A Furry, Finned or Feathered Treatment Plan

leafanclub

Due to changes in Fair Housing Act laws, clinicians are experiencing a significant increase in requests from patients for medical documentation to keep emotional support animals with them in “no-pets policy” rental housing. On a college campus, this leads to far more than just two-legged mammals inhabiting dorm rooms.  There has been an animal explosion on our University campus with over seventy animals of various types approved as an “ESA” in the residence halls and unknown dozens more who live with their owners off campus yet still frequent campus.  Only a small minority of these animals are actually trained and certified as service animals with the right to accompany their owner on public transportation to any public place, including classrooms and eating establishments.  The rest are approved only for housing purposes, yet they are regularly showing up in airplane cabins and grocery stores, dressed in little jackets that are easily purchased along with “certification letters” for big prices on the internet.  ESAs have become part of the campus and community landscape.

As a relatively outdoorsy, green and tolerant northwest University campus, the presence of animals on our campus has yet to seem like a big deal, but as the animal numbers inevitably increase due to 25% of the college student population nationwide currently eligible for an animal due to a mental health diagnosis, it is becoming a big deal as individuals insist on exercising their civil rights along with their dogs.

And it isn’t always dogs.  There are cats, along with the occasional pocketed rat, hamster, guinea pig, flying squirrel, and ferret not to mention emotional support pot bellied pigs, tarantulas, and various types of birds.  And at least one snake.

Yes, a snake.

As a physician farmer concerned with stewardship of the patients I treat and the land and animals I care for, I’m emotionally caught and ethically bound in this treatment trend.  The law compels clinicians to provide the requested documentation to avoid  potential law suits alleging discrimination, yet I’m also concerned for the rights of the animals themselves.   I’ve loved, owned and cared for animals most of my sixty two years and certainly missed my pets during the thirteen years I was in college, medical school, residency and doing inner city work (my tropical fish and goldfish notwithstanding).  I neither had the time, the money, the space nor the inclination to keep an animal on a schedule and in an environment that I myself could barely tolerate, as stressed as I was.   That is not stopping the distressed college student of today from demanding they be able to keep their animals with them in their stress-mess.

As a clinician, I’d much prefer writing fewer pharmaceutical prescriptions and help individuals find non-medicinal ways to address their distress.   I’d like to see my patients develop coping skills to deal with the trouble that comes their way without falling apart, and the resilience to pick themselves up when they have been knocked down and feel broken.   I’d like to see them develop the inner strength that comes with maturity and experience and knowing that “this too will pass.”  I’d like individuals to see themselves as part of a diverse community and not a lone ranger of one, understanding that their actions have a ripple effect on those living, working, eating, riding and studying around them. Perhaps corporate work places, schools and universities should host a collaborative animal center with rotating dogs and cats from the local animal shelter, so those who wish to may have time with animals on their breaks without impacting others who aren’t animal fans, or with potentially life threatening animal dander allergies.

So I find myself reluctantly writing a prescription for a living breathing creature perceived by the law as a “treatment” rather than a profound responsibility that owners must take on for the lifetime of the animal.   With great gravity, I always let my patients know an animal is not disposable like a bottle of pills (or a human therapist) when no longer needed and must have a lifelong commitment from its owner beyond a particular time of high personal stress.

Pardon me now while I go take care of my dogs, my cats, by birds, and my horses and yes, my goldfish.  They are my joy to support for decades and for as long as they need me.

josekelsy

A Z-Pack Pas De Deux

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I’ve been really miserable for three days and need that 5 day antibiotic to get better faster.

Ninety eight percent of the time these symptoms are due to a viral infection and will resolve without antibiotics.

But I can’t breathe and I can’t sleep.

You can use salt water rinses and a few days of decongestant nose spray to ease the congestion.

But my face feels like there is a blown up balloon inside.

Try applying a warm towel to your face.

And I’m feverish and having sweats at night.

Your temp is 99.2. You can use ibuprofen or acetominophen to help the feverish feeling.

But my snot is green.

That’s not unusual with viral upper respiratory infections.

And my teeth are starting to hurt and my ears are popping.

Let me know if that is not resolving in a week or so.

But I’m starting to cough.

Your lungs are clear so breathe steam, push fluids and prop up with an extra pillow.

But sometimes I cough to the point of gagging. Isn’t whooping cough going around?

Your illness doesn’t fit the timeline for pertussis.  You can consider using an over the counter cough suppressant.

But I always end up needing antibiotics. This is like my regular sinus infection thing.

There’s plenty of evidence they can do more harm than good.  They really aren’t indicated at this point in your illness and could have nasty side effects.

But I always get better faster with antibiotics. Doctors always give me antibiotics.

Studies show that two weeks later there is no significant difference in symptoms between those treated with antibiotics and those who did self-care without them.

But I have a really hard week coming up and I won’t be able to rest.

This could be your body’s way of saying that you need to evaluate your priorities.

But I just waited an hour to see you.

I really am sorry about the wait; we’re seeing a lot of sick people with this viral thing going around.

But I paid a $20 co-pay today for this visit.

We’re very appreciative of you paying promptly on the day of service.

But I can go down the street to the walk in clinic and for $130 they will write me an antibiotic prescription without making me feel guilty for asking.

I wouldn’t recommend taking unnecessary medication that can lead to bacterial resistance, side effects and allergic reactions. I truly believe you can be spared the expense, inconvenience and potential risk of taking something you don’t really need.

So that’s it?  Salt water rinses and wait it out?  That’s all you can offer?

Let me know if your symptoms are unresolved or worsening in the next week or so.

So you spent all that time in school just to tell people they don’t need medicine?

I believe I help people heal themselves and educate them about when they do need medicine and then facilitate appropriate treatment. 

I’m going to go find a real doctor who will listen to me.

A real doctor vows to first do no harm.  I know you want something different than I’m offering you and I wish you the best as you recover.

No Time

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centralsakura

I know from experience that when I allow busy little doings to fill the precious time of early morning, when contemplation might flourish, I open the doors to the demon of acedia. Noon becomes a blur – no time, no time – the wolfing down of a sandwich as I listen to the morning’s phone messages and plan the afternoon’s errands.

When evening comes, I am so exhausted that vespers has become impossible. It is as if I have taken the world’s weight on my shoulders and am too greedy, and too foolish, to surrender it to God.
~Kathleen Norris from The Quotidian Mysteries

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lundeapple

These are days with no breathing room,
no time to stop and appreciate each moment
as a bud about to burst into bloom.

And it is my fault
that I’m not breathing deeply enough~
simply skimming the surface
in my race to the end of the day
as time’s petals, so open, so brilliant, so eternal
close up unseen and unknown.

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babypeony

Seeing the World Through a Walnut

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Old friend now there is no one alive
who remembers when you were young
it was high summer when I first saw you
in the blaze of day most of my life ago
with the dry grass whispering in your shade
and already you had lived through wars
and echoes of wars around your silence
through days of parting and seasons of absence
with the house emptying as the years went their way
until it was home to bats and swallows
and still when spring climbed toward summer

you opened once more the curled sleeping fingers
of newborn leaves as though nothing had happened
you and the seasons spoke the same language
and all these years I have looked through your limbs
to the river below and the roofs and the night
and you were the way I saw the world
~W.S. Merwin from “Elegy for a Walnut”

dawn7254

poplarwalnut

 

This grand old tree defines the seasons for me~
and defines me as I age.
This winter’s storms took its branches down in the night
with deafening cracks so loud
I feared to see the remnant in the morning,
yet it stands, intrepid
for another round of seasons–
tired, sagging, broken
and still reaching to the sky.

 

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Into Light All Things Must Fall

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The hen flings a single pebble aside
with her yellow, reptilian foot.
Never in eternity the same sound–
a small stone falling on a red leaf.

The juncture of twig and branch,
scarred with lichen, is a gate
we might enter, singing.

The mouse pulls batting
from a hundred-year-old quilt.
She chewed a hole in a blue star
to get it, and now she thrives…
Now is her time to thrive.

Things: simply lasting, then
failing to last: water, a blue heron’s
eye, and the light passing
between them: into light all things
must fall, glad at last to have fallen.
~Jane Kenyon “Things”

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Things we think will last won’t.

As transient as a storm-birthed rainbow,
Light passes between things and us,
illuminating a pathway
to something far more lasting.

So we follow, falling, always falling,
failing ourselves to last
until lifted up into the light
at last.

Gladly we reflect the Light
ourselves.

cloudroll

Forgiving the Scythe

earsgrass

To the earnest love that laid the swale in rows…

The fact is the sweetest dream that labor knows.
My long scythe whispered and left the hay to make.
~Robert Frost in “Mowing”

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Winslow Homer’s The Veteran in a New Field

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The grass around our orchard and yet-to-be-planted garden is now thigh-high. It practically squeaks while it grows. Anything that used to be in plain sight on the ground is rapidly being swallowed up in a sea of green: a ball, a pet dish, a garden gnome, a hose, a tractor implement, a bucket. In an effort to stem this tidal flood of grass, I grab the scythe out of the garden shed and plan my attack. The pastures are too wet yet for heavy hooves so I have hungry horses to provide for and there is more than plenty fodder to cut down for them.

I’m not a weed whacker kind of gal. First there is the necessary fuel, the noise necessitating ear plugs, the risk of flying particles requiring goggles–it all seems too much like and act of war to be remotely enjoyable. Instead, I’m trying to take scything lessons from my husband. Emphasis on “trying”.

I grew up watching my father scythe our hay in our field because he couldn’t afford a mower for his tractor. He enjoyed physical labor in the fields and woods–his other favorite hand tool was a brush cutter that he’d take to blackberry bushes. He would head out to the field with the scythe over this shoulder, grim reaper style. Once he was standing on the edge of the grass needing to be mowed, he would then lower the scythe, curved blade to the ground, turn slightly, positioning his hands on the two handles just so, raise the scythe up past his shoulders, and then in a full body twist almost like a golf swing, he’d bring the blade down. It would follow a smooth arc through the base of the standing grass, laying clumps flat in a tidy pile alongside the 2 inch stubble left behind. It was a swift, silky muscle movement — a thing of beauty.

I’ve yet to manage anything nearly as graceful. I tend to chop and mangle rather than effect an efficient slicing blow. I unintentionally trample the grass I mean to cut. I get blisters from holding the handles too tightly. It feels hopeless that I’ll ever perfect that whispery rise and fall of the scythe, with the rhythmic shush sound of the slice that is almost hypnotic.

Not only am I an ineffective scything human, but I have also learned what it is like to be the grass I am unintentionally mutilating, on the receiving end of a glancing blow that misses the mark. I bear plenty of footprints from the trampling. It can take awhile to stand back up after being knocked repeatedly to the ground.

Sometimes it makes more sense to simply start over as stubble, oozing and bleeding green, with deep roots that no one can reach. As I grow back, I will sing rather than squeak, and I’ll forgive the scythe every time it comes down on my head.

 

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peekaboo

Aiming High

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Aim at Heaven and you will get Earth ‘thrown in’:
aim at Earth and you will get neither.
~ C.S. Lewis from The Joyful Christian

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The night sky was still dim and pale. 
There, peeping among the cloud wrack above a dark tor high up in the mountains,
Sam saw a white star twinkle for a while. 
The beauty of it smote his heart,
as he looked up out of the forsaken land, and hope returned to him. 
For like a shaft, clear and cold,
the thought pierced him that in the end
the Shadow was only a small and passing thing:
there was light and high beauty for ever beyond its reach.
~J.R.R. Tolikien, The Return of the King

orangesky

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We long for a heaven that feels so elusive;
we who are so weary
and with so much need
seek out Light so seemingly
beyond our reach.

Yet by reaching beyond the here and now
we find heaven descended to us
in His incarnate earthliness.

No shadow cast in this worldly darkness,
and no iron nails
can quell the beauty
of His everlasting brilliance.

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Throwing Off the Covers

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Why do we bother with the rest of the day,
the swale of the afternoon,
the sudden dip into evening,
then night with his notorious perfumes,
his many-pointed stars?
This is the best—
throwing off the light covers,
feet on the cold floor,
and buzzing around the house on espresso—
maybe a splash of water on the face,
a palmful of vitamins—
but mostly buzzing around the house on espresso,
dictionary and atlas open on the rug,
the typewriter waiting for the key of the head,
a cello on the radio,
and, if necessary, the windows—
trees fifty, a hundred years old
out there,
heavy clouds on the way
and the lawn steaming like a horse
in the early morning.
~Billy Collins “Morning”

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This is the best~~
heading with dogs and camera up the hill
on an early spring morning,
with nothing more than the hope
I can bring this magic back to the house
and preserve it long after the foglight evaporates,
the day moves on and distracted by life,
I’ve forgotten all about how
this is the best~~

haflingermares

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God Leaps Out

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… And now in vast, cold, empty space, alone.
Yet hidden deep within the grown-up heart,
A longing for the first world, the ancient one …
Then, from His place of ambush, God leapt out.
~ Rainer Maria Rilke

lundebloom

That’s the mystery of us.
But then there’s the mystery of God,
lying in ambush,
watching, waiting,
waiting for the fulfillment of time,
the nexus of his grace and our vulnerability.
Maybe today.
~Kathleen Mulhern “Hangs My Helpless Soul on Thee”

sunset51171

Sometimes, during a long night of fitful sleep,
when nothing makes sense and worry takes over,
I ponder the mystery of how our brains were made to wonder at all.

I long for a simpler time,
for clarity of purpose,
for laughter through tears,
for gratitude even in hard times.

Yet as I toss and turn,
I know my God lies in wait for me,
as He watches for the moment
when being ambushed is exactly what I need.

morninghaze

Touch Me Afresh

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Thou mastering me
God! giver of breath and bread;
World’s strand, sway of the sea;
Lord of living and dead;
Thou hast bound bones and veins in me, fastened me flesh,
And after it almost unmade, what with dread,
Thy doing: and dost thou touch me afresh?
Over again I feel thy finger and find thee.
~Gerard Manley Hopkins from “The Wreck of the Deutschland”

 

dandy52172

The downy thousands of tiny puffball galaxies
have returned strewn in our fields,
swirling in a universe of yellow stars
tossed from your Hand
and blown by your breath.

I’m blown away too ~
Your handiwork has knitted
field to flesh,
Your touch a moment of freshened grace.

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