Category: disappointment

Clearing the Fog of Medical Advice

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Be obscure clearly.
Muddiness is not merely a disturber of prose, it is also a destroyer of life, of hope: death on the highway caused by a badly worded road sign … think of the tragedies that are rooted in ambiguity, and be clear!
~E.B. White from his classic book on writing well –The Elements of Style

As a family doctor with over forty years of clinical practice under my belt, I have found the E.B. White’s advice for writing can be applied to the field of medicine. I tried my best to clarify the obscurity of the human condition in my job, hoping my patients could provide me the information I needed to make a sound diagnosis and treatment recommendation.

Communication is hard work for many patients, especially when they are depressed and anxious on top of whatever they are experiencing physically. There is still plenty of unknowns in the psychology and physiology of humans. Then, throw in a disease process or two or three to complicate what appears to be “normal” and further consider the side effects and complications of various treatments.

Evidence-based decision making isn’t always perfectly equipped to produce the best and only solution to one individual’s problem.

Sometimes the solution to a patient’s symptom is foggy, muddy, and obscure, not at all pristine and clear. It is the physician’s job to try to bring everything into the best focus possible. Then it is our job to communicate our thinking and decision process in a way that respects the patient’s right to be skeptical.

A physician’s clinical work is challenging on the best of days when everything goes well. We see things we have never seen before, expect the unexpected, learn skills we never thought we’d need to know, and attempt to make the best choice between competing treatment alternatives. Physicians constantly unlearn things we thought were gospel truth, but have just been disproven by the latest, double-blind controlled study, which may soon be reversed by a newer study.

We find ourselves standing on evidence-based quicksand even though our patients trust that we are giving them rock-solid advice based on a foundation of truth learned over years of education and training. Add in medical decision-making that is driven by cultural, political, or financial outcomes, rather than what works best for the individual, and our hoped-for clinical clarity becomes even more obscured.

Forty-two years of doctoring in the midst of the mystery of medicine means learning, unlearning, listening, discerning, explaining, guessing, hoping, and remaining very humble in the face of a disease process or a public health threat like COVID. What works well for one patient may not be appropriate for another despite what the best evidence says or what insurance companies and the government are willing to cover. Each individual we see deserves the clarity of a fresh look and perspective, instead of being treated by cook-book algorithm.

So, as a physician and healer, be obscure clearly. 
A life may depend on it.

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The Air Charged With Blessings

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I thought of happiness, how it is woven
Out of the silence in the empty house each day
And how it is not sudden and it is not given
But is creation itself like the growth of a tree.
No one has seen it happen, but inside the bark
Another circle is growing in the expanding ring.
No one has heard the root go deeper in the dark,
But the tree is lifted by this inward work
And its plumes shine, and its leaves are glittering.

For what is happiness but growth in peace,
And as the air moves, so the old dreams stir
The shining leaves of present happiness?
No one has heard thought or listened to a mind,
But where people have lived in inwardness
The air is charged with blessing and does bless;
Windows look out on mountains and the walls are kind.
~ May Sarton, from “The Work of Happiness”  in  Collected Poems, 1930-1993

The settled happiness and security which we all desire,
God withholds from us by the very nature of the world:
but joy, pleasure, and merriment, he has scattered broadcast.
We are never safe, but we have plenty of fun, and some ecstasy.
It is not hard to see why.

The security we crave would teach us
to rest our hearts in this world
and oppose an obstacle to our return to God:
a few moments of happy love, a landscape, a symphony,
a merry meeting with our friends, a bath
or a football match, have no such tendency.

Our Father refreshes us on the journey with some pleasant inns,
but will not encourage us to mistake them for home.
~C.S. Lewis from The Problem of Pain

I am reminded every day, as headlines proclaim bad news:
this is not our home. I am only a wayfarer, not a settler.

Just like the distress of my four year old grandson, staying overnight and waking with a bad dream, appearing at my bedside at 3 AM, saying simply “I need a hug!”

We need reassurance that all this scary stuff is not forever.

Sometimes I lose focus on the “why” of my journey
on this troubled earth:
so much of my time and energy is understandably spent
seeking safety and security, striving on a journey
I hope will be filled with happiness, joy and contentment,
as if that is my ultimate destination and purpose.

Yet the nature of a fallen world filled with faltering souls such as myself leads me down boulder-strewn paths filled with potholes and sheer cliffs and yes, bad dreams.

At times nowhere feels safe or secure and I overthink my next step.

God hears my fear of the unknown destination, as only He can know what lies ahead on my or anyone’s journey. God in His mercy does not leave us homeless, without hope and unable to wake from the bad dream.

We breathe air charged with His blessing. He gifts Himself; I can breathe because of Him.

I need a hug…

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In the Best Possible Way

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Let us go forward quietly,
forever making for the light,
and lifting up our hearts
in the knowledge that we are as others are
(and that others are as we are),
and that it is right to love one another
in the best possible way – believing all things,
hoping for all things,
and enduring all things. 
~Vincent Van Gogh from “Letters to Theo”

We like to blame our DNA for our tribal nature, to justify setting ourselves apart from the “other.” We tend to be discontent with whatever we are given — but that belief is exactly how humanity’s troubles began.

Every election and convention season only intensifies our sense of “otherness”, further putting wedges between us, driving us apart and further into the darkness.

We are slaves to divisiveness: even worshiping it in the name of “becoming great again”, emphasizing our own “truth” in the name of “unity.”

I simply can’t listen to it.
There is so much anger in the voices of our self-appointed “leaders.”

I want to know it is still possible to love each other in all our differences in the best possible way, with quiet endurance and hope. No shouting, no shootings, no need for a cascade of dropping balloons, and no ridiculous rancorous rhetoric.

We are as others are — others are as we are — denying it is folly. Believing it is the beginning of a selfless love for the “other”, something God did intend for our DNA, as His children who are no longer animals.

Indeed, God Himself became the “Other” living among us to show us just how it can be done.

It’s in every one of us. Now we must make it so.

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All Politics is Applesauce…

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I tell you folks, all politics is applesauce.
~Will Rogers

Applesauce-making is one of my more satisfying domestic activities.  Peeling and coring apples can be tedious, as there are always plenty of bad spots to cut out. Though uncommon in our organic orchard, there is the occasional wiggling worm to find and dispose of before cooking. 

Our late summer transparent apples make a creamy tart sauce smooth to the tongue. With all the careful preparation before cooking, all blemishes are removed, with any extra unwanted wormy protein deposited in the compost bucket along with mountains of peel, cores and seeds.

If only our two main political parties would pick and prepare their presumptive nominees with as much concern and care…

Would that we could similarly pare out, peel off, dispose in the compost all the political flyers flooding our mailbox, the robo-call telephone messages asking for donations, the radio, TV and internet ads that burden us all until we crack and break under the weight. Most of the election fruit ends up rotting on the tree, turning us all to mush in the process. I’m weary just thinking about the millions of dollars spent in advertising these two (as yet) unofficial presidential candidates that could be used for far greater good and benefit for the citizenry.

Now we have a televised debate where one candidate is clearly incapable of providing coherent answers and the other, a convicted felon who spouts lies that go unchallenged as a result. It is clear now the whole kettle of sauce is spoiled. We could cook it all day long and there still are worms waving in the air, rotten cores festering, scabby peels floating on top, with the bottom scalding with the heat of the cook stove. 

Our political parties have profoundly failed the American people by propping up candidates unworthy of the office. I pray for a day when we can set our differences aside and raise up leaders who can do so as well. We must blend together our diverse flavors and characteristics for the good of all. Then, “applesauce” politics won’t simply be a mixture of nonsense and BS, as Will Rogers implies, but something actually nourishing for a flourishing future.

That’ll be the day…

There are men running governments who shouldn’t be allowed to play with matches.
~Will Rogers

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The Color of a Pivoting Ear

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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” from The Singing

Oh little one
who was to be born this week in June
forty one 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, when I think of you
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 remain close to find out.

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A Cloak of Colors

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On the day when
The weight deadens
On your shoulders
And you stumble,
May the clay dance
To balance you.

And when your eyes
freeze behind
the grey window
and the ghost of loss
gets into you,
may a flock of colours,
Indigo, red, green
And azure blue,
Come to awaken in you
A meadow of delight.

May the nourishment of the earth be yours,
May the clarity of light be yours,
May the fluency of the ocean be yours,
May the protection of the ancestors be yours.

And so may a slow
Wind work these words
Of love around you,
An invisible cloak
To mind your life.
~John O’Donohue from “Beannacht“

We all will stumble, bearing the bruises and scars of our fall.
We all waken to gray days when there appears no point in getting up.
We all can be sucked into the darkest thoughts,
tunneling ever more deeply.

In those moments, those days, those months,
may we be wrapped tightly in love’s cloak of invisibility,
hiding us from a darkness that can swallow us no longer.

We are led onto a brightening path of light and color,
filled with contentment and encouragement, our failing feet steadied.
The gray is absorbed into an ever-changing kaleidoscope,
the way to go illuminated with hope.

May our brokenness be forever healed by words of blessing.

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I Now Walk Wary

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Someone spoke to me last night,
told me the truth. Just a few words,
but I recognized it.
I knew I should make myself get up,
write it down, but it was late,
and I was exhausted from working
all day in the garden, moving rocks.
Now, I remember only the flavor—
not like food, sweet or sharp.
More like a fine powder, like dust.
And I wasn’t elated or frightened,
but simply rapt, aware.
That’s how it is sometimes—
God comes to your window,
all bright light and black wings,
and you’re just too tired to open it.
~Dorianne Laux “Dust” from What We Carry

On the stiff twig up there
Hunches a wet black rook
Arranging and rearranging its feathers in the rain-
I do not expect a miracle
Or an accident

To set the sight on fire
In my eye, nor seek
Any more in the desultory weather some design,
But let spotted leaves fall as they fall
Without ceremony, or portent.

Although, I admit, I desire,
Occasionally, some backtalk
From the mute sky, I can’t honestly complain:
A certain minor light may still
Lean incandescent

Out of kitchen table or chair
As if a celestial burning took
Possession of the most obtuse objects now and then —
Thus hallowing an interval
Otherwise inconsequent

By bestowing largesse, honor
One might say love. At any rate, I now walk
Wary (for it could happen
Even in this dull, ruinous landscape); sceptical
Yet politic, ignorant

Of whatever angel any choose to flare
Suddenly at my elbow. 
I only know that a rook
Ordering its black feathers can so shine
As to seize my senses, haul
My eyelids up, and grant

A brief respite from fear
Of total neutrality. With luck,
Trekking stubborn through this season
Of fatigue, I shall
Patch together a content

Of sorts. Miracles occur,
If you care to call those spasmodic
Tricks of radiance miracles. The wait’s begun again,
The long wait for the angel.
For that rare, random descent.
~Sylvia Plath “Black Rook in Rainy Weather”

…it is no trick of light
nor is it random
when He comes to our window,
wanting us to let Him in.

This descent to us
is planned and very real:
He seizes us and does not let go
even when we are too tired
to open to Him.

We wait,
this long wait while moving rocks;
tired of waiting,
seeking contentment while waiting
rapt,
aware,
weary,
but awake and ready for His grace.

photo by Nate Gibson

I wait for the Lord, my whole being waits,
    and in his word I put my hope.
Psalm 130:5

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Who is the Great I Am: A Saturday of Stillness

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God goes, belonging to every riven thing he’s made
sing his being simply by being
the thing it is:
stone and tree and sky,
man who sees and sings and wonders why

God goes. Belonging, to every riven thing he’s made,
means a storm of peace.
Think of the atoms inside the stone.
Think of the man who sits alone
trying to will himself into a stillness where

God goes belonging. To every riven thing he’s made
there is given one shade
shaped exactly to the thing itself:
under the tree a darker tree;
under the man the only man to see

God goes belonging to every riven thing. He’s made
the things that bring him near,
made the mind that makes him go.
A part of what man knows,
apart from what man knows,

God goes belonging to every riven thing he’s made.
~Christian Wiman “Every Riven Thing”

The Holy Saturday of our life must be the preparation for Easter,
the persistent hope for the final glory of God. 
The virtue of our daily life is the hope which does what is possible
and expects God to do the impossible. 
To express it somewhat paradoxically, but nevertheless seriously: 
the worst has actually already happened; 
we exist,
and even death cannot deprive us of this. 
Now is the Holy Saturday of our ordinary life, 
but there will also be Easter, our true and eternal life. 
~Karl Rahner “Holy Saturday” in The Great Church Year

This is the day in between when nothing makes sense: 
 we are lost, hopeless, grieving, riven beyond recognition.

We are brought to our senses by this one Death, this premeditated killing, this senseless act that darkened the skies, shook the earth and tore down the curtained barriers to the Living Eternal God.

The worst has already happened, despite how horrific are the constant tragic events filling our headlines.

Today, this Holy Saturday we are in between, stumbling in the darkness but aware of hints of light, of buds, of life, of promised fruit to come.

The best has already happened; it happened even as we remained oblivious to its impossibility.

We move through this Saturday, doing what is possible even when it feels senseless, even as we feel split apart, torn and sundered.

Tomorrow it will all make sense: our hope brings us face to face with our God who is and was and does the impossible.

So Joseph bought some linen cloth, took down the body, wrapped it in the linen, and placed it in a tomb cut out of rock. Then he rolled a stone against the entrance of the tomb. Mary Magdalene and Mary the mother of Joseph saw where he was laid.
Mark 15:46-47

Wait for the Lord; be strong and take heart and wait for the Lord.
Psalm 27:14

This Lenten season I reflect on the words of the 19th century southern spiritual hymn “What Wondrous Love is This”

I see his blood upon the rose
And in the stars the glory of his eyes,
His body gleams amid eternal snows,
His tears fall from the skies.

I see his face in every flower;
The thunder and the singing of the birds
Are but his voice-and carven by his power
Rocks are his written words.

All pathways by his feet are worn,
His strong heart stirs the ever-beating sea,
His crown of thorns is twined with every thorn,
His cross is every tree.
~Joseph Plunkett “I See His Blood Upon the Rose”

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To Bear the Dreadful Curse: Over This Bent World

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The world is charged with the grandeur of God.   
It will flame out, like shining from shook foil;   
It gathers to a greatness, like the ooze of oil
Crushed. Why do men then now not reck his rod?
Generations have trod, have trod, have trod;   
And all is seared with trade; bleared, smeared with toil;   
And wears man’s smudge and shares man’s smell: the soil
Is bare now, nor can foot feel, being shod.
And for all this, nature is never spent;   
There lives the dearest freshness deep down things;
And though the last lights off the black West went   
Oh, morning, at the brown brink eastward, springs —
Because the Holy Ghost over the bent   
World broods with warm breast and with ah! bright wings.
~Gerard Manley Hopkins “God’s Grandeur”

Today marks the crushing of Christ in the Garden of the Oil Press, Gethsemane. 

“Gethsemane” means “oil press” –a place of olive trees treasured for the fine oil delivered from their fruit. And so, on this Thursday night, the pressure is turned up high on the disciples, not just on Jesus.

The disciples are expected, indeed commanded, to keep watch alongside the Master, to be filled with prayer, to avoid the temptation of weakened flesh thrown at them at every turn.

But they fail pressure testing and fall apart. 

Like them, I am easily lulled by complacency, by my over-indulged satiety for material comforts that do not truly fill hunger or quench thirst,  by my belief that being called a follower of Jesus is enough.

It is not enough.
I fail the pressure test as well.

I fall asleep through His anguish.
I dream, oblivious, while He sweats blood.
I might even deny I know Him when pressed hard.

Yet, the moment of betrayal becomes the moment He is glorified,
thereby God is glorified. 

Crushed, bleeding,  poured out over the world
— from precious loving wings that brood and cover us —
He becomes the sacrifice that anoints us.

Incredibly,
indeed miraculously,
He, the crushed, loves us,
bent and flattened as we are –
anyway.

Jerusalem, Jerusalem, you who kill the prophets and stone those sent to you, how often I have longed to gather your children together, as a hen gathers her chicks under her wings, and you were not willing.
Luke 13:34

This Lenten season I reflect on the words of the 19th century southern spiritual hymn “What Wondrous Love is This”

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When I Was Sinking Down: Treading Water

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Measure the walls. Count the ribs. Notch the long days.
Look up for blue sky through the spout. Make small fires
with the broken hulls of fishing boats. Practice smoke signals.
Call old friends, and listen for echoes of distant voices.
Organize your calendar. Dream of the beach. Look each way
for the dim glow of light. Work on your reports. Review
each of your life’s ten million choices. Endure moments
of self-loathing. Find the evidence of those before you.
Destroy it. Try to be very quiet, and listen for the sound
of gears and moving water. Listen for the sound of your heart.
Be thankful that you are here, swallowed with all hope,
where you can rest and wait. Be nostalgic. Think of all
the things you did and could have done. Remember
treading water in the center of the still night sea, your toes
pointing again and again down, down into the black depths.
~Dan Albergotti “Things to Do in the Belly of the Whale” from The Boatloads.

Down into the icy depths you plunge,
The cold dark undertow of your depression,
Even your memories of light made strange,
As you fall further from all comprehension.
You feel as though they’ve thrown you overboard,
Your fellow Christians on the sunlit deck,
A stone-cold Jonah on whom scorn is poured,
A sacrifice to save them from the wreck.

But someone has their hands on your long line,
You sound for them the depths they sail above,
One who takes Jonah as his only sign
Sinks lower still to hold you in his love,
And though, you cannot see, or speak, or breathe,
The everlasting arms are underneath.
~Malcolm Guite “Christian Plummet”

But the Lord replied, “Is it right for you to be angry?
…should I not have concern for the great city of Nineveh, in which there are more than a hundred and twenty thousand people who cannot tell their right hand from their left—and also many animals?”
Jonah 4:4 and 4:11

Maybe you too feel as though you have been swallowed into the belly of the whale, treading water in the dark, disoriented and not just a little angry about the undeserving state of the world. All you can see of the outside is a bit of blue sky through a tiny hole above your head.

If you are like me, this makes you plenty grumpy. How did we end up in this mess?

Yet the belly of the whale is not forever. Surprisingly, it is a time of contemplation with little distraction other than our own conflicted feelings. We’ll soon be regurgitated back onto the shore of our trivial pursuits and busyness where suddenly life once again will feel too noisy with too many demands.

This quiet time is meant to teach something to you and me, even if it is just to count the mighty ribs protecting us, gaze into our own darkness and contemplate how we were trying to avoid what God asked of us.

I have a long list of things I could have done when the Lord prompted me, but instead stayed stubbornly resistant – treading water through life.

It’s time to stop being angry after being burped out to do what I should have done before sinking down, sinking down, sinking down…

This Lenten season I reflect on the words of the 19th century southern spiritual hymn “What Wondrous Love is This”

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