Month: June 2012

Rosy Sunsets

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photo by Nate Gibson

If I can put one touch of rosy sunset into the life of any man or woman, I shall feel that I have worked with God.
G.K. Chesterton

Most evenings there is no sunset fanfare, no departing glowing orb on the horizon, no color spreading upward into the clouds.  The typical evening canvas is just grey and ordinary at dusk, transitioning to twilight, giving into nightfall. Grey-darkergrey-black.

Yet there are times not at all ordinary.  On those evenings, the Master reaches deep for his palette and starts mixing.  As He begins His work,  grey gradually gives way to amber and orange, shifting to red and purple and yellow.   A daub here, a speckle there, then full out splash and streak.  We are invited to pick up a brush and apprentice for Him, learning the sweep of the hand, the grace of the wrist stroke, the fine work of the brush tip outlining the black of darkening shadows.

There can be no wrong color combination; anything goes.  It is a riveting gift of extraordinary artwork: it is meant to be shared, to be taught, to be cherished even if only for a few brief minutes.

When the sky glows with unfolding rose petals, all will see it; this work won’t be hidden away in a gallery or museum.

All too soon it moves on, the canvas plain and dark once again.  And we’re left holding the brush, eager and ready to try again when the timing is right.

photo by Nate Gibson
photo by Nate Gibson
photo by Nate Gibson

Its Small Self

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For a long time
     I was not even
        in this world, yet
           every summer

every rose
     opened in perfect sweetness
        and lived
           in gracious repose,

in its own exotic fragrance,
     in its huge willingness to give
        something, from its small self,
           to the entirety of the world...

Mary Oliver from “The Poet Visits The Museum of Fine Arts”

This time of year, I go out to our flower garden twice a week and pick several fresh rosebuds for the bud vase on our kitchen table.  This feels like a luxury to interrupt the natural unfolding of a blossom simply so that it can be enjoyed indoors for a few days, but “its huge willingness to give something” grants me permission to do this.  I am consoled that there will be more buds where those came from.  The blooms will continue to grace our table until October when the first hard frost will sap them of all color and fragrance, leaving them deadened knots of brown curled petals.  They give no more for seven long months.

I wait impatiently for that first spring bud to appear, forcing myself to wait several weeks before I begin rosebud harvesting.  Although roses from the florist may be perfect color and long lasting,  they are neither as sweet nor their scent as exotic as those growing in the soil right under our windows.

It is a wee joy receiving this humble gift from the garden.  It is enough that a rose in gracious repose gave its small self long before I was and will continue long after me.   I hope I am as willing to give something from my small self during my time here, and may it ever be as sweet.

The Way We Long To Be

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spiraea douglasii

“I had a dog
who loved flowers.
Briskly she went
through the fields,
…and easily
she adored
every blossom

not in the serious
careful way
that we choose
this blossom or that blossom

the way we praise or don’t praise –
the way we love
or don’t love –
but the way

we long to be –
that happy
in the heaven of earth –
that wild, that loving.”
—Mary Oliver

Why do we not feel the joie de vivre, the ebullience and fullness of every moment?  What makes us hide ourselves rather than join the walk in the garden in the cool of the day? What makes us choose this blossom or that, this tree or that, this fruit or that, judging good, better and best?  What has happened to wild loving appreciation of the heaven of earth?

We gave it up for one taste.  Lost heaven and regretted it immediately.

Now joie de vivre awaits, beyond this, above this.  Invited, all expenses paid, unearned, back to the way we long to be.

It’s loving that wild.

Elderberry

Spotting POTS

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As a college health physician, I see my fair share of fainting patients, including syncopal episodes within the clinic itself, typically while they are using the toilet, or after venipuncture and vaccinations.  Our staff is as proactive as possible to avoid these predictable occurrences, listening for problems in the restrooms, putting students in a recliner chair for their blood draws and observing them for awhile post-injection for lightheadedness.  Despite taking reasonable precautions, fainting is still common in a clinical setting, especially for those with previous history of vasovagal syncope, and those coming in with significant acute illness and/or anticipatory anxiety.

What is particularly puzzling is a two-fold increase this year in reported syncopal episodes outside the clinical setting–in dorms, apartments, class rooms and dining halls.  These events become disruptive and concerning for everyone involved–the patient subsequently feels embarrassed and frightened, especially if it is a first time event,  professors and peers witnessing a sudden loss of consciousness inevitably call 911 from their cell phones right away,  and when EMTs arrive, they do only a cursory review as the patient is conscious with usually no need to be transported to an emergency room.  We try to see them in clinic right away.

As I reviewed charts of several dozen students with syncopal episodes outside a clinical setting during a recent quarter,  I could usually identify a clear explanation for the faint such as significant stress, a recent viral illness, excessive alcohol or other recreational drug use, menstrual period onset, or volume depletion for other reasons.   There were two new onsets of seizure disorder and one student eventually diagnosed with narcolepsy.  These faints are, for the most part,  uncomplicated and isolated vasovagal events.   More perplexing is the increased number of young adults,  particularly young women,  with repeated syncopal episodes associated with increases in heart rate, along with significant additional symptomatology that now is being described in the literature as Positional Orthostatic Tachycardic Syndrome (POTS).

Some estimates say over 500,000 Americans may be afflicted with repeated episodes of lightheadedness and fainting due to a host of complex factors thought to be due to autonomic dysfunction.  Standard criteria for making the POTS diagnosis are still not fully defined — this is a clinical syndrome made up of a variety of symptoms that can be extremely variable and sometimes dramatically debilitating for afflicted individuals.  There can be profound fatigue, headaches, cloudy thinking, inability to stay upright for prolonged periods, frequent lightheadednesss, nausea, palpitations and chest pains.  The work up itself is also complex and not always straight forward:  screening lab work with additional evaluation of adrenal and renin/angiotensin/aldosterone systems, EKG, 24 hour holter monitor, 30 day event monitor, brain imaging, EEGs, tilt table testing.  As there is no one specialty that evaluates symptoms like these,  frequently cardiology, neurology and psychiatry consultations are needed. There follows empiric treatment trials of medication such as fludocortisone, midodrine, beta blockers, SSRIs, erythropoetin, along with trials of exercise therapy for conditioning, counseling for the associated anxiety and depression,  as well as increased salt and volume intake, particularly early in the morning.  Compression stockings can sometimes help.  Severe cases may require a pacemaker to help manage the tachyarrhythmias.  Many patients access alternative therapies such as naturopathy and homeopathy, as well as acupuncture.  It is crucial that POTS patients remain physically active as much as possible and not get deconditioned by staying down in bed or on the couch due to their symptoms.  Tincture of time has seemed to make the most significant difference in improving the syndrome.  Approximately 80% of the patients experience waxing and waning symptoms that eventually go into remission in a matter of weeks to months.  A significant percentage continue to have debilitating symptoms for years well into adulthood.

It is not clear why there are more teenagers and younger adults being identified with autonomic dysfunction leading to repeated syncope and near syncope, nor an obvious explanation of the preponderance of women (4-5:1) over men.  There appears to be a familial component that may be significant, but theories include a post-viral etiology, dietary and activity factors, and medication/recreational drug use.  The bottom line is that we don’t know the precise causes but we do know for certain that young people’s lives and well being can be severely impaired by the symptoms.

As more integrated specialty clinics for POTS diagnostic evaluations and treatment are forming at large medical centers, the primary care physician needs to be on the look out to spot potential POTS patients.  We must not dismiss the repeated fainter as someone “with a sensitive nervous system” or simply “anxious.”  There may be a great deal more going on that deserves fuller assessment, initiation of careful treatment trials and most of all, our compassionate care.

 

 

Blown Away

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photo by Nate Gibson

“Flung is too harsh a word for the rush of the world. Blown is more like it, but blown by a generous, unending breath.”
Annie Dillard

It isn’t possible.  The five year old me who had a sudden terrifying revelation that I would some day cease to be has become the almost fifty eight year old me who is more terrified at the head long rush of life than of its end.  The world hurtles through space and time at a pace that leaves me breathless.  Throughout my fifty-plus years, I have felt flung all too frequently,  bruised and weary from the hurry and hubbub.

Good thing there is someone else breathing each breath for me or I would have never made it another minute.  I’d be down and gone in a heartbeat.

Now comes a few days of breathing space, taking a respite from routine.  I’m lifted lighter, drifting where I’m blown, less weighted with the next thing to do and the next place to be.

Instead I just be and always will be.  Be blown away unending.  Blown by breath that loves, fills and nurtures, its generous promise hopeful and fulfilled.

The old me simply ceases to be.  Blown away.

If only the five year old me could have known.

“Wherever I am, the world comes after me.
It offers me its busyness. It does not believe
that I do not want it. Now I understand
why the old poets of China went so far and high
into the mountains, then crept into the pale mist.”
— Mary Oliver

photo by Josh Scholten
photo by Nate Gibson

Reckless Blooming

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“Everything is blooming most recklessly; if it were voices instead of colors, there would be an unbelievable shrieking into the heart of the night.”
― Rainer Maria Rilke

A rainy summer yields abundant shade-loving blossoms.   Continuous cloud cover and plenty of moisture may subdue a summer mood but not in the case of begonias, fuchsia, and impatiens.  Their vivid colors are happily chanting playground rhymes, when not singing arias, reciting epic poetry, and laughing uproariously while partying hardy into the night.

If they were fragrance instead of colors, they would be a perfume shop full of perfectly coiffed matrons who trail scents behind them.  If they were tactile instead of colors, they would be plush velveteen cushions topped with purring cats with switching tails.   If they were taste instead of colors, they would be spice and pepper-hot to the point of tears.

Their reckless blooming abandon is enough in itself to make me weep, without noisy parties,  chilis, heavy scents, or ruffled cat fur needed.

No sun required.  No tropical temperatures.  No promise of 18 hours of daylight.

They simply have enough of what they need to give all they’ve got.   All I need to do is show up, open my eyes and believe.

Dog and God

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photo of Dylan by Nate Gibson

“God… sat down for a moment when the dog was finished in order to watch it… and to know that it was good, that nothing was lacking, that it could not have been made better.”
― Rainer Maria Rilke

Ten dogs have left pawprints on my heart over fifty eight years.  There was a thirteen year long dogless period while I went to college, medical school and residency, living in inhospitable urban environs, working unsuitable dog-keeping hours.  Those were sad years indeed with no dog hair to vacuum or slobber to mop up.

The first dog in our married life, a Tervuren,  rode home from Oregon on my pregnant lap in the passenger seat, all sixty five pounds of her.  I think our first born has a permanent dog imprint on his side as a result, and it certainly resulted in his dog-loving brain.   Four dogs and thirty years later, we are currently owned by a gentle hobbit-souled Cardigan Corgi who is nearing the end of his time on earth, but still has a hop in his step and a wag in his tail.

Dogs could not have been made better among God’s creations because they love unconditionally, forgive without holding a grudge and show unbounded joy umpteen times a day.    It’s true–it would be nice if they would poop only in discrete off-the-path areas, use their teeth only for dog designated chew toys, and vocalize only briefly when greeting and warning, but hey, nobody is perfect.

So to Buttons, Sammy, Sandy, Sparky, Toby, Tango, Talley, Makai, Frodo and Dylan:  God was watching when He made you and saw that it was good.

You were good for me too.

Hana–Brian and Bette VanderHaak’s dog in Japan –American or Japanese?  Doesn’t matter — she owns the chair and her family

Where to Search

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photo by Josh Scholten

“A man travels the world over in search of what he needs and returns home to find it.”
Kathleen Norris

I remember well the feeling of restlessness, having an itch that couldn’t be reached, feeling too rooted and uneasy staying in one place for long, especially if that place was my hometown.  I knew I must be destined for greater things, grander plans and extraordinary destinations.  There exists in most human beings an inborn compulsion to wander far beyond one’s own threshold, venturing out into unfamiliar and sometimes hostile surroundings simply because one can.   It is the prerogative of the young to explore, loosen anchor and pull up stakes and simply go.  Most cannot articulate why but simply feel something akin to a siren call.

And so at twenty I heard and I went, considerably aging my parents in the process and not much caring that I did.  To their credit, they never told me no, never questioned my judgement, and never inflicted guilt when I returned home after the adventure went sour.

I had gone on a personal quest to the other side of the world and had come home empty.  But home itself was not empty nor had it ever been and has not been since.

There is a Dorothy-esque feeling in returning home from a land of wonders and horrors, to realize there is no place like home.    There was no way to know until I went away,  searching, then coming home empty-handed, to understand home was right inside my heart the whole time.  There was no leaving after all, not really.

So I’m here to stay–there is no greater, grander or more extraordinary than right here.  Even when I board a plane for a far off place, I know I’ll be back as this is where the search ends and the lost found.

My head now rests easy on the pillow.

Green Wet Trembling June

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“Green was the silence, wet was the light, the month of June trembled like a butterfly”.
Pablo Neruda

We may be three days into summer but aside from the date on the calendar, it would be difficult to prove otherwise.  It is unseasonably cool, the skies stony gray, the rivers running full and fast, the ground peppered with puddles. Rain fell in torrents last night, hiding behind the cover of darkness as if ashamed of itself.   As it should be.  Then a mid-afternoon thunder and lightening gully-washing storm passed through and completely drenched my drying laundry on the clothesline.

Enough is enough.

What all this moisture yields is acres and acres of towering grass growth, more grass than imaginable, more grass than we can keep mowed,  burying the horses up to their backs as they dive head long into the pasture.  The Haflingers don’t need to lower their necks to graze,  choosing instead to simply strip off the ripe tops of the grasses as they forge paths through five foot forage.   It is like children at a birthday party swiping the frosting off cupcake after cupcake, licking their fingers as they go.  Instead of icing, the horses’ muzzles are smeared with dandelion fluff,  grass seed and buttercup petals.

June tends to shroud its promise of longer days under clouds in the northwest.  Outdoor weddings brace for rain and wind with a supply of umbrellas, graduation picnics are served in the garage and Fathers’ Day barbeques under tent canopies.  There is a wary anticipation of solstice as it signals the slow inexorable return of darkness from which we have not yet recovered.

So I tremble as I splash through the squishiness of June,  quivering like a wet butterfly emerging from its cocoon ready to unfurl its wings to dry, but unsure how to fly and uncertain of the new world that awaits.  In fact the dark empty cocoon can look mighty inviting on a rainy June night or during a loud mid-day thunderstorm.   If I could manage to squeeze myself back in, it might be worth a try.

After all, there is no place like home.

Council of Clowns

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“Coyotes have the gift of seldom being seen; they keep to the edge of vision and beyond, loping in and out of cover on the plains and highlands. And at night, when the whole world belongs to them, they parley at the river with the dogs, their higher, sharper voices full of authority and rebuke. They are an old council of clowns, and they are listened to.”
N. Scott Momaday in “House Made of Dawn”

On early summer nights like this, with light just fading from the sky at 10 PM, it will be only a few minutes before the local coyote choristers begin their nightly serenade.   This can be a surround-sound experience with coyote packs echoing back and forth from distant corners of farmland and woodlands below the hill where we live.  Their shrill yipping and yapping song, with hollering, chortling and hooting, becomes  impossible to ignore just as it is time to go to sleep.  Like priming a pump, the rise and fall of the coyote ensemble inevitably inspires the farm dogs to tune up, exercising their vocal cords with a howl or two.  It becomes canine bedlam outside our windows, right at bedtime.

Coyotes send a mixed message:   they insist on being heard and listened to, yet are seldom visible.  In a rare sighting, it is a low slung slinking form scooting across a field with a rabbit in its mouth, or patiently waiting at a fence line as a new calf is born, hoping to duck in and grab the placenta before the cow notices.   They are not particularly brave nor bold yet they insist on commanding attention and ear drums.

Irritating not only for their ill-timed concerts, they also have a propensity for thieving sleeping chickens from coop roosts in the night.  Despite my disgust for that behavior, I have to grudgingly admire such independent self sufficient characters.   They do know how to take care of themselves in a dog-eat-dog world, primarily by eating whatever they can get their jaws around and carry away, no matter who it may belong to.

I can just envision this old council of clowns gathered around giggling and sniggering in the dark at their own silly stories of the hunt.   As I listen from a distance, sometimes just a few yards, sometimes miles, I wish to be let in on the joke.

Just once I want to howl back, plaintive, pleading, pejorative–another bozo adding my voice to the noisy nocturnal chorus– hoping somebody, anybody might listen, hear and join in the laughter.