Nurse Conference 2013 - Padma Lakshmi

Nurse Conference 2013 - Padma Lakshmi

Nurses Conference 2013 - Padma Lakshmi

I want to thank everyone for being here especially on this chilly, fall Saturday. I want to thank Mady Schuman and welcome her as the new Executive Director and thank all the people that are involved in putting this together. I heard you guys had some A/V problems this morning. But luckily there is no A/V, there are no visuals in my presentation.

The only visual is me but I want you to visualize something. I want you to look at my face and throughout my talk I want you to just imagine my face multiplied by a 190 million. One hundred and ninety million women on a cold, chilly October Saturday, 190 million young girls who are doubled over in pain, 190 million girls who maybe get sent to their school nurse who does not know what is going on; or gets teased by her younger or older siblings to get out of the bathroom because they take up too much time and do not get believed, a lot of times, by their general practitioner or their parents. Not all cases are the same. I am going to talk to you about mine this morning. So but yes, this is a brought lunch, after this we do get to eat.

I got my period when I was 13 years old. I got it on my 13th birthday, so that was a great gift, kind of, not. So I got my period and was very... I was prepared for my period because my mother, who is also a nurse who helped me with firstly for the idea for this conference a few years ago, she told me that I would probably have trouble when I had my period. By trouble she meant swelling, bloating, what she called emotionality. What I now realize was just a reaction to chronic pain and hormone and chronic pain and headaches, back aches, cramps, numbing. Over the years all of what my mother said came true. I did not really think about it that much because when she talked to me she gave me that talk that all parents give their children about the birds and the bees. She said, "You know this is just your lot in life. Some girls get pain and some girls don't. I had pains so you'll probably have it". I was expecting it.

Over the years, over the months, all through high school it got heavier, and heavier and heavier. If you were my school nurse in my high school you could have known that I had endometriosis even if you never laid eyes on me. All you had to look at was my attendance record and you would have seen that I was missing from school, from track practice, from school dances, from class projects four or five days a month. That is almost 25 percent of my education that I was just absent for, not there. And that is not even talking about the ways that it affected me emotionally and physically and mentally. That is just academic, that is just social.

 

Because endometriosis, we have had ample visuals about how it actually occurs in the body, because it occurs and develops in the body when a young woman is becoming a woman it becomes part and parcel of how she feels about her body; about how she feels about herself and her self-esteem. It is such a tender and vulnerable time for most of us. To layer on top of it a condition like this that you really do not want to talk about is very traumatic; not only for the young girl but for everyone who she loves and for everyone who loves her in her family and social circle.

At Endofound we like to think of this not as a woman's disease, we like to think of it as a family issue. Because, when a woman is down with pain everyone in her household suffers. Think about when you guys miss work because you are sick with the flu. And I am sure there are women in this room who have endometriosis, that know it and I am sure there are women in this room who have endometriosis who have not been formally diagnosed. But I would guess you have some suspicion of it because you are here for a start.

I went through high school and I went through all of that and I got to college. Sharon is my college roommate; she and I went to university together. The pain started getting worse and worse and worse. I remember being in tears in our big, beautiful kitchen for a college apartment, I must say we were very lucky, I would say, "Sharon please go get me a heating pad because my heating pad broke... Please can you go the pharmacy and fill this prescription out". Sharon can tell you she thought it was a little bit dramatic or histrionic because I was! I was in so much pain. It is hard sometimes to accept why things happen for a reason, because, you know, my roommate Kelly was taking two Advil, putting a Tampax in her back pocket for later and going off to basketball practice when she had her period. And I was literally doubled over in my bed. The only reason I would get up was to change the towel under my backside because I knew I would leak again.

It is very embarrassing to talk about this when you are 14, when you are 16, shit, when you are 35 or 40 it is hard to talk about it. But you have to talk about it because the only thing that I have now understood about my own condition and about my own pain that I suffered for decades is that the reason I had the pain was to be here today. It must have been. To hold this mic and to talk to you and to talk to another group of women and hopefully that they will pay it forward.

One thing I am going to ask you guys to do is, if you would not mind, after leaving these doors today, within one week, it is Saturday, okay, so next Saturday is November 2nd, within these seven days please tell seven people. Just tell seven people. Do you have Facebook? Put it on Facebook. Take a picture of the poster send it on to people in your email list. Talk to other nurses who are colleagues of yours who have not gone through this program or who were unable to be here today. Maybe go back to your practices, your schools, and see - look at the attendance records of some girls. Ask your colleagues, say, "Are there any people that are, women that are missing, young girls that are missing..." because that becomes very important. Sometimes a young girl just needs somebody to say, "You know, this isn't right, can I help you?" It is astonishing to me that I went undiagnosed until I was 36 years old. But that is the truth. I had very good health insurance, I was very blessed and lucky to have that. There were medical professionals in my family, my mother is a registered nurse she worked at Sloan Kettering when I was young and yet, I went undiagnosed. I had access to the best medical care in Los Angeles or London or New York, wherever I was living at the time. I continued on this way started...calls, started modeling. In my modeling career too I would have to time out in the calendar and see when my period was coming. I would have to tell my agent, "I'm sorry, I can't do that shoot" because I knew I would have my period. I would be scared if it was a bathing suit or something that I would soil the samples at work. It was incredibly embarrassing. The last thing you want to do is call your colleague and call in sick again for a condition like this. So I would make up excuses. I did not always want to say I had my period, so I had a headache, or I had the flu, or I had a personal emergency or a family emergency, I locked myself in the elevator. Anything so that I did not seem like a chronic problem because if they understood that this was a chronic problem then I knew that I would not get looked at the same way for jobs. Pretty girls are a dime a dozen and I knew that there were 17 models who were willing to do my job. All you had to do was go down alphabetically. It already took half the alphabet to get to me. So, I hid it a lot of the times or I diminished the scale of its effect on my life.

Now we are going to flash forward to my 30s. I think I was 33 and I was living in Los Angeles. By the way, all this time I had been going on regular gynecological exams. I mean...probably once every year, once every two years, nobody said to me, "Why are you taking a handful of Vicodin every month?" Nobody said, "Gee, Tylenol 3 with codeine every two hours. Maybe we should check this out". Nobody said it to me. I had gynecologists who put me on birth control to try and as they said "suppress your symptoms" and it did suppress my symptoms. But I think for me that was not a blessing because all it did was mask the problem and delay me having to deal with it. So the disease grew and grew and grew, like rings on a tree, like weeds in a garden.

I wanted to call the foundation the Healthy Womb Society because I thought endometriosis was such a long word, you know? It was not very appetizing. But I think it is good that we called it Endofound because we need to say it all the time. You know, the supercalifragilisticexpialidocious, you can say endometriosis, endometriosis, endometriosis so that people understand the word, they are familiar with the word, they know how to pronounce it, they know what it is and they know how to treat it, that there is treatment.

I was on birth control for most of my 20s and then I went off birth control and I had all kinds of problems with birth control; it would give me pregnancy spots, it had all kinds of collateral effects but the biggest effect that it had was it delayed me actually dealing with this disease. It gave me another instrument by which to shove it under the covers, put it in the drawer and away, until next month when it came. It is almost like an alcoholic who does not want to think they are an alcoholic. They put everything away when they are sober and then next month it happens again. I just did not know what to do. So finally I had really bad cramps. I went to see a doctor in Beverly Hills and he performed a surgery. Listening to Dr. Seckin's presentation about endometriotic cysts and so, he told me, "You have two cysts in your body in your ovaries. I'm going to remove them. One is endometriotic, where blood filled", he said. But he still never said the words to me, "You have endometriosis. It's a condition, you have to check it out you have to maintain it. It's not normal". Because it is not normal. Pain is your body's way of telling you something is wrong.

 

The only patient worse off than a stage four endometriosis patient like me is the one who presents as asymptomatic, who does not have any pain and does not know that anything is wrong. That is terrible. In my case I knew something was wrong and all the people around me did too. They were just dealing with the superficial aspects of it rather than the cause.

So I had the cysts removed and fine, okay. And he said everything should be fine now, really. He said, "You'll be okay now". And it was not. Slowly, the cramps started coming back and getting worse. And then, one day on my second wedding anniversary I went out to dinner with my husband. I did not want to go but it was our anniversary, reservations in a beautiful restaurant downtown. Went to dinner and increasingly my lower back was hurting. It was not time for my period so I did not think anything. I asked the maitre d' for a pillow. Because it is me they gave me all these dishes from the kitchen that I did not ask for. The only high class problem I have with being on Top Chef. And you know I kept like saying, "Okay, okay, let's just muddle through". We went home and I said to my husband, "I, I, something's wrong. I really have cramps. I don't feel well". You know, my lower back was radiating with pain, I did not know what to do. And he literally thought I was just exaggerating because I did not want to be intimate. I did not want to be romantic. We had a fight, not the first, not the last fight.

It is very lonely for people who love people with endometriosis. Now looking back on it six years after I wonder what our marriage would have been like if I did not have endometriosis?

I called my doctor, and I have a very nice doctor, he does make house visits and he said, "Listen I'm out in New Jersey, drink some green, drink some mint tea because mint is an antispasmodic". I said, "We are way beyond fucking mint tea". I am sorry to say it. I was literally like I felt crazy. I felt my scalp itching. And, you know, four slammed doors later, across, you know, my step-son's room he is sleeping in there. I am sleeping there and I am on the phone with Dr. Primus and he said, "If you can just hang on I'll be there in an hour" he got stuck in traffic. I said, "I need to call an ambulance, I'm scared". This was like midnight. He said, "If you call an ambulance New York state law they have to take you in to the hospital. I don't want you sitting in the emergency room for six hours. You don't now what it's going to be like". And I said, "I can't stand it any more". I called the ambulance.

The ambulance, the guys came, Dr. Primus got there. He can see I am in pain. He can see, because he knows. He said, "Okay, I need to give her some pain medication". "No, you cannot give it. We cannot give it". He said, "Okay, I'll follow you to the hospital". We go to the hospital. I meet a great doctor who is very sweet who was a gastro surgeon. They tried to make me drink something and take this scan. I throw up all over the scan and it is horrible. My family is being called from Connecticut and everybody is rushing to the hospital. The only satisfying brief moment was when I said to my husband, "You believe me now?"

This doctor did gastro surgery laparoscopically and he came to talk to me after, all my family members, a sea of brown people in the waiting room. He looks, they say, "What's going on with her now?" He said, "You know I see you have a scar on your arm. We went in there and there was a little piece of scar tissue that had wrapped itself around your small intestine. And we don't really know why the body produces scar tissue it just does. Maybe it's scarring from the ovarian cyst you had removed a few years ago in Los Angeles. And I think it has been there for a while because I lifted it up, I snipped it and the intestine should spring up but it didn't. It had still remained depressed; it's like stepping on a garden hose. So I can massage it". So all that food I had been eating was backed up and that was what I was throwing up. Nothing could pass, my system was completely blocked. He said, "But, now you should be fine. Now everything should be fine. It's okay". Nothing was fine.

I truly believe that that doctor who is here on the...side gave me the best care he knew how to give. The care he would have given his daughter or his sister, his wife or mother. But he is a very established amazing doctor; he went to medical school 40 years ago. They did not teach you that much, especially if you were not a gynecologist, about endometriosis. Which is why conferences like this and the medical conference we run is very important. I believe that every doctor, every doctor should know about endometriosis; any doctor working in the body cavity because it becomes misdiagnosed so much; diverticulitis. My mum had her appendix out. She now believes it was because of endometriosis. They just did not know what to do back then. So I said, "Okay, this time I'm going to be fine too", was not fine.

Then I was at a photo shoot for my cookbook and I started bleeding in the middle of my cycle. I did not know why. I sent the assistant out to get me Tampax just so I would not, I knew we only had the location for the day. I had to do the photo shoot. I was not in pain but I was having this weird bleeding so I just, again, tried to stop the problem and move on, tried to shove the problem away. Put a Tampax in, tried, you know, smile and do the picture like nothing was wrong. Then finally, after the shoot I took out all the bunch of tissues, called Dr. Primus. I said, "This is what happened, I don't know what to do". He said, "You know you're always complaining about cramps since I've known you. If you can't get a hold of your gynecologist I'm always giving you medicine, I'm always seeing this as a repeating pattern and I'm very worried. Please go see a friend of mine and tell him that I sent you. Tell him that I'm worried about you. And I'll talk to him too".

 

It was October 2006. No, yeah, 2006 October. It was a chilly day like this. I will never forget the day. I had a big day of appointments starting at 5:30 to be on the Today show, and ending at 6:45 by going to a fashion dinner at Bergdorf or something for a friend of mine. In the middle of this I had made this appointment at Dr. Seckin's office and I went there. I remember I had, like all of us, we have a million things a day to do so we try like multitask? So, okay, if I wear my evening gown I can go to see Dr. Seckin and I can go straight to Bergdorf. I am sitting there in a twinkling in my little cute cocktail dress, my boobs all up to my chin, waiting to see Dr. Seckin. I go in and he asks me, he says, "Come into my office" and he is asking me like three pages of questions. And I am thinking, "I already filled the 14 pages that you have to fill on the clipboard before I got to you". So, fine, fine, I am looking at my watch, okay. He takes me to the examining room; he and his nurse examined me. He asks if he can do a rectal exam. I have never had a rectal exam, I highly do not recommend it if you can avoid it. So, I am going okay, that is weird that was the first time that something was not at all okay. But little did I know that was the first sign of hope when somebody actually went the next step rather than just pulling out the prescription pad.

He said, "Okay Ms. Lakshmi, please get dressed and come to see me in my office". And he closed the door and I asked him, I said, "Dr. Seckin, can you please tell me is this going to take a long time? Because I'm a little bit late, I have this dinner". I am thinking it is not that far from his office to Bergdorf. There is enough time that I can maybe put lipstick on and like just clean up under my eyes. He said, "You know Ms. Lakshmi this is going to take a while. I suggest you put down your cell phone. I believe you when you think you are telling me the truth to the questions that I asked you before I examined you over there. Because you are standing on your own two feet and you walked in through my door to my office. But your anatomy and your story do not match your life. And I don't know why you're not on the sidewalk, on the floor, writhing in pain. I think you have sublimated your pain so long and so well and so professionally that you don't know you're in pain anymore and you are functioning at a level that is really unconscionable" is the word I believed he used. "I don't believe you when you say everything is normal at home with your husband. I don't believe you when you say you have mild gastric problems. And I don't believe that nobody, ever, detected this in you. Did you go to the doctor? Do you just have your GP give you meds? How many gynecologists do you have? Who is your last gynecologist? Where do you live? Why did this guy do surgery? What's his name? Did he do this, did he say that?" And I said, "Well, is it a big problem? Like what do we do? He said, "Yeah, it's a big problem. It's a really big problem". And I said, "Well how long, what do we have to do?" "We have to operate right away". I said, "Oh, well that's not going to work". I said, "Well, when do we have to do that?" He said, "No, immediately!" So again, I have this mechanism of compartmentalizing everything so I said, "Okay". This was in October, like now. I said, "What if we do it the Wednesday before Thanksgiving?" Because then I figured a) none of my family will have to take off their work, they will already be off; and b) I won't really be missing for work because everybody will be off. Because he said you will probably be maybe in the hospital overnight and probably in bed all weekend but within a week you can go to the gym and go to your desk go to the office". Okay, great.

 

So we prepared. I said, "I want to do the Wednesday before Thanksgiving". I had it here. He said, "I think this surgery should take about an hour and a half but we'll see". Dr. Seckin was in surgery with me for four and a half hours. Talk about kidneys in stents? I had those. I had stitches in four major organs. He did 19 biopsies of which 17 were positive for endometriosis. He scraped out of me what was blocking things and a lot of what you saw. I have always had the suspicion that he is showing slides of my body and I do not want him to do that. It is very hard for me to watch. It is really hard to get up here and talk about your period. To you guys not so much but in general, nobody wants to talk about their vagina. But I do it all the time because I hope that there are all those 190 million faces of the next generation of girls who will not have to go through what I did.

So I had that first surgery and I was not up after the weekend. And I was not back to work or the gym in a week. It was Thanksgiving. I was in bed, lying in my bed until February. That is how much it affected me. I was weak, my mother flew in from Los Angeles and then she flew out. I think she was still working at the time she is retired now. My aunt flew in from India to take care of me, to relieve her. It just was - and you know when you have that many weeks to lie on your back and look at a white ceiling it really makes you think about your whole life. You have no choice. A lot of time on your hands to let your mind wander. I started to think why the hell was I not diagnosed? Why did not somebody see what was going on, why did my mother, why did my mother tell me not to be scared? It is very scary what happened to my body. Why did every gynecologist say, "You know it's not really - you don't want to be on Vicodin or Anaprox or Naproxen". I know all of the trade names for all of those kinds of medicines in any country I have lived because for a while I lived in France, I lived in Spain, spent six years, most of my 20s, in Italy. I think I knew all of the names they make this. Naproxen is horrible. Anaprox made my stomach burn. Vicodin gave me constipation like you would not believe, and nausea and headaches. But nobody said what is causing this, what can we do? Once I had that operation things got a lot better. And he told me, "I may have to go back". I got scared and he said, "At one point..." you know how he talks you've heard him talking, "At one point I was lost in your womb. I didn't know where I was. I took a left turn and then I was lost". He said, "This is connected to that that is connected to this, none of it should be connected at all. And you know there is a path and now I'm off the path". It was like, okay. He said, "The anesthesia has worn off too much for this conversation".

Then I got back to my life and slowly things got better and I had another surgery with Dr. Seckin. After the first surgery he came to my bed and he said, "Do you know that your left ovary, part of it is really not there?" And I did not know that at all. Nobody told me that. He said, "I saved your right fallopian tube but I want to tell you that I don't know if I'll be able to in the long term. I'm leaving it for now. We're going to do another follow up surgery because it's - it's such a stress on the body". He did it laparoscopically but still you think about all that intricate cutting. I always like to think of the womb as a garden, you know, where life grows. Endometriosis is like weeds in a garden. So you have to get a doctor who is patient and thorough and a perfectionist who really wants to go behind the bushes and behind the fence and under the rock and around the flowers so the flowers stay intact. The fruit trees still blossom. But you have to get every last thing out, even if you do not do it in one go because like weeds, it comes back.

So I had two, three surgeries - I have had five surgeries in total including the cyst surgery, including the gastro surgery that really just was the tip of the iceberg we know. I went through a divorce. I got divorced in 2007. In 2008 I think Dr. Seckin and I were talking about starting a foundation or they had done something for patients before I got here so I have got to give credit to all the people that were with Dr. Seckin before I ever met him. And then we decided okay let us really launch it and stuff. In that process he said, "I really want to you to talk to young girls. I have this patient, she saw you walking out my office. She really loves Top Chef and she's very scared, can you just talk to her so she will be, you know, she'll feel like somebody who is on the other side can understand her?" And then we started doing this kind of privately we started doing it thinking about starting Endofound. During that time, it was a very lonely time for me because for six months I was living at the Surrey Hotel uptown. I was going through a divorce and I just called it the Sorry Hotel. Sorry. Sorry, have to go. Sorry. I am so upset I am telling - and then I moved into my little apartment downtown and he said, "You know, what're you doing about your fertility?" I said, "Well, you know, I don't know". He said, "You know your 38 you're going to be 39, whatever." I said, "You're right, you're right, let's freeze my eggs". By this time he had to remove my right fallopian tube. So my left ovary was shot, my right fallopian tube was gone. Basically rabbit ears were holding it all together.

So we went to a very swanky fertility place up on Madison Avenue and I met with the doctor. They can do all of these tests when you want to freeze your eggs, and not that is covered by insurance, talk about Sweden you should be in Manhattan you don't know how hard it is here. And in the process of doing all those tests I got a call from the doctor who said, "Ms. Lakshmi, I'd like you to come in I want to talk to you". I said, "No, no, no you talk to me on the phone, I'm very busy, what is it?" He said, "Your ovaries - I got your results back". I said, "Okay, tell me what I have to do". He said, "Your ovaries are older than you are". I guarantee, no matter how good you're feeling and I wasn't feeling that great about my 40th birthday coming, you never want to hear, have someone tell you you're insides are even older than you are. And he said, "You know I think there is going to be a ten to 15 percent chance that you are going to ever be able to get pregnant even with IVF". I said, "Well, what about naturally?" He said, "I don't think you have a very good chance at all". I said, "Define not a very good chance." He said, "In my professional opinion I would be incredibly shocked if you got pregnant, at all". So we froze my eggs. I still think about those three little guys in some fridge somewhere, they are my little seeds of hope. I was devastated.

 

At first I was really just shocked and sad, and then slowly it began to rise up in me, almost like gastric acid, literally like a burning red swirl that came up and came up and came up. And it was like that when I was bedridden after the first surgery. I started getting really angry. I started getting really upset. I started saying, "Why is this happening?"

 

I remember years ago I had tea once with Jesse Jackson. Whatever you may think of Jesse Jackson the reverend...I want you to know when you are one on one with him he still talks in rhymes. He does! He does, he still talks with those, you know, those kinds of limericks - always he's very poetic. And I will never forget one of the things he said years ago, he said, "As a black community, as people, we have to turn our pain into power". I thought that was such a great turn of phrase and it always stayed with me. In this case my pain had turned to anger and I really did not know anywhere, I did not have anywhere for that anger to go. So I called Dr. Seckin and I was in tears, I was literally blathering and I told him what this other doctor said and he said, "Okay, we will try but you know insha'Allah, what can we do". And I said I wanted to do this thing now, I want to do it, let's start the foundation, let's do what we like, pull together four...and three tables someplace and party and raise some money with it, like 15 minutes, pulled all our friends to do it.

That was in April of 2009 when we started Endofound and we had our first little charity event and since then we have - I gave an interview to Newsweek.com when we did it and a researcher named Linda Griffith at MIT happened to read the article and she had been a lifelong sufferer of endometriosis and had hidden it from work colleagues because she did not want to be passed up for tenure or promotions or grants. She even had a couch installed in the women's bathroom so she had a place in private to lie down. She had many surgeries and ah - but reading this article she said made her want to do something about it. At the time she had gotten the MacArthur Grant, the MacArthur Genius Grant and she managed to cobble a few, this is her words - "I managed to cobble a few more million dollars together" that is how Linda Griffiths speaks, in those kind of terms. They opened this research centre and so just because one person said something to another person I always say, I tell you this story because I want you to remember those seven people in these seven days that you are going to tell about this disease, including of course any patient that comes across your desk that you think may need this information.

So we started this organization in April 2009 and in June of 2009 he did not even believe me at first, he thought I was being hysterical, he said, "I know you want to be pregnant but I'm sorry I don't think you're pregnant". I said, "No, I'm pregnant". And I got pregnant. I got knocked up the old fashioned way. I really did. Believe you me I would not have done it the way I did it if I had a choice but nonetheless, no matter how Krishna got here I am so happy she is here. A basic Google search will tell you all the gory details but I digress. Basically, I think that me opening my mouth up and me being so pissed off  about what happened to me and agreeing to talk about my vagina and my periods and my Tampax and my numb butt to anybody who will listen is what gave me the baby.

I am Hindu so I am religious, I am not religious really, but anyway, I do believe that if you pay things forward that you may not get immediately a payoff for doing your best or trying to right a wrong but in the long run you will get paid back. And just holding this mic today and having you guys all here on a Saturday when there are millions of things you could all be doing, I know; carving pumpkins, making soup, thanks because I really appreciate you guys being here and I really want you to tell the seven people that the face you saw here today is really just one out of a 190 million faces.

There was some discussion about who was really responsible for getting me pregnant, Dr. Seckin was. I owe him, not in that way, I meant, she knows - but I am serious. I am so lucky because I have this beautiful little girl. I would not have even probably addressed the situation if I had not met Dr. Seckin. Never mind my illness, but even the notion of my fertility. Most of us are struggling with our careers, the young girls that you see in your schools, if you are school nurses, are going to be the same way. Our world is so fast we are delaying motherhood and becoming a parent in our late 30s, early 40s, mid 40s. I spent my whole life trying not to get pregnant. Can you imagine what it was like to hear that I could not get pregnant after all of that?

We think that we have a lot of time and we think we can push these things under the covers and in the drawer but we cannot. We need as women, as professionals, as doctors, as citizen and fellow human beings we need to open our eyes to what is happening around us. If you have anybody who comes across your window screen that you think could be helped by any information you heard today please open our mouth. If one doctor, one school nurse, one relative, one girlfriend had opened her mouth maybe I would have gone to a Dr. Seckin if not Dr. Seckin many years earlier. I want to see that poster that is out there, I want to see that poster in every girl's locker room, in every woman's bathroom, in every health spa in every facialist. I want to see a mini version on the back of every Tampax box. I want to see pages and pages and pages in every medical textbook of every medical student whether they are in a nursing program or a doctor program to understand endometriosis. Even if I am going to get treated for something else that doctor can say, "You know I'd like to explore this avenue and if I can't explore it with you I'd like you to see somebody who can". Remember that old Fabergé commercial "they'll tell two friends and they'll tell two friends" nobody remembers that? I am that old? You guys remember. That is what I want you to do. And you nurses are our first line of defense. Nobody wants to go to the doctor, even less want to go to the gynecologist. I am 43, I do not want to go to the gynecologist either and I love my gynecologist.

A young girl does not want to go to the doctor. That is why you nurses who have much more influence than a doctor that she sees for five or ten minutes can help, can change a girl's life. If I think back on all of those four or five days that I missed from going out with my girlfriends, from helping my grandmother to learning a new recipe to being at the gym to being at the library, whatever, think about how much more - not only I could have been enriched but how much more my community could have been enriched by me. It is also a big wage loss; some miss work, all of these things. You guys can do the math. I just want you to remember the two numbers I said - 190 million. That is just the people who have trouble with their period. That is not the people who are around those women and love them and have to make up their work at work, have to make the food that they do not cook, have to take the kids to school, have to do, have to do, have to do. I want you to remember that number seven; seven different people in the next seven different days. Thank you very much.