It was like a church to me. I entered it on soft foot, Breath held like a cap in the hand. It was quiet. What God was there made himself felt, Not listened to, in clean colours That brought a moistening of the eye, In movement of the wind over grass.
There were no prayers said. But stillness Of the heart’s passions — that was praise Enough; and the mind’s cession Of its kingdom. I walked on, Simple and poor, while the air crumbled And broke on me generously as bread. ~R.S. Thomas “The Moor”
A strange empty day. I did not feel well, lay around…. I always forget how important the empty days are, how important it may be sometimes not to expect to produce anything, even a few lines in a journal. I am still pursued by a neurosis about work inherited from my father. A day where one has not pushed oneself to the limit seems a damaged damaging day, a sinful day. Not so! The most valuable thing we can do for the psyche, occasionally, is to let it rest, wander, live in the changing light of a room, not try to be or do anything whatever. Tonight I do feel in a state of grace, limbered up, less strained. ~May Sarton from Journal of a Solitude (January 18, 1971 entry)
Once in your life you pass Through a place so pure It becomes tainted even By your regard, a space Of trees and air where Dusk comes as perfect ripeness. Here the only sounds are Sighs of rain and snow, Small rustlings of plants As they unwrap in twilight. This is where you will go At last when coldness comes. It is something you realize When you first see it, But instantly forget. At the end of your life You remember and dwell in Its faultless light forever. ~Paul Zimmer “The Place” from Crossing to Sunlight Revisited
My family members and I have had weeks of feeling just on the verge of conquering the latest viral upper respiratory illness, but then would find ourselves welcoming the next cold as if it were a long lost friend.
I’m discouraged by ongoing fatigue and need for isolation that has accompanied these illnesses, due to our persistent sneezes and coughs.
All this has forced me to rest, take a breath and feel lucky to be alive, even if feeling unwell. I know too many folks who are dealing with much greater burdens.
Indeed, this morning brought a moment of grace for me. I witnessed manna falling from the sky.
Often times a sunrise is as plain and gray as I am, but at times, it is fire lit from above and beneath, igniting and transforming the sky, completely overwhelming me.
I was swept away, transfixed by colors and swirls and shadows, forever grateful to be fed by such heavenly bread broken over my head.
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When I was sick with a head cold, my head full of pressure, my father would soak a washcloth in hot water, then ball it up, ring it out. He would open it above my head, then place it against my face like a second skin, the light around me disappearing entirely except through the spaces between the stitching. I would inhale the steam in that darkness, hearing his voice on the other side, otherwise almost devoid of any other bodily sense but the warmth and depth of his voice, as if I had already died and was on the other side of life waiting for the sickness to lift, but I wasn’t. I was still on this earth, the washcloth going cold on my face, my body still sick, and my father still there when I opened my eyes, as he always was, there to give me warmth before going cold again. ~William Fargason “Elegy with Steam”
A common clinic conversation this time of year:
I’ve been really miserable with a cold for three days, and as my COVID test is negative, I need that 5 day Z-pack antibiotic to get better faster.
It really can be miserable suffering from cold symptoms. Ninety eight percent of the time these symptoms are due to a viral infection and since your rapid RSV and influenza nasal swab tests are also negative today, your illness should resolve over the next few days without you needing a prescription medication.
But I can’t breathe and I can’t sleep.
You can use salt water rinses and a few days of decongestant nose spray to ease the congestion.
But my face feels like there is a blown up balloon inside.
Try applying a warm towel to your face – the heat will help improve circulation in your sinuses and ease your discomfort.When it cools off, warm it up again – basically rinse and repeat.
And I’m feverish and having sweats at night.
Your temp today is 99.2 so not a concern. You can use ibuprofen or acetominophen to help the feverish feeling.
But my snot is green.
That’s not unusual with viral upper respiratory infections and not necessarily an indicator of a bacterial infection.
And my teeth are starting to hurt and my ears are popping.
Let me know if that is not resolving over the next few days.
But I’m starting to cough.
Your lungs are clear today so it is likely from post nasal drainage irritating your upper airway. Best way to help that is to breathe steam to keep your bronchial tubes moist, push fluids and prop up with an extra pillow.
But sometimes I cough to the point of gagging. Isn’t whooping cough going around?
Your illness doesn’t fit the typical timeline for pertussis. You can consider using an over the counter cough suppressant if needed.
But I always end up needing antibiotics. This is just like my regular sinus infection thing I get every year.
There’s plenty of evidence antibiotics can do more harm than good, eliminating healthy bacteria in your gut. They really aren’t indicated at this point in your illness and could have nasty side effects.
But I always get better faster with antibiotics. Doctors always give me antibiotics.
Studies show that two weeks later there is no significant difference in symptoms between those treated with antibiotics and those who did self-care without them.
But I have a really hard week coming up and my whole family is sick and I won’t be able to rest.
This could be your body’s way of saying that you need to take the time you need to recover – is there someone who can help pick up the load your carry?
But I just waited an hour to see you.
I really am sorry about the wait; we’re seeing a lot of sick people with so much viral illness going around and needing to test to rule out COVID and influenza.
But I paid a $20 co-pay today for this visit.
We’re very appreciative of you paying so promptly on the day of service.
But I can go down the street to the urgent care clinic or do one of those telehealth doctor visits and for $210 they will write me an antibiotic prescription without making me feel guilty for asking.
I wouldn’t recommend taking unnecessary medication that can lead to bacterial resistance, side effects and allergic reactions. I truly believe you can be spared the expense, inconvenience and potential risk of taking something you don’t really need.
So that’s it? Salt water rinses, warm towels on my face and just wait it out? That’s all you can offer?
Let me know if your symptoms are unresolved or worsening over the next few days.
So you spent all that time in school just to tell people they don’t need medicine?
I believe I can help most people heal themselves with self-care at home. I try to educate my patients about when they do need medicine and then facilitate appropriate treatment. Also, I want to thank you for wearing your mask today to reduce the chance of transmitting your virus to those around you.
I’m going to go find a real doctor who will actually listen to me and give me what I need.
It certainly is a choice you can make. A real doctor vows to first do no harm while always listening to what you think, what your physical examination shows, then takes into account what evidence-based clinical data says is the best and safest course of action. I realize you want something other than what I’m offering you today. If you are feeling worse over the next few days or develop new symptoms, please let me know so we can reevaluate how best to treat you.
I’ll bet you’ll tell me next you want me to get one of those COVID vaccines too, won’t you?
Actually, I prefer you be feeling a bit better before you receive both the COVID and influenza vaccines. That would offer extra immunity protection for you through the next few months. Shall we schedule you for a time for your vaccination updates next week?Remember, I’m still here if you need to review your options again…
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May the wind always be in her hair May the sky always be wide with hope above her And may all the hills be an exhilaration the trials but a trail, all the stones but stairs to God. May she be bread and feed many with her life and her laughter May she be thread and mend brokenness and knit hearts… ~Ann Voskamp from “A Prayer for a Daughter”
Nate and Ben and brand new baby LeaDaddy and Lea
Mommy and Lea
“I have noticed,” she said slowly, “that time does not really exist for mothers, with regard to their children. It does not matter greatly how old the child is – in the blink of an eye, the mother can see the child again as she was when she was born, when she learned to walk, as she was at any age — at any time, even when the child is fully grown….” ~Diana Gabaldon from Voyager
Just checking to see if she is real…
Your rolling and stretching had grown quieter that stormy winter night thirty years ago, but still no labor came as it should. Already a week overdue post-Christmas, you clung to amnion and womb, not yet ready. Then as the wind blew more wicked and snow flew sideways, landing in piling drifts, the roads became more impassable, nearly impossible to traverse.
So your dad and I tried, concerned about your stillness and my advanced age, worried about being stranded on the farm far from town. When a neighbor came to stay with your brothers overnight, we headed down the road and our car got stuck in a snowpile in the deep darkness, our tires spinning, whining against the snow. Another neighbor’s earth mover dug us out to freedom.
You floated silent and still, knowing your time was not yet.
Creeping slowly through the dark night blizzard, we arrived to the warm glow of the hospital, your heartbeat checked out steady, all seemed fine.
I slept not at all.
The morning’s sun glistened off sculptured snow as your heart ominously slowed. You and I were jostled, turned, oxygenated, but nothing changed. You beat even more slowly, threatening to let go your tenuous grip on life.
The nurses’ eyes told me we had trouble. The doctor, grim faced, announced delivery must happen quickly, taking you now, hoping we were not too late. I was rolled, numbed, stunned, clasping your father’s hand, closing my eyes, not wanting to see the bustle around me, trying not to hear the shouted orders, the tension in the voices, the quiet at the moment of opening when it was unknown what would be found.
And then you cried. A hearty healthy husky cry, a welcomed song of life uninterrupted. Perturbed and disturbed from the warmth of womb, to the cold shock of a bright lit operating room, your first vocal solo brought applause from the surrounding audience who admired your purplish pink skin, your shock of damp red hair, your blue eyes squeezed tight, then blinking open, wondering and wondrous, emerging and saved from a storm within and without.
You were brought wrapped for me to see and touch before you were whisked away to be checked over thoroughly, your father trailing behind the parade to the nursery. I closed my eyes, swirling in a brain blizzard of what-ifs.
If no snow storm had come, you would have fallen asleep forever within my womb, no longer nurtured by my aging and failing placenta, cut off from what you needed to stay alive. There would have been only our soft weeping, knowing what could have been if we had only known, if God had provided a sign to go for help.
So you were saved by a providential storm and dug out from a drift: I celebrate when I hear your voice singing- your students love you as their teacher and mentor, you are a thread born to knit and mend hearts, all because of a night of blowing snow.
My annual retelling of the most remarkable day of my life thirty years ago today when our daughter Eleanor (“Lea”) Sarah Gibson was born, hale and hearty because the good Lord sent a wind and snow storm to blow us into the hospital in time to save her. She is now married to her true love Brian–another gift sent from the Lord; we know you will be awesome parents when your turn comes!
When the doctor suggested surgery and a brace for all my youngest years, my parents scrambled to take me to massage therapy, deep tissue work, osteopathy, and soon my crooked spine unspooled a bit, I could breathe again, and move more in a body unclouded by pain. My mom would tell me to sing songs to her the whole forty-five minute drive to Middle Two Rock Road and forty- five minutes back from physical therapy. She’d say, even my voice sounded unfettered by my spine afterward. So I sang and sang, because I thought she liked it. I never asked her what she gave up to drive me, or how her day was before this chore. Today, at her age, I was driving myself home from yet another spine appointment, singing along to some maudlin but solid song on the radio, and I saw a mom take her raincoat off and give it to her young daughter when a storm took over the afternoon. My god, I thought, my whole life I’ve been under her raincoat thinking it was somehow a marvel that I never got wet. ~Ada Limón “The Raincoat”
When I was 13, I grew too quickly. My spine developed a thoracic scoliosis (curvature) — after inspecting my back as I bent over to touch my toes, my pediatrician referred me to a pediatric orthopedic specialist an hour away from my home town.
The question was whether I would need to have a metal rod surgically placed along my spine to prevent it from more misalignment or whether I would need to wear a back brace like a turtle. The least intervention would be physical therapy to try to keep my back and abdominal muscles as strong as possible to limit the curvature.
Since my father didn’t have much flexibility in his work schedule, my mother had to drive me to the “big city” for my appointments – as a nervous driver, she did it only because she knew it was necessary to get the medical opinion needed. She asked me to read aloud to her from whatever book I was reading at the time – I don’t think she listened closely but I think she knew it would keep me occupied while she navigated traffic.
At first, we went every three months for new xrays. The orthopedist would draw on my bare back and on my spine xrays with a black marker, calculating my curves and angles with his protractor, watching for a trend of worsening as I grew taller. He reassured us that I hadn’t yet reached a critical level of deviation requiring more aggressive treatment.
Eventually my growth rate slowed down and the specialist dismissed me from further visits, wishing me well. He told me I would certainly be somewhat “crooked” for the rest of my life, and it would inevitably worsen in my later years. I continued to visit PT for regular visits; my mom would patiently wait in the car as I sweated my way through the regimen.
The orthopedist was right about the curvature of my aging spine. I am not only a couple inches shorter now, but my rib cage and chest wall is asymmetric affecting my ability to stand up totally straight. Just last week, I had an xray of my collar bones as even those joints have developed wear and tear changes. I consider being crooked a small price to pay for avoiding a serious surgery or a miserable brace as a teenager.
What I didn’t understand at the time was the commitment my mother made to make sure I got the care I needed, even if it meant great inconvenience in her life, even if she was awake at night worried about the outcome of the appointments, even if the financial burden was significant for my family. She, like so many parents with children with significant medical or psychological challenges, gave up her wants and wishes to make sure I received what I needed. As a kid, I just assumed that’s what a mom does. Later, as a mom myself, I realized it is what moms do, but often at significant personal cost. As a physician, I saw many young people whose parents couldn’t make the commitment to see they got the care they needed, and it showed.
I was one blessed by parents who did what their kids needed to thrive.
My mom constantly offered me her raincoat so I wouldn’t get wet. Meanwhile she was being drenched.
Thank you, Mom, for making sure I was covered by your love. I still am.
Original Barnstorming artwork note cards available as a gift to you with a $50 donation to support Barnstorming – information here
I like to stroll the graveyard in the middle of town With my friend Anne, though we seldom agree On what an epitaph we happen to read implies. I’m inclined to find the one-line gravestone, Dr. Noah Vedder, M.D., as sadly comic. If we can’t take our money into the dark, I read it as saying, at least we can take our titles. But Anne, whose sympathies are aroused More quickly than mine, reads it more darkly As confessional. Here is the man’s admission That he saw himself as a better doctor Than he was a friend, or father, or husband, A better listener in his office than at home.
If his kin were responsible for the inscription, Its terseness, I say, may suggest they were moved More by duty than they were by love. But for her, its terseness seems to imply Their painful acknowledgment that no praise Inscribed on the stone would keep their friend From being forgotten soon after they would be. And behind this truth she hears a protest: If the world were fair, he wouldn’t be sentenced To endless retirement but allowed to practice, In a life beyond this one, the profession he loved.
What use would a doctor be, I ask, in a realm Where bodies are laid aside? But for her the point is That those who knew him were certain that if Such a realm existed and a doctor were called for there, He’d volunteer, glad to hold office hours And glad after hours to visit patients Too sick to leave home, However modest the streets they lived on, However winding and poorly lit. ~Carl Dennis “At the Graveyard with Anne”
Since my people are crushed, I am crushed; I mourn, and horror grips me. Is there no balm in Gilead? Is there no physician there? Why then is there no healing for the wound of my people? Jeremiah 8:21-22
We physicians can be an arrogant lot in our devotion to our profession above all else in our lives – I’ve known a few who wear their M.D. title full-time like a banner and shield to prove their expertise.
The only time the label M.D. is relevant is on a name tag in a clinical setting and often it doesn’t even make a difference there. We do what we can with what knowledge we possess from our training, as limited as it is. There is so much that we don’t know and don’t understand.
Even so, there are many altruistic physicians who give of themselves 24 hours a day for their lifetime. Some would gladly continue their healing efforts long after they have become dust, yet those skills are no longer needed. In heaven, all are already healed.
Our healing comes from beyond our expertise, from a balm that can never be prescribed. We have a Great Physician who never forgets us, even when we are crushed and mourning, when all seems hopeless with our wounds so incredibly deep.
We are not forgotten.
Every face is in you, every voice, Every sorrow in you. Every pity, every love, Every memory, woven into fire. Every breath is in you, every cry, Every longing in you.
Every singing, every hope, Every healing, woven into fire. Every heart is in you, Every tongue, every trembling in you, Every blessing, every soul, Every shining, woven into fire. ~Michael Dennis Browne
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“I have noticed,” she said slowly, “that time does not really exist for mothers, with regard to their children. It does not matter greatly how old the child is – in the blink of an eye, the mother can see the child again as she was when she was born, when she learned to walk, as she was at any age — at any time, even when the child is fully grown….” ~Diana Gabaldon from Voyager
May the wind always be in her hair May the sky always be wide with hope above her And may all the hills be an exhilaration the trials but a trail, all the stones but stairs to God.
May she be bread and feed many with her life and her laughter May she be thread and mend brokenness and knit hearts… ~Ann Voskamp from “A Prayer for a Daughter”
Your rolling and stretching had grown quieter that stormy winter night twenty nine years ago, but still no labor came as it should. Already a week overdue post-Christmas, you clung to amnion and womb, not yet ready. Then as the wind blew more wicked and snow flew sideways, landing in piling drifts, the roads became more impassable, nearly impossible to traverse.
So your dad and I tried, concerned about your stillness and my advanced age, worried about being stranded on the farm far from town. So a neighbor came to stay with your brothers overnight, we headed down the road and our car got stuck in a snowpile in the deep darkness, our tires spinning, whining against the snow. Another neighbor’s earth mover dug us out to freedom.
You floated silent and still, knowing your time was not yet.
Creeping slowly through the dark night blizzard, we arrived to the warm glow of the hospital, your heartbeat checked out steady, all seemed fine.
I slept not at all.
The morning’s sun glistened off sculptured snow as your heart ominously slowed. You and I were jostled, turned, oxygenated, but nothing changed. You beat even more slowly, threatening to let loose your tenuous grip on life.
The nurses’ eyes told me we had trouble. The doctor, grim faced, announced delivery must happen quickly, taking you now, hoping we were not too late. I was rolled, numbed, stunned, clasping your father’s hand, closing my eyes, not wanting to see the bustle around me, trying not to hear the shouted orders, the tension in the voices, the quiet at the moment of opening when it was unknown what would be found.
And then you cried. A hearty healthy husky cry, a welcomed song of life uninterrupted. Perturbed and disturbed from the warmth of womb, to the cold shock of a bright lit operating room, your first vocal solo brought applause from the surrounding audience who admired your purplish pink skin, your shock of damp red hair, your blue eyes squeezed tight, then blinking open, wondering and wondrous, emerging and saved from a storm within and without.
You were brought wrapped for me to see and touch before you were whisked away to be checked over thoroughly, your father trailing behind the parade to the nursery. I closed my eyes, swirling in a brain blizzard of what-ifs.
If no snow storm had come, you would have fallen asleep forever within my womb, no longer nurtured by my aging and failing placenta, cut off from what you needed to stay alive. There would have been only our soft weeping, knowing what could have been if we had only known, if God had provided a sign to go for help.
So you were saved by a providential storm and dug out from a drift: I celebrate when I hear your voice singing, and when your students love you as their teacher, knowing you are a thread born to knit and mend hearts, all because of blowing snow.
My annual retelling of the most remarkable day of my life when our daughter Eleanor (“Lea”) Sarah Gibson was born, hale and hearty because the good Lord sent a snow and wind storm to blow us into the hospital in time to save her. She is now married to her true love Brian who is another gift sent from the Lord; someday their hope for parenthood will come true for them as well.
“They’re benign,” the radiologist says, pointing to specks on the x ray that look like dust motes stopped cold in their dance. His words take my spine like flame. I suddenly love the radiologist, the nurse, my paper gown, the vapid print on the dressing room wall. I pull on my radiant clothes. I step out into the Hanging Gardens, the Taj Mahal, the Niagara Falls of the parking lot. ~Jo McDougall, “Mammogram” from In the Home of the Famous Dead: Collected Poems
Outside the house the wind is howling and the trees are creaking horribly. This is an old story with its old beginning, as I lay me down to sleep. But when I wake up, sunlight has taken over the room. You have already made the coffee and the radio brings us music from a confident age. In the paper bad news is set in distant places. Whatever was bound to happen in my story did not happen. But I know there are rules that cannot be broken. Perhaps a name was changed. A small mistake. Perhaps a woman I do not know is facing the day with the heavy heart that, by all rights, should have been mine. ~Lisel Mueller “In November”
It does not escape me, especially on mammogram days~~
(although I wake every day knowing this):
an earthquake happened somewhere else, a war left people homeless and lifeless, a windstorm leveled a town, a drunk driver destroyed a family, a fire left a house in ashes, a famine caused children to starve, a flood ravaged a village, a devastating diagnosis darkened someone’s remaining days.
No mistake has been made, yet I wake knowing this part of my story has not yet visited me, the heavy heart that could have been mine is spared again, still beating, still breaking, still bleeding, still believing the radiance from this good news is real and once again happened today.
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 have been born this week in June thirty eight years ago~ so wanted so anticipated but lost too soon.
Gone as swiftly in a clot of red as a doe disappearing soundlessly into a thicket: so long ago it makes me question if you were real, until my heart clenches again at the memory.
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 this time, but stay to find out.
A new book from Barnstorming is available to order here:
There are three kinds of men. The ones that learn by reading. The few who learn by observation. The rest of them have to pee on the electric fence for themselves. ~Will Rogers
Learning is a universal human experience from the moment we take our first breath. It is never finished until the last breath is given up. With a lifetime of learning, one would think eventually we should get it right.
But we don’t. We tend to learn the hard way especially when it comes to matters having to do with our (or others’) health.
As physicians in training, we “see one, do one, teach one.” That kind of approach doesn’t always go so well for the patient. As patients, we like to eat, drink, and live how we wish, demanding what interventions we want only when we want them – this also doesn’t go so well for the patient. You’d think we’d know better, but as fallible human beings, we may impulsively make decisions about our health without actually using our heads (is it evidence-based or simply an anecdotal story about what “worked” for someone else?).
The cows and horses on our farm need to touch an electric fence only once when reaching for greener grass on the other side. That moment provides a sufficient learning curve for them to make an important decision. They won’t try testing it again no matter how alluring the world appears on the other side. Humans are smarter sentient beings who should learn as quickly as animals but unfortunately don’t. I know all too well what a shock feels like and I want to avoid repeating that experience. Even so, in unguarded careless moments of feeling invulnerable (it can’t happen to me!), and yearning to have what I don’t necessarily need, I may find myself reaching for the greener grass (or another cookie) even though I know better. I suspect I’m not alone in my surprise when I’m jolted back to reality when I continually indulge myself and climb on the scale to see the results.
Many great minds have worked out various theories of effective learning, but, great mind or not, Will Rogers confirms a common sense suspicion: an adverse experience, like a “bolt out of the blue,” can be a powerful teacher. As clinicians, we call it “a teachable moment.” None of us want to experience a teachable moment — none of us, and we resent it when someone points it out to us.
When physicians and patients learn the hard way, we need to come along aside one another rather than work at cross-purposes.
Nobody in the hospital Could tell the age Of the old woman who Was called Susanna
Because she had no visitors I would stop by to see her But she was always sleeping
One day I was beside her When she woke up Opening small dark eyes Of a surprising clearness
She looked at me and said You want to know the truth? I answered Yes
She said it’s something that My mother told me
There’s not a single inch Of our whole body That the Lord does not love
She then went back to sleep. ~Anne Porter from “Susanna”
photo by Andrea Nipges
So many people lie in a hospital bed these days, all alone and fearful, wondering what could happen next, waiting for the tide to turn and move them back to the shore or sweep them out into the arms of their Creator forever.
We tend to forget the love of the One who made us, including our funny looking feet, our anxieties, the crooked teeth, the wrinkles, the scars, the split ends —
We see only our imperfections and frailty when our Creator sees dust made manifest in His image.
He loves us even when we do not love ourselves, as we hide our flaws and cover up our vulnerable nakedness.
He loves every inch because we are His opus, a masterpiece, so He became one of us.
He knew exactly what He was doing and even now, in the midst of our loneliness, He knows exactly what He is doing with the dust that still swirls around us.
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