Category: Doctoring

A Delicate Sadness of Dusk

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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

From morning suns and evening dews
At first thy little being came:
If nothing once, you nothing lose,
For when you die you are the same;
The space between, is but an hour,
The frail duration of a flower.
~Philip Freneau from “The Wild Honey Suckle”

It sprang up wild along the chain link fence—thick,
with glorious white
and yellow summer blooms, and green tips that we
pinched and pulled for one
perfect drop of gold honey. But Dad hated
it—hated its lack
of rows and containment, its disorder. Each
year, he dug, bulldozed,
and set fire to those determined vines. But each
year, they just grew back
stronger. Maybe that’s why I felt the urge to
plant it that one day
in May, when cancer stepped onto my front porch
and rang the doorbell,
loose matches spilling out of its ugly fists.
~Karla Morton “Honeysuckle” from Accidental Origami: New and Selected Works

Some things are very dear to me–
Such things as flowers bathed by rain
Or patterns traced upon the sea
Or crocuses where snow has lain . . .
The iridescence of a gem,
The moon’s cool opalescent light,
Azaleas and the scent of them,
And honeysuckles in the night.
And many sounds are also dear–
Like winds that sing among the trees
Or crickets calling from the weir
Or Negroes humming melodies.
But dearer far than all surmise
Are sudden tear-drops in your eyes
~Gwendolyn Bennett— Sonnet 2

I am an easy cryer. It takes very little to tip me over the edge: a hymn, a poem, simply witnessing a child’s joy.

Suddenly my eyes fill up.

I blame this on my paternal grandmother who was in tears much of the time while visiting our family, crying happy, crying sad, crying frustrated and angry tears, crying desperate tears after being diagnosed with metastatic pancreatic cancer. I think of her often as she was the age I am now, grateful I too have not been visited with such dire news.

My greatest trigger to weep myself is watching someone else tear up.
I think my grandmother left behind some powerful empathy genes and I will honor that when I visit her grave this weekend to lay flowers.

I needed to desensitize my response to others’ tears to be effective as a physician/healer. Witnessing tears in the exam room is a normal part of the job: patients are anxious, ill, in pain or just need to decompress in safety. I learned early on to be unobtrusive and not interrupt, letting the flow of tears be part of how the patient was trying to communicate their distress. It was a struggle when my inclination was to cry right along with them.

But I needed to remain the rock in the room, solid and steady. I could understand their tears as yet another symptom of a clinical presentation, allowing me to observe without being clouded by my own emotional response.

Sometimes that worked. Sometimes not. At times overwhelmed myself, I wept at births, I wept at deaths, I wept at the sharing of bad news.

Now retired and liberated from the exam room, I freely and regularly weep at the state of the world, or when I read of disaster and tragedy, and especially when I witness intentional harm and cruelty in others. I’m no longer a stone, but more like an over-filled sponge being squeezed – everything builds up until I can hold it no more.

Reading headlines in the news is sometimes more than I can bear.
I cry myself dry.

And that is okay, thanks to Grandma. Once emptied out, I can be filled again by so much that is good and precious and beautiful in this life – a sad and delicate dusk, the promising light of dawn, the persistence of the wild honeysuckles, the raindrops on colorful blooms, the resonance of a heartfelt spiritual, the love of my husband, children, grandchildren and friends.

Now those are worth weeping over.

The Lines Went Flat…

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First of all, we’ve been using the wrong word all these years. It means without rhythm. The only arrhythmia is asystole, I tell my students. That’s the flat line accompanied by the clang of alarms in all the television dramas. There’s not much you can do about it; the patient is dead and usually stays dead. The correct word to describe all the ways a heart can dance and die is dysrhythmia, which means a disordered rhythm. There’s the soldiered march of ventricular tachycardia or the pirouette twirl of Torsades. Ventricular fibrillation simply quivers on the monitor. When these rhythms occur, the patient is pulseless and sometimes you give magnesium, usually shock, and always pump their chest to the beat of whatever song lives in your head. Once I was speaking with a man who stopped in the middle of a word, and I watched the rhythm on the monitor change. When I didn’t feel a pulse, I started CPR, and then we placed the paddles on his chest and shouted, Clear, just like in the movies. And it worked. He opened his eyes and looked at me and said, I don’t feel good. And I said, It’s okay, I’m going to get you better and smoothed the fair from his forehead, but then the alarms blared and the V tach returned, and we did it all over again—the drugs and compressions and shocks, and his eyes opened one more time and he mouthed I’m scared around the tube I’d placed in his throat, and I said, I’m here with you. But that was the last time he said anything. We didn’t stop for thirty minutes or more. He’d waved to his family when the medics loaded him into the ambulance with just a little chest pain, so they were shocked when I entered the small consult room to tell them he had died. His teenage son collapsed and landed on his knees and punched the ground and said, But we were fighting, and I think the last thing I said was I hate you.

All I’m trying to say is that it’s really important to use the right words.
~Rachel Mallalieu “A Brief History of Arrhythmia” from the journal PEMBROKE MAGAZINE

If you break
break going out not in.
How you live your life I don’t care
but I’ll sell my arms for you,
hold your secrets for ever.

If I speak of death
which you fear now, greatly,
it is without answers,
except that each
one we know is
in our blood.
Don’t recall graves.
Memory is permanent.
~Michael Ondaatje from “To a Sad Daughter”

I was still a kid
interning at State
he reminisces late in the meal—
It was a young red-headed woman
looked like my sister
when the lines went flat
I fell apart
shook
like a car with a broken axle
Went to the head surgeon
a fatherly man
Boy, he said, you got to fill a graveyard
before you know this business
and you just did row one, plot one.
~Alicia Suskin Ostriker, “The Surgeon” from The Book of Seventy

Like many other medical professionals who have worked in the trenches of frontline healthcare, I too am fascinated by the emergency room streaming drama “The Pitt.”

At first, I couldn’t watch without feeling I too should be working at the bedside alongside the ER team, trying my best to do the task assigned to me, responding to each new instruction, grateful when things go as hoped, crushed when nothing helps and the patient is lost.

The Pitt is the newest addition to the canon of medical dramas and feels like the real thing. All the technology is there, the medical terminology and procedures are real, in addition to the fraught interaction of professionals under stress. Most of all, it feels real because it shows patients and their families trying to cope with the worst day of their lives.

And medical miracles do happen, on TV and in real life.

Recently, a church friend was rescued in a drowning event, was unconscious on a ventilator for nearly a week, with much uncertainty about how much damage his brain had endured while under water. Several weeks later, he is now home, dealing with some memory gaps and muscle weakness, but improving strength daily.

Last week, I had the privilege of meeting a middle-aged pastor who was saved a few weeks ago when his heart stopped in his sleep. His wife started CPR, paramedics shocked his heart in the field more than once, he was stabilized in the ER, unconscious on a ventilator, cooled down to a lower body temperature to preserve his brain function.

His care team, along with family and friends, watched and waited and prayed, uncertain what would be the rest of his story.

When he was warmed up 24 hours later, he woke up, able to breathe on his own. Other than no memory for those brief hours of unconsciousness, he is still himself – living with a new awareness of his vulnerability and an immense gratitude, now with an implanted defibrillator in his chest.

The right words after being brought back from the dead?
The right words when we never know if they will be the last words we utter or the last we will ever hear?

I know what they would be for me. I carry them in my heart…

Lit From Within

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For God, who said, “Let light shine out of darkness,” has shone in our hearts to give the light of the knowledge of the glory of God in the face of Jesus Christ.
2 Corinthians 4:6

…there must take place that struggle
no human presumes to picture:
living, dying, descending to rescue the just
from shadow, were lesser travails
than this: to break
through earth and stone of the faithless world
back to the cold sepulchre, tearstained
stifling shroud; to break from them
back into breath and heartbeat, and walk
the world again, closed into days and weeks again,
wounds of His anguish open, and Spirit
streaming through every cell of flesh
so that if mortal sight could bear
to perceive it, it would be seen
His mortal flesh was lit from within, now,
and aching for home. He must return,
first, in Divine patience, and know
hunger again, and give
to humble friends the joy
of giving Him food—fish and a honeycomb.
~Denise Levertov from “Ikon: The Harrowing of Hell”

People are like stained-glass windows.  They sparkle and shine when the sun is out, but when the darkness sets in, their true beauty is revealed only if there is a light from within.
~ Elisabeth Kübler-Ross

Christ forced open a door that has been locked since the death of the first man. He has met, fought and beaten the king of death. Everything is different because he has done so.
~C.S. Lewis from Miracles

In my clinical work over four decades, I met people living with dark times. It is rare for a patient to come to clinic because all is well. 

They come because they are beaten down, struggling to keep going, running out of fuel, hungry for calm as they are blown about by the storms of life.

It was my challenge to stoke and feed the inner light hidden deep within each person, fighting back the darkness as I sorted out how to mend their unwellness.

I’m reminded Christ came back from the harrowing darkness of hell to be joyfully met by His disciples, who fed His hunger. Then He cooked breakfast for them, forever offering Himself as sanctuary from the darkness He had known.

So too, we are fed, bathing in His glow.

Lyrics
Jesus Christ, inner light,
let not our own darkness conquer us.
Jesus Christ, inner light,
enable us to welcome your love.
Jesus Christ, in our search for you,
Bring us into the warmth of your light.
Jesus Christ, inner light,
enable us to welcome your love.

Lyrics:
Through love to light!
Oh, wonderful the way
That leads from darkness to the perfect day!
From darkness and from sorrow of the night
To morning that comes singing o’er the sea.
Through love to light!
Through light, O God, to thee,
Who art the love of love, the eternal light of light!

Bring to Light the Mystery: Foot Washing

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sculpture by Max Greiner

Being thorough, I remove a holey sock
to view a diabetic man’s filthy feet.
I use the time to complete our talk
of what drove him to live on the street
as I wonder how any of this can help.

While he tells me more of his medical past,
I run warm water into a stainless bowl.
I immerse both his feet and begin to ask
myself what good it does for this poor soul
to allow himself to undergo this ablution.

Silently I sluice the water between his toes
and soap the crusty callous at his heel.
I marvel at his arch and notice how closely
it fits my palm. I know he can feel
this proximity too. He shuts his eyes.

Months of useless layers peel away,
revealing layers useless weeks ago.
Removing the tough brown hide of yesterday
yields clean pink skin, but we both know
this ritual will be useless days from now.

Still, this moment may withstand time’s test,
teaching us each lessons unknown before.
I learn the medicine of selflessness.
He learns what medicine is really for–
the hope that basin, soap and touch can bear.
~Robert Fawcett “Washing Feet”

Jesus washing the feet of his disciples by Finnish artist Albert Gustaf Edelfelt

What e’er the soul has felt or suffered long,
Oh, heart! this one thing should not be forgot:
Christ washed the feet of Judas.
~George Marion McClellan
from “The Feet of Judas” in The Book of American Negro Poetry 1922

Ford Maddox Brown — Washing Peter’s Feet

As an aide in a rest home caring for the crippled feet of the elderly,
as a medical student in an inner city hospital seeing the homeless whose socks had to be peeled off carefully to avoid pulling off gangrenous toes, as a doctor working with the down and out detox patients from the streets who had no access to soap and water for weeks,

I’ve washed feet as part of my job.

People always protest,
just as Peter did when Jesus started to wash his feet.
We never believe our feet,
those homely gnarled bunioned claw-toed calloused parts of us,
deserve that attention, and certainly not love.

We are ashamed to have someone care about them, care for them, when we don’t care enough on our own.

I have never washed the feet of someone about to betray me,
leading me to my death.

I have never had my feet washed by someone
who understood my heart needed cleansing even more than my feet, who loved me that much.

Until now.

This one thing should not be forgot:
Kneeling, He wears the humility and towels of a servant as His only raiments. He gently cups our heels in His palms, washes and dries our soles and arches and toes, but our hearts are held, still beating, in His loving hands.

Bring to Light the Mystery: Unsettled Petals

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sakura217

God is within all things, but not enclosed;
outside all things, but not excluded;
above all things but not aloof;
below all things but not debased.
~St. Bonaventure, 14th C. philosopher and theologian 

wwusakura4
wwusakura6

Beauty, to the Japanese of old, held together the ephemeral with the sacred. Cherry blossoms are most beautiful as they fall, and that experience of appreciation lead the Japanese to consider their mortality.

Hakanai bi (ephemeral beauty) denotes sadness, and yet in the awareness of the pathos of life, the Japanese found profound beauty.

For the Japanese, the sense of beauty is deeply tragic, tied to the inevitability of death.

Jesus’ tears were also ephemeral and beautiful. His tears remain with us as an enduring reminder of the Savior who weeps. Rather than to despair, though, Jesus’ tears lead the way to the greatest hope of the resurrection. Rather than suicide, Jesus’ tears lead to abundant life.
~Makoto Fujimura

Everyone feels grief
when cherry blossoms scatter.
Might they then be tears –
those drops of moisture falling
in the gentle rains of spring?
~Otomo no Juronushi (late 9th century)

fallensakura
fallen sakura petals in Tokyo (photo by Nate Gibson)
sakurarain
fallen sakura blossoms in Tokyo, photo by Nate Gibson

For four decades, as a family physician, I saw patients struggling with depression, some contemplating whether living another day was worth the pain and effort. 

Most described their feelings completely dry-eyed, unwilling to let their emotions flow from inside and flood their outsides. Others sat soaking in tears of hopelessness and despair.

Their weeping moved and reassured me — it is a raw and authentic spilling over when the internal dam is breaking. It is so human, yet we also know tears contain the divine.

When I read that Jesus weeps as He witnesses the tears of grief of His dear friends, I am comforted. He understands and feels what we feel, His tears just as plentiful and salty, His overwhelming feelings of love brimming so full they must be let go and cannot be held back.

Our Jesus who wept with us became a promise of ultimate joy.

There is beauty in this: His rain of tears, the spilling of the divine onto our mortal soil like the unsettled petals of spring.

photo by Nate Gibson

This year’s Barnstorming Lenten theme is Ephesians 3:9:

…to bring to light for everyone what is the plan of the mystery hidden for ages in God, who created all things…

Bring to Light the Mystery: Leaping and Shouting

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photo by Josh Scholten

Then will the eyes of the blind be opened
and the ears of the deaf unstopped.
Then will the lame leap like a deer,
and the mute tongue shout for joy.
Isaiah 35:5-6

Scripture documents Jesus’ healing miracles for those of us who were not there to witness them – a touch of saliva to eyes and tongue, fingers placed in ears, words that give new life to paralyzed limbs. 

As a physician who has worked with many tools in healing over forty years, I do know the power of spoken words, or the comforting touch, but never used saliva and mud. 

There is nothing I can do with those simple means to reverse the irreversible. Of course many medical “miracles” happen every day in the 21st century, but the spit and words of the 1st century are far more miraculous because of from Whom they came.

These ancient miracles took place when a willing heart met Mercy head on. No surgery required, no expensive medications, no magnetic imaging, no robotic procedures. In comparison to the skills of the ultimate Physician, I’m humbled in my obvious limitations. I myself was a blind, deaf, dumb and lame healer, immobilized until I underwent a modern heart-opening procedure myself. Not just a cardiac intervention to dilate my coronary arteries, but the knowledge that my spiritual heart has been opened wide.

Grateful, I become unstoppable, as I too now leap and shout for joy.

painting by Norman Rockwell

This year’s Barnstorming Lenten theme is Ephesians 3:9:

…to bring to light for everyone what is the plan of the mystery hidden for ages in God, who created all things…

Bring to Light the Mystery: Her Wounds to be Healed

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The earth invalid, dropsied, bruised, wheeled
Out in the sun,
After frightful operation.
She lies back, wounds undressed to the sun,
To be healed,
Sheltered from the sneapy chill creeping North wind,
Leans back, eyes closed, exhausted, smiling
Into the sun. Perhaps dozing a little.
While we sit, and smile, and wait, and know
She is not going to die. 
~Ted Hughes from “ A March Morning Unlike Others” from Ted Hughes. Collected Poems

March. I am beginning
to anticipate a thaw. Early mornings
the earth, old unbeliever, is still crusted with frost
where the moles have nosed up their
cold castings, and the ground cover
in shadow under the cedars hasn’t softened
for months, fogs layering their slow, complicated ice
around foliage and stem
night by night,

but as the light lengthens, preacher
of good news, evangelizing leaves and branches,
his large gestures beckon green
out of gray. Pinpricks of coral bursting
from the cotoneasters. A single bee
finding the white heather. Eager lemon-yellow
aconites glowing, low to the ground like
little uplifted faces. A crocus shooting up
a purple hand here, there, as I stand
on my doorstep, my own face drinking in heat
and light like a bud welcoming resurrection,
and my hand up, too, ready to sign on
for conversion.
~Luci Shaw “Revival” from What the Light Was Like.

This year, spring has been emerging early from an exceptionally warm and un-snowy winter, yet blizzard conditions last night closed the Cascade mountain passes with high winds causing extensive power outages in the Puget Sound region.

Our hilltop farm was spared overnight – we are grateful for light and heat this morning.

Up until now, all growing things have been several weeks ahead of the usual budding/blooming schedule when, like the old “Wizard of Oz” movie, the landscape suddenly turns from monochrome to technicolor with a soundtrack going from forlorn to glorious.

Like most folks, I too yearn for spring to commence, tapping my foot impatiently as if I’m personally owed an extravagant seasonal transformation from dormant to verdant. 

We wait for the Great Physician’s announcement that His patient survived winter once again:
“I’m happy to say the Earth is alive and restored, wounded but healing, breathing on her own but too addled by last night’s windstorm for you to expect much from her just yet.”

As we celebrate her imminent healing, we are reassured His Creation is still very much alive- we rejoice in this temporary home of ours.
A promising prognosis for this patient coming out of the fog of winter:
she lives, she breathes, she thrives, to bloom and sing with everything she’s got.
So soon, so will I.

This year’s Barnstorming Lenten theme is Ephesians 3:9:

…to bring to light for everyone what is the plan of the mystery hidden for ages in God, who created all things…

Bring to Light the Mystery: Where Are You?

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Then the man and his wife heard the sound of the Lord God as he was walking in the garden in the cool of the day, and they hid from the Lord God among the trees of the garden. But the Lord God called to the man, “Where are you?”
Genesis 3:8-9


We’ve moved into a bigger house.
Now our voices wander among the rooms
calling, Where are you?

And what we can’t forget
of other houses confuses us
as we answer back and forth, Over here!

It’s a little like returning to the village
where you were born, the sad bewilderment
of discrepancies between
what you remember and what’s there.

No. It’s more like a memory of heaven.
Voices coming closer, voices moving away,

and what we thought we knew
about life on earth confounding us.

And then that question
from which all the other questions begin.
~Li-Young Lee “Discrepancies, Happy and Sad” from Book of My Nights

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

Ready or not, you tell me, here I come!
And so I know I’m hiding, and I know
My hiding-place is useless. You will come
And find me. You are searching high and low.
Today I’m hiding low, down here, below,
Below the sunlit surface others see.
Oh find me quickly, quickly come to me.
And here you come and here I come to you.
I come to you because you come to me.
You know my hiding places. I know you,
I reach you through your hiding-places too;
Touching the slender thread, but now I see –
Even in darkness I can see you shine,
Risen in bread, and revelling in wine.
~Malcolm Guite “Hide and Seek”

When I go to the doctor, I trust I’m seeing someone who tries to know me thoroughly enough that they will help me move out of illness into better health. There are times when, as a patient, I need to be asked: Where are you in your life right now?
What are your worries and fears?
How can I support you through this?

This is how acceptance feels: trusting someone enough to come out of hiding, even when ashamed or fearful or feeling hopeless.

As a physician myself, I am reminded by the amount of “noticing” I needed to do in the course of my work over the decades. Each patient (and there were so many) deserved my full attention for the few minutes we are together. I started my clinical evaluation the minute we sat down together and I began taking in all the complex verbal and non-verbal clues they offered up, sometimes unwittingly.

As their audience, I become a witness to their struggle; even more, I must understand it in order to best assist them.  My brain must rise to the occasion of taking in another person, accepting them for who they are, offering them the gift of compassion and simply be there for them – just them – right then.

God doesn’t struggle in His Holy work as I did in my clinical duties. He knows us so thoroughly because He made us; He knows our thoughts before we put them into words.
There is no point in hiding from Him.

He can hold us in His Hand, discerns our secret heartbeats.

We, the no longer hidden, are His. His alone.

This year’s Barnstorming Lenten theme is Ephesians 3:9:

…to bring to light for everyone what is the plan of the mystery hidden for ages in God, who created all things…

Bring to Light the Mystery: A Good Cleansing

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Wash away all my iniquity
and cleanse me from my sin.
For I know my transgressions,
and my sin is always before me.
Psalm 51:2-3

Sometimes I wish I could be drenched thoroughly when I’ve gotten myself completely covered with muck–muddy hands, dirty feet, smudged face, soiled soul. It takes work, but I can remove all the signs of griminess on the surface.

Yet when I look in the mirror, I can see everything that desperately needs spiritual soap–now.  It is under the surface, harder to reach with soap, so I act helpless to do anything about it.
Maybe tomorrow…

People can be pretty effective at hiding the problems in their lives, even from themselves. However, in the clinical work I did for decades, it wasn’t always so easy to conceal. 

Patients came to inpatient detox because they had hit bottom in every way, so they are forced to confront the troubles that brought them there. I cared for people who had sold themselves, sold others, abandoned spouses as well as their own children, murdered others and tried to murder themselves. They come in so grimy, it is hard to even see their skin. They cry out for cleansing, for forgiveness, for healing. 

Sometimes they willingly submit to that wash cycle, yet sometimes the scrubbing that is the detox process is just too physically hard and painful despite all my efforts to ease it. They can’t handle it and leave before they are truly clean.
Maybe tomorrow.

I grieved for them when that happened.

Not once must I forget that their sin, ever so much more obvious,  is no greater than mine–we are all tainted goods. Our only hope is the Lord holding onto us tightly over holy waters to make sure we’re scrubbed until we shine: a true cleansing baptism.

Not tomorrow.

Today.

This year’s Barnstorming Lenten theme is Ephesians 3:9:

…to bring to light for everyone what is the plan of the mystery hidden for ages in God, who created all things…

Lyrics by David Wilton

Wash me clean
In the warm sun dry me
Cleanse my heart
From all iniquity
Baptize me
In the Holy Spirit sea
Renew my mind
That wickedness may flee

Barren fields will sprout trees
Deaf and blind will hear and see
Dead will raise and begin to breathe

Restore my soul
Holy Spirit take hold
Bathe me in
Your peace and let it flow
Grant me hope
In the dark have Your light shown
Sing Your love
The sweetest song I’ve ever known

Earth groans in pain to see
Sons of God declare to be
The full and glorious family

Surviving Worry

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With Cats, some say, one rule is true:
Don’t speak till you are spoken to.
Myself, I do not hold with that –
~T.S. Eliot from “The Ad-Dressing of Cats”

A true story I wrote 15 years ago…

Considering myself a Dr. Doolittle of sorts, always talking to the animals, I reach out to pet a stray cat sitting quietly outside our barn one evening while doing barn chores. This is a grayish fluffy cat I see around the barns every few months or so–he doesn’t put in frequent appearances and reminds me of a kitten we raised on this farm a few years back, though his markings are a bit different, so I know it is not our cat.

We have 6 cats to pet here who claim “us” as their home and family, so there is no lack of fur balls to love. There are probably that many more who hang out,  now and then, considering our farm fair game and looking for an occasional free meal. This cat just seemed to need a reassuring pat at that moment – or maybe I needed the reassurance. 

Wrong.

I found myself with a cat attached to my wrist by teeth and claws. It took a bit of an effort to shake him off and he escaped into the night. I then surveyed the damage he inflicted and immediately went to wash my wounds. They were deep punctures near my wrist joint–not good.  Lucky for me I was up to date on my tetanus booster.

By the next day the wounds were getting inflamed and quite sore. I know all too well the propensity of cat bites to get badly infected with Pasteurella multocida, a “bad actor” bacteria that can penetrate deep tissues and bone if not treated with aggressive antibiotics. After getting 6 opinions from my colleagues at clinic, all of whom stood solemnly shaking their heads at my 12 hour delay in getting medical attention,  I surrendered and called my doctor’s office. I pleaded for a “no visit” prescription as I was up to my eyeballs in my own patients, and he obliged me. I picked up the antibiotic prescription during a break, sat in the car ready to swallow the first one and then decided to wait a little longer before starting them, knowing they wallop the gut bacteria and cause pretty nasty side effects. I wanted to see if my own immune system might just be sufficient.

So the bacterial infection risk was significant and real but I was prepared to deal with it. For some reason I didn’t really think about the risk of rabies until the middle of the night when all dark and depressing thoughts seem to come real to me.

I don’t know this cat. I doubt he has an owner and it is highly unlikely he is rabies vaccinated. My own cats aren’t rabies vaccinated (and neither am I) though if I was a conscientious owner, they would be.  Yes, we have bats in our barns and woods and no, there has not been a rabid bat reported in our area in some time.

But what if this cat were potentially infected with the rabies virus but not yet showing symptoms? Now my mind started to work overtime as any good neurotic will do. Last summer a rabid kitten in North Carolina potentially exposed 10 people when it was passed around a softball tournament, no one aware it was ill until it died and was tested. Lots of people had to have rabies shots as a result.

This cat who had bitten me was long gone–there was no finding him in the vast woods and farmland surrounding us. He couldn’t be kept in observation for 10 days and watched for symptoms, nor could he be sacrificed to examine his neural tissue for signs of the virus.

I called the health department to ask what their recommendation was in a case like this. Do they recommend rabies immune globulin injection which should have been done as soon as possible after the bite? I talked with a nurse who read from a prepared script for worried people like me. 

Feral cats in our area have not been reported to have rabies nor have skunks or raccoons. Only local bats have been reported to have rabies but not recently. This cat would have had to have been bitten by a rabid bat to be rabid. This was considered a “provoked” attack as I had reached out to pet the cat. This was not a cat acting unusually other than having wrapped itself around my arm.  No, the Health Dept would not recommend rabies immune globulin in this situation but I was free to contact my own doctor to have it done at my own expense if I wished to have the series of 5 vaccination shots over the next month at a cost of about $3000. Yes, there would be a degree of uncertainty about this and I’d have to live with that uncertainty but she reassured me this was considered a very low risk incident.

I knew this was exactly what I would be told and I would have counseled any patient with the same words. Somehow it is always more personal when the risk of being wrong has such dire consequences. 

I could see the headlines “Local Doctor Dies From Rabid Cat Bite”.

This is not how I want to be remembered.

Rabies is one of the worst possible ways to die. The cases I’ve read about are among the most frightening I’ve ever seen in the medical literature. Not only is it painful and horrific but it puts family and care providers at risk as well. It also has an unpredictable incubation period of a up to a month or two, even being reported as long as a year after an exposure. What a long time to wait in uncertainty. It also has a prodrome of several days of very nonspecific symptoms of headache, fever and general malaise, like any other viral infection before the encephalitis and other bad stuff hits. I was going to think about it any time I had a little headache or chill.  This was assuredly going to be a real test of my dubious ability to stifle my tendency for 4-dimensional worries.

I decided to live with the low risk uncertainty and forego the vaccination series. It was a pragmatic decision based on the odds. My wounds slowly healed without needing antibiotics. For ten days I watched for my attacker cat whenever I went to the barn, but he didn’t put in an appearance. I put out extra food and hoped to lure him in. It would have been just be so nice to see his healthy face and not have to think about this gray cloud hanging over me for the next few months, as I wondered about every stray symptom. 

No gray kitty to be seen.

Almost a month has gone by now and he finally showed up last night.  I could have grabbed him and hugged him but I know better now. No more Dr. Doolittle.

He is perfectly fine and now so am I, cured of a terminal case of worry and hypochondria which is not nearly as deadly as rabies but can be debilitating and life shortening none the less.

From now on, I’ll be contented to just “talk to the animals” like any good Dr. Doolittle.  I don’t need to cuddle them.