layers across the treetops and blankets the sky.  A slight breeze picks up, creating tiny ripples on the water.  A lake otter swims alone along the shoreline.  Boats begin their journey across the lake, white tails of water trailing behind; fishermen in search of that perfect secluded spot to catch their prize.

As my senses are gently coaxed awake, I wonder…. Do night owls, late to bed and late to rise, find the same quiet and peace in the nighttime?  When they wake, in the height of the day, do they wake to an assault on the senses?  I cherish these early mornings and their treasures of sight and sound – these moments with Mother Nature, before our busy days begin.

Game of Thrones

Well, you know you haven’t been contributing to your blog enough when you aren’t even getting spam comments (such as “I love your blog post! Check out my site for discounts on Viagra). Apparently, I have fallen totally off of the blog grid. It has been a month or more since I have written anything for my blog. I can hear you judging me so you should know that I have been writing other stuff. My writing energies lately seem to be spent on my medical passions of preventive care (please, everyone out there, get your vaccinations) and physician wellness. However, I do admit that my attentions are also drawn toward non-literary pursuits…. Damn you, Game of Thrones.

Whomever wrote and produced this series obviously just didn’t want anyone to get anything done. My husband and I are watching it on DVD and there have been many a day where I want to do nothing else but see what Daenerys Targaryen is going to do with her wayward dragon children or how Arya Stark is going to track down and kill every last person on her bedtime kill list. By the way, has anyone else noticed how the women of Game of Thrones are kicking ass and taking names? You go girls! And then there’s John Snow. He’s yummy.

You know your Game of Thrones addiction has gotten out of hand when your children are complaining that you never spend time with them in the evenings and that you are always kicking them out of the room so you can watch said TV show. I feel kinda bad about this. But obviously not too bad because I continue to do it.

Does anyone else also worry that their neighbors are going to look in their window and think that they are watching porn? We have this big picture window in our family room and I have to draw the curtains sometimes because of all the nudity happening on the screen. Maybe I’m a little prudish but I don’t want people getting the wrong idea.

In younger days, before kids, my husband and I would spend hours binge watching 24, convincing each other that we could stay up for “just one more” and not be too tired the next day. Now, it is one and done. I must be getting older. In my heart of hearts I am young enough to stay up until midnight watching multiple episodes but, in reality, I have to get up at 5 AM and it ain’t pretty around my house if momma doesn’t get her sleep. So, it is taking us a while to get through the series.

We are finishing up season four and I can’t wait to see what happens next! If you are caught up to present day, please don’t give away any secrets. But, I am praying to the Gods, to the old and the new, that Jaime Lannister will fall out of love with his witch of a sister and find love with Brienne of Tarth and that Arya’s Needle will find its way into the hearts of her foes and that The Mother of Dragons and John Snow will rule over the Seven Kingdoms together. Do you see what you are missing if you are not watching this show? But, beware. Start it and your sleep, your relationships with your children, and your ability to get anything done may suffer.

Looking Out The Window

My sister and I sat in the back seat of our giant boat of a car, our mom at the wheel.

This was before shoulder belts. All we had were lap belts and if we loosened them just enough, we could turn and face each other, our backs against the doors, feet sneaking their way, inch by inch, to the other person’s side of the seat.

“Mom,” one of us would yell. “She’s touching me! Her feet are touching me!” Our legs flew in kicks and shoves. Luckily, there was an unspoken rule that no shoes would be worn in such conflicts as this truly could have done damage to one’s shins.

This was also before all cars had air conditioning and it was the middle of a Georgia July. We were driving to the beach, to a little old house on Hunting Island, South Carolina called Mosquito Haven.

It was hot and we were cranky.

A hand reached around from the front seat, waving wildly in search of legs to smack. “Stop it, girls! Leave each other alone and stop complaining! I don’t want to hear another word. Look out the window!”

This was always Mom’s answer to any car ride dispute. “Look out the window.” As if what was out the window was so fascinating, it would instantly distract us from whatever perceived slight had begun the melee.

I looked out the window at the highway passing by. The grass on the strip of land between the two sides of the road was brown and dry. Little patches of red Georgia clay peeked through, cracked and yearning for rain.

Trucks zoomed by; big freight trucks carrying heavy loads, creating a wind tunnel effect, pulling our car to one side as they passed, always with a “How’s my driving” sticker on the back; little pickup trucks, invariably with a hound dog hanging out one side, catching the breeze in its jowls; caravans of military trucks, their passengers in full fatigues, windows down, looking very serious on their way to somewhere important.

The sides of the road held patches of dappled shade, respite for birds and other critters seeking refuge from the heat. The trees were overrun by kudzu which was slowly but surely conquering the plants and buildings of the South. I imagine the war may have taken a different turn if General Pickett’s Charge had been as persistent and driven as that of kudzu.

At spots along the road, little stands of peaches and corn and other summer crops could be found. If we were lucky, we would happen upon vats of boiling peanuts, their salty brine permeating the air.

When we passed the giant peach, a water tower painted up to look exactly like a giant peach, we knew we were a little over halfway there.

As looking out the window slowly lost its interest, the hot wind coming through the open windows would lull me to sleep. I slept fitfully, awoken periodically by the sun pouring in the window, making me too hot and causing little rivers of perspiration to run down my back. I drifted in and out, catching the occasional view of bugs that had the misfortune of getting caught up in our travels; spiders climbing along the half open window until swept away on a highway breeze; bees and gnats and other bugs splattered in all their gutsy glory against our front windshield, their innards making a smear as the windshield wipers tried to wash them away.

Eventually, the smells coming through the window would change. A dank, marshy smell – a mixture of fish and sulfur – would waft in, burning the nostrils awake. The ground changed, red clay giving over to sandier soil, blown in little drifts onto the highway. The trees were smaller, scrubbier; more shrubs than trees. Seagulls would appear on the breeze.

We were close.

Looking out the window resumed. Sometimes, on these trips, my sister and I would play games of “That’s my horse.” (But you could substitute “horse” with any other object of desire – house, boat, car). “Horse” was more often reserved for trips to visit our friends who lived in the country. We would keep a keen eye out for anything appealing and try to lay claim to it before the other one did. I’m not sure why this was such a fun game but it sure kept us occupied for a while.

Soon, we passed over long bridges, with salty waterways below. We saw fathers and children hanging fishing lines over the edge, if the water was close. If we were higher up, we would sometimes pass over draw bridges, smaller sailboats and fishing boats passing beneath. If we were unlucky, we would get stuck on one side of a drawn draw bridge, waiting in the stifling heat for a large ship to make its way through.

As we crossed over each little island in the chain, stopping briefly at the Piggly Wiggly and the fish shop to pick up provisions for our week at Mosquito Haven, excitement grew. Passing onto Hunting Island, we would see the lighthouse in the distance and catch glimpses of the ocean through the heavy foliage.

Finally, we would pull into the long sandy drive of Mosquito Haven, a little house on stilts, just steps from the ocean and I would jump out of the car and run to the beach to get the first feel of sand between my toes. The house wasn’t fancy, and it unfortunately lived up to its buggy name, but it was our escape for the summer. It was a place where life was simple and still. It was a place where we would read to pass the time, and then read some more. We would hunt for sand dollars and sharks’ teeth on the beach at low tide. We would play cards and listen to music on the radio. We would collect driftwood. We would eat fresh fish and drink iced tea and would sit outside on the screened porch at night, listening to the hum of the insects.

I don’t think I truly appreciated these summers until later. As kids, we take such things for granted. As a pre-teen, I felt I was being dragged away from more exciting pursuits and would rather have spent time with my friends. But, like my own teen and pre-teen children, though initially feeling captive to these family activities, I ultimately truly enjoyed the adventure. Mosquito Haven is gone now, victim to the swells of the ocean. I am able to revisit her only through the lens of memory and of yellowed photographs in an album. We made our pilgrimage there every summer for many years and, though the journey was long and hot, I took comfort in its familiarity. Now, when life gets hectic, I think back on our travels and I genuinely miss those times – unencumbered by the responsibilities and details of daily life – looking out the window and watching the world go by.

 

Mom, Wife, Doctor, Activist

If you had asked me a year ago if I ever thought I would be active in political discussions, working to effect policy, protesting, and organizing I would have said “Absolutely not!” I don’t like to call attention to myself. I prefer to work behind the scenes and effect change one person at a time. I would rather hide behind my stethoscope and my pen and paper than put myself out there at risk of having to speak for a cause and take on the establishment. But the election of Donald Trump, with his ensuing systematic attempts to dismantle the rights and protections of others as well as to defund organizations that have contributed to the enrichment of our culture, the betterment of our society, and that have worked to advance our understanding of and our respect for the world around us, has turned me into what I am today. In addition to my roles as Mom, Wife, and Doctor, I now also don the hat of Activist. I no longer feel that I can rely on others to ensure protection of my liberties, of our liberties. Look what happened when we assumed that the American voter would make reasonable decisions about who to elect as President of the United States. All Hell broke loose.

And I am not alone. In fact, the Trump presidency has created the greatest generation of activists that this country has seen in a long time. Never before have we seen so many people organized around a cause. Perhaps this will be his only positive lasting legacy. The large majority of Americans, whether they would admit to it in public or not, are nervous about what is happening in our Government right now. Trump is taking aim at some of the very institutions that have made this nation great. He is doing the opposite of what his campaign slogan promised. He is making America dangerous, intolerant, hateful, and the laughing stock of the international community. He is setting back the advances we have seen in race relations, gender equality, LGBTQ rights, health care, international relations, environmental protections, and the list goes on. He forgets that we are the United States of America. Every time he removes freedoms from one of us, it threatens the safety of all. Every time he takes aim at social programs for one group, it weakens the societal safety net of all Americans. And I, we, cannot stand by and let him unravel this beautiful patchwork quilt of diversity and liberty that is our great nation.

It is as if he is trying to cross off a check list, one item at a time; trying to undo every measure or bill put in place by the Obama administration, just to say he lived up to a campaign promise. Never mind the fact that he and his sycophantic cabinet offer no realistic or reasonable alternatives or replacements. And the American people are becoming wise to his game. He is a figurehead only, and a very poor one at that. And for all the obstructionist tactics the Republican Party has used over the last eight years of Obama’s presidency and for all the talk of bridging the party divide, he is making no efforts to bring Democrats and Republicans together to develop solutions. Instead, he is ramming presidential order after presidential order down our throats like he’s in some race to the finish line. Perhaps he sees that his tenure in the White House is coming to an end and this is a frantic dash to do something, anything that he promised on the campaign trail. Otherwise, his presidency would be an unmitigated failure and he himself would be a national embarrassment. Well, Mr. President. It is too late for that.

The March for Science is coming up on April 22. In contrast to the dozens of people that showed up to the Anti-vaccine movement’s March for Truth yesterday in Washington, DC, the nation is again going to witness the huge outpouring of support that the world has for its fellow citizens, its planet, and for reason and fact. The March for Science will bring tens of thousands, perhaps hundreds of thousands, of people from around the world to speak out against Trump’s anti-health, anti-environment, and anti-intellectual agenda.

Without the Environmental Protection Agency, we would have many more deaths due to poor air quality, many more children poisoned by lead in their drinking water, many more species on the verge of extinction, many more instances of severe and damaging weather. Without Planned Parenthood, we would have even higher numbers of pregnancy terminations (since more accidental pregnancies would occur without access to birth control), greater numbers of sexually transmitted infections, and higher rates of cervical and penile cancers. With the doubt and fear mongering that Trump plans to disseminate in questioning the efficacy and safety of vaccinations, he would set public health advances back to the 1700s when we saw millions of people die from vaccine-preventable illness. Does he even know how many organizations (both government funded and private) are already devoted to monitoring the safety of vaccines? I count at least eight and there are undoubtedly more. Yet he would have us believe that 220 years of vaccine science is false, inadequate and needs to be redone. And who’s going to pay for that?

If we love this country and we want to preserve the rights and dignities of all Americans, we must stand up and let our voices be heard. If we stand for truth and justice and equal opportunity for all, we must stand against Trump and his administration. His policies may not directly affect you or your loved ones now but, if we allow tyranny and prejudice to stand, who’s to say what group he will target next. His words and actions are not Christian (nor are they consistent with the messages of love and tolerance that are central to the teachings of all of the major religions), they are not American, they are not even Human. Most of us are born with an innate instinct to show care and compassion for our fellow humans. This moral compass seems to be lacking in president Trump.

So, I hope that you will join me at the upcoming March for Science rally on April 22. Let your activist flag fly.  Speak up for that which you believe. Help bring this reign of absurdity to an end.

A Prayer for Today

Dear Lord,

Thank you for your many blessings. May they keep me sane during these times of trial.

Lord, I am having a difficult time finding the goodness in everyone. Help me loveth my neighbor, no matter who they voted for. Help me to find something positive in this “presidency”. Perhaps you have sent us this erratic, insecure, uninformed lunatic to draw contrast to that which is just and right in the world. For humans banding together in support of each other and against hate is truly Good.   Let me not harbor feelings of ill will towards him or those that support him but understand what drew them to him in the first place.

Lord, help me to survive the 13-year-old rollercoaster that is my eldest child. Hold my tongue, Lord, so that I may not say something I regret when he has challenged me one too many times. Hold my hands, Lord, when he changeth my radio station and toucheth my gearshift while I am driving. Help me to enjoy the snuggles that have inexplicably returned following a multi year absence, only to be followed by yelling and slamming of doors. Let me not sell him to the gypsies, as he will someday regain his full faculties and become a rational human being again.

Lord, please relieve us from that which is white and falling from the sky. It was beautiful in December and January but now it maketh me want to hurt myself, or others. Bring blue skies and sunshine and shoots of green. Bring birdsong and flowers. Help me to find my inner peace and joy so that my family does not have to suffer my gray moods.

Lord, help me to find strength in you. Help me to find my spunk, my childlike joy and wonder, my sense of humor, and my strength and grit in the face of adversity. Help me to love and forgive. Help me to fight for others without losing myself in the process. If you could just help me to channel my inner Rose Nylund, Julia Sugarbaker, and Anne Shirley then I’m sure I’ll get there.

Please send peace and love and safety and health to all, even to you know who.

Amen.

Thoreau-ing It All Away

Have you ever wanted to just get away from life? Lately, I have been having these fantasies about going and living in the middle of the woods – alone. I really don’t want to leave my husband and my kids but I desire solitude, just for a little while. Just for a time, I’d like to live with no civilization; no computers; no phones; no television. I’d like to wake up when the sunlight streams through the windows and go to bed when the light is fading. I want to hear nothing but birds singing and leaves rustling. I want stillness. I want quiet. I want my thoughts to be the only things that break my communion with the trees and the water and the earth. Because I like to name things, I like to call this fantasy of mine “Thoreau-ing it all away”. But maybe not all of it – and not forever. Just for a week or two.

The world is just too much for me right now. The negativity and inhumanity that is occurring is making me weary. I have a hard time focusing on my work these days. I feel overwhelmed and drained and helpless. I no longer have faith that everything will turn out ok. I no longer have faith that people are inherently good and that they will do what is right and just. Getting away – unplugging – is probably not what I should do with all that’s going in the world. I should engage, now more than ever. And I most likely will – tomorrow. But today, in this moment, engaging feels like a heavy burden and I’d like to indulge in this daydream.

In my little cabin in the woods, I will sleep as long as I want to. I will cook to the rhythm of salsa and to the sizzle in the pan, with a glass of wine in my hand. I will take baths and read books (actual books, not just magazines and journals and online news articles). I will take long walks through the forest and stop to listen to the trickle of a stream and to the hooting of an owl. I will write without interruption. I will breath deeply. I will recharge. And then… I will be ready to return to the world.

An Open Letter to Mr. Trump and Mr. Kennedy

Dear Mr. Trump and Mr. Kennedy,

Are you serious? I mean, are you really serious – a committee to investigate the effectiveness of vaccines? What do you think science has been doing for the last 220 years? We are going to spend millions of dollars and precious hours that could be better spent, I don’t know, say… working on securing peace in the Middle East or developing a realistic and actionable alternative to the Affordable Care Act (which, by the way, I happen to like and don’t feel needs replacement but, perhaps, improvement). This is ridiculous!

We (I really want to say “you” but I’m trying to be inclusive here) must have an unbelievably short collective memory. Do you not remember smallpox? Do you not remember polio? Do you not remember the Influenza pandemic of 1918, which affected 1/5th of the world’s population and killed more people than died in all of WWI? 50 million people died! That’s million, with an “M”! Why do we not see these horrible plagues anymore? Because of vaccines, that’s why! But, somehow, even though many people – healthy people – still die of the flu every year, this doesn’t feel like a current concern. Maybe it’s not sexy enough of an issue. I would stake my career on the fact that, if there were an Ebola outbreak and people were bleeding out of their eyeballs and dying left and right, every single person out there would stand in line to get a vaccine if one was available. Maybe the flu and other vaccine-preventable diseases just aren’t scary enough.

How pretentious and elitist of us. This move, to question the utility and benefit of vaccinations, is a luxury of the wealthy. You do not see the people of third world countries or those in our own country who are just scraping by, living paycheck to paycheck, questioning the benefit of vaccines. To them, this is a life and death situation. Whether to vaccinate is a make or break decision. For those out there who don’t have access to adequate health care or can’t afford the medication or the doctor bills to treat an illness, having a family member get sick can be catastrophic. They can’t afford to take time off of work to nurse their child or themselves back to health. So, what happens? Kids get sent to school during illness. Adults continue to go to work during illness. And illness spreads.

It feels like I spend half my day trying to convince people to get vaccinated. As a family doctor, who cares for a largely middle to upper middle class patient population, I get a lot of questioning patients. In 2015, after growing frustrations with how much effort was expended addressing this issue, and not feeling fully prepared to answer all the concerns that my patients had, I took the time to do my homework. I took every doubt, every reason that I have heard not to vaccinate, and addressed each one in turn. I wrote an article about it called An Ounce of Prevention and you can read it if you are so inclined, or you can do your own research. You will find, as I did, what we as people of Science and Medicine already knew. Vaccines are safe and vaccines save lives!

What I know to be true in my heart of hearts and what I see to be true in my everyday practice, is that population health and individual health are inseparable. If you choose not to get vaccinated, so be it. You are an adult. But know that your choice puts others at risk. We vaccinate not only to protect ourselves but also to protect the more vulnerable in our community. Or maybe you don’t care about those more vulnerable and at risk individuals.

Make your own personal decisions, but don’t deny the right to this lifesaving health intervention to others and don’t waste our time and dollars setting back the clock to the 1700s.

Sincerely,

Gretchen LaSalle, MD

Stand

And so we will Stand,                                                                                                                                     just as we had planned,                                                                                                                               with our heads held high.

I sit here, muscles in spasm, gripping my nerves and skeleton.  I cannot sleep.  I have my second cold sore in as many weeks and I am just now coming to the realization that I am stressed.  The body often reveals what the mind cannot see.

The kids are good.  My husband is loving.  Everyone’s healthy (save that cold sore and the spasmed muscles).  Work is rewarding.  I love the time I spend with my patients and coworkers. I love teaching.  But providing health care is a fight.  A constant fight.  And there are wolves at the door, threatening to take away the care and coverage that so many need and from which so many have benefitted.  And then, there’s Inauguration day looming.  It is enough to make a person want to lay down, roll over and wish the next four years away.  But we can’t.   Now is the time to say what must be said.  Now is the time to let our voices be heard.  Now is the time to stand.  I don’t know about you, but I don’t want to look back on anything that happens in the coming four years, anything that takes away rights and freedoms and opportunities for others, and say that I could have done, should have done, more.  I hope you will join me in taking a stand on January 21st at your local Women’s Day march.  Join the greatest gathering of activists that this country has seen in some time.  Be a force for change.  Stand.