Month: June 2017

That Pivoting Ear

barnstormingblog2 Comments

wwudeer1

ahmama

Near dusk, near a path, near a brook,
we stopped, I in disquiet and dismay
for the suffering of someone I loved,
the doe in her always incipient alarm.

All that moved was her pivoting ear
the reddening sun was shining through
transformed to a color I’d only seen
in a photo of a new child in a womb.

Nothing else stirred, not a leaf,
not the air, but she startled and bolted
away from me into the crackling brush.

The part of my pain which sometimes
releases me from it fled with her, the rest,
in the rake of the late light, stayed.
~C. K. Williams  “The Doe”

sunset625176

wwudeer2

Oh little one
to have been born this week in June
thirty four years ago~
so wanted
so anticipated
but lost too soon
gone as swiftly in a clot of red
as a doe disappearing in a thicket:
a memory that makes me question
if you were real,
but you were
and you are
and someday
I’ll know you when I see you
and curious about who I am,
you won’t flee,
but stay to find out.

wwudeer2

 

 

A Salt Water Cure

barnstormingblog5 Comments

fidalgotree2

…when he looked at the ocean,
he caught a glimpse of the One he was praying to.
Maybe what made him weep was
how vast and overwhelming it was
and yet at the same time as near
as the breath of it in his nostrils,
as salty as his own tears.
~Frederick Buechner writing about Paul Tillich in Beyond Words

pnpsunset714

fidalgobeach2

 

The cure for anything is salt water–sweat, tears or the sea.
~Isak Dinesen

 

Wavecrash2
photo by Nate Gibson

 

I grew up an easy crier.  Actually growing up hasn’t cured it, nor has middle age.  I’m still an easy crier – a hard thing to admit especially when my tears flow at an inopportune time in a public place.

It might have had something to do with being a middle child, bombarded from both directions by siblings who recognized how little aggravation it took to make me cry, or it may have been my hypersensitive feelings about …. everything.  I felt really alone in my tearful travails until my formidable grandmother, another easy weepy, explained that my strong/tall/tough/nothing-rocks-him former WWII Marine father had been a very weepy little boy.  She despaired that he would ever get past being awash in tears at every turn.  His alcoholic father tormented him about it, wondering if he would ever learn to “man up.”

So this is a congenital condition and that’s my excuse.

A few years ago I read a fascinating article about how different kinds of tears (tears of joy, tears of pain, tears of grief, tears of frustration, tears of irritated eyes, tears of onion cutting) all look different and remarkably apt, when dried and pictured under the microscope.  This is more than mere salt water leaking from our eyes — this is our heart and soul and hormonal barometer streaming down our faces – a visible litmus test of our deepest feelings.

I witness many tears every day in my office, and not tears of joy.  These are tears borne of pain and loss and rejection and failure, of hopelessness and helplessness, loneliness and anguish.  Often my patients will describe having a “break down” by which they mean uncontrollable crying.  It is one of the first-mentioned symptoms they want relief from.

Tears do come less frequently as depression lifts and anxiety lessens but I let my patients know (and remind myself) that tears are a transparent palette for painting the desires and concerns of our heart.  Dry up the tears and one dries up emotions that express who we are and who we strive to be.

When I’m able, I celebrate the salt water squeezing from my eyes, knowing it means I’m so fully human that I leak my humanity everywhere I go.  Even God wept while dwelling among us on earth, and what’s good enough for Him is certainly good enough for me.

weepingrose

 

 

 

The Vaccination Conundrum

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cacti4

 

It is proof of MMR immunity season again.  Students entering school this fall are being asked to prove they have been fully vaccinated against Mump, Measles (rubeola) and Rubella infection as well as other routine immunizations in order to be allowed to enroll.  A small but significant and vehement minority insist they should be allowed a personal exemption from the requirement that the majority willingly comply with.

Concerned, caring parents make the decision every day to forego life-saving immunity by refusing to vaccinate their children, truly believing they are doing the right thing. They do not perceive an imminent risk to their child from the older contagious diseases despite their resurgence in developed countries like the U.S., focusing instead on the low—or often non-existent but ballyhooed—risks of vaccinations.

These are parents—most of them well-educated and on both ends of the political spectrum—who refuse to vaccinate their children, thereby denying a consensus of scientific evidence and increasing the risk for further outbreaks. “Oh my God. Wealthy, white, liberal enclaves are at risk!” declares Daily Show correspondent Samantha Bee, mocking the anti-vaccine bloggers and activists. So too at risk are some conservative Christian church communities where vaccination rates are low.

As clever the satire may be, I can’t bring myself to laugh or crack a smile. Now in my 60s, I remember the illnesses brought on by these diseases before vaccines. As a physician, I’ve seen cases of them coming back with fatal consequences.

Maybe some of us have forgotten or are too young to realize the severity of these conditions. Healthcare providers who haven’t had firsthand experience with these contagious diseases don’t always think of them when confronted with classic signs and symptoms. But it’s only been a little over 50 years since vaccinations became routine for childhood killers like tetanus, diphtheria, polio, measles, mumps, and pertussis, or whooping cough. Americans growing up before then had no choice but to suffer through childhood infectious diseases as they quickly spread through a community.

Most of us survived our illnesses, rewarded for our affliction with permanent natural immunity. Others suffered lifelong consequences: paralysis from polio, deafness from rubella, sterility from mumps. Some did not survive at all. My father nearly died at age 41 from a case of the mumps I brought home from school. As an infant, my sister-in-law almost didn’t pull through when she turned blue from pertussis infection.

Today, I’ve seen healthy people develop encephalitis and pneumonia from chicken pox. A fit college student in my practice died of influenza within a week of the start of his symptoms. Our university clinic just diagnosed a case of mumps during a local outbreak.  Our herd-immunity for many vaccine-preventable conditions has been waning, as reports of pertussis, measles, mumps, and chicken pox reemerge, in affluent countries with robust health care systems.

Parents who opt to leave their children unvaccinated contribute to the recent outbreaks. Well-meaning American parents are convinced they are doing the best thing by protecting their children from potentially rare and often unproven vaccine side effects. Some Christian parents claim vaccine risks are unwarranted, since God will provide the needed immunity if their children gets sick.

Most cases originate overseas, so it’s especially critical that Americans be vaccinated when traveling outside the U.S., even to Europe. (Those who serve in mission fields are particularly vulnerable, and I’ve found it interesting that previously unvaccinated Christians are more than willing to accept immunizations when they know for certain they will be exposed.)

As a physician of faith, I tell parents God indeed provides immunity. But as we’ve seen over millennia, it comes by very real suffering through a potentially fatal disease. In our modern society, God grants us everyday miracles, both pharmacologic and surgical, including the potential of long-lasting immunity in the form of a vial of vaccine. I don’t think these parents would deny insulin for their child newly diagnosed with diabetes, nor would they fail to strap their child into a car seat before starting the ignition. Vaccines are instruments of prevention, too, given to our healthy youngsters in order to keep them (and others) healthy.

“I’m concerned that so many people seem willing to let others carry the supposed burden of vaccination so that they don’t have to,” wrote Rachel Marie Stone in a Her.meneutics post several years ago. “To me, that’s a failure of the commandment to love our neighbors: our infant neighbors, our elderly neighbors, and our immune-compromised neighbors.”

When I was vaccinated for diphtheria, pertussis, and tetanus (DPT) at the age of 4 months in 1954, my mother wrote in my baby book: Up most of the night with fever 104.5 degrees, a good “take” for the vaccine. She was relieved that it had made me sick, as it meant that my stimulated immune system would keep me safe if exposed to those killer diseases that were so common in the 1950s. Our society doesn’t think about immunizations as we did back then and thankfully a febrile reaction like that would be unusual due to significant changes in how today’s more effective vaccines are formulated.

I wish vaccines were perfect in their protection and potential side effects, but they aren’t. I wish medications developed for treatment of some of these illnesses were perfectly effective, but we can’t depend on a guarantee of cure once sickened. I wish our immune systems were perfect in their response to exposure to pathogens, but they too fail and people do die. Even though there will never be perfect prevention or treatment, parents in third world countries who have watched their children suffer and die from completely preventable disease will walk miles, for days, to get their children vaccinated when they learn of a mobile health clinic setting up an immunization center. Undeterred by that harsh reality, some in our highly educated society choose to run, not walk, in the opposite direction from much more easily accessible free state-supplied vaccine.

There will always be a new plague to worry about. Even as we eradicated illnesses through vaccine, we watched HIV, SARS, avian flu, multidrug-resistant tuberculosis, and MERS infect us. Some countries have seen the return of polio, and we remain concerned over smallpox somehow finding its way out of its lockbox in laboratories.

Given these threats and the new pathogens on the horizon, it remains unwise to refuse safe and effective vaccination. By doing so, we invite the old plagues, these killers of yesteryear, back into our homes, our churches and schools, and inevitably, onto our death certificates.

We can and must do better for our next generation.

 

(an earlier version of this essay was published online three years ago with a significant negative reaction from Christian readers.  It bears repetition because anti-vaccination beliefs continue to be an issue in the midst of current rubeola measles and mumps outbreaks in the U.S.)

cacti9

Lift the Farm Like a Lid

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mejier3

tubtrough

 

chelanducklings1

 

Straws like tame lightnings lie about the grass
And hang zigzag on hedges. Green as glass
The water in the horse-trough shines.
Nine ducks go wobbling by in two straight lines.

A hen stares at nothing with one eye,
Then picks it up. Out of an empty sky
A swallow falls and, flickering through
The barn, dives up again into the dizzy blue.

I lie, not thinking, in the cool, soft grass,
Afraid of where a thought might take me – as
This grasshopper with plated face
Unfolds his legs and finds himself in space.

Self under self, a pile of selves I stand
Threaded on time, and with metaphysic hand
Lift the farm like a lid and see
Farm within farm, and in the centre, me.
~Norman MacCaig “Summer Farm”

 

johnshens

sunsetdan

missingroof

 

photo by Bette Vander Haak

 

Most of my life, a barn has stood a few dozen yards from my back door. As a small child, I learned to ride a tricycle on the wooden planks of the chicken coop, sat on the bony back of a Guernsey cow while my father milked by hand, found new litters of kittens in cobweb-filled hideaways, and leaped with abandon into stacks of loose hay in a massive loft.

As a young girl, I preferred to clean stalls rather than my bedroom. The acoustics in the barn were first rate for singing loud and the horses and cows never covered their ears, although the dog would usually howl. A hay loft was the perfect spot for hiding a writing journal and reading books. It was a place for quiet contemplation and sometimes fervent prayer when I was worried: a sanctuary for turbulent adolescence.

Through college and medical training, I managed to live over twelve years in the city without access to a barn or the critters that lived inside. I searched for plenty of surrogate retreats: the library stacks, empty chapels within the hospitals I worked, even a remote mountainous wildlife refuge in central Africa.

It is hard to ignore one’s genetic destiny to struggle as a steward of the land through the challenges of economics and weather. My blood runs with DNA of wheat and lentil growers, loggers, cattle ranchers, dairy farmers, work horse teamsters, and flower and vegetable gardeners. A farm eventually called me to come back home and so I heeded over thirty years ago, along with a husband from a dairy farming background himself, and eventually there followed three children, now grown and flown far from the farm.

Like a once sturdily built barn now sagging and leaning, I too am buffeted by the gales of mid-life. My doors have been flung open wide, my roof/lid lifted and pulled off, at times leaving me reeling. More and more now I need restoration, renewal and reconciliation. And so I set to work to fix up my life with all the skill I can muster: setting things right where they’ve been upended, painting a fresh coat where chipped and dulled, shoring up rotted foundations.

If only I can get it done well enough, with sufficient perseverance, I surely can recover from the latest blow. But my hard work and determination is not enough. It is never enough. I am never finished.

The only true sanctuary isn’t found in a weather-beaten barn of rough-hewn old growth timbers vulnerable to the winds of life.

The barnstorming must happen within me, in the depths of my soul, comforted only by the encompassing and salvaging arms of God.

There I am held, transformed and restored, grateful beyond measure.

 

 

sunset625175

unfurling

An Unblinking Fermata

barnstormingblog1 Comment

sunset625177

roseunfurl

 

daylily62215

In science
we have been reading only the notes to a poem:
in Christianity
we find the poem itself.
~C.S. Lewis from Miracles

 

mothwing2

 

Science fails
to love us,
to reach out and grasp the hand of the dying,
to give hope to the weak and afraid,
to become sacrifice for our sin,
to be our rescue by offering everlasting grace.

Science is merely the end-of-day footnote
to a Word far greater~
an unblinking fermata within
His ultimate symphonic Work.

 

mothwing3

hollyhockred

sunset625171

 

To Dwell in Sovereign Barns

barnstormingblog3 Comments

roundbarn

redbarn

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photo by Nate Gibson

 

The grass so little has to do,—    
A sphere of simple green,   
With only butterflies to brood,
And bees to entertain, 
    
And stir all day to pretty tunes        
The breezes fetch along,
And hold the sunshine in its lap   
And bow to everything; 
    
And thread the dews all night, like pearls,
And make itself so fine,—            
A duchess were too common 
For such a noticing.   
    
And even when it dies, to pass    
In odors so divine,    
As lowly spices gone to sleep,        
Or amulets of pine.    
    
And then to dwell in sovereign barns,    
And dream the days away,— 
The grass so little has to do,
I wish I were a hay!
~Emily Dickinson

florabarn

emptyhaybarn

This is the week of the year our barn is at its emptiest, right before it fills up again. There is something very lonely about a barn completely empty of its hay stores.

Its hollow interior echoes with a century of farmers’ voices:
soothing an upset cow during a difficult milking,
uncovering a litter of kittens high in a hay loft,
shouting orders to a steady workhorse,
singing a soft hymn while cleaning stalls,
startling out loud as a barn owl or bat flies low overhead.

The dust motes lazily drift by in the twilight, seemingly forever suspended above the straw covered wood floor, floating protected from the cooling evening breezes.

There is no heart beat left in an empty barn. It is in full arrest, all life blood drained out, vital signs flat lined. I can hardly bear to go inside.

The weather is cooperating so the grass was cut two days ago.  Today it will be tossed about on the field to dry in a process called “tedding”, then tomorrow raked into windrows and baled for pick up by our “family and friends” hay crew.

Suddenly, the barn is shocked back to a pulse, with the throb of voices, music blaring, dust and pollen flying chaotically, the rattle of the electric “elevator” hauling bales from wagon to loft, the grunts and groans of the crew as they heft and heave the bales into place in the stack. This often goes on late into the night, the barn ablaze with lights, the barnyard buzzing with excitement and activity. It almost looks as if it is on fire.

Vital signs measurable, rhythm restored, volume depletion reversed, prognosis good for another year.

A healthy rhythm is elusive in this modern age of full time jobs off the farm, necessitating careful coordination with the schedule of the farmer who cuts and bales for many neighbors all within the same window of good weather. The farmer races his equipment from field to field, swooping around with a goliath tractor taking 12 foot swaths, raising dust clouds, and then on to the next job. It is so unlike the rhythm of a century ago when a horse drawn mower cut the tall grass in a gentle four foot swath, with a pulsing shh shh shh shh shh shh tempo that could be heard stretching across the fields. It is an unfamiliar sound today, the almost-silence of no motor at all, just the jingle of the harness and the mower blades slicing back and forth as the team pulls the equipment down the field. We’ve lost the peacefulness of a team of horses at work, necessitating a slower pace and the need to stop at the end of a row for a breather.

The old barn will be resuscitated once again. Its floor will creak with the weight of the hay bales, the walls will groan with the pressure of stacks. The missing shingles on the roof will be replaced and the doors locked tight against the winter winds. But it will be breathing on its own, having needed only a short rest these last few weeks.

Inside, once again, filled to the brim, life is held tight by twine, just waiting to be released.

mowingfield

396747_496652663682556_1002398142_n
Photo of Aaron Janicki raking hay with his Oberlander team in Skagit County courtesy of Tayler Rae

tjoelkerbarn

sunbeambarn3

 

A Field To Go Back To

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steptoe9

steptoe3

You wake wanting the dream
you left behind in sleep,
water washing through everything,
clearing away sediment
of years, uncovering the lost
and forgotten. You hear the sun
breaking on cold grass,
on eaves, on stone steps
outside. You see light
igniting sparks of dust
in the air. You feel for the first
time in years the world
electrified with morning.

You know something has changed
in the night, something you thought
gone from the world has come back:
shooting stars in the pasture,
sleeping beneath a field
of daisies, wisteria climbing
over fences, houses, trees.

This is a place that smells
like childhood and old age.
It is a limb you swung from,
a field you go back to.

~Scott Owens “The Arrival of the Past” from Down to Sleep

wisteriabarb2

 

Returning to my mother’s Palouse country to meet again with my aunt and cousins:

(her brother’s widow, now 97, her nieces and nephews–those who still farm and those who wish they still could)

I know these wheat fields lie deep in my DNA and my heart is comforted by the familiarity of the tone and hue of the soil, the freshness of the breezes, the undulation of the grain over the hillsides, the lilt of the meadowlark’s song.

This is always a welcome return home as I feel my mother’s genes rise up within me to greet this family, and know that yes, to this too I belong.

It is a rare and abiding comfort.

steptoe1

daisy6153

 

An Audience of Terminal Patients

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chelanblooms1

Write as if you were dying. At the same time, assume you write for an audience consisting solely of terminal patients. That is, after all, the case.
~Annie Dillard from “Write Till You Drop”

chelanducklings5

You’re going to feel like hell if you wake up someday and you never wrote the stuff that is tugging on the sleeves of your heart: your stories, memories, visions, and songs–your truth, your version of things–in your own voice. That’s really all you have to offer us, and that’s also why you were born.

~Anne Lamott in a recent TED Talk

chelanspirea

I began to write after September 11, 2001 because that day it became obvious to me I was dying, albeit more slowly than the thousands who vanished that day in fire and ash, their voices obliterated with their bodies.   So, nearly each day since, while I still have voice and a new dawn to greet, I speak through my fingers and my camera lens to others dying around me.

My good friend, Sara, who I’ve known and loved half my life, is fighting for her life in an all day cancer surgery today, having fought a chronic disease and a totally different cancer once before and won.  She knows well the hard cost of winning even when the odds aren’t good,  yet still has a courage in her to fight once again.

That will to fight is heavy on my mind today.

We are, after all, terminal patients, some more imminent than others, some of us more prepared to move on, as if our readiness had anything to do with the timing.

Each day I too get a little closer, so I write and share photos of my world in order to hang on awhile longer.  Each day I must detach just a little bit, leaving a small trace of my voice and myself behind.  Eventually, through unmerited grace, so much of me will be left on the page there won’t be anything or anyone left to do the typing.

There is no moment or picture or word to waste.

 

chelanpoppies

 image1

 

Doc Season

barnstormingblog10 Comments

duckchelan2

img_0761


It may not be rabbit season or duck season but it definitely seems to be doc season, especially as the next version of the American Health Care Act is unveiled today. This (and the Affordable Care Act which preceded it) is not about patients — it is about how to keep doctors and the health care industry under reasonable cost control and maintain some semblance of quality service.

Physicians are lined up squarely in the gun sights of the media, government agencies and legislators, as well as our employers and coworkers, not to mention our own professional organizations, our Board Certifying bodies, and our dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim. It’s not enough any more to wear a bullet proof white coat. It’s driving doctors to hang up their stethoscope much earlier than they expected just to get out of the line of fire. Depending on who is expressing an opinion, doctors are seen as overcompensated, demanding, whiny, too uncommitted, too over-committed, uncaring, egotistical, close-minded, inflexible, and especially, and most annoyingly – perpetually late.

One of the most frequent complaints expressed about doctors is their lack of sensitivity to the demands of their patients’ schedule. Doctors do run late and patients wait. And wait. And wait some more. Patients get angry while waiting and this is reflected in patient (dis)satisfaction surveys which are becoming one of the tools the industry uses to judge the quality of a physician’s work and character as well as their salary compensation.  It is considered basic Customer Service 101.

I admit I’m one of those late doctors. I don’t share the reasons why I’m late with my patients as I enter the exam room apologizing for my tardiness. Taking time to explain takes time away from the task at hand: taking care of the person sitting or lying in front of me. At that moment, they are the most important person in the world to me. More important than the six waiting to see me, more important than the several dozen emails and calls waiting to be returned, more important than the fact I missed lunch or need to go to the bathroom, more important even than the text message from my daughter from school or the worry I carry about my dying mother.

I’m a salaried doctor, just like more and more of my primary care colleagues these days, providing more patient care with fewer resources. I don’t earn more by seeing more patients. There is a work load that I’m expected to carry and my day doesn’t end until that work is done. Some days are typically a four patient an hour schedule, but most days my colleagues and I must work in extra patients triaged to us by careful nurse screeners, and there are only so many minutes that can be squeezed out of an hour so patients end up feeling the pinch. I really want to try to go over the list of concerns some patients bring in so they don’t need to return to clinic for another appointment, and I really do try to deal with the inevitable “oh, by the way” question when my hand is on the door knob. Anytime that happens, I run later in my schedule, but I see it as my mission to provide essential caring for the “most important person in the world” at that moment.

The patient who is angry about waiting for me to arrive in the exam room can’t know that I’m late because the previous patient just found out that her upset stomach was caused by an unplanned and unwanted pregnancy. Perhaps they might be more understanding if they knew that an earlier patient came in with severe self injury so deep it required repair. Or the woman with a week of cough and new rib pain with a deep breath that could be a simple viral infection is showing signs of a pulmonary embolism caused by oral contraceptives. Or the man with blood on the toilet paper after a bowel movement finding out he has sexually transmitted anal warts when he’s never disclosed he has sex with other men, or the woman with bloating whose examination reveals an ominous ovarian mass, or finding incidental needle tracks on arms during an evaluation for itchiness, which leads to a suspicion of undiagnosed chronic hepatitis.

Doctors running late are not being inconsiderate, selfish or insensitive to their patients’ needs. Quite the opposite. We strive to make our patients feel respected, listened to and cared for. Most days it is a challenge to do that well and stay on time. For those who say we are being greedy, so we need to see fewer patients, I respond that health care reform and salaried employment demands we see more patients in less time, not fewer patients in more time. The waiting will only get longer as more doctors hang up their stethoscopes rather than become a target of anger and resentment as every day becomes “doctor season.”

Patients need to bring a book or catch up on correspondence,  bring knitting, schedule for the first appointment of the day. They also need to bring along a dose of charitable grace when they see how crowded the waiting room is. It might help to know you are not alone in your worry and misery.

But your doctor and health care team is very alone, scrambling to do the very best healing they can in the time available.

I’m not hanging my stethoscope up anytime soon though some days I’m so weary by the end, I’m not sure my brain between the ear tips is still functioning. I don’t wear a bullet proof white coat since I refuse to be defensive. If it really is doctor season, I’ll just continue on apologizing as I walk into each exam room, my focus directed to the needs of the “most important person in the whole world.”

And that human being deserves every minute I can give them.

chelanbirches2

chelanshadows

Why Do We Bother?

barnstormingblog3 Comments

wallysolstice

 

dawn7251
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”
dawn7253
Dawn is a new gift every day,
even if the shortest night was sleepless,
and the longest day won’t return for another year.We get up
to see just what might happen
as you never know what might be
just over the horizon
as we round the solstice corner
to face the darkening.That’s why we bother.

dawn12221
morninghaze
clouds101143