He thought of all the time he wasted being good. Clutched by the guilt of excellence. Polite. Well-trained. But when the long summer afternoons came, too hot to move from the window fan, scent of vapor rising from water jackets, he found pleasure in doing the nothing that had no regrets– wasted afternoons under the Wisteria vine when no one was watching. Aroma thick as a breeze on his shoulder. Thinking of women constantly, forgetting to water the chickens in the barn. He was beginning to feel the release of duty, to feel what it’s like to feel. Demands waiting like barking dogs at the periphery. His good intention to visit the sick woman falling aside as he listened to the rattle of starlings in the rafters––discovering that strange lightness of the body. And the new importance of oak branches where they separate from the trunk. How far out the leaves begin to spread. The startling arrangement of moss like whiskers without discipline. The long plains of earth reaching to the clouds behind the back yard fence. How the ground pushes back when you walk. ~David Watts, M.D. – “Another Side of Transgression” from Having and Keeping
Decades of demands and responsibilities become a falling-down fence line with no end in sight. Having been raised an obedient person with a heightened sense of obligation about constantly fixing what needs repair, I’ve done what I could, where I could, when I could, how I could, though too often ineffective in my efforts.
I’ve always moved from task to task to task – life’s string of fence posts held wires that always needed stretching and patching and straightening. By continually working, I hoped I too would remain standing and functional.
It’s clear the fence isn’t perfect, nor will it ever be. It has served a purpose, as have I. Now I wander along the fencerow, focusing on the walk and the view rather than searching out every little thing which is leaning or loose or gaping.
This walk feels good, lighter, almost cushiony, almost like rolling with joy in the freedom of it. I’m ambling along for no particular reason at all, which is almost intoxicating.
I think I’ll get used to the importance of doing nothing whatsoever.
A new Barnstorming book is available for order here:
Whatever he needs, he has or doesn’t have by now. Whatever the world is going to do to him it has started to do. With a pencil and two Hardy Boys and a peanut butter sandwich and grapes he is on his way, there is nothing more we can do for him. Whatever is stored in his heart, he can use, now. Whatever he has laid up in his mind he can call on. What he does not have he can lack. The bus gets smaller and smaller, as one folds a flag at the end of a ceremony, onto itself, and onto itself, until only a heavy wedge remains. Whatever his exuberant soul can do for him, it is doing right now. Whatever his arrogance can do it is doing to him. Everything that’s been done to him, he will now do. Everything that’s been placed in him will come out, now, the contents of a trunk unpacked and lined up on a bunk in the underpine light. ~Sharon Olds “The Summer-Camp Bus Pulls Away from the Curb”
This is the season for graduations and commencements to the next phase of life, when students move into the adult world and don’t look back.
As a parent, as an educator, as a mentor within church and community, and over thirty two years as a college health physician witnessing this transition many times over, I can’t help but be wistful about what I may have left undone and unsaid with the generation about to launch. In their moments of vulnerability, did I pack enough love into their hearts so they can pull it out when it is most needed?
When our three children traveled the world after their graduations, moving beyond the fenced perimeter of our little farm, I trusted they left well prepared.
As a former school board member, I watched our students, parents and teachers work diligently together in their preparation for that graduation day, knowing the encompassing love behind each congratulatory hand shake.
When another batch of our church family children say goodbye, I remember holding them in the nursery, listening to their joyful voices as I played piano accompaniment in Sunday School, feeding them in innumerable potlucks over the years. I pray we have fed them well in every way with enough spiritual food to stick to their ribs in the “thin” and hungry times.
When hundreds of my student/patients move on each year beyond our university health clinic, I pray for their continued emotional growth buoyed by plenty of resilience when the road gets inevitably bumpy.
I believe I know what is stored in the hearts of our graduates because I, among many others, helped them pack it full of love. Only they will know the time to unpack it when the need arises.
And now, this year, I find I am “graduating” as well, moving away from a regular clinic work schedule to whatever waits for me next. I cleaned out my desk yesterday, carrying the detritus of three decades back home with me, including a packed-away glass “tear drop” I somehow earned ten years ago for “exceptional effort.” All I really remember about that time in my professional life are the shed tears that award acknowledged unbeknownst. It was a fitting symbol for what I had been through during a hard year.
I’m not exactly climbing on a bus with my lunch packed to go to summer camp, but it feels a bit similar as I enter this new phase. I’m nervous, I’m sad, I’m excited, I’m exuberant, so much like all the graduates I’ve seen commence over the years.
And best of all for me, summer camp is right here on the farm, peanut butter sandwiches included.
A new book from Barnstorming available to order here:
The wind, one brilliant day, called to my soul with an odor of jasmine.
“In return for the odor of my jasmine, I’d like all the odor of your roses.”
“I have no roses; all the flowers in my garden are dead.”
“Well then, I’ll take the withered petals and the yellowed leaves and the waters of the fountain.”
The wind left. And I wept. And I said to myself: “What have you done with the garden that was entrusted to you?” ~Antonio Machado “The Wind, One Brilliant Day” translated by Robert Bly
This garden bloomed with potential, entrusted to me for 32 years: the health and well-being of 16,000 students, most thriving and flourishing, some withering, their petals falling, a few have been lost altogether.
As the winds of time sweep away another group of graduates from my care, to be blown to places unknown, their beauty and fragrance gone from here.
I marvel at their growth, but also weary weep for those who left too soon, wondering if I failed to water them enough – or is it I who am parched in this garden with a thirst unceasing, my roots reaching deep into drought-stricken soil, ever so slowly drying out?
A new book from Barnstorming available for order here:
Nothing seems to please a fly so much as to be taken for a currant; and if it can be baked in a cake and palmed off on the unwary, it dies happy. ~Mark Twain
Today I will wrap up 45 years of uninterrupted training and doctoring. Most of that time, I have worried I’m like a fly hiding among the black currants hoping to eventually become part of the currant cake.
Maybe no one has noticed. These days we call it the “impostor” syndrome. Mark Twain knew all about currant cake and how easy it was for a fly to blend into its batter.
Even while bearing three children and going through a few surgeries myself, I’ve not been away from patients for more than twenty consecutive days at any one time. This is primarily out of my concern that, even after a few weeks, I would forget all that I’ve ever known. In fact, half of what I learned in medical school and residency over forty years ago has evolved, thanks to new discoveries and clarifying research. I worried if I were to actually to step away from doctoring for an extended time, then return to see patients again, I would be masquerading as a physician rather than be the real thing. A mere fly among the currants palmed off on the unwary.
If being truly honest, those who spend their professional lives providing medical care to others always share this concern: if a patient only knew how much we don’t know and will never know, despite everything we DO know, there would really be no trust left for us at all.
Of course, some say, didn’t the COVID pandemic prove our ignorance? Physicians started at Ground Zero with a novel virus with unclear transmissibility and immense potential to wreak havoc on the human body … or cause no symptoms whatsoever. We had no collected data to base prevention or treatment decisions: would masks just protect others or would they only protect ourselves, or maybe they protect both? Could a common inexpensive anti-inflammatory/antimalarial drug be beneficial or would a parasitic wormer medication be somehow effective to fight the devastation of the virus?
Effective treatments are still being sought all these months later; others have been debated, studied and discarded as worthless.
Or would this pandemic finally resolve thanks to effective yet controversial public health mandates while rapidly distributing highly effective vaccines developed from many prior years of carefully performed research?
During the past 16 months, your next door neighbor, or the loudest tweet on Twitter proclaimed more expertise than the average medical professional and definitely had a stronger opinion. At least we doctors knew how much we didn’t know and how much was simply guess work based on experience, good intentions and hopeful prayer. Gradually, while lives were lost, including too many of our own, real data began to trickle in so decisions could be made with some evidence backing them. But even that data continues to evolve, day by day, as authentic medical evidence always does.
That doesn’t stop all the “quack” flies out there from climbing into the batter pretending to be currants. With so much rapidly changing medical information at everyone’s fingertips, who needs a trained physician when there are so many other resources – sketchy and opportunistic though they may be – for seeking health care advice?
Even so, I am convinced most patients really do care that doctors share the best information they have available at any point in time. None of us who are doctoring wants to be the “fly” in the batter of health care.
As I meet with my last patient today, I know over forty years of clinical experience has given me an eye and an ear for the subtle signs and symptoms that no googled website or internet doc-in-the-box can discern. The avoidance of eye contact, the tremble of the lip as they speak, the barely palpable rash, the hardly discernible extra heart sound, the fullness over an ovary, the slight squeak in a lung base. These are things I am privileged to see and hear and about which I make decisions together with my patients. What I’ve done over four decades has been no masquerade; out of my natural caution, I am not appearing to be someone I am not. This is what I was trained to do and have done for thousands of days and many more thousands of patients during my professional life, while passing a comprehensive certification examination every few years to prove my continued study and changing fund of knowledge.
The hidden fly in the currant bush of health care may be disguised enough that an unwary patient might gobble it down to their ultimate detriment. I know I’ve not been that doctor. I’ve been the real thing all these years for my patients, even if I’ve seemed a bit on the tart side at times, yet offering up just enough tang to be exactly what was needed in the moment and in the long term.
And someday, hopefully not too soon, I will die happy having done this with my life.
A new book from Barnstorming is available to order here:
You can’t say you haven’t been warned: there are creepy crawlies in this post
Things I will never like: 1. Drying off with a cold, damp towel. 2. The feeling of seaweed wrapping around my legs. 3. Anything that was popular in the 70’s. 4. Licorice, yam, or raisins. 5. That high-pitched screech that babies make. 6. Writhing maggots. ~Bill Watterson from It’s A Magical World: A Calvin and Hobbes Collection
A few weeks ago, I had a bit of home-made potato corn chowder left over that I added to our compost bin in our barnyard. It isn’t often that much animal protein makes its way into the bin so when I checked on the compost a few days later, I was amazed to see it teeming with fly maggots in the midst of their Thanksgiving feast. Ordinarily pictures and videos of maggots would not find their way to this blog. People might be looking at this blog while eating their breakfast or lunch and writhing maggots are not something you are expecting to see. My apologies in advance and now is the time to delete delete delete.
Therefore: a trigger warning. Don’t scroll down further if you would rather avoid seeing (and hearing) creepy crawly things.
My first medical exposure to maggots came while examining the leg and foot wounds of the homeless folks I helped care for when training in an inner city emergency room. Peeling off old ragged stockings and socks would often reveal more than dirty feet – in fact, the maggots may have been somewhat beneficial in those cases yet we were quick to dispose of them.
Maggots are, in fact, fascinating creatures with potential therapeutic value, notwithstanding their gross-out factor. This week in a brief Atlantic article found here, there is a summary of a recent study in France comparing typical surgical debridement of venous ulcers of the skin with maggot therapy. Maggots were faster in cleaning the wounds but didn’t enhance eventual healing any more than traditional surgical care. There wasn’t a difference in the discomfort level as long as the patient didn’t know which therapy was being used. For those who had been randomly assigned to maggot therapy in one study, an astounding 89% said they would opt for the insects over surgeons if faced with needing wound care in the future.
I’m not sure what that says about surgeons, but it is a great compliment to maggot larvae!
Here is a formal cross-referenced evidence-based summary from UptoDate.com about wound treatment with biologic methods:
Biologic — An additional method of wound debridement uses the larvae of the Australian sheep blow fly (Lucilia [Phaenicia] cuprina) or green bottle fly (Lucilia [Phaenicia] sericata, Medical Maggots) [42,43]. Maggot therapy can be used as a bridge between debridement procedures, or for debridement of chronic wounds when surgical debridement is not available or cannot be performed . Maggot therapy may also reduce the duration of antibiotic therapy in some patients .
Maggot therapy has been used in the treatment of pressure ulcers [45,46], chronic venous ulceration [47-50], diabetic ulcers [42,51], and other acute and chronic wounds . The larvae secrete proteolytic enzymes that liquefy necrotic tissue, which is subsequently ingested while leaving healthy tissue intact. Basic and clinical research suggests that maggot therapy has additional benefits, including antimicrobial action and stimulation of wound healing [43,47,53,54]. However, randomized trials have not found consistent reductions in the time to wound healing compared with standard wound therapy (eg, debridement, hydrogel, moist dressings) [55,56]. Maggot therapy appears to be at least equivalent to hydrogel in terms of cost [56,57].
Dressing changes include the application of a perimeter dressing and a cover dressing of mesh (chiffon) that helps direct the larvae into the wound and limits their migration (movie 1). Larvae are generally changed every 48 to 72 hours. One study that evaluated maggot therapy in chronic venous wounds found no advantage to continuing maggot therapy beyond one week . Patients were randomly assigned to maggot therapy (n = 58) or conventional treatment (n = 61). The difference in the slough percentage was significantly increased in the maggot therapy group compared with the control groups at day 8 (67 versus 55 percent), but not at 15 or 30 days.
The larvae can also be applied within a prefabricated “biobag”, commercially available outside the United States, that facilitates application and dressing change [58-61]. Randomized trials comparing “free range” with “biobag”-contained larvae in the debridement of wounds have not been performed.
A main disadvantage of maggot therapy relates to negative perceptions aboutits use by patients and staff. One concern among patients is the possibility that the larvae can escape the dressing, although this rarely occurs. Although one study identified that approximately 50 percent of patients indicated they would prefer conventional wound therapy over maggot therapy, 89 percent of the patients randomly assigned to maggot therapy said they would undergo larval treatment again . Perceived pain or discomfort with the dressings associated with maggot therapy may limit its use in approximately 20 percent of patients.
The STARZ show Outlander (a show and series of books by scientist Diana Gabaldon I thoroughly enjoy) used real maggots in the fifth season of the show when in 18th century America, wife (and surgeon) Claire successfully treats her husband Jamie’s snakebite wound with the larvae. Actress Caitriona Balfe describes her co-starring maggots in this brief video:
So there are still things to learn about medical therapies we used in the past which have been sidelined or forgotten in our push for modern treatment modalities. The days of leeches and maggots may not be over after all.
And now for video, complete with little maggotty sound effects — scroll down
Maggots in our compost bin – enjoying corn and potato chowder leftovers
A new book from Barnstorming is available to order here
The talkative guest has gone, and we sit in the yard saying nothing. The slender moon comes over the peak of the barn.
The air is damp, and dense with the scent of honeysuckle. . . . The last clever story has been told and answered with laughter.
With my sleeping self I met my obligations, but now I am aware of the silence, and your affection, and the delicate sadness of dusk. ~Jane Kenyon, “The Visit” from Collected Poems
As we slowly adapt to evenings spent with family and friends again, taking off our masks to actually witness the emotion on a familiar, now unveiled, face:
There are smiles and laughter again. We are trying to remember how to be ourselves outside the fearfulness that contagion wrought. More important: there are tears again. And wistfulness. And regret. And longing.
This delicate sadness happened – even to those of us who were never directly touched by sickness. We will never be the same, never so light of heart again, remembering what this past year has cost.
It is a slow transition to dusk. We sit together now and watch it come.
I am hardly ever able to sort through my memories and come away whole or untroubled. It is difficult to sift through the stones, the weighty moments and know which is rare gem, which raw coal, which worthless shale or slate. So, one by one, I drag them across the page and when one cuts into the white, leaves a trail of blood, no matter how narrow the stream, then I know I’ve found the real thing, the diamond, one of the priceless gems my pain produced. “There! There,” I say, “is a memory worth keeping.” ~Nikki Grimes“Poems”
I have tucked-away memories that still scratch my tender skin: when they surface, I tend to bleed at the recollection, feeling the familiar sting behind my eyelids and upside-down stomach.
Some people work hard to completely bury painful history, unwilling to allow it back into the daylight to inflict even more harm.
I don’t welcome overwhelming memories back, but when they come unbidden, I grant them access only because I know, as this happened to me long ago, I will feel the sharp ache of sorrow when I witness bleeding in another.
I was there too. I am there with you now. What happened was real but done. Its healing leaves behind only a thin line where the bleeding was.
Gardens are also good places to sulk. You pass beds of spiky voodoo lilies and trip over the roots of a sweet gum tree, in search of medieval plants whose leaves, when they drop off turn into birds if they fall on land, and colored carp if they plop into water.
Suddenly the archetypal human desire for peace with every other species wells up in you. The lion and the lamb cuddling up. The snake and the snail, kissing. Even the prick of the thistle, queen of the weeds, revives your secret belief in perpetual spring, your faith that for every hurt there is a leaf to cure it. ~Amy Gerstler “Perpetual Spring” from Bitter Angel
We all want to fix what ails us: that was the point of my many years of medical training and over 40 years “practicing” that art. We want to know there is a cure for every hurt, an answer for every question, a resolution to every mystery, or peace for every conflict.
And there is. It just isn’t always on our timeline, nor is it always the answer we expect, nor the conflict magically dissolved. The mystery shall remain mystery until every tear is dried, as we stand before the Face of our Holy God who both loves and judges our hearts.
Sometimes this life hurts – a lot – but I believe in the perpetual Spring and Resurrection that guarantees our complete healing.
When we reach the field she is still eating the heads of yellow flowers and pollen has turned her whiskers gold. Lady, her stomach bulges out, the ribs have grown wide. We wait, our bare feet dangling in the horse trough, warm water where goldfish brush our smooth ankles. We wait while the liquid breaks down Lady’s dark legs and that slick wet colt like a black tadpole darts out beginning at once to sprout legs. She licks it to its feet, the membrane still there, red, transparent the sun coming up shines through, the sky turns bright with morning and the land with pollen blowing off the corn, land that will always own us, everywhere it is red. ~Linda Hogan, “Celebration: Birth of a Colt” from Red Clay.
First, her fluid flows in subtle stream then gushes in sudden drench. Soaking, saturating, precipitating inevitability. No longer cushioned slick sliding forward following the rich river downstream to freedom.
The smell of birth clings to shoes, clothes, hands as soaked in soupy brine I reach to embrace new life sliding toward me.
I too was caught once; three times emptied into other hands, my babies wet on my chest their slippery skin under my lips so salty sweet
In a moment’s scent the rush of life returns; now only barn or field birthings yet still as sweet and rich. I carry the smell of damp foal fur with me all day to recall from whence I came. I floated once and will float free someday again.