Empty of Air

On the green hill with the river beyond it
long ago and my father there
and my grandmother standing in her faded clothes
wrinkled high-laced black shoes in the spring grass
among the few gravestones inside their low fence
by the small white wooden church
the clear panes of its windows
letting the scene through from the windows
on the other side of the empty room
and a view of the trees over there
my grandmother hardly turned her head
staring like a cloud at the empty air
not looking at the green glass gravestone
with the name on it of the man to whom
she had been married and who had been
my father’s father she went on saying nothing
her eyes wandering above the trees
that hid the river from where we were
a place where she had stood with him one time
when they were young and the bell kept ringing

~W. S. Merwin “Widnoon” from The Moon Before Morning 

I remember my grandfather as a somber quiet man who used to slowly rock in a wooden chair that now happens to sit empty here in our home.

For most of his life, my Grandpa drank heavily but he wasn’t just any drunk.  He was a mean drunk. Surly, cursing, prone to throwing things and people, especially at home.

Grandma used to say he learned to drink in the logging camps and I suspect that is true. He started working as a logger before he was fully grown, dropping out of school, leaving home around age sixteen and heading up to the hills where real money could be made. He learned more than how to cut down huge old growth Douglas Fir trees, skid them down the hills using a team of horses, and then roll them onto waiting wagons to be hauled to the mills. He learned how to live with a group of men who surfaced once or twice a month from the hills to take a bath, bootleg booze during prohibition and maybe go to church with their womenfolk.

Mostly the loggers taught him how to curse and drink.

He headed home to the farm with muscles and attitude a few years later, and started the process of felling trees, creating a “stump farm” that was a challenge to work because huge stumps dotted the fields and hills. He slowly worked at blasting them out of the ground so the land could be tilled. It proved more than he had strength and motivation to do, so his fields were never very fruitful, mostly growing hay for his own animals. He went to work in the local saw mill to make ends meet.

He cleaned up some when he met my grandmother, who at eighteen was seven years younger, and eager to escape her role as chief cook and bottle washer for her widowed father and younger brother.  She was devout, lively and full of energy and talked constantly while he, especially when sober, preferred to let others do the talking. It was an unusual match but he liked her cooking and she was ready to escape the drudgery of her father’s household and be wooed.

They settled on the stump farm and began raising a family, trying to eke out what living they could from the land, from the sporadic work he found at the saw mill, and every Sunday, took the wagon a mile down the road to the Bible Church where they both sang with gusto.

He still drank when he had the money, blowing his pay in the local tavern, and stumbling in the back door roaring and burping, falling into bed with his shoes on. Grandma was a teetotaler and yelled into his ruddy face about the wrath of God anytime he drank, their four children hiding when the dishes started to fly, and when he would whip off his belt to hit anyone who looked sideways at him.

When their eldest daughter took sick and died of lymphoma at age eight despite the little doctoring that was available, Grandpa got sober for awhile. He saw it as punishment from God, or at least that is what Grandma told him through her sobs as she struggled to cope with her loss.

Over the years, he relapsed many times, losing fingers in his work at the mill, and losing the respect of his wife, his children and the people in the community. Grandma took the kids for several months to cook in a boarding house in a neighboring town, simply to be able to feed her family while Grandpa squandered what he had on drink. Reconciled over and over again, Grandma would come back to him, sending their only son to fetch him from the tavern for the night. My Dad would bicycle to that dark and smoky place, stand Grandpa up and guide him staggering out to their truck for the weaving drive home on country roads. On more than one occasion, Grandpa, belligerent as ever, would resist leaving and throw a punch at his boy, usually missing by a mile.

But once the boy grew taller and strong enough to fight back, managing to knock Grandpa to the ground in self-defense, the punching and resistance stopped. The boozing didn’t.

Grandpa sobered up for good while his boy fought in the war overseas in the forties, striking a bargain with God that his boy would come home safe to work the farm as long as Grandpa left alcohol alone.  It stuck and he stayed sober. His boy came home. Grandpa saw it as a promise kept and became an elder in his Bible Church, taught Sunday School and gave his extra cash to the church rather than the tavern. He and Grandma donated a house on their property to the church for a parsonage.

Some twelve years later, sitting in a Christmas Sunday School program one Christmas Eve, Grandpa leaned toward Grandma and she saw his face broken out in sweat, his face ashen.

“It’s hot in here, I need air, “ he said and collapsed in her lap. He was gone, just like that. He left the rest of his family behind while he sat in church, sober as can be, on the day before Christmas.

There is no question in my mind he knew he was forgiven. He headed home one more time, not weaving or swerving but traveling straight and narrow.

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Reflecting Back…

The Pacific Medical Center (2012) Photo by Joe Mabel
http://www.pactower.org

Some years ago, while sitting with my husband and young family high in the upper reaches of Seattle’s (then) Safeco Field watching the Mariners lose to the Cleveland (then) Indians, my attention diverted from the baseball game to the expansive view of the surrounding city.

In particular, I couldn’t help but place myself back inside the old Art Deco building that sits up on Beacon Hill (now known as the Pac Tower.) I had spent a hundreds of hours of my life in that building in the late 1970s; it was easy imagine my younger self in those hallways and rooms.

The 90 year old building had a number of different purposes since originally being constructed to provide hospital care for the region’s Merchant seamen. By 1999, it had become the home of a five year old business that had outgrown Jeff Bezos’ garage — Amazon.com. 

I trained inside the walls of that Public Health Hospital, back in the days when it was the hospital in the region for not only Merchant Marines, but many of the indigenous people of the Pacific northwest and Alaska, in addition to local folks who needed affordable (as in free) health care. I had opportunity to work several clinical rotations in this building as a University of Washington medical student, and to think of it being Amazon’s first (but not last) major headquarters for Amazon made my brain do twists. 

I remembered so much life and death happening inside those walls over the years. 

I first walked into this building as a very green 24 year old med student beginning a surgical rotation in fall 1976, knowing only which end of the stethoscope to put in my ears and which end rests on the patient. On the first day I was shown how to put on a surgical gown, masks and sterile gloves without contaminating myself and the people around me. I never have forgotten that sequence of moves, even though my opportunity to go into an operating room (other than as a patient) became rare after my training days. My chief surgical resident was an exceptionally talented young man who worked himself and everyone working with him around the clock caring for his patients. This brilliant surgeon could only operate on patients while listening and singing to the music of Elvis Presley. I can’t hear any Elvis Presley songs to this day without smelling the odors of surgery–cauterized blood vessels and pus. 

He was soon to become a leading trauma surgeon in a city known for its fine surgeons. The pressure was too much for him. He experienced a personal crisis for which he sought treatment. When he returned to medicine, he abandoned his incredible surgical skills to train as a psychiatrist and still remains an authority on helping impaired physicians, assisting other care providers to acknowledge and deal with addiction and mental health burnout before they harm a patient. 

Those endless clinical rotation days and nights meant witnessing the misery of the most vulnerable of humanity in desperate need of healing, and sometimes we succeeded, but often we did not.  I still have a recurring dream of running up and down the staircases of the Public Health Hospital, bringing pint after pint of blood to the OR from the lab as our team operated on an Alaskan indigenous patient bleeding from dilated esophageal varices, developed as a result of a damaged liver from chronic alcohol dependency. We did not save her, nor have I saved her even once in my dreams over the decades, though I keep trying to run faster. My response to her death was to spend 20 years of my clinical career working with patients in an alcohol and drug treatment program, hoping to prevent her fate in others.

Nor did we save a classmate of mine, on a rotation on a different service, the daughter of a beloved radiologist in this very hospital, who for reasons unknown, had a cardiac arrest while napping briefly during her 32 hour shift.  Another medical student sleeping in the same room heard her odd breathing, found her unresponsive and all medical interventions were employed, to no avail. Even when all the right people, and the right equipment, and the right medicine is seconds away, death can still come, even to healthy people in their 20s.  This was a shock to us all, and an extraordinarily humbling lesson to the pompous and overconfident among us. We might die, in our sleep, whenever it is our time. Years later, I still remember that in my evening prayers.

There was also the young surgical resident who was hospitalized there with jaundice and subsequently died of Hepatitis B, contracted from a blood exposure during his training. No vaccination was available in those days, but was in development. And it was in this and other hospitals in the city, we began to see unusual cases of gay men with severe wasting, rare skin cancers and difficult to treat pneumonias. Initially called GRID (gay-related immune deficiency), it was renamed AIDS as it began appearing in the general population as well, and for too long was a death sentence for anyone infected.

One on-call night in particular is memorable. It was Christmas Eve, and a heavy snowstorm had brought the city to a standstill.  We had very little to do that night in the hospital as the elective surgeries were all postponed until after the holiday and no ambulance could easily make it up the steep drive to the ER, so they were being diverted to other hospitals. As a result, our patient load was light. I was in my tiny sleeping room, on the 14th floor of the tower, facing out north to the city of Seattle, able to enjoy the view of the city, everything blanketed under snow, so peaceful and very quiet.  The freeway, ordinarily so busy day and night, was practically abandoned, and the lights of the city were brighter from the snowfall. It was an enchanting vision of a city forced to slow itself and be still, so anticipatory on a sacred and holy night.

I remember thinking about how young and inexperienced I was, and how very little I knew. My chief resident thought I’d make a good surgeon – I was a diligent worker and technically very good with my hands. My heart told me that I’d be better as a generalist/family doctor. The city held many attractions and excitement, but I longed to return to a farm and a someday family. It was a wistful bittersweet night and I slept very little, perched on that little bed overlooking the sleeping snowy city. I wondered where life might take me, as I reflected on who I was becoming and where I was meant to be.

Forty five years later, I still am reminded every day at how little I know,  but I do realize this:
for however long we’re on this earth, each day we have a distinct purpose and reason for being.

That day, my purpose was to be snowbound on that Christmas day at the old Public Health Hospital, unable to go home from my shift because my car was stuck in the parking lot. Instead, I covered for others who couldn’t make it in to work, singing Christmas carols for all the patients who had to stay put in their hospital beds.

Soon, my purpose was to meet the man I was to marry, eventually living with three beloved children on a little farm 100 miles to the north while practicing medicine in a variety of primary care roles for over forty years. 

And perhaps, my purpose now in retirement is to share a few stories while reflecting on a life still in progress.

Only the Lord knows why He places us where He does.

view from the “sleeping room” at the top of the tower
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Last Year’s Mistakes Wiped Clean

redsquare
 
 
That old September feeling, left over from school days, of summer passing… Another fall, another turned page: there was something of jubilee in that annual autumnal beginning, as if last year’s mistakes had been wiped clean by summer.
~Wallace Stegner from Angle of Repose
 
 
 
fallleaves91518
 
 
mapleWWU
 
 
 

Sixteen thousand students have appeared magically overnight on the campus where I’ve worked for three decades.  Unfortunately a record was set for the number who ended up in the emergency room last night due to their celebrating the start of the school year a bit too aggressively.

How is it the start of a new school year can be wistful, jubilant and potentially hazardous all at the same time?  There are always plenty of mistakes to be made and plenty to learn from, though sometimes at tremendous cost.  This is a risky way to start an education.

More than New Year’s Day, the beginning of autumn represents so many turned-over new “leafs”.  We are reminded of this whenever we look at the trees all over our beautiful campus and how their leaves are turning and letting go, seemingly joyful as they make way for the next stage of growth, the slate wiped clean and ready to be scribbled on once again.

Every autumn each emerging adult comes to the university with a similar clean slate, hoping to start fresh, leaving behind what has not worked well for them in the past.  These are our future patients who we hope are open to change because they are dedicating themselves to self-transformation through knowledge and discipline.

It is a true privilege, as a college health doc, to participate in our students’ transition to become autonomous critical thinkers striving to better the world as compassionate global citizens.  Their rich colors deepen when they let go to fly wherever the wind may next take them.

We who remain rooted in place celebrate each new beginning, knowing we nurture the hoped-for transformation…

…as long as we can keep them out of the emergency room.

 

irresistiblewwu

 

wwu11147

 

 

A Flower Unplucked

rainyroseA flower unplucked is but left to the falling,
And nothing is gained by not gathering roses.
~Robert Frost from “Asking for Roses”

 

Robin Williams spent his lifetime coaxing us to laugh till we cried,
making us cringe and too often wanting to hide from his manic intensity.

He left no flower unplucked and now he has left us weeping again
too soon,
petals shattered and strewn,
a lingering scent of roses rising.

rainyrose2

rainyrose3

Hiding Nothing

changedpriorities
You can hide nothing from God.
The mask you wear before men will do you no good before Him.
He wants to see you as you are,
He wants to be gracious to you.
You do not have to go on lying to yourself and your brothers,
as if you were without sin;
you can dare to be a sinner.

~Dietrich Bonhoeffer from Life Together

One of my Monday morning jobs in our college health clinic is to meet with any student who got so intoxicated they had to spend part of the weekend in the emergency room.  Alcohol poisonings are distressingly common on all college campuses, and ours is no exception.   What I do during our morning-after visit is review the records with the student so they have some idea what took place before they woke up hours later on a gurney in a noisy smelly emergency room– alcohol is an effective amnesia-producing anesthetic when it doesn’t manage to outright kill its consumer.   It is a humbling experience to read about what one said and did while one was under the influence of intoxicants and yet have no memory of any of it.   That is why my time is well spent with the recovering and remorseful.   Not only does their stomach lining still burn from all the vomiting, but their head hurts from acknowledging the risks they took in the name of having a good time.  It is rare that I ever need to meet again with the same student about similar behavior.

This, in reality,  is a very effective kind of hurting, one that is crucial to future decision-making: dangerous behavior is far less appealing when one still carries the scars.  Priorities change for the better.

Today I won’t be able to work in several hundred now-sober students into this morning’s clinic schedule after the unfortunate and widely publicized events that happened just a couple blocks off our college campus a little over 24 hours ago.  I suspect most of the students involved remember more than they wish to about their participation in a big-block-party-gone-terribly-wrong.  They were part of an aggressive mob mentality threatening law enforcement personnel trying to disperse an increasingly rowdy and obnoxious crowd.  Some are finding themselves in video and Instagram/Facebook documentation of their profane words and gestures, throwing potentially lethal objects, vandalizing private and city property as well as causing thousands of dollars of city resources to confront out of control drunk rioters.   These students can try to lay low but there is no place to hide from their inner knowledge of what they have done, the part they played and the irreparable damage they caused to individuals, relationships, property and as well as the reputations of the city and the university.  There is no comforting alcohol amnesia to hide within this time.

The only possible healing from an event like this is to come clean about what one has done, admit the mistakes made and work to make it right no matter the cost — to dare to acknowledge the sins committed and accept the consequences of one’s actions.

Hiding is cheap — guilt and shame remain behind the mask.
Grace and forgiveness is costly but there is no longer need to hide and be eaten away by a continually hurting soul.

My prescription for this day and in the days to come:  changed priorities ahead.  College is about obtaining a valuable and precious education, not about finding the biggest and best party of intoxicants.

Take with food and a large dose of humility.

The Last Hour

photo by Josh Scholten

Resolved, never to do anything which I would be afraid to do if it were the last hour of my life.
~Jonathan Edwards

The first few weekends of any university’s fall semester is fraught with risk.  It is a time when freshmen, in particular, participate in age-old college rituals that take some to the emergency room and result in a few lying in the morgue.  There is sometimes an attitude of tossing care and good judgement to the wind.  Leaving home and being on one’s own means the freedom to do what one wants, when one wants, until the moment when payment comes due.

The national headlines in autumn over the last few years have shouted in large font about toxic reactions at parties serving Four Loko, about students gone missing, about fatal falls off overloaded balconies, and this week about the devastating effects of alcohol enemas.  There never seems to be an end to ways students can experiment with stretching and possibly breaking the slender thread between life and death, in the name of fun and games.

A helpful rule of thumb has always been what our grandmothers said:  “Don’t ever do anything you’d be embarrassed to see on the front page of the newspaper.”

In this day and age of social media, as newspapers become less relevant, the new rule of thumb should be: “Resolved, never to do anything which I would be afraid to see on FaceBook, YouTube or going viral in a matter of hours.”  Unfortunately, in the twisted way modern society works for some, that is all the more incentive.

Jonathan Edwards, writing almost 300 years ago, had it right.  We need to live each hour as if it were our last, considering what that hour might mean for eternity.

A Speech About Compost

(I gave this speech at the annual medical staff dinner last night when asked to “say a few words” (well, it ended up being more than a *few* words) after being selected as one of two “Physicians of Excellence” for 2010 at St. Joseph Hospital, Bellingham)

It was quite unexpected to get a call from Jim Hopper two months ago asking me if I was planning to attend tonight’s dinner.   The usual answer to that question would be  “uh, no…that’s my barn cleaning time…” , but he told me it would be a good idea for me to show up.   So, I’m quite humbled that the medical staff leadership would acknowledge a doctor who tries hard to fly under the radar by attending as few dinner meetings as possible due to farm and family obligations…

Dan and I arrived in Whatcom County  25 years ago; at that time I was a pregnant family doc having trained at Group Health Cooperative, and left behind one of the most diverse and wonderful practices in the Rainier Valley in Seattle.  We had decided we didn’t want to raise our family in the city, so we moved to a farm north of Bellingham, only a few miles from his parents and back to a part of the state where my grandparents had grown up.  I began practice by filling in as a locums for whoever would have me, and it was no time at all that I had more jobs than I knew what to do with.  I filled in at Intalco doing worker physicals, was a supervisor of the nurse practitioners at Planned Parenthood for several years, was the first doctor at the Interfaith Clinic, and soon was managing detox for Whatcom County at Olympic Treatment Center.  I also started seeing children who needed an evaluation for sexual abuse, ending up seeing over 1000 children over 10 years, and testifying in over 100 trials in a 5 county region.

The chemical dependency work moved to the Recovery Center at St. Joseph Hospital in 1988, and I’ve continued to do medical detox as well as my work at the Student Health Center at WWU for over 20 years.

I am not as skilled a diagnostician as many of you.  I’m not as good at surgical procedures, nor am I a wiz at administration.  What I am good at is making compost, which is really what I’ve done when I’ve taken care of thousands of chemical dependency inpatients over the last twenty years.

As a farmer, I spend over an hour a day cleaning my barn, and wheel heavy loads of organic material to a large pile in our barnyard which composts year round.  Piling up all that messy stuff that is no longer needed is crucial to the process: it heats up quickly to the point of steaming, and within months, it becomes rich fertilizer, ready to help the fields to grow grass, or the garden to produce vegetables, or the fragrant blooms in the flower beds.  It becomes something far greater and more productive than what it was to begin with.  That’s what intensively managed detox and treatment of addictions is like.

As clinicians, we help our patients “clean up” the parts of their lives they really don’t need, that they can’t manage any longer, that are causing problems with their health, their families and jobs, and most of all, their relationship with their Creator.  There isn’t a soul walking this earth who doesn’t struggle in some way with things that take over our lives, whether it is work,  computer use, food, gambling, you name it.  For the chemically dependent, it comes in the form of smoke, a powder, a bottle, a syringe or a pill.  There is nothing that has proven more effective than “piling up together” learning what it takes to walk the road to health and healing, “heating up”, so to speak, in an organic process of transformation that is, for lack of any better description, primarily a spiritual treatment process.  When a support group becomes a crucible for the “refiner’s fire”,  it does its best work melting people down to get rid of the impurities before they can be built back up again, stronger than ever.  They become compost, productive, ready to grow others.

This work with a spectrum of individuals of all races, professional and blue collar, rich and homeless,  coming from all over the state for help,  has been transforming for me.  I have worked with incredibly gifted nursing and counseling staff, some recovering themselves, who have dedicated their careers to this work. Over twenty years, I’ve been on call for detox 24/7 for  90% of those days, nights, holidays and weekends, and I thank Dr. Bob Watson and Dr. Tim Buckley for covering for me every once in awhile so I can turn off my pager.  I thank my husband, Dan Gibson, and our three children for letting me commit to this work.

As Jesus says in Matthew 25: 40–‘I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.’

We must not turn away from those who are our most vulnerable, who clearly need our help the most.   I certainly could not over the past twenty years.

Thank you for acknowledging that.

A Knock on the Door

knockFour years ago, a young woman I’d been seeing for several weeks in my clinic called unexpectedly Friday afternoon and canceled an upcoming appointment for the following Monday and did not reschedule. The receptionist sent me a message as is our policy for patients who “cancel and do not reschedule”. It gave me a bad feeling that she was turning her back on her treatment plan and I was uneasy about the upcoming weekend without knowing what was going on with her.

I could have just put on my coat and headed home at the end of that long Friday but decided to call my patient. She didn’t answer her phone. I mulled over my options, looked up her apartment address and drove there. As I approached her door, I could hear someone moving around in her apartment, but she didn’t respond to my knocks or my voice.

I decided to stay right there, talking to her through the door for about 15 minutes, letting her know I wasn’t leaving until she opened up the door. I finally told her she could decide to open the door or I would call 911 and ask the police to come to make sure she was okay. She then opened the door, tears streaming down her face. She had been drinking heavily, with liquor bottles strewn around on the floor. She admitted an intent to overdose on aspirin and vodka. The vodka was already consumed but the unopened aspirin bottle was in her hand. I was the last person she expected to see at her door.

I called the mental health unit at the local hospital and they had an open bed. I told my patient that we could save time and hassle by heading over right then and there, and avoid the emergency room mess, and the possibility of an involuntary detainment.

She agreed to come with me and be admitted voluntarily for stabilization. I went the following day to visit her and she greeted me with a hug and thanked me for not giving up on her when she had given up on herself. In sobriety, her eyes were brighter and she was more hopeful. She never expected anyone to care enough to come looking for her, and to stand firm when she was rejecting all approaches. She was astounded and grateful, and frankly, so was I.

Four years later, a small card arrived this week in my clinic mailbox on a most challenging work day, from an unfamiliar address two thousand miles away. The name looked vaguely familiar to me but when I opened and read the contents, this time it was my turn to let tears flow:

“Dear Doctor,

I am not sure if you will remember me considering you see a number of patients daily; however, I am a patient whose life you changed in the most positive way. I never truly THANKED YOU for listening to me and hearing my silent words of grief and hearing my cries for help. If it had not been for you, had you not knocked on my door, I would not be writing this letter to you today. I don’t know exactly what to say to the person who saved me from hurting myself fatally. You were a stranger in my life, but a dear friend in my time of need. THANK YOU, for everything that you did for me. You have a permanent place in my heart, you have given my spirit hope, you have reminded me that a life is worth living. Thank you, thank you, thank you! Sincerely, L_____”

I’m grateful 4 years ago I had the sense to go knock on her door, the stubbornness to stay put until she responded, and most of all, I’m appreciative for her gracious note letting me know it made a difference. Now, on a most difficult day this week, she made a difference for me.

She has knocked on my door and I have opened it, awash in my own tears.