immunization

opening the ivory tower doors

/ gal / Leave a comment

Ivory Tower

Deeply imprinted into my psyche, the Ivory Tower from my favorite and most-viewed movie from adolescence, The Neverending Story

When I was in my mid-twenties, I began my career in the social sector working in philanthropy. I worked in a foundation that helped progressive individuals give money away to social change organizations all over the world. The internet was barely a thing back then – I think I had an AOL email address – and I got the job looking for an administrative assistant position in the newspaper. When I was called for an interview, I asked if they could send me information about the organization so that I could learn more about what they did. I didn’t know anything about foundations, about donors, about non-profit organizations and NGOs, or about grantmaking. A few days later a packet arrived in my mailbox – it was a grants list of the organizations the foundation’s donors had supported in the previous year, but it only listed the name of the donor funds and the names of their grantees. That’s not a lot of information to explain the work of an organization if you don’t have the ability to look them up online, and online didn’t really exist yet.

So off I went to my interview, and I sat in a small room with two of the foundation’s program officers – I didn’t know what a program officer was, either, and they were kind of intimidating. I was 24. The intimidating program officer who chose me to be her assistant has become one of my closest friends and most cherished mentors. From her and my other colleagues at the foundation – over four and a half years and afterwards when I branched out on my own – I learned everything I know about the world of giving and the incredible non-profit organizations that do so much to sustain and balance out our world. By the time I left the foundation to start a consulting practice working with non-profit and philanthropic organizations, I had become a program officer. Talk about the school of life.

During one of my first weeks working there, I was asked to contact a list of past grant recipients to ask for their reports on how they had used their grants so far. I left phone messages for the ones who didn’t answer, telling them I was calling from the foundation and could they please call me back. In under an hour, all of my phone messages had been returned. I was stunned, and when I shared this with my boss, she smiled and said, “That’s because they know you have the money.” “But I don’t have the money,” I replied. “I’m just an assistant.” “But you’re connected to the people who do, and money = power.” And she explained to me that, in our work, we were trying to redistribute some of that power to make things more equal – at least that was the goal of philanthropy.

We had a staff training during my time working at the foundation, and the theme was privilege. I’d worked there a few years by then, and I was aware of the incredible privilege of the philanthropists we worked with. But we weren’t talking about their privilege, we were talking about ours. It was uncomfortable. We were asked to think of the ways in which we had grown up with privilege, and no matter how rich or poor each of us were, just by virtue of being there, gainfully employed doing meaningful work managing great resources, all of us were privileged. And my list of privilege was so long, I realized, especially after listening to some of my colleagues share the challenges they had grown up with in disadvantaged communities or as immigrants or as people of color.

Privilege: I grew up speaking two languages. I went to schools with small classrooms and brand new textbooks. I grew up around technology years before technology was in every home. I grew up in a town influenced by a major university. We owned our home. I got to travel all over the world. I had a doctor and a dentist and a retainer for my overbite. My mom took me to her hairdresser to get my hair cut. My dad helped me buy a used car when I turned 16 by getting me a summer job filing receipts in his company. College was paid for and my grades and activities got me into every school I applied to. I grew up in a home filled with books and art and music. I had piano lessons and saxophone lessons, tried ballet and jazz dance, took art classes. I grew up in a safe place free from violence where I could ride my bike or take the bus all over town without a care. I had friends whose families came from all over the world – doctors and professors and researchers and tech executives. I had an allowance. I went to summer camp. I am white.

Privilege.

What an ivory tower I had always lived in! And what an ivory tower did I now find myself in, giving money away to communities in need. Those words: In need. They made me uncomfortable. I didn’t like the dynamic – that some people have and others don’t, and no matter how much we might try to redistribute the resources, there are always some with privilege and some without. And there are levels of privilege – we each fall somewhere on a continuum.

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I still think a lot about privilege. I think about it as the white mother to a black son. I think about our choice to move to a town with higher property taxes and excellent public schools for our children. I think about it every time I go to a doctor’s appointment or to the pharmacy to pick up a prescription and I am able to afford my co-pay. I think about it as I make the monthly payment for our mortgage, for our cars. I think about it as I look at the packing list for my daughter’s summer camp.

As a child, my favorite subject in school was social studies – that wonderful topic that encapsulated all things having to do with human beings and societies: history, political science, sociology, psychology, anthropology. The things I was most curious about. I wanted to be a psychologist, and I would watch Afterschool Specials and any Nine O’Clock Movie that had to do with a social issue: mental illness, addiction, homelessness, school reform, runaway teens. It was the eighties during Reagan, the years of This is your brain (camera zooms in on a whole intact egg). This is your brain on drugs (camera zooms in on egg frying in a pan).

I entered college as a psychology major, at some point changed to anthropology, changed again to sociology, and finished with a BA in history; so I got a nice well rounded liberal arts education and have done absolutely nothing related to my degree. But what draws me, what compels me, hasn’t changed since I was my daughter’s age. Social studies is still my favorite subject; it’s what I think about, read about, write about and try to teach my children about. It’s what I’ve been blessed for 20 years to have as the focus of my work.

I spent time in my daughter’s fifth grade class this morning, helping a group of kids with their end-of-the-year presentations about community and global issues. I was in social studies heaven. 11 is an incredible age because you can start to talk about the grey areas, the nuance in between black and white. You can start to talk about the complexity of issues like gang violence and global responses to natural disasters. You can start to talk about privilege.

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I thought about privilege a lot last night. I was the moderator for a local UNICEF event about the Eliminate Project, whose goal it is to eliminate maternal and neonatal tetanus worldwide through UNICEF’s incredible immunization and health programs. We watched a video and listened to first-hand stories about babies dying – 140 each day – from this vaccine preventable disease. I moderated a panel of speakers who spoke about how entirely possible it is to completely eliminate this disease – and how this has already been achieved in 36 countries, with 23 remaining. I thought about places where babies die each day from poverty and violence and lack of health care and sanitation. I thought of my own baby who had died, and all of the resources we were able to rally to give her every possible chance during her two months of life.

And I thought about tetanus here in the U.S., where babies don’t die of this bacteria that lives in soil. I remembered getting my tetanus booster as an older child, again as an adult. I thought about a conversation I had with a friend when my daughter was a toddler, how this friend who had been a pediatrician explained to me that tetanus isn’t just in rusty nails, but also in the dirt all around us.

I thought a lot last night about how privileged we are in this country to even be able to have a conversation about whether or not it is safe or necessary to vaccinate our children. We don’t see on a daily basis the diseases that kill children and adults in developing countries; some, like polio, which used to exist here. We don’t see an infant suffering from or dying from tetanus, so we have the luxury to actually consider whether or not our children need that vaccine. I know how much I wrestled with those questions when my daughter was little.

I just felt privileged, and I sat with that feeling as I drove home last night. And I’m sitting with it today. It still makes me uncomfortable – things that are unjust, unfair, unequal make me uncomfortable. And to be honest, I hope that never stops, because the moment I get too comfortable is the moment I stop caring, and I don’t plan to stop caring.

It makes me feel grateful, too. Grateful for my health. Grateful for clean water and a warm bed and my home and abundant nourishing food that is refrigerated. Grateful for the washing machine that spins my bedsheets as I write. Grateful for my children’s pediatrician, always available. Grateful for my safe neighborhood. Grateful for the school bus that picks up my daughter in the morning to take her to her wonderful school. Grateful for green space. Grateful for the community and culture and diversity I get to be a part of.

And grateful to be able to play my very small part to make things just a little bit more just, fair and equal.

courage and fear

/ gal / 1 Comment

I’ve learned a few things about myself in the past week since my January 26 post about my personal process around immunization was picked up by the Washington Post and printed in a shorter version as a Sunday Op-Ed.

I’ve learned that I am courageous. I don’t mean that in a boastful way, but I think we spend waste a lot of time doubting our own courage, keeping ourselves quiet. And we are often courageous in small and unexpected ways that are important to recognize. I’ve done plenty of that – keeping myself smaller than I know I can be.

I’ve learned that I have a voice and that I should use it. A sincere voice that speaks to more than my family and friends, but also to people I don’t know. Several older and wiser people in my life have told me that your forties are the best decade because you’ve released many of the insecurities of your previous decades, you know who you are, you have less tolerance for bullshit, and you’re not afraid to speak up. I accept their wisdom as permission to believe I know a few things and should make use of what I know.

I’ve learned that I am a peacemaker, that I take seriously the desire not to offend, not to condemn, not to alienate, not to preach. I’ve learned that I am sensitive to criticism. (Is there anybody out there who’s not?) I’ve learned that when your piece appears in the Washington Post and generates 557 comments (or comments to comments), it’s a good idea to stop reading those comments after about 50. I’ve learned that some people love a soapbox from which to speak preach rant and attack, and that it takes very little courage to do so from an anonymous ID in the comments section of a major newspaper. I’ve learned that fear (and prejudice) can sometimes lead people to be really nasty to each other.

A piece by David Brooks on Conflict and Ego in last Friday’s New York Times was helpful.

I’ve learned that it takes great courage to share a very personal story in such a public way; and that it’s much easier to criticize or dismiss someone’s personal journey, and to project your own fears, judgments and beliefs onto them. Reading what some of my commenters – critics and supporters – projected onto me when they read about my experience was shocking, in a way, and I had to remember that their words spoke more about them than they did about me. It took turning off the computer, putting down my phone and going outside to garden and play with my children to remind myself of who I truly am at my core. To remind myself of where my heart is. I don’t think I will ever read a personal essay in quite the same way again. We are capable of being so deeply moved by a piece that, in the best of circumstances, we connect and feel understood; and in the worst of circumstances, we manipulate what we read to simply prove our biases, prejudices and fears.

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There is so much fear around this conversation about immunizations. I won’t even point out that the fear is on “both sides” of the conversation (which I think is obvious to anyone who is reading anything about it) because I think the fact that the story is being told as “this side vs. that side” is a symptom of fear. We fear what we don’t understand, and we don’t seek to understand what we fear. It can be easier to place ourselves in contrast to the other, to see ourselves on one side while “they” are on the other side. The problem with that simple equation, though, is that there are never just two sides. If you see it as a debate, it is two-sided. But I see it as a conversation, one that we are all a part of. 

In an interview with Vox last Friday, On Immunity author Eula Biss spoke to how this conversation, the responsibility we have to protect each other, involves all of us. Even those of us who are not parents making vaccine decisions for our children. She spoke about the “complicated backstories” that lead each of us to make very personal and often complicated decisions, and how in the case of vaccines our decisions go beyond ourselves. That, right there, is what I think makes this whole discussion incredibly complicated (and fascinating) – it’s messy; like debates about abortion or circumcision, the personal becomes political. But unlike abortion and circumcision, we immunize ourselves not just for our bodies but also for others.

“We live in at least, I, live and participate in a parenting culture, an upper middle class, usually white, well-educated parenting culture, that really encourages and supports fear and fearfulness. Fear is understood as a sort of intelligence in this culture. Promoting fear in another parent or mother is seen as a kind of favor. If you don’t think somebody’s feeling afraid enough, your job is to scare them. I think the other way into empathy is to look at how scared people are, and to think about why they’re scared, and what’s happening culturally to support and encourage that fear.”

That’s Eula Biss in the Vox article. I spent most of my Monday following the Washington Post Sunday publication hyper aware of my own fears. I poured out the remaining contents of a bottle of mouthwash because its neon blue color had been haunting me, as if screaming out, “I am filled with chemicals and they are getting into your body and you don’t know what they might do!” I chewed on a piece of gum my daughter gave me, then spit it out about 3 minutes later because I worried what artificial ingredients were responsible for making a piece of chewy stuff red and cinnamon flavored. I questioned whether I had sold out my belief in all things natural, beliefs I never questioned very much until recently. I don’t question those beliefs because all of a sudden I think chemicals are better for me than natural ingredients – all the cleaning and beauty products in our home (except for the blue mouthwash) are still free of that long list of offensive ingredients you see everywhere these days. But I take medication daily and weekly for my auto-immune condition; I have to prioritize what is most important in terms of organic and grass-fed when I buy groceries because I don’t make $1 million a year; I drive a 12 year old car that isn’t electric or hybrid; and I’m not going to keep my kids from eating pizza and cake at a birthday party because the cheese contains hormones and the frosting is made of partially hydrogenated oils.

I think we do what we can to make the best decisions possible – decisions that have to feel right not just in our heads but also in our hearts. We make choices based on what we know in one moment, and cannot blame ourselves later for what we didn’t know then that we do now. Sometimes our decisions change, and to me that is a good thing. One of those same elders in my life once told me when I was in my late twenties, “Consistency is overrated.” There is no medal given to the person who succeeds in holding the same beliefs their entire life. We are here to grow. Our thoughts and understandings evolve, and sometimes we surprise ourselves with where we arrive. And then when we think we’re done because we have arrived, we continue to change.

That takes courage, and courage is defined as “a quality of spirit that enables you to face danger or pain without showing fear.”

immune, or how i made friends with my monsters

/ gal / 3 Comments

I’ve been kind of obsessively reading a book the past few weeks called On Immunity by Eula Biss. I’ve read it with a yellow highlighter in hand, marking passages that make me think, that make me go, “Mmm hmm, I’ve been there. I know that thought. I know that fear.” It didn’t take me long to realize that her writing – which is philosophical and poetic more than it is medical, in spite of her topic – was familiar. I had read and scanned and saved an article she’d written in January 2013 called Sentimental Medicine, which was published in Harper’s Magazine. It was this article that grew into her book.

When I finished the book I read an interview with the author in which she explained that she hadn’t set out to write a book or even a published essay about vaccination. She had started writing about it for herself, to sort out her own thoughts about it all. I get that, too. That’s why the book was so fascinating to me, because of my own journey around this in the last 12 years. When I was a child, I wanted to be a psychologist, and perhaps I should have listened to that call. I am fascinated by the human process, and in my personal psych lab I am my own favorite study. I read the book because I wanted to better understand my own personal journey around vaccination; because I am fascinated by the process that led me to do a 180 around the question of whether and when to vaccinate my children.

Disclaimer: I’m not writing this to preach. I’m not writing this to change anyone’s mind. My intention is not to tell anyone what to do. I’m writing only about my own journey here. And I understand how deeply personal a choice this is, even while I now understand how deeply public a choice it also is.

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When I was pregnant with my first daughter 12 years ago, whether or not we would immunize her was a hot topic. I read everything I could get my hands on at the time, talked about it with our midwives, talked about it with fellow pregnant friends. I lived in the San Francisco Bay Area, and if you’ve ever lived in the Bay Area you know that there are ways of thinking that aren’t questioned in a way they would be if you left the Bay Area – which I did four years later. Especially around all things related to motherhood and children – birth, breastfeeding, vaccination, nutrition, education.

It was easy to feel inadequate amid the collective messages that circled around me at the time; in fact, it didn’t take long for me to feel like no matter how hard I tried, I was doomed to fail at being the perfect parent and raising a radiant, thriving child. The homebirth collective I was a part of held an “immunization panel” to discuss the issue, where parents could ask questions of practitioners on both sides of the “to immunize or not to immunize” question. When I remember it now, I’m not so sure the panel really did include all ends of the spectrum. But I really believed, at the time, that I had done my homework. Before our daughter was even born, I spoke with her pediatrician – who after practicing for over 35 years was no novice to children’s health – about a delayed and partial vaccine schedule for our child.

And that is what we did. For her entire first year of life, our daughter wasn’t vaccinated. I wanted her pristine immune system to have a chance to build up on its own, without being bombarded with viruses and chemicals. I breastfed her and understood that this would keep her safe. She wasn’t in daycare during that time so she wouldn’t be prone to all of those germs. Her pediatrician explained that an adult with whooping cough might just have a cough, whereas a baby with it could stop breathing, so to keep her away from anyone coughing, even at the grocery store. I could do that.

When she turned one, a magical number I’d decided was enough time for her immune system to be strong enough, I took her to get her first shot. On her immunization record, it says that shot was for HIB, which I remember her doctor said was very dangerous for a young child. A month later she got her first polio shot, and five months after that she got her first dose of DTaP, except I asked for the version that did not contain the P for whooping cough. My understanding was that she was past the point when pertussis could make her airways shut down; she couldn’t die if she got whooping cough and I was more terrified of what I’d read and heard was in that part of the vaccine and what it could do to permanently damage her body. I can’t remember anymore what terrified me so.

It took the next 9 years to get my daughter caught up on all of her immunizations. At 11 years old she still hates needles, and since I wanted her to get no more than one or two vaccines per visit, that was a lot of needles and a lot of visits and a lot of trips to frozen yogurt afterwards.

What changed? I can’t say exactly, but a few things happened. First, we moved from the Bay Area and landed abroad and then in the Midwest for several years, and the messages around us changed. While we were abroad, I got very sick with shingles and my then three year old daughter kept wanting to touch my blisters, which could give her chickenpox. I couldn’t imagine caring for a child sick with chickenpox while I myself was so miserable with fiery blisters on my chest, back and arm. So I got in a cab and rode to the other side of town to pick up what seemed like the last remaining chickenpox vaccine in the city, and then took my daughter to the American doctor to get the vaccine put into her system. He warned me that it would take two weeks to really build up her immunity and that she would need a second dose at some point to be even more effective.

The first time I felt let down by what I had believed about vaccines was when I got the shingles. I had had chickenpox as a baby, a full blown case, the kind that I had previously understood would provide me with much “stronger immunity” to shingles than the chickenpox vaccine ever could. Well, I know now that shingles doesn’t work that way – once the chickenpox virus is in your system from having had it, you are always at risk of getting shingles, a piece of the same virus that travels in your nerves, and it can come out when your immune system is compromised in some way, which mine was.

We left our life abroad abruptly and unexpectedly when we learned that our second daughter, who had been growing inside me for 21 weeks, had a serious and life-threatening birth defect. Our baby girl was born back in the Bay Area and lived for just two months. For her entire short life, she struggled to breathe. She lived attached to machines that helped her to breathe and tubes that administered medicine and fed her my breast milk. During the few weeks when we held hope that she might at some point be able to come home on oxygen, we talked to the doctors about whether they could vaccinate a child so fragile, and which vaccines were most important to protect her. We discussed the yearly RSV vaccine for children with fragile lungs and airways. We discussed the pneumococcal PCV and HIB vaccines. We discussed whether she could wait to get her Hep A and B shots.

What changes forever when you watch your very sick child fight for every breath, when you hold your child alive but attached to so many wires and tubes helping to support her, when you hold your child as she breathes her very last breaths and her spirit lets go of her fragile body? You take nothing for granted again when it comes to the health of your children. Nothing. And what matters changes completely. Forever.

I took so much for granted when I was pregnant with my first daughter. And for the first half of my pregnancy with my second daughter (which was actually my third pregnancy since I’d miscarried early the second time) I was also incredibly confident. Even with the shingles I had during that third pregnancy, a few months before the ultrasound that revealed her birth defect. I remember rebelling against using the word “defect,” instead referring to it as a birth “anomaly.” With time, I’m no longer attached in that way; they’re just words, really.

When we made our decisions about vaccines the first time, I hadn’t seen what my daughter’s pediatrician had seen in the clinics overseas where she had volunteered and in the U.S. hospitals where she had worked. I hadn’t yet spent 58 days in the NICU, praying over my child that the fluid in her lungs wouldn’t become full blown pneumonia. I hadn’t seen all of the other sick babies around her. I hadn’t yet heard from other bereaved parents about all the ways babies can die. It was all abstract. My child couldn’t die from measles. My mom had had measles and she was just fine…

After our baby died and we had moved to the Midwest, our new pediatrician was a heavy pusher of vaccination. She was not green either, she’d been practicing for over 20 years and she understood public health. She was as concerned about the community at large as she was about my daughter and her other young patients. “You can go blind from measles,” she explained. At first it irritated me, and I clung to my long-held beliefs about not wanting to bombard my robustly healthy five year old with a bunch of shots filled with preservatives, many for diseases that didn’t even exist anymore, at least not in the U.S. I didn’t want to sell my Bay Area-raised soul just because I was living in the Midwest, where so many less people seemed to question vaccination.

But something happened over time: I forgot why I had felt the way I’d felt when my daughter was born. I couldn’t explain to her doctor or to other moms why vaccines were so dangerous. In a way, my fear of immunization began to dissolve, perhaps because of all I’d seen in the NICU. Perhaps because I no longer trusted that nothing could harm my child if only I did all the right things to strengthen her immune system.

Over time, I started hearing our new pediatrician differently, trusting that she had my child’s – and all children’s – health at heart. We continued to get her caught up on her shots. My only holdout was the flu shot. I still believed that for my healthy daughter, and for our healthy family, the flu wasn’t a danger. We all took our vitamin D and fish oil and ate well and washed our hands. The viruses our daughter got about once a year, whether they were the flu or something else, meant a lot of movies while she lay on the couch drinking Gatorade and sucking on popsicles; they would strengthen her body to protect her from worse things.

Then I read Biss’s piece in Harper’s and for the first time, I understood how herd immunity works. And that is the piece that tipped the balance in how I felt. There is a line somewhere in the article – and in her book where these pieces of the article appear – where she explains that for many years it worked for some people not to be immunized because of the herd immunity provided by all those around them who are vaccinated. I was reading the article at work while I ate my lunch, and I froze. A voice in my head – my own voice from years before when my first daughter was just a baby – said, “We don’t need to vaccinate her. She’s safe even without her shots because everyone around her is vaccinated.” I actually said that, several times, to several people. Friends said the same thing to me about their unvaccinated children. We had that luxury – we could count on herd immunity to protect our unvaccinated children from illnesses.

I didn’t think about others. I didn’t think about children like my second daughter, who are too sick to be vaccinated but who need more than anyone to be protected from illness, how herd immunity protects them. I didn’t think about old people, those who could die even from the flu. I didn’t think about how herd immunity protects pregnant women and their babies. I didn’t understand then – as I was now understanding for the first time – how my vaccinating my child meant contributing to the protection of not just my community but the larger community of our entire world.

I copied the article and gave it to my husband to read. I think he was relieved. I shared it with a few friends, not because I felt the need to convert anyone to my new realization but because I needed to process what I had just understood with people I trusted. I can’t say exactly why the idea of protecting others all of a sudden hit me in a way it hadn’t before – I have always been a sensitive and empathic person – but it did. Hearing myself all those years before taking for granted that my unvaccinated child could remain protected without my having to vaccinated her… well, that got me.

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“One of the mercies of immunity produced by vaccination is that a small number of people can forgo vaccination without putting themselves or others at greatly increased risk. But the exact number of people this might be – the threshold at which herd immunity is lost and the risk of disease rises dramatically for both the vaccinated and the unvaccinated – varies depending on the disease and the vaccine and the population in question. We know the threshold, in many cases, only after we’ve exceeded it. And so this puts the conscientious objector in the precarious position of potentially contributing to an epidemic.” – On Immunity, Eula Biss

Measles is back in California. That makes me wonder if I would have trusted the herd immunity around me quite so cavalierly if this had been the scenario when I was pregnant for the first time.

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“Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” – Illness as Metaphor, Susan Sontag

I live with an auto immune condition that requires me to be on immunosuppressant medication. That means that I have joined the ranks of those with fragile immune systems – babies, elders, pregnant women. I am more susceptible to viruses than others. I can get more sick than others. Thankfully, this has not played out in horrible ways, and I do a lot to support my health and immunity. But it is always something I am aware of and health is not something I take for granted. This year we all got flu shots, including my strong-as-an-ox husband because his work takes him to hospitals and nursing homes and places where people are vulnerable.

My son came to us through adoption, and there is so much we don’t know about his biological family’s health history. He is almost two years old and he has had almost all of his shots according to schedule. The only one I requested delaying, because he was born early and weighed less than 4 pounds at birth, is Hep B, but he had that shot within his first year. Like my biological daughter, he is robustly healthy.

My daughter is all caught up on her shots, too, and next month at her annual physical she will get some of her boosters and one vaccine that didn’t exist when I was her age, HPV. A vaccine that can help prevent the only thing known to cause cervical cancer? To me, that one is a no-brainer. I am not naive about this. I still read everything I can get my hands on about immunizations and so many other things related to health. I read them critically and I ask a lot of questions. I read medical journals and philosophical pieces like Biss’s book, which questions the origins of our fears and mistrust about all things medical and “foreign.”

And lately, I’ve been questioning a lot of my own fears. Because I don’t have the luxury anymore of taking medicine for granted; medicine, that imperfect system, has helped me. I have an ongoing relationship with my doctor and each year I am the only one in our family who meets my health insurance out-of-pocket maximum. I recognize my need for the medical system, however much I would love to not come anywhere close to that limit each year.

Because my illness is related to my digestive system, I have spent a LOT of energy fearing what I consume. I have wished I could afford to eat only grass-fed meat, eggs, dairy, only entirely organic vegetables and fruit and grains. I have spent weeks and months trying out a paleo diet, a vegetarian diet, a grain free diet, a vegan diet. I have feared meat and I have feared soy. I have feared grains and dairy and sugar and caffeine and alcohol, even chocolate. I have feared toxins and heavy metals and chemicals and candida and leaky gut, and so many other things I can’t even remember them anymore. I have learned the hard way that detoxing and cleansing are not good for me, that they always trigger a flare of my illness.

And I have learned that this fear doesn’t serve me, that it doesn’t guide me towards healing. I am learning to nourish myself and to approach cooking and eating as an exercise in nurturing – myself and my family. As I read Biss’s book I heard myself so many times; her fears were mine, her insecurities as a mother were my own. And one more thing was mine, too: a surrender of the idea that we have any control over any of it.

We spend 9 months in a completely sterile environment, and the minute we come through the birth canal we are exposed to millions of bacteria. Google the word microbiome and you’ll understand how dependent we all are on these bacteria, which also need us to survive. And, as Biss describes, how intricately connected we are with everything that lives within and around us, including each other.

For me, that helps to take away a lot of the fear. Since I can’t protect my children or myself from EVERYTHING that is out there (and everything that is already a part of us), all I can do is my best to care for, nurture and protect our perfectly imperfect bodies.

Note: Biss refers to “how we make friends with our monsters” on page 154 of her book. This made me think about how we all carry monsters inside of us, both literally (the organisms that are a part of us and that we are a part of) and metaphorically (our fears, our insecurities), and that perhaps if we make friends with them we can see how much we need them and they need us.