The wind, one brilliant day, called to my soul with an odor of jasmine.
“In return for the odor of my jasmine, I’d like all the odor of your roses.”
“I have no roses; all the flowers in my garden are dead.”
“Well then, I’ll take the withered petals and the yellowed leaves and the waters of the fountain.”
The wind left. And I wept. And I said to myself: “What have you done with the garden that was entrusted to you?” ~Antonio Machado “The Wind, One Brilliant Day” translated by Robert Bly
This garden bloomed with potential, entrusted to me for 32 years: the health and well-being of 16,000 students, most thriving and flourishing, some withering, their petals falling, a few have been lost altogether.
As the winds of time sweep away another group of graduates from my care, to be blown to places unknown, their beauty and fragrance gone from here.
I marvel at their growth, but also weary weep for those who left too soon, wondering if I failed to water them enough – or is it I who am parched in this garden with a thirst unceasing, my roots reaching deep into drought-stricken soil, ever so slowly drying out?
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I had a profound amazement at the sovereignty of Being becoming a dizzy sensation of tumbling endlessly into the abyss of its mystery; an unbounded joy at being alive, at having been given the chance to live through all I have lived through, and at the fact thateverything has a deep and obvious meaning – this joy formed a strange alliance in me with a vague horror at the inapprehensibility and unattainability of everything I was so close to in that moment, standing at the very “edge of the infinite”;
I was flooded with a sense of ultimate happiness and harmony with the world and with myself, with that moment, with all the moments I could call up, and with everything invisible that lies behind it and has meaning. ~Václav Havel in a letter to his wife
– for Czesław Miłosz
How unattainable life is, it only reveals its features in memory, in nonexistence. How unattainable afternoons, ripe, tumultuous, leaves bursting with sap; swollen fruit, the rustling silks of women who pass on the other side of the street, and the shouts of boys leaving school. Unattainable. The simplest apple inscrutable, round. The crowns of trees shake in warm currents of air. Unattainably distant mountains. Intangible rainbows. Huge cliffs of clouds flowing slowly through the sky. The sumptuous, unattainable afternoon. My life, swirling, unattainable, free. ~Adam Zagajewski, “Fruit” Translated by Renata Gorczyńska and C. K. Williams
Heaven and earth are only three feet apart, but in the thin places that distance is even smaller. A thin place is where the veil that separates heaven and earth is lifted and one is able to receive a glimpse of the glory of God. ~Celtic saying
Sometimes the abundance in my life is so unbounded, I possibly can’t absorb it all, like an endless feast that far exceeds my hunger.
At times I have no idea how hungry I am until it is laid out before me; I don’t know where to begin.
When I feel myself on that cliff of overwhelm, that thin edge of knowing I can almost reach past the finite to touch the infinite, I realize it is unattainable.
Not now, not yet.
We live in the already but not yet. The all-encompassing I AM is here among us, His Spirit surrounding us with beauty beyond imagining. But we are waiting, wondering, wistful as the kingdom of God is already here and yet to come.
So He offers a glimpse and a taste and it is so very very good.
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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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Happy the man, whose wish and care A few paternal acres bound, Content to breathe his native air, In his own ground. Whose herds with milk, whose fields with bread, Whose flocks supply him with attire, Whose trees in summer yield him shade, In winter fire.
Blest, who can unconcernedly find Hours, days, and years slide soft away, In health of body, peace of mind, Quiet by day,
Sound sleep by night; study and ease, Together mixed; sweet recreation; And innocence, which most does please, With meditation.
Thus let me live, unseen, unknown; Thus unlamented let me die; Steal from the world, and not a stone Tell where I lie.
But the effect of her being on those around her was incalculably diffusive: for the growing good of the world is partly dependent on unhistoric acts, and that things are not so ill with you and me as they might have been, is half owing to the number who lived faithfully a hidden life, and rest in unvisited tombs. ~George Eliot’s final sentence in Middlemarch
We have no idea who came before us, unseen, unknown, unheralded, unvisited, yet they, by living and dying, made our lives better today.
They lie, forgotten, now dust in the ground.
Yet they lived fully and lovingly, stewards of the earth and its creatures, parents to the next generation and the next and the next, placed here as images of their Creator.
May we, someday, having also lived faithfully in the fullness of time, leave behind a legacy of good and unhistoric acts that leave this world a better place for those who walk behind us in our footsteps.
It’s the least we can do, to honor those whose footprints we now follow.
A new book from Barnstorming available for order here
The children have gone to bed. We are so tired we could fold ourselves neatly behind our eyes and sleep mid-word, sleep standing warm among the creatures in the barn, lean together and sleep, forgetting each other completely in the velvet, the forgiveness of that sleep.
Then the one small cry: one strike of the match-head of sound: one child’s voice: and the hundred names of love are lit as we rise and walk down the hall.
One hundred nights we wake like this, wake out of our nowhere to kneel by small beds in darkness. One hundred flowers open in our hands, a name for love written in each one. ~Annie Lighthart “The Hundred Names of Love”
In the lull of evening, your son nested in your arms becomes heavier and with a sigh his body sloughs off its weight like an anchor into deep sleep, until his small breath is the only thing that exists.
And as you move the slow dance through the dim hall to his bedroom and bow down to deliver his sleeping form, arms parting, each muscle defining its arc and release— you remember the feeling of childhood,
traveling beneath a full moon, your mother’s unmistakable laugh, a field of wild grass, windows open and the night rushing in as headlights trace wands of light across your face—
there was a narrative you were braiding, meanings you wanted to pluck from the air, but the touch of a hand eased it from your brow and with each stroke you waded further
into the certainty of knowing your sleeping form would be ushered by good and true arms into the calm ocean that is your bed. — Alexandra Lytton Regalado, “The T’ai Chi of Putting a Sleeping Child to Bed” author of Matria
Each of those countless nights of a child wakening, each of the hundreds of hours of lulling them in the moonlit dark, leading them back to the soft forgiveness of sleep.
I remember the moves of that hypnotic dance, a head nestled snug into my neck, their chest pressed into mine, our hearts beating in synchrony as if they were still inside.
Even when our sleep was spare and our rest was sparse, those night times rocking in unison were worth every waking moment, trusting we’re in this together, no matter what, no matter how long.
We’re in this together.
A new book from Barnstorming is available to order here:
…God’s attention is indeed fixed on the little things. But this is not because God is a great cosmic cop, eager to catch us in minor transgressions, but simply because God loves us–loves us so much that the divine presence is revealed even in the meaningless workings of daily life. It is in the ordinary, the here-and-now, that God asks us to recognize that the creation is indeed refreshed like dew-laden grass that is “renewed in the morning” or to put it in more personal and also theological terms, “our inner nature is being renewed everyday”. ~Kathleen Norrisfrom The Quotidian Mysteries
Whether it is in a favorite book of fiction or poetry, or from the Word itself, or as I keep my eyes open to the daily wonders around me, I feel compelled to share the good parts with those of you who visit here.
It is easy to be ground to a pulp by the little things: waiting in line too long, heavy traffic, an insistent alarm clock, a mouse (or more) in the house, miserable spring-time pollen allergies, wearing a face mask though we no longer want to.
God is in the details, from dew drop to tear drop and even to nose snot. His ubiquitous presence is in all things, large and small, not just the “good parts” of His exquisite grandeur.
It isn’t all elegance from our limited perspective, but still, they are all good parts worthy of His divine attention.
The time has come to be refreshed and renewed by His care revealed in the tiniest ways.
He has my attention and I hope I now have yours.
A new book from Barnstorming – available to order here
Sometimes I have loved the peacefulness of an ordinary Sunday. It is like standing in a newly planted garden after a warm rain. You can feel the silent and invisible life. ~Marilynne Robinson from Gilead
It is ordinary time, in the church calendar and in my life…
As I am covered with Sabbath rest quiet and deep as if planted in soil finally warming from a too long winter~
I realize there is nothing ordinary about what is happening in the church, in the world, or in me.
We are called by the Light to push away from darkness, to reach to the sky, to grasp and bloom and fruit.
We begin as mere and ordinary seed.
Therefore, nothing is more extraordinary than an ordinary Sunday.
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In spring there’s hope, in fall the exquisite, necessary diminishing, in winter I am as sleepy as any beast in its leafy cave, but in summer there is everywhere the luminous sprawl of gifts, the hospitality of the Lord and my inadequate answers as I row my beautiful, temporary body through this water-lily world. ~Mary Oliver from “Six Recognitions of the Lord”
what I want in my life is to be willing to be dazzled— to cast aside the weight of facts
and maybe even to float a little above this difficult world. I want to believe I am looking
into the white fire of a great mystery. ~Mary Oliver from “The Ponds”
I admit to being oblivious to the wonders going on beneath my feet, around my middle and above my head. My nose is to the grindstone, doing what needs to be done.
When a moment comes out of nowhere and I’m dazzled by something I’ve seen or heard or smelled, it shouldn’t come as a surprise. It has always been there; I’m simply waking to it.
Lord, lift my head in the midst of my blind hunger to see what you have already prepared for me.
Translation from Icelandic:
Hear, smith of heavens. The poet seeketh. In thy still small voice Mayest thou show grace. As I call on thee, Thou my creator. I am thy servant, Thou art my true Lord.
God, I call on thee; For thee to heal me. Bid me, prince of peace, Thou my supreme need. Ever I need thee, Generous and great, O’er all human woe, City of thy heart.
Guard me, my savior. Ever I need thee, Through ev’ry moment In this world so wide. Virgin–born, send me Noble motives now. Aid cometh from thee, To my deepest heart.
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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
It may be hard for an egg to turn into a bird: it would be a jolly sight harder for it to learn to fly while remaining an egg. We are like eggs at present. And you cannot go on indefinitely being just an ordinary, decent egg. We must be hatched or go bad. C. S. Lewis from Mere Christianity
….in the garden there was nothing which was not quite like themselves— nothing which did not understand the wonderfulness of what was happening to them— the immense, tender, terrible, heart-breaking beauty and solemnity of Eggs.
… if an Egg were taken away or hurt the whole world would whirl round and crash through space and come to an end— ~Frances Hodgson Burnett from The Secret Garden
I revel in being the good egg. Smooth on the surface, gooey inside, often a bit scrambled, yet ordinary and decent, indistinguishable from others, blending in, not making waves.
It’s not been bad staying just as I am. Except I can no longer remain like this.
A dent or two have appeared in my outer shell from bumps along the way, and a crack up one side extends daily.
It has come time to change or face inevitable rot.
Nothing can be the same again: the fragments of shell left behind must be abandoned as useless confinement.
Newly hatched and transformed: there is the wind beneath my wings. I’ll soar toward an endless horizon that stretches beyond eternity, no longer ordinary.
A new book from Barnstorming is available for order here: