Braiding of Moments

To notice the braiding of moments—

This is how the world is built
in the depths we cannot see,
but, stopping for a moment,
we can feel it,
in the solitude of any night.

In the absence of light,
on the precipice of dreams we
can hear a jot of humming,
as the unseen parts of the world spin
and gather themselves within us,
inside the air that eases down
the leaves and sustains, as it moves
toward us, the distant calling of an owl.
~Richard Maxson “Dreams and After”

Last night we were awakened by a summer windstorm – from a muggy stillness where no air moves to sudden breezes flowing roughshod over our bed. Our wind chimes outside clanged a cacophony rather than gentle harmonic tones. The window shades became percussion instruments. Anything not fastened down went airborne.

This fortuitous storm pulled me from a bad dream of a recent stress-filled work day I didn’t manage well. As I woke startled to bed sheets blowing, I gulped at the fresh air as it passed by, allowing my dream to exhale right through the window, never to return.

Life’s intertwined moments, good, bad and indifferent, remain carefully braided together, bound and strengthened so the weaker strands are held steadfast by the enveloping twists and turns of those sturdier ones.

What was, is and will be are held together unbroken, bolstered by tougher stuff than we may think possible.

And we, swinging in the breezes, simply must hang on for dear life, if only by a slender thread.

Where Have I Been?

And the seasons they go round and round
And the painted ponies go up and down
We’re captive on the carousel of time
We can’t return, we can only look behind
From where we came
And go round and round and round
In the circle game…
~Joni Mitchell “The Circle Game”

those lovely horses,
that galloped me,

moving the world,
piston push and pull,

into the past—dream to
where? there, when

the clouds swayed by
then trees, as a tire

swing swung
me under—rope groan.

now, the brass beam,
holds my bent face,

calliope cadence—O
where have I been?
~Richard Maxson “Carousel at Seventy”

photo by Tomomi
photo by Tomomi

Sixty years ago in July, I was a five year old having her first ride on the historic carousel at Woodland Park Zoo before we moved from Stanwood to Olympia.
Fifty years ago — a teenager watching the first men walk on the moon the summer I started work as an assistant to a local dentist.
Forty years ago — deep in the guts of a hospital working a forty hour shift thinking about the man who was to become my husband.
Thirty years ago — my husband and I picking up bales of hay with two young children in tow after I had just accepted a new position doctoring at the local university & we are offered an opportunity to buy a larger farm.
Twenty years ago — with three children and our farm house remodel complete, we have three local parents with health issues needing support, helping with church activities and worship, raising Haflinger foals and organizing a summer local Haflinger gathering of nearly 100 horses and owners, planning a new clinic building.
Ten years ago — two sons launched with one about to move to Japan, a daughter at home with a new driver’s license, my mother slowly bidding goodbye to life at a local care center, farming is less about horse raising and more about gardening, starting to record life on my blog.
Five years ago — two sons married, a daughter off in the midwest as a camp counselor so our first summer without children at home. Time for a new puppy!
Now
O where have I been?
We can only look behind from where we came.

The decades pass, round and round – there is comfort knowing that through the ups and downs of daily life, I am still hanging on and if I slip and fall, there is Someone ready to catch me.


Don’t Go Too Early

Wait, for now.
Distrust everything, if you have to.
But trust the hours. Haven’t they
carried you everywhere, up to now?
Personal events will become interesting again.
Hair will become interesting.
Pain will become interesting.
Buds that open out of season will become lovely again.
Second-hand gloves will become lovely again,
their memories are what give them
the need for other hands. And the desolation
of lovers is the same: that enormous emptiness
carved out of such tiny beings as we are
asks to be filled; the need
for the new love is faithfulness to the old.

Wait.
Don’t go too early.
You’re tired. But everyone’s tired.
But no one is tired enough.
Only wait a while and listen.
Music of hair,
Music of pain,
music of looms weaving all our loves again.
Be there to hear it, it will be the only time,
most of all to hear,
the flute of your whole existence,
rehearsed by the sorrows, play itself into total exhaustion.
~Galway Kinnell “Wait”
from A New Selected Poems 

If everyone abandons you and even drives you away by force,
then when you are left alone
fall on the earth and kiss it,
water it with your tears,
and it will bring forth fruit
even though no one has seen or heard you in your solitude.
Believe to the end, even if all people went astray
and you were left the only one faithful;
bring your offering even then and praise God in your loneliness. 
~Fyodor Dostoyevsky from The Brothers Karamazov

Suicide rates of teenagers in the United States have increased well over 30% since 2009. It is a national epidemic and tragedy.

Based on the anguish of the patients I see every day,
one after another and another,
over and over again I hear
a too-easy contemplation of suicide,
from “It would be easier if I were dead”
or “no one cares if I live or die”,
or “the world would be better off without me”,
or “I’m not worthy to be here”
to “that is my plan, it is my right and no one can stop me”.

Without us all pledging an oath to live life no matter what,
willing to lay ourselves down for one another,
to bridge the sorrow and lead the troubled to the light,
there will be no slowing of this trend.

…when there is no loyalty to life, as stressful and messy as it can be,
…when there is no honoring of the holiness of each created being as weak and frail and prone to helpless hopelessness as we are,
…when there is no resistance to the buffeting winds of life~

please just wait a little longer, only a little longer:
don’t go too early

Take the Hand You Know Belongs in Yours

I think of the story
of the storm and everyone
waking and seeing
the distant
yet familiar figure
far across the water
calling to them…

…so that when 
we finally step out of the boat 
toward them, we find
everything holds
us, and everything confirms
our courage, and if you wanted 
to drown you could, 
but you don’t 
because finally 
after all this struggle
and all these years
you don’t want to any more
you’ve simply had enough
of drowning
and you want to live and you 
want to love and you will
walk across any territory
and any darkness
however fluid and however
dangerous to take the
one hand you know
belongs in yours.
~David Whyte from “The Truelove” in The House of Belonging

Yesterday was the wrap-up to my thirtieth academic year working as a college health physician.  Despite budget challenges, inadequate staffing, a higher severity of illness in a patient population with burgeoning mental health needs,  our staff did an incredible job this year serving students and their families with the resources we do have.  

Reaching the end of the school year is always poignant: we will miss the graduating students we have gotten to know so well over four or five (or six!) years,  while we watch others leave temporarily for the summer, some to far away places around the globe.

We weep for those who have failed out, given up or fallen away from those who care deeply about them, some never to return to school again, and a few giving up on life itself. They did not take the hand offered to guide them through, even though they tired of drowning.

In my work I have tried to do what is needed when it is needed no matter what time of the day or night.  There are obviously times when I fall short– too vehement when I need to be quiet, too urgent and pressured when I need to be patient,  too anxious to do something/anything when it is best to simply do no harm.

I can only hold out my hand and wait. 

Each year I learn enough from each patient to fill volumes, as they speak of their struggles, their pain, their stories and sometimes hearing, most tragically, their forever silence.

I honor you, our students, on this day, to confirm your courage stepping out from the safety of the boat — not to drown, never to drown — but wanting to live, wanting to love, wanting to move healthier, better equipped and joyful into the rest of your lives.

Just take the outreached Hand that belongs in yours.


Where Morning Lies

Will there really be a “Morning”?
Is there such a thing as “Day”?
Could I see it from the mountains
If I were as tall as they?

Has it feet like Water lilies?
Has it feathers like a Bird?
Is it brought from famous countries
Of which I have never heard?

Oh some Scholar! Oh some Sailor!
Oh some Wise Man from the skies!
Please to tell a little Pilgrim
Where the place called “Morning” lies!
~Emily Dickinson

You are the future, the immense morning sky
turning red over the prairies of eternity…

You are the meaning deepest inside things
that never reveals the secret of its owner.
And how you look depends on where we are:
from a boat, you are shore, from the shore a boat.
~Rainer Maria Rilke,  from Love Poems to God from the Book of Hours

I know now what weariness is when the mind stops
and night is a dark blanket of peace and forgetting
and the morning breaks to the same ritual and the same
demands and the silence.
~Jane Clement from No One Can Stem the Tide

I head to clinic this morning
knowing from now on
my work will feel different after today,
no longer the same ritual,
no longer the same demands.

Mornings will be more resonant, depending on where I am:
from the boat I no longer must be shore,
from the shore I no longer need to row the boat.

I can simply be what the patient needs in the moment
and the patient is all I need.

Amen and amen.


Your Days Are Short Here

Your days are short here; this is the last of your springs.
And now in the serenity and quiet of this lovely place,
touch the depths of truth, feel the hem of Heaven.
You will go away with old, good friends.
And don’t forget when you leave why you came.

~Adlai Stevenson, to the Class of ’54 Princeton University

I was eight years old in June 1963 when the Readers’ Digest arrived in the mail inside its little brown paper wrapper. As usual, I sat down in my favorite overstuffed chair with my skinny legs dangling over the side arm and started at the beginning,  reading the jokes, the short articles and stories on harrowing adventures and rescues, pets that had been lost and found their way home, and then toward the back came to the book excerpt: “The Triumph of Janis Babson” by Lawrence Elliott.

Something about the little girl’s picture at the start of the story captured me right away–she had such friendly eyes with a sunny smile that partially hid buck teeth.  This Canadian child, Janis Babson, was diagnosed with leukemia when she was only ten, and despite all efforts to stop the illness, she died in 1961.  The story was written about her determination to donate her eyes after her death, and her courage facing death was astounding.  Being nearly the same age, I was captivated and petrified at the story, amazed at Janis’ straight forward approach to her death, her family’s incredible support of her wishes, and especially her final moments, when (as I recall 54 years later) Janis looked as if she were beholding some splendor, her smile radiant.

”Is this Heaven?” she asked.   She looked directly at her father and mother and called to them:  “Mommy… Daddy !… come… quick !”

And then she was gone.  I cried buckets of tears, reading and rereading that death scene.  My mom finally had to take the magazine away from me and shooed me outside to go run off my grief.  How could I run and play when Janis no longer could?  It was a devastating realization that a child my age could get sick and die, and that God allowed it to happen.

Yet this story was more than just a tear-jerker for the readers.  Janis’ final wish was granted –those eyes that had seen the angels were donated after her death so that they would help another person see.  Janis  had hoped never to be forgotten.  Amazingly, she influenced thousands of people who read her story to consider and commit to organ donation, most of whom remember her vividly through that book excerpt in Readers’ Digest.  I know I could not sleep the night after I read her story and determined to do something significant with my life, no matter how long or short it was.  Her story influenced my eventual decision to become a physician.  She made me think about death at a very young age as that little girl’s tragic story could have been mine and I was certain I could never have been so brave and so confident in my dying moments.

Janis persevered with a unique sense of purpose and mission for one so young.  As a ten year old, she developed character that some people never develop in a much longer lifetime.  Her faith and her deep respect for the gift she was capable of giving through her death brought hope and light to scores of people who still remember her to this day.

Out of the recesses of my memory, I recalled Janis’ story a few years ago when I learned of a local child who had been diagnosed with a serious cancer.  I could not recall Janis’ name, but in googling “Readers’  Digest girl cancer story”,  by the miracle of the internet I rediscovered her name, the name of the book and a discussion forum that included posts of people who were children in the sixties, like me,  who had been incredibly touched by Janis when they read this same story as a child.  Many were inspired to become health care providers like myself and some became professionals working with organ donation.

Janis and family, may you know the gift you gave so many people through your courage in the midst of suffering, and the resulting hope in the glory of the Lord.  Your days were short here, but you touched the depth of truth and touched the hem of heaven.
~~the angels are coming indeed.

We who have been your old good friends,  because of your story,  have not forgotten how you left us and why you came in the first place.

For excerpts from “The Triumph of Janis Babson”, click here

Finding Out Who the Patient Is

Portrait by Norman Rockwell

If you want to identify me, 
ask me not where I live, 
or what I like to eat, 
or how I comb my hair, 
but ask me what I am living for, 
in detail, 
ask me what I think is keeping me 
from living fully 
for the thing I want to live for. 
~ Thomas Merton from My Argument with the Gestapo

As a patient waiting to see my health care provider,  I would adapt Merton’s template of personal revelation this way:

If you want to know who I am,
ask me not about my insurance plan,
or what is my current address,
or whether I have a POLST on file,
or whether I have signed the Notice of Privacy Practice,
or whether I’ll accept a message on my phone —
but ask me what I am most concerned about,
in detail,
ask me what I think is causing my symptoms
and what I think is keeping me
from eating healthy, exercising regularly,
and choosing moderation in all things
so that I can live fully
for the thing I want to live for.

As a physician in the midst of a busy clinic day, I struggle to know who my patients are beyond their standard medical history and demographics.  One of my goals in our primary care clinic, now sixteen years into electronic medical record (EMR) use,  is to create a way for our patients to provide their personal history online to us via their password secured web portal.   These are the questions our clinic staff may not have opportunity to ask or record during clinic visits.  Having the patient personally document their social history and background for us to have in the chart –in essence, telling us their story in their own words–can be very helpful diagnostically and for individualizing the best treatment approach for each unique individual.

There needs to be an “About me” section in the EMR that would contain biographical and personal history information the patient could provide online via writing or video.

Tell us about yourself

This is your own personal history in your own words to be added to your electronic medical record in the folder “About Me”. You can edit and add information at any time via this secure patient portal to update it.

We want to know your story.  Only you can tell us what you think is most important for us as your health care providers to know about you.  We may not always have the time to ask and document these detailed questions in a brief clinic visit, so we are asking for your help.  

Why do we want to know your non-medical background as well as medical background?

We evaluate a patient’s symptoms of concern but we also are dedicated to helping our patients stay healthy life long.  To assist us in this effort, it is very helpful to know as much about you as possible, in addition to your past medical history.   It is crucial also to understand your family background and social history.  We want to know more about your personal goals, and what you think may be preventing you right now from living fully for the things you consider most important to you. 

This is your opportunity to tell us about yourself, with suggested questions below that you can consider answering.  This information is treated as a confidential part of your medical record, just like all information contained in your record.  You can add more at any time by returning to this site.

1)      Tell us about your family—who raised you and grew up with you, and who currently lives with you– including your racial/ethnic/cultural heritage. If relevant,  tell us whether you have biological beginnings outside of your family (e.g. adopted, egg donation, surrogate pregnancy, artificial insemination, in vitro fertilization)    Provide information on any illnesses in your biologic family.

2)     List the states or countries you have lived in, and what countries outside the U.S. you have lived in longer than a month.  Have you served in the military or another government entity, like the Peace Corps?

3)      Tell us about your educational and job background. This could include your schooling or training history,  paid or volunteer work you’ve done.  What are your hobbies, how do you spend your leisure time, what are your passions and future goals.  Where do you see yourself in ten years?

4)      Tell us about your sexual orientation and/or gender preference.

5)      Tell us about your current emotional support system—who are you most likely to share with when things are going very well for you and especially when things are not going well.

6)      Tell us about your spiritual background,  whether you are part of a faith or religious community and if so, how it impacts your life.

7)       Tell us what worries you most about your health.

8)      What would you have done differently if you could change things in your life?  What are you most thankful for in your life?

9)      What else do you feel it is important for us to know about you?

Thank you for helping us get to know you better so we can provide medical care that best meets your unique needs.

As our clinic is moving to an updated EMR, I’m interested in hearing feedback from patients and health care providers.  What additional questions would you want asked as part of personal history documentation in a medical record?

Electronic medical records allow us, as never before, the ability to share information securely between patients and their health care providers.
Patients want to tell us their story and we want to know more about them. 

It is time we asked them and truly listen to what they have to say.