It has been a long 18 months of dwelling deeply in all kinds of “supposes” and “what ifs” because people were being crushed by a virus right and left.
I understand this kind of thinking, particularly when “in the moment” tragedies, (like a Florida condo building collapsing in the middle of the night) play out real-time in the palm of our hand in front of our eyes and we feel helpless to do anything but watch it unfold.
Those who know me well know I can fret and worry better than most. Medical training only makes this worse. I’m taught to think catastrophically. That is what I have done for a living – to always be ready for the worse case scenario and simply assume it will happen.
Sometimes it does happen and no amount of wishing it away will work.
When I rise, too often sleepless, to face a day of uncertainty as we all do ~ after careful thought, I reach for the certainty I am promised over the uncertainty I can only imagine:
What is my only comfort in life and in death? That I am not my own, but belong —body and soul, in life and in death— to my faithful Savior, Jesus Christ.
“Supposing it didn’t” — says our Lord (and we are comforted by this) but even if it did … even if it did – as awful things sometimes do – we are never abandoned.
He is with us always.
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We will grieve not, rather find Strength in what remains behind; In the primal sympathy Which having been must ever be;
Thanks to the human heart by which we live, Thanks to its tenderness, its joys, and fears, To me the meanest flower that blows can give Thoughts that do often lie too deep for tears. ~William Wordsworth from “Ode: Intimations of Immortality from Recollections of Early Childhood”
Twenty-six years ago today we watched at your bedside as you labored, readying yourself to die and we could not help except to be there while we watched you move farther away from us.
This dying, the hardest work you had ever done:
harder than handling the plow behind a team of draft horses, harder than confronting a broken, alcoholic and abusive father, harder than slashing brambles and branches to clear the woods, harder than digging out stumps, cementing foundations, building roofs, harder than shipping out, leaving behind a new wife after a week of marriage, harder than leading a battalion of men to battle on Saipan, Tinian and Tarawa, harder than returning home so changed there were no words, harder than returning to school, working long hours to support family, harder than running a farm with only muscle and will power, harder than coping with an ill wife, infertility, job conflict, discontent, harder than building your own pool, your own garage, your own house, harder than your marriage ending, a second wife dying, and returning home forgiven.
Dying was the hardest of all as no amount of muscle or smarts could stop it crushing you, taking away the strength you relied on for 73 years.
So as you lay helpless, moaning, struggling to breathe, we knew your hard work was complete and what was yet undone was up to us to finish for you.
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After three weeks of hot weather and drought, we’ve had a week of cold and rain, just the way it ought to be here in the north, in June, a fire going in the woodstove all day long, so you can go outside in the cold and rain anytime and smell the wood smoke in the air.
I spent seven hours yesterday at my daughter’s house helping her expand their garden by at least ten times. We dug up sod by the shovelful, shook off the dirt as best we could; sod into the wheelbarrow and off to the pile at the edge of the yard. Then all that over and over again. Five hours total work-time, with time out for lunch and supper. By the time I got home I knew all too well that seventy-two is not thirty-five; I could barely move.
I got to quit earlier than Nadine. She told me I’d done enough and that I should go get a beer and lie down on the chaise lounge and cheer her on, which is what I did.
All this made me remember my father forty years ago helping me with my garden. My father’s dead now, and has been dead for many years, which is how I’ll be one of these days too. And then Nadine will help her child, who is not yet here, with her garden. Old Nadine, aching and sore, will be in my empty shoes, cheering on her own.
So it goes. The wheel turns, generation after generation, around and around. We ride for a little while, get off and somebody else gets on. Over and over, again and again. ~David Budbill “Seventy-Two Is Not Thirty-Five” from Tumbling toward the End.
June is not supposed to be like this.
It is typically cool and rainy during these first few weeks of summer. June is an impossible month to hold outdoor weddings as we discovered a year ago. We celebrated our daughter and son-in-law’s wedding amid chilly breezes and sprinkles, avoiding a downpour.
Yet if it had been this year we would have all baked and sweated to a golden melting crust sitting in the full sun.
Yesterday we reached 106 F here in the normally temperate Pacific Northwest. I am scanning the weather forecast for any hint of rain (none) and am celebrating the prediction of mid-80s temperatures (hopefully soon). I once thought 85 to be intolerably hot.
It all is a matter of perspective when considering how things “ought” to be.
Wild temperature fluctuations and weather extremes are not new to this earth, but they certainly seem more frequent, causing more damage and suffering among all earth dwellers, whether plant or animal. We expect natural predictable cycles in the seasons and in the passing of one generation to another — a smooth replacement plan as older gives way to the younger.
This is how it ought to be. Yet it isn’t always so. Sometimes not even close.
We’ll remember 2020 and early 2021 as months of pandemic that sucked the life and joy from so many of us. Now the crazy heat index of June 2021 is effectively distracting us from a dwindling risk of COVID infection to consider instead the immediacy of how to avoid overheating ourselves, our animals and our gardens/crops.
It is always something in this life of peril and worry.
That is just how it is, rather than how it ought to be.
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Nothing seems to please a fly so much as to be taken for a currant; and if it can be baked in a cake and palmed off on the unwary, it dies happy. ~Mark Twain
Today I will wrap up 45 years of uninterrupted training and doctoring. Most of that time, I have worried I’m like a fly hiding among the black currants hoping to eventually become part of the currant cake.
Maybe no one has noticed. These days we call it the “impostor” syndrome. Mark Twain knew all about currant cake and how easy it was for a fly to blend into its batter.
Even while bearing three children and going through a few surgeries myself, I’ve not been away from patients for more than twenty consecutive days at any one time. This is primarily out of my concern that, even after a few weeks, I would forget all that I’ve ever known. In fact, half of what I learned in medical school and residency over forty years ago has evolved, thanks to new discoveries and clarifying research. I worried if I were to actually to step away from doctoring for an extended time, then return to see patients again, I would be masquerading as a physician rather than be the real thing. A mere fly among the currants palmed off on the unwary.
If being truly honest, those who spend their professional lives providing medical care to others always share this concern: if a patient only knew how much we don’t know and will never know, despite everything we DO know, there would really be no trust left for us at all.
Of course, some say, didn’t the COVID pandemic prove our ignorance? Physicians started at Ground Zero with a novel virus with unclear transmissibility and immense potential to wreak havoc on the human body … or cause no symptoms whatsoever. We had no collected data to base prevention or treatment decisions: would masks just protect others or would they only protect ourselves, or maybe they protect both? Could a common inexpensive anti-inflammatory/antimalarial drug be beneficial or would a parasitic wormer medication be somehow effective to fight the devastation of the virus?
Effective treatments are still being sought all these months later; others have been debated, studied and discarded as worthless.
Or would this pandemic finally resolve thanks to effective yet controversial public health mandates while rapidly distributing highly effective vaccines developed from many prior years of carefully performed research?
During the past 16 months, your next door neighbor, or the loudest tweet on Twitter proclaimed more expertise than the average medical professional and definitely had a stronger opinion. At least we doctors knew how much we didn’t know and how much was simply guess work based on experience, good intentions and hopeful prayer. Gradually, while lives were lost, including too many of our own, real data began to trickle in so decisions could be made with some evidence backing them. But even that data continues to evolve, day by day, as authentic medical evidence always does.
That doesn’t stop all the “quack” flies out there from climbing into the batter pretending to be currants. With so much rapidly changing medical information at everyone’s fingertips, who needs a trained physician when there are so many other resources – sketchy and opportunistic though they may be – for seeking health care advice?
Even so, I am convinced most patients really do care that doctors share the best information they have available at any point in time. None of us who are doctoring wants to be the “fly” in the batter of health care.
As I meet with my last patient today, I know over forty years of clinical experience has given me an eye and an ear for the subtle signs and symptoms that no googled website or internet doc-in-the-box can discern. The avoidance of eye contact, the tremble of the lip as they speak, the barely palpable rash, the hardly discernible extra heart sound, the fullness over an ovary, the slight squeak in a lung base. These are things I am privileged to see and hear and about which I make decisions together with my patients. What I’ve done over four decades has been no masquerade; out of my natural caution, I am not appearing to be someone I am not. This is what I was trained to do and have done for thousands of days and many more thousands of patients during my professional life, while passing a comprehensive certification examination every few years to prove my continued study and changing fund of knowledge.
The hidden fly in the currant bush of health care may be disguised enough that an unwary patient might gobble it down to their ultimate detriment. I know I’ve not been that doctor. I’ve been the real thing all these years for my patients, even if I’ve seemed a bit on the tart side at times, yet offering up just enough tang to be exactly what was needed in the moment and in the long term.
And someday, hopefully not too soon, I will die happy having done this with my life.
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You can’t say you haven’t been warned: there are creepy crawlies in this post
Things I will never like: 1. Drying off with a cold, damp towel. 2. The feeling of seaweed wrapping around my legs. 3. Anything that was popular in the 70’s. 4. Licorice, yam, or raisins. 5. That high-pitched screech that babies make. 6. Writhing maggots. ~Bill Watterson from It’s A Magical World: A Calvin and Hobbes Collection
A few weeks ago, I had a bit of home-made potato corn chowder left over that I added to our compost bin in our barnyard. It isn’t often that much animal protein makes its way into the bin so when I checked on the compost a few days later, I was amazed to see it teeming with fly maggots in the midst of their Thanksgiving feast. Ordinarily pictures and videos of maggots would not find their way to this blog. People might be looking at this blog while eating their breakfast or lunch and writhing maggots are not something you are expecting to see. My apologies in advance and now is the time to delete delete delete.
Therefore: a trigger warning. Don’t scroll down further if you would rather avoid seeing (and hearing) creepy crawly things.
My first medical exposure to maggots came while examining the leg and foot wounds of the homeless folks I helped care for when training in an inner city emergency room. Peeling off old ragged stockings and socks would often reveal more than dirty feet – in fact, the maggots may have been somewhat beneficial in those cases yet we were quick to dispose of them.
Maggots are, in fact, fascinating creatures with potential therapeutic value, notwithstanding their gross-out factor. This week in a brief Atlantic article found here, there is a summary of a recent study in France comparing typical surgical debridement of venous ulcers of the skin with maggot therapy. Maggots were faster in cleaning the wounds but didn’t enhance eventual healing any more than traditional surgical care. There wasn’t a difference in the discomfort level as long as the patient didn’t know which therapy was being used. For those who had been randomly assigned to maggot therapy in one study, an astounding 89% said they would opt for the insects over surgeons if faced with needing wound care in the future.
I’m not sure what that says about surgeons, but it is a great compliment to maggot larvae!
Here is a formal cross-referenced evidence-based summary from UptoDate.com about wound treatment with biologic methods:
Biologic — An additional method of wound debridement uses the larvae of the Australian sheep blow fly (Lucilia [Phaenicia] cuprina) or green bottle fly (Lucilia [Phaenicia] sericata, Medical Maggots) [42,43]. Maggot therapy can be used as a bridge between debridement procedures, or for debridement of chronic wounds when surgical debridement is not available or cannot be performed . Maggot therapy may also reduce the duration of antibiotic therapy in some patients .
Maggot therapy has been used in the treatment of pressure ulcers [45,46], chronic venous ulceration [47-50], diabetic ulcers [42,51], and other acute and chronic wounds . The larvae secrete proteolytic enzymes that liquefy necrotic tissue, which is subsequently ingested while leaving healthy tissue intact. Basic and clinical research suggests that maggot therapy has additional benefits, including antimicrobial action and stimulation of wound healing [43,47,53,54]. However, randomized trials have not found consistent reductions in the time to wound healing compared with standard wound therapy (eg, debridement, hydrogel, moist dressings) [55,56]. Maggot therapy appears to be at least equivalent to hydrogel in terms of cost [56,57].
Dressing changes include the application of a perimeter dressing and a cover dressing of mesh (chiffon) that helps direct the larvae into the wound and limits their migration (movie 1). Larvae are generally changed every 48 to 72 hours. One study that evaluated maggot therapy in chronic venous wounds found no advantage to continuing maggot therapy beyond one week . Patients were randomly assigned to maggot therapy (n = 58) or conventional treatment (n = 61). The difference in the slough percentage was significantly increased in the maggot therapy group compared with the control groups at day 8 (67 versus 55 percent), but not at 15 or 30 days.
The larvae can also be applied within a prefabricated “biobag”, commercially available outside the United States, that facilitates application and dressing change [58-61]. Randomized trials comparing “free range” with “biobag”-contained larvae in the debridement of wounds have not been performed.
A main disadvantage of maggot therapy relates to negative perceptions aboutits use by patients and staff. One concern among patients is the possibility that the larvae can escape the dressing, although this rarely occurs. Although one study identified that approximately 50 percent of patients indicated they would prefer conventional wound therapy over maggot therapy, 89 percent of the patients randomly assigned to maggot therapy said they would undergo larval treatment again . Perceived pain or discomfort with the dressings associated with maggot therapy may limit its use in approximately 20 percent of patients.
The STARZ show Outlander (a show and series of books by scientist Diana Gabaldon I thoroughly enjoy) used real maggots in the fifth season of the show when in 18th century America, wife (and surgeon) Claire successfully treats her husband Jamie’s snakebite wound with the larvae. Actress Caitriona Balfe describes her co-starring maggots in this brief video:
So there are still things to learn about medical therapies we used in the past which have been sidelined or forgotten in our push for modern treatment modalities. The days of leeches and maggots may not be over after all.
And now for video, complete with little maggotty sound effects — scroll down
Maggots in our compost bin – enjoying corn and potato chowder leftovers
A new book from Barnstorming is available to order here
The talkative guest has gone, and we sit in the yard saying nothing. The slender moon comes over the peak of the barn.
The air is damp, and dense with the scent of honeysuckle. . . . The last clever story has been told and answered with laughter.
With my sleeping self I met my obligations, but now I am aware of the silence, and your affection, and the delicate sadness of dusk. ~Jane Kenyon, “The Visit” from Collected Poems
As we slowly adapt to evenings spent with family and friends again, taking off our masks to actually witness the emotion on a familiar, now unveiled, face:
There are smiles and laughter again. We are trying to remember how to be ourselves outside the fearfulness that contagion wrought. More important: there are tears again. And wistfulness. And regret. And longing.
This delicate sadness happened – even to those of us who were never directly touched by sickness. We will never be the same, never so light of heart again, remembering what this past year has cost.
It is a slow transition to dusk. We sit together now and watch it come.
Gardens are also good places to sulk. You pass beds of spiky voodoo lilies and trip over the roots of a sweet gum tree, in search of medieval plants whose leaves, when they drop off turn into birds if they fall on land, and colored carp if they plop into water.
Suddenly the archetypal human desire for peace with every other species wells up in you. The lion and the lamb cuddling up. The snake and the snail, kissing. Even the prick of the thistle, queen of the weeds, revives your secret belief in perpetual spring, your faith that for every hurt there is a leaf to cure it. ~Amy Gerstler “Perpetual Spring” from Bitter Angel
We all want to fix what ails us: that was the point of my many years of medical training and over 40 years “practicing” that art. We want to know there is a cure for every hurt, an answer for every question, a resolution to every mystery, or peace for every conflict.
And there is. It just isn’t always on our timeline, nor is it always the answer we expect, nor the conflict magically dissolved. The mystery shall remain mystery until every tear is dried, as we stand before the Face of our Holy God who both loves and judges our hearts.
Sometimes this life hurts – a lot – but I believe in the perpetual Spring and Resurrection that guarantees our complete healing.
The whole mass of Christians are the physical organism through which Christ acts— that we are his fingers and muscles, the cells of His body. ~C.S. Lewisfrom Mere Christianity
Now you are the body of Christ, and each one of you is a part of it. 1Corinthians 12:27
Christ has no body now but yours. No hands, no feet on earth but yours. Yours are the eyes through which he looks compassion on this world. Yours are the feet with which he walks to do good. Yours are the hands through which he blesses all the world. Yours are the hands, yours are the feet, yours are the eyes, you are his body. Christ has no body now on earth but yours. ~Teresa of Avila
When I am awake in the night to attend to those who are hurting, some who have been hurt by illness, injury or abuse or who hurt themselves to escape their hopelessness, I remember, in my own weariness, this dear one too is part of His body, one of the cells that adjoins the cell that is me, each of us critical to the life raised in the body of Christ.
Why have have so many of us Christians forgotten this in the last year? How can we not care first and foremost for the vulnerable, for our beloved brothers and sisters in Christ, as well as those who we don’t know and don’t yet know Christ, by doing whatever we can, whether it is the inconvenience of masking or accepting the low risk of an effective vaccine, to shield others and ourselves from potential harm and end this painful time of pandemic history?
Pastor Tim Keller has said: Christians are called by God to be living so sacrificially and beautifully that the people around us, who don’t believe what we believe, will soon be unable to imagine the world without us.
Thank you to David French, Michael Luo, and Scott Sauls for their insights into the role of Christ’s church during the pandemic and how we can do better in living out our mandate as the body and cells of Christ.
Keep watch, dear Lord, with those who work, or watch, or weep this night, and give your angels charge over those who sleep. Tend the sick, Lord Christ; give rest to the weary, bless the dying, soothe the suffering, pity the afflicted, shield the joyous; and all for your loves sake. Amen. ~Common Book of Prayer
He will cover you with his feathers, and under his wings you will find refuge; his faithfulness will be your shield and rampart. Psalm 91:4
To be commanded to love God at all, let alone in the wilderness, is like being commanded to be well when we are sick, to sing for joy when we are dying of thirst, to run when our legs are broken. But this is the first and great commandment nonetheless. Even in the wilderness- especially in the wilderness – you shall love him. ~Frederick Buechner from A Room Called Remember:Uncollected Pieces
I usually think of wilderness as a distant peak far removed from anything or anyone. From my farmhouse window on a clear day, I can see a number of distant peaks if the cloud cover moves away to reveal them.
Or perhaps the wilderness is a desolate plain that extends for miles without relief in sight.
Wilderness is also found in an isolated corner of my human heart. I keep it far removed from anything and anyone. During my televisit computer work, I witness this wilderness in others, many times every day.
A diagnosis of “wilderness of the heart” doesn’t require a psychiatric manual: there is despair, discouragement, disappointment, lack of gratitude, lack of hope. One possible treatment to tame that wilderness is a covenantal obedience to God and others. It reaches so deep no corner is left untouched.
There come times in one’s life, and this past year especially, when loving God as commanded seems impossible. We are too broken, too frightened, too ill and too wary to trust God with faith and devotion. We are treading life simply to stay afloat.
During this second Lenten pandemic, God’s love becomes respite and rescue from the wilderness of my own making. He is the sweet cure for a bitter and broken heart.
I tell you the truth, if you have faith as small as a mustard seed, you can say to this mountain, `Move from here to there’ and it will move. Nothing will be impossible for you. Matthew 17:20
How pale is the sky that brings forth the rain As the changing of seasons prepares me again For the long bitter nights and the wild winter’s day My heart has grown cold, my love stored away My heart has grown cold, my love stored away
I’ve been to the mountain, left my tracks in the snow Where souls have been lost and the walking wounded go I’ve taken the pain, no girl should endure But faith can move mountains of that I am sure Faith can move mountains of that I am sure
Just get me through December A promise I’ll remember Get me through December So I can start again
No divine purpose brings freedom from sin And peace is a gift that must come from within And I’ve looked for the love that will bring me to rest Feeding this hunger beating strong in my chest Feeding this hunger beating strong in my chest ~Gordie Sampson & Fred Lavery
It is winter in Narnia… and has been for ever so long …. always winter, but never Christmas. ~C. S. Lewis from The Lion, Witch and the Wardrobe
We’ve been traveling through a wilderness of the pandemic for nearly a year, even as the calendar has changed from spring to summer to autumn and in December back to winter. In this winter wilderness, we struggle with the chill of isolation from each other and from God, the endless discouragement and fatigue, and the hot cold of resentment and anger.
We are called in the gospel of Matthew to leave behind our helplessness when overwhelmed by pervasive wilderness. He tells us to believe, even if it is only the tiniest grain of faith. Our cold hearts love and hunger for God.
So if we can’t make it to the mountain in the distance, our faith can move the mountain closer. God hears our plea and brings His peace to us by bringing Himself as close as the beating heart in our chest. There will be a Christmas again and there will be Easter.