Tag: Doctoring

You Can Have an Abundant August

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But you can have the fig tree and its fat leaves like clown hands
gloved with green. You can have the touch of a single eleven-year-old finger on your cheek, waking you at one a.m. to say the hamster is back.

You can have the purr of the cat and the soulful look
of the black dog, the look that says, If I could I would bite
every sorrow until it fled, and when it is August,
you can have August and abundantly so. You can have love,
though often it will be mysterious, like the white foam
that bubbles up at the top of the bean pot over the red kidneys
until you realize foam’s twin is blood.

You can speak a foreign language, sometimes,
and it can mean something. You can visit the marker on the grave
where your father wept openly. You can’t bring back the dead,
but you can have the words forgive and forget hold hands
as if they meant to spend a lifetime together.

You can have your grandfather sitting on the side of your bed,
at least for a while, you can have clouds and letters, the leaping
of distances, and Indian food with yellow sauce like sunrise.

You can’t count on grace to pick you out of a crowd
but here is your friend to teach you how to high jump,
how to throw yourself over the bar, backwards,
until you learn about love, about sweet surrender,
and here are periwinkles, buses that kneel, farms in the mind
as real as Africa.

And when adulthood fails you,
you can still summon the memory of the black swan on the pond
of your childhood, the rye bread with peanut butter and bananas
your grandmother gave you while the rest of the family slept.
There is the voice you can still summon at will, like your mother’s,
it will always whisper, you can’t have it all,
but there is this.
~Barbara Ras from “You Can’t Have It All” from Bite Every Sorrow

My pragmatic mother gave up her teaching career for marriage and family so would remind me regularly that I couldn’t have it all:
there was no way a woman can have a husband and children and a farm and a garden and animals and a profession and write and travel and volunteer in the community and not make a mess of it all and herself.

My father would listen to her and say to me softly under his breath: “you do whatever you put your mind to…you know what you are here for.”

They were both right.

The alluring abundance of this life has invited me to want to touch and feel and taste it all, not unlike another woman who was placed with purpose in the Garden to be a side-by-side companion and co-worker. Yet she demonstrated what happens when you want more than you are given and yes, she indeed made a mess of things.

Yet there is this:
despite wanting it all and working hard for it all
and believing I could do it all,
I missed the point altogether.

Life is all gift, never earned.
Life is all grace, not deserved.
It is all August abundance,
it is right now,
sustaining us through the year’s
droughts and floods and storms and drab gray weather.

And there is this:
I know what I am here for.

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Like Light and Cloud Shadows

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…you mustn’t be frightened …
if a sadness rises in front of you,
larger than any you have ever seen;
if an anxiety, like light and cloud-shadows,
moves over your hands and over everything you do.
You must realize that something is happening to you,
that life has not forgotten you,
that it holds you in its hand and will not let you fall.
Why do you want to shut out of your life any uneasiness,
any misery, any depression, since after all
you don’t know what work these conditions are doing inside you?
~Rainer Maria Rilke from Letters to a Young Poet

…difficulties are magnified out of all proportion
simply by fear and anxiety.
From the moment we wake until we fall asleep
we must commend other people wholly and unreservedly to God and leave them in his hands,
and transform our anxiety for them into prayers on their behalf: 
With sorrow and with grief…
God will not be distracted.
~Dietrich Bonhoeffer in Letters from Prison

During my decades as a primary care physician for a university health center, my clinic days were often filled with young adults who were so consumed by anxiety they were immobilized in their ability to move forward through life’s inevitable obstacles and difficulties. They were so stuck in overwhelming feelings, they couldn’t sleep or eat or think clearly. They tended to self-medicate, self-injure and self-hate. Unable to nurture themselves or others, they withered like a flower without roots deep enough to reach the vast reservoir untapped beneath them.  In epidemic numbers, some decide to die, even before life really has fully begun for them.

My role was to help find healing solutions, whether it was counseling therapy, a break from school, or a medicine that may give some form of relief. 

My heart knows the ultimate answer is not as simple as choosing the right prescription – light and cloud shadows differ for each person – it can feel like the sun is blocked forever, all that is left is rain and snow and gray.

I too have known anxiety and how it can distort every thought.

We who are anxious can depend upon a Creator who is not distracted from His care for us even if we have turned away in our worry and sorrow, unable to look past our own eyelashes. 

Like a thirsty withering plant, we need to reach higher and deeper: asking for help and support, working through solutions with those helpers, acknowledging there exists a healing power greater than ourselves.

So we are called to pray for ourselves and for others. Self compassion and caring for others can disable anxiety and fear by transforming it to growth, gratitude and grace.  

No longer withering, we just might bloom.

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Where You Go, I Will Go: Even in the Wilderness

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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

The wilderness might be a distant peak far removed from anything or anyone, where there is bleak darkness.

The wilderness might be the darkest corner of the human heart we keep far away from anything and anyone. 

From my kitchen window on a clear day, I sometimes see a distant mountain wilderness, when the cloud cover moves away. 

During decades of perching on a round stool in clinic exam rooms,  I was given access to hearts lost in the wilderness many times every day.

Sometimes the commandment to love God seems impossible. We are too self-sufficient, too broken, too frightened, too wary to trust God with our love and devotion. 

Recognizing a diagnosis of wilderness of the heart is straight forward: despair, discouragement,disappointment, lack of gratitude, lack of hope. 

The treatment is to allow the healing power of the Father who sent His own Son to navigate the wilderness in our place.

He reaches for our bitter, wary, and broken hearts that beat within our bodies, to bring us home from the dark wilderness of our souls.

This year’s Lenten theme:

…where you go I will go…
Ruth 1:16

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Is There a Cure?

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“Peasant women digging potatoes” Van Gogh 1885 Kröller-Müller Museum The Netherlands

“Do you know a cure for me?”
“Why yes,” he said, “I know a cure for everything. Salt water.”
“Salt water?” I asked him.
“Yes,” he said, “in one way or the other. Sweat, or tears, or the salt sea.”
~Isak Dinesen from Seven Gothic Tales

A good night sleep, or a ten minute bawl, or a pint of chocolate ice cream, or all three together, is good medicine.
~Ray Bradbury from Dandelion Wine

The woods are lovely, dark and deep,   
But I have promises to keep,   
And miles to go before I sleep,   
And miles to go before I sleep.
~Robert Frost from “Stopping by Woods on a Snowy Evening”

If there is anything I learned in 42 years of doctoring, it’s that physicians “practice” every day in the pursuit of getting it right. As much as MDs emphasize the science of what we do through “evidence-based” decision-making, there were still days when a fair amount of educated guessing and a gut feeling was based on past experience, along with my best hunch. 

Many patients don’t arrive with classic cookbook symptoms that fit the standardized diagnostic and treatment algorithms. The nuances of their stories require interpretation, discernment, and flexibility. A surprise once in awhile made me look at a patient in a new or unexpected way and taught me something I didn’t know before. It kept me coming back with more questions, to figure out the mystery and dig a little deeper.

I also learned that though much medical treatment comes through some intervention using surgical procedures, pills or injections, those aren’t the only options in our doctor bag.

A simple good night’s sleep can do wonders for what ails a mind and body, especially when we’ve kept our promises.

At times the most appropriate cure is simple salt water in all its forms – just feeling ocean waves lapping at our feet, or sweating it out with exertion, or feeling the flow of tears down our cheeks.

How many of us allow ourselves a good cry when we feel it welling up behind our eyes?  It could be a sentimental moment–a song that brings back bittersweet memories, a movie that touches just the right chord of feeling and connection. It may be a moment of frustration and anger when nothing seems to go right. It could be the pain of physical illness or injury or emotional turmoil. 

Or just maybe there is weeping when everything is absolutely perfect and there cannot be another moment just like it, so it is tough to let it go without our tears spilling over.

And lastly, aside from the obvious curative properties of salt water, the healing found in chocolate is unquestioned by this physician. It can fix most everything that ails a person – at least for an hour or so.

It doesn’t always take an M.D. degree to determine the best medicine. It just takes a degree in common sense.

Healing tools to consider when all else fails: 
sleep, weep, keep ( promises), and reap (chocolate!)

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Hiding Nothing

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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

In your hands

The dog, the donkey, surely they know
They are alive.
Who would argue otherwise?

But now, after years of consideration,
I am getting beyond that.
What about the sunflowers? What about
The tulips, and the pines?

Listen, all you have to do is start and
There’ll be no stopping.
What about mountains? What about water
Slipping over rocks?

And speaking of stones, what about
The little ones you can
Hold in your hands, their heartbeats
So secret, so hidden it may take years

Before, finally, you hear them?
~Mary Oliver “in your hands” from Swan: Prose and Poems

When I take myself to the doctor, I trust I’m seeing someone who tries to know me thoroughly enough that he or she can help me move out of illness into better health.

This is how acceptance feels: trusting someone enough to come out of hiding, allowing them to see the parts of me I prefer to keep hidden.

As a physician myself, I am reminded by the amount of “noticing” I did in the course of my work. Each patient, and there were so many,  deserved my full attention for the few minutes we were together.  I started my clinical evaluation the minute I entered the room and I began taking in all the complex verbal and non-verbal clues offered up, sometimes unwittingly, by another human being.

During the COVID pandemic, my interactions with patients became all “virtual” so I didn’t have the ability to observe as thoroughly as I usually did. Instead, I needed them to tell me outright what was going on in their lives, their minds and their hearts in both spoken or written words. I couldn’t ‘see’ them, even on a screen, in the same way as face to face in the same room.

How can someone call out their worries to me when they are hidden behind a camera lens?

I can’t witness first hand the trembling hands, their sweatiness, their scars of self injury.  Still, I am their audience and a witness to their struggle; even more, I must understand their fears to best help them. My brain must rise to the occasion of taking in another person, accepting them for who they are, with every wart and blemish, offering them the gift of compassion and simply be there for them at that moment.

God isn’t blinded in His Holy work as I am in my clinical duties. He knows us thoroughly because He made us; He knows our thoughts before we put them into words. There is no point in trying to stay hidden from Him.

He holds us, little pebbles that we are, in His Hand, and He listens to our secret heartbeats.

Those of us who believe we can remain effectively hidden will never be invisible to God.

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A Human Being, Not a Human Doing

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There comes the strangest moment in your life,
when everything you thought before breaks free—
what you relied upon, as ground-rule and as rite
looks upside down from how it used to be.

Your heart’s in retrograde. You simply have no choice.
Things people told you turn out to be true.
You have to hold that body, hear that voice.
You’d have sworn no one knew you more than you.

How many people thought you’d never change?
But here you have. It’s beautiful. It’s strange.
~Kate Light from “There Comes the Strangest Moment” in Open Slowly

This disease of being “busy” (and let’s call it what it is, the dis-ease of being busy, when we are never at ease) is spiritually destructive to our health and wellbeing.

It saps our ability to be fully present with those we love the most in our families, and keeps us from forming the kind of community that we all so desperately crave.

Tell me you remember you are still a human being,
not just a human doing.
Tell me you’re more than just a machine,
checking off items from your to-do list.
Have that conversation, that glance, that touch.
Be a healing conversation,
one filled with grace and presence.

Put your hand on my arm, look me in the eye,
and connect with me for one second.
Tell me something about your heart, and awaken my heart.
Help me remember that I too am a full and complete human being…
~Omid Safi from The Disease of Being Busy

It has been nearly three years since I hung up my stethoscope. I’m no longer paid to be very busy. It isn’t feeling strange to wake up with no “job” to go to.

I still am vigorously treading water but with no destination in mind other than to stay afloat. It’s enough to just move and breathe in this new and strangely unfamiliar territory.

It was scary at first, backing off from all-consuming clinic responsibilities, yet knowing I was becoming less effective due to my diminishing passion and energy for the work. I’d been working in some capacity for over fifty years, starting in high school.

I could barely remember who I was before I became a physician.

So here I am — changed and changing — volunteering here and there, budding and blooming in new colors and shapes, exercising a different part of my brain, and simply praying I make good use of the time left to me, being something as worthwhile as what I had been doing.

So, once again, my days have become… strangely beautiful… in ways I could never have imagined.

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Startled By the Sun, Not By the Eclipse

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We should always endeavour to wonder at the permanent thing, not at the mere exception. We should be startled by the sun, and not by the eclipse. We should wonder less at the earthquake, and wonder more about the earth.
~ G.K. Chesterton from ILLUSTRATED LONDON NEWS, October 21, 1905

As a physician, I was trained to perform physical examinations by learning first what was normal about the human body. As young, theoretically healthy, medical students, we practiced physical examinations on each other, and then had to demonstrate our skills in front of a professor for our class grade in physical assessments.

Since I went to medical school at a time when fewer than 1 in 5 students was a woman, each female student was placed in a physical exam group of three men, taught by a male physician, and then evaluated by a male professor. These were full examinations, including internal assessments, conducted in a typical open-backed hospital gown, in a classroom with long black lab tables to substitute for exam tables.

It was the ultimate feeling of vulnerability to be exposed to one’s classmates, supervisors and evaluators in such a way. Yet, it helped me understand the naked vulnerability of a patient undressing for a physician’s evaluation in the exam room.

After learning to assess and document what was normal in the physical exam, I was then trained to take note of the exceptions –
the human body equivalent of
an eclipse or an earthquake,
a wildfire or drought,
a hurricane or flood,
or merely an annoying pothole or molehill.

A physician’s attention is rarely focused on everything that is going well with the human body, but instead concentrating on what is aberrant, failing, or could be made better.

This is unfortunate; there is much beauty and amazing design to behold in every person I meet, especially those with chronic illness who feel nothing is as it should be — they feel despair and frustration at how their mind or body is aging, failing or faltering.

To counter this tendency to just find what’s wrong and needed fixing, I learned over the years to talk out loud as I was trained to do during those medical school physical assessments:
you have no concerning skin lesions,
your eardrums look clear,
your eyes react normally,
your tonsils are fine,
your thyroid feels smooth,
your lymph nodes are tiny,
your lungs auscultate clear,
your heart sounds are perfect,
your breasts reveal no palpable lumps,
your belly exam is reassuring,
your reflexes are symmetrical,
your prostate is smooth and normal,
your cervix, uterus and ovaries are healthy,
your emotional response to your stress level and
your tears are completely understandable.

I also wrote messages to patients meant to reassure:
your labs are in a typical range
or are getting better
or at least maintaining,
your xray shows no concerns,
or isn’t getting worse,
those medication side effects are to be expected and could go away.

I chose to acknowledge what was working well before attempting to intervene in what is not.

I’m not sure how much difference it made to my patient.
But it made a difference to me to wonder first at who this whole patient was before I focused in on what was broken and causing dis-ease.

I remain startled nearly 50 years later, and always astonished, by the sheer wonder that is our bodies – the Artist’s masterpiece.

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Still Open for Business

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Astonishing material and revelation appear in our lives all the time. Let it be.
Unto us, so much is given.
We just have to be open for business.
~Anne Lamott from Help Thanks Wow: Three Essential Prayers

It was my privilege to work in a profession where astonishment and revelation awaited me behind each exam room door.

During an average clinic day, I opened those doors 36 times, then close them behind me and settle in for the ten or fifteen minutes allocated per patient. I needed to peel through the layers of a problem quickly to find the core of truth about why a patient was seeking help.

Sometimes what I was looking for was right on the surface: a bad cough, a swollen ankle, a bad laceration, but also easily were their tears, their pain, their fear. Most of the time, the reason was buried deep and I needed to wade through the rashes and sore throats and headaches to find it.

Once in a while, I could actually do something tangible to help right then and there — sew up the cut, lance the boil, splint the fracture, restore hearing by removing a plug of wax from an ear canal.

Often I simply gave permission to a patient to be sick — to allow themselves time to renew, rest and trust their bodies to know what is needed to heal well.

Sometimes, I was the coach pushing them to stop living “sick” — to stop self-medicating when life is challenging, to stretch even when it hurts, to strive to overcome the overwhelm.

Always I was looking for an opening to say something a patient may consider later — how they might make different choices, how they could be bolder and braver in their self care and care for others, how every day is a thread in the larger tapestry of their one precious life.

At night I took calls and each morning woke early to get online work done, trying to avoid feeling unprepared and inadequate to the volume of tasks heaped upon the day. I know I was frequently stretched beyond my capacity, stressed by administrative pressures and obstacles I faced in providing the best care.

I understood trials my patients were facing because I had faced them too. I shared their worry, their fears and vulnerabilities because I had lived through it too.

Even now, I try to simply let it be, especially through troubled times, when I have been gifted so much over the years. So my own experience is a gift I can still share here, even in retirement.

I’ll never forget: no matter who waited behind the exam room door, they never failed to be astonishing and revelatory to me, professionally and personally.

I’m so grateful I was open for business for 42 years.
I don’t see patients in an exam room any longer.
This Doctor is In, writing every day, with friendly advice.
Let it be so.

Peanuts comic by Charles Schulz

What is it You see
What do I possess
Oh how could it be
I should be so blessed

I am nothing much
Neither saint nor queen
I am just a girl
And You are everything

But if You ask
Let it be so
Let it be so
and if You will
Let it be so

I am so afraid
Of this great unknown
They may turn away
I may be all alone

My life is so small
so small a price to pay
to see my savior come
and take my sin away

I will bear their scorn
I will wear the shame
All things for the good
All things in Your name

Father be my strength
Shepherd hold my hand
Open wide my heart
to welcome who is there
~Sarah Hart

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When a Great Soul Dies

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When great souls die,
the air around us becomes
light, rare, sterile.
We breathe, briefly.
Our eyes, briefly,
see with a hurtful clarity.
Our memory, suddenly sharpened,
examines, gnaws on kind words
unsaid, promised walks
never taken.

Great souls die and
our reality, bound to
them, takes leave of us.
Our souls, dependent upon their
nurture,now shrink, wizened.
Our minds, formed
and informed by their
radiance, fall away.
We are not so much maddened
as reduced to the unutterable ignorance of
dark, cold
caves.

And when great souls die,
after a period peace blooms,
slowly and always
irregularly. Spaces fill
with a kind of
soothing electric vibration.
Our senses, restored, never
to be the same, whisper to us.
They existed. They existed.
We can be. Be and be
better. For they existed.
~Maya Angelou from “When Great Trees Fall”

Sara,
my dear friend of nearly forty years,

When I learned you died this morning, your body overwhelmed by a sudden illness no one anticipated – I sat in stillness, trying once again to remember your soft voice, as if you were still part of this world.

I knew you were gone.

It was God’s timing to collect you back and so you went. We all are poorer without you – you the richer as you settle into a body no longer a burden and a struggle.

As recently as last week, you wondered aloud if you had it in you, after decades of surviving chronic illness and two cancers, to keep going with all your physical challenges. God heard your prayer. Instead of feeling depleted and emptied of purpose, you are now restored. The love and energy you shared during your long life, through your doctoring and farming and mothering and grandmothering, is replenished in the presence of Jesus Christ.

You have left so much of yourself behind:
Your mentoring made me a better doctor.
Your example made me a better mother.
Your gentle compassion made me a better friend.
Your forgiving grace and quiet patience made me a better person.

I wasn’t yet ready to say goodbye to you:
I regret not saying everything I needed to say.
I regret not taking more walks with you.
I regret not letting you know how much you blessed me
and the world simply by existing.

Now there is no doubt you are blessing heaven.
And so we who love you – your husband, children, grandchildren,
your friends, colleagues, former patients –
gratefully share the rare gift of grace that is
Dr. Sara Cuene Watson.

All flesh is grass,
and all its beauty is like the flower of the field.
The grass withers,
the flower fades when the breath of the LORD blows on it;
surely the people are grass.
The grass withers, the flower fades,
but the word of our God will stand forever.
Isaiah 40: 6-8

(Photos from Dordt University prairie)

Anatomy Lesson

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Thumb stuck out as I go
I’m just travelin’ up the road
Maps don’t do much for me, friend
I follow the weather and the wind

I’m hitch hikin’ all day long
Got what I can carry and my song
I’m a rolling stone just rolling on
Catch me now ’cause tomorrow I’ll be gone
~Bruce Springsteen from “Hitch Hikin'”

His reputation was well known and all the medical students had heard the stories about Dr. Rosse. As the Anatomy Professor, his class would become the primary focus of student energy in the first year of medical school, with other classes seeming like so much background noise.

Dr. Rosse believed in active student participation in class, in the cadaver lab, on oral tests. He told us from the first day on: ” You will learn to THINK in this class like you’ve never thought before! Your patient’s lives depend on this. You will be prepared for my class each and every day, just as you must be prepared for whatever your patients will need from you.”

He was correct.

There were 110 of us in the lecture hall that first day, looking nervously at each other and at the empty podium down in front. We had been assigned three chapters in the anatomy textbook before Dr. Rosse’s first lecture and were expected to know the names of the bones and major blood vessels.

Dr. Rosse’s assignment for himself was to memorize our names and faces from a photo directory provided to him two days previously.

He began his lecture in the barely darkened room, running quickly through a carousel of slides of graphic photos and drawings of body parts. Within five minutes, he stopped and in his thick European accent, pointed at a student in the second row said: “Mr. Davis, can you tell me the name of this blood vessel on this slide?”

The student sat up startled, and sat silent, gathering his wits. Dr. Rosse looked pointedly at his wrist watch and started saying, “Drip. Drip. Drip.”  The student started to sweat.

“Drip, drip, drip, your patient is losing blood, Mr. Davis.”

The student, in a moment of enlightenment asked,” the inferior vena cava?” and Dr. Rosse said, “Very good, Mr. Davis!” and made a notation on the tablet on the podium in front of him.

The rest of our hearts immediately were in our throats, something that Dr. Rosse would later tell us was an anatomic impossibility, no matter how much it felt like it. There would be no dozing off, daydreaming or not preparing for this class.

My turn came the following week as he called out my name, his steely eyes fixed on only me. I got off fairly easy with a question from Dr. Rosse about the attachments for the extensor pollicis longus. I had memorized all the arm muscles the night before so was prepared.

“Yes, very good, Miss Polis.  Now tell me, if I were to fall off this podium right now, land on my outstretched arm and rupture my extensor pollicis longus, what would I not be able to do with my arm?”

I had no idea. I looked at him somewhat aghast. I thought I had done the necessary preparation to be ready for his questioning. My memorizing names and locations of muscles and tendons had only taken me so far. I had not really thought about the functionality of what I was learning and how it might be relevant to my future patients.

“Think now Miss Polis! This is not so very hard that you can’t THINK it out!”  Dr. Rosse demanded from the podium.

So I guessed. “Uh, you can’t grip?”

“Exactly wrong! Take a hike back to your study carrel, Miss Polis. You have not prepared yourself well enough. Go back to your book, and with each muscle you memorize, you must feel it on yourself or your study partner and think about how it works. Your patient will thank you for that someday.”

I was mortified that day, but survived that anatomy class, survived six oral exams over the cadaver with Dr. Rosse, and although I didn’t get an A in his class, I was very relieved to get a B+. As a student, I had never been asked before to actually apply what I was learning to make it relevant to my future work. Dr. Rosse was right. I had learned to not just memorize, but to think.

And when I saw my first extensor pollicis longus rupture seven years later in my practice, I was absolutely confident of the diagnosis because my patient could not lift up his thumb when asked to act like he was hitchhiking.  And my patient did thank me.  Dr. Rosse was right again.

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