The Fog is Rising

I must go in; the fog is rising…
~Emily Dickinson, her last words

I have watched the dying
in their last hours:
often through the fog of waning breaths,
they see what I cannot,
they listen to what I do not hear,
stretching their arms overhead
as their fingers extend and grasp
to touch what is, as yet,
far beyond my reach.

I watch and wonder how it is
to reverse the journey that brought me here
from the fog of my amnion.

The mist of living lifts.

I will enter a place
unsurpassed in brilliance and clarity;
the mystery of what lies beyond solved
only by going in to it,
welcomed back to where I started.

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Whispering Words of Wisdom: Let It Be

Aspire to decency. Practice civility toward one another. Admire and emulate ethical behavior wherever you find it. Apply a rigid standard of morality to your lives; and if, periodically, you fail ­as you surely will, adjust your lives, not the standards.
Ted Koppel

Ten years ago during this week in August, my clinical work was routine and ordinary but took a quick turn when I got a message from the media director at my university that a 14 month old medical opinion article I’d written for the student newspaper and then posted as a regular contributor on www.kevinmd.com was suddenly being quoted on the Huffington Post, Salon.com and other websites.  

Within hours, over a dozen media websites were citing “A War on Pubic Hair”

The original article was written as one in a series of opinion pieces on medical issues pertinent to college students requested by the student newspaper. I wrote it in spring 2011 after draining my umpteenth staph bacteria genital abscess due to the increasingly common practice of cosmetic removal of pubic hair. I felt the students needed to understand the hazards of what they were doing and hoped I could spare the next patient from experiencing an infection so painful and potentially serious.

So it went viral, over a year after it was written, all in a matter of hours. I was being quoted as if I had just been interviewed by these news agencies, which I had not, and they began feeding wrong information to each other: I was identified as “a leading British physician” since the first media report originated in the U.K.  One British site actually asked permission to reprint the original article, which I appreciated so that my words could not be taken out of context, but they attached a photo of me to the article lifted from my family picture on my personal blog.

Soon my personal cell phone started to ring in the middle of the night and my email in-box filled up. Messages from Europe, South America and all over the U.S. came in with requests for interviews, wanting me to elaborate in more detail on my very “provocative” point of view. I said no to every one of them even though some were respectable agencies, like the BBC, because I’d said all I had to say on this particular subject. I did not want my long career to be reduced to my defense of pubic hair or my life motto to read “Leave it alone!” Indeed I can hold my head up and be proud to tell my grandchildren someday that I actually turned down the Playboy Channel.

The online comments on the articles rapidly reproduced themselves, numbering in the thousands, with many hostile to my perspective and saying so in the most mean and inflammatory ways possible, citing my age, my looks and obvious lack of sex appeal as showing I lacked credibility in this subject. I dared to question the point of a multi-billion dollar cosmetic industry spawned by the even bigger multi-billion dollar porn industry, and no one was going to let me get away with it unscathed.

Civility has become even more endangered on the internet in the intervening ten years so I believe I actually got off easy at the time. Human beings lack accountability for their words and actions while hiding behind anonymous comments on media websites and blogs. It is easy to attack, lie, threaten, and bully when it is only words on a screen directed at someone you don’t know and will never meet. Decency and civility are lost forever when the standards for moral and ethical behavior disappear in a fog of pixels and bytes.

It has taken some time and distance for me to consider whether I did the right thing writing about a medical issue no one else would touch at the time. The “bare” trend has definitely waned over the last decade yet plenty of people still engage in the practice, although the recent sexual spread of the monkey pox virus is making some think twice about it.

If I managed to convince someone to put away the razor, stop the waxing, and respect their body as nature intended it to be, maybe I did the right thing after all.

After all – I shared whispered words of wisdom:
Let it be…

Cartoon by Clay Bennett
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To Keep From Being Forgotten

I like to stroll the graveyard in the middle of town
With my friend Anne, though we seldom agree
On what an epitaph we happen to read implies.
I’m inclined to find the one-line gravestone,
Dr. Noah Vedder, M.D., as sadly comic.
If we can’t take our money into the dark,
I read it as saying, at least we can take our titles.
But Anne, whose sympathies are aroused
More quickly than mine, reads it more darkly
As confessional. Here is the man’s admission
That he saw himself as a better doctor
Than he was a friend, or father, or husband,
A better listener in his office than at home.

If his kin were responsible for the inscription,
Its terseness, I say, may suggest they were moved
More by duty than they were by love.
But for her, its terseness seems to imply
Their painful acknowledgment that no praise
Inscribed on the stone would keep their friend
From being forgotten soon after they would be.
And behind this truth she hears a protest:
If the world were fair, he wouldn’t be sentenced
To endless retirement but allowed to practice,
In a life beyond this one, the profession he loved.

What use would a doctor be, I ask, in a realm
Where bodies are laid aside? But for her the point is
That those who knew him were certain that if
Such a realm existed and a doctor were called for there,
He’d volunteer, glad to hold office hours
And glad after hours to visit patients
Too sick to leave home,
However modest the streets they lived on,
However winding and poorly lit.

~Carl Dennis “At the Graveyard with Anne”

Since my people are crushed, I am crushed;
    I mourn, and horror grips me.
 Is there no balm in Gilead?
    Is there no physician there?
Why then is there no healing
    for the wound of my people?

Jeremiah 8:21-22

We physicians can be an arrogant lot in our devotion to our profession above all else in our lives – I’ve known a few who wear their M.D. title full-time like a banner and shield to prove their expertise.

The only time the label M.D. is relevant is on a name tag in a clinical setting and often it doesn’t even make a difference there. We do what we can with what knowledge we possess from our training, as limited as it is. There is so much that we don’t know and don’t understand.

Even so, there are many altruistic physicians who give of themselves 24 hours a day for their lifetime. Some would gladly continue their healing efforts long after they have become dust, yet those skills are no longer needed. In heaven, all are already healed.

Our healing comes from beyond our expertise, from a balm that can never be prescribed. We have a Great Physician who never forgets us, even when we are crushed and mourning, when all seems hopeless with our wounds so incredibly deep.

We are not forgotten.

Every face is in you, every voice,
Every sorrow in you.
Every pity, every love,
Every memory, woven into fire.
Every breath is in you, every cry,
Every longing in you.

Every singing, every hope,
Every healing, woven into fire.
Every heart is in you,
Every tongue, every trembling in you,
Every blessing, every soul,
Every shining, woven into fire.
~Michael Dennis Browne

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When Mortal Life Shall Cease

(Fourteen years ago this week, a healthy young college student came to our university health clinic ill with seasonal influenza complicated by pneumonia. His family gave permission for his story to be told. I share this again to honor the patients, young and old, who have fallen victim to the even more devastating COVID-19 pandemic over the past two years, as well as their families who have not had the same privilege of being at their bedside as they die. And honoring the health care workers who have witnessed so many preventable deaths over and over and will never truly recover from that experience.)

Nothing was helping.  Everything had been tried for a week of the most intensive critical care possible.  A twenty year old man – completely healthy only two weeks previously – was dying and nothing could stop it.

The battle against a sudden MRSA (Methicillin Resistant Staph Aureus) pneumonia precipitated by a routine seasonal influenza infection had been lost. Despite aggressive hemodynamic, antibiotic, antiviral and ventilator management, he was becoming more hypoxic and his renal function was deteriorating.  He was no longer responsive to stimuli.

The intensivist looked weary and defeated. The nurses were staring at their laps, unable to look up, their eyes tearing. The hospital chaplain reached out to hold this young man’s mother’s shaking hands.

After a week of heroic effort and treatment, there was now clarity about the next step.

Two hours later, a group gathered in the waiting room outside the ICU doors. The average age was about 21; they assisted each other in tying on the gowns over their clothing, distributed gloves and masks. Together, holding each other up, they waited for the signal to gather in his room after the ventilator had been removed and he was breathing without assistance. They entered and gathered around his bed.

He was ravaged by this sudden illness, his strong body beaten and giving up. His breathing was now ragged and irregular, sedation preventing response but not necessarily preventing awareness. He was surrounded by silence as each individual who had known and loved him struggled with the knowledge that this was the final goodbye.

His father approached the head of the bed and put his hands on his boy’s forehead and cheek.  He held this young man’s face tenderly, bowing in silent prayer and then murmuring words of comfort:

It is okay to let go. It is okay to leave us now.
We will see you again. We’ll meet again.
We’ll know where you will be.

His mother stood alongside, rubbing her son’s arms, gazing into his face as he slowly slowly slipped away. His father began humming, indistinguishable notes initially, just low sounds coming from a deep well of anguish and loss.

As the son’s breaths spaced farther apart, his dad’s hummed song became recognizable as the hymn of praise by John Newton, Amazing Grace.  The words started to form around the notes. At first his dad was singing alone, giving this gift to his son as he passed, and then his mom joined in as well. His sisters wept. His friends didn’t know all the words but tried to sing through their tears. The chaplain helped when we stumbled, not knowing if we were getting it right, not ever having done anything like this before.

Amazing Grace, how sweet the sound,
That saved a wretch like me.
I once was lost but now am found,
Was blind, but now I see.

Through many dangers, toils and snares
I have already come;
‘Tis Grace that brought me safe thus far
and Grace will lead me home.

Yea, when this flesh and heart shall fail,
And mortal life shall cease,
I shall possess within the veil,
A life of joy and peace.

When we’ve been here ten thousand years
Bright shining as the sun.
We’ve no less days to sing God’s praise
Than when we’ve first begun.

And he left us.

His mom hugged each sobbing person there–the young friends, the nurses, the doctors humbled by powerful pathogens. She thanked each one for being present for his death, for their vigil kept through the week in the hospital as his flesh and heart had failed.

This young man, now lost to this mortal life, had profoundly touched people in a way he could not have ever predicted or expected. His parents’ grief, so gracious and giving to the young people who had never confronted death before, remains unforgettable.

This was their sacred gift to their son so Grace could lead him home.

The Impeded Stream

It may be that when we no longer know what to do we have come to our real work and that when we no longer know which way to go we have begun our real journey. The mind that is not baffled is not employed. The impeded stream is the one that sings.The world, the truth, is more abounding, more delightful, more demanding than we thought. What appeared for a time perhaps to be mere dutifulness … suddenly breaks open in sweetness — and we are not where we thought we were, nowhere that we could have expected to be.
~Wendell Berry from “Poetry and Marriage: The Use of Old Forms,” in Standing By Words

Who among us knows with certainty each morning
what we are meant to do that day
or where we are to go?

Or do we make our best guess by
putting one foot ahead of the other as we were taught
until the day is done and it is time to rest?

For me, over four decades,
I woke baffled each day
that I was allowed
to eavesdrop on heartbeats,
touch tender bellies,
sew up broken skin,
set fractured bones,
listen to and through tears.

I woke humbled with commitment and duty
to keep going even when too tired,
to offer care even when rejected.
to keep striving even if impeded.

Doing that work, I learned that
obstacles will slow but cannot stop
the cascade of love and hope over the rocks of life.

My days overflow with the uncertainty
of what comes next:
finding my real work
is to wade in deep,
tumbling over the barriers
and still keep singing.

Simply keep singing.

photo by Josh Scholten

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We May Or Might Never, Meet Here Again

My great grandfather had some fields in North Carolina
and he willed those fields to his sons and his sons
willed them to their sons so there is a two-hundred-year-old
farm house on that land where several generations
of my family fried chicken and laughed and hung

their laundry beneath the trees. There are things you
know when your family has lived close to the earth:
things that make magic seem likely. Dig a hole on the new
of the moon and you will have dirt to throw away
but dig one on the old of the moon and you won’t have

enough to fill it back up again: I learned this trick
in the backyard of childhood with my hands. If you know
the way the moon pulls at everything then you can feel
it on the streets of a city where you cannot see the sky.

I may walk the streets
of this century and make my living in an office
but my blood is old farming blood and my true
self is underground like a potato.

I have taken root in my grandfather’s
fields: I am hanging my laundry beneath his trees.
~Faith Shearin from “Fields”

It just isn’t possible to completely take me off the farm – I have generations of farmers extending back on both sides of my family, so I have dug myself a hole here, resting easy in the soil like a potato and ventured out only as I needed to in order to actually make a living.

A gathering of all my vaccinated clinic colleagues came to our farm yesterday to help me celebrate my retiring from office life. They brought beautiful flowers, plentiful food, kind and restoring words, thirty year old photos and lovely parting gifts, as well as my singing doctor buddy sharing a sea shanty about bittersweet parting. It is helping ease my sorrow at leaving regular doctoring behind, knowing there are more days to come, more time to grow things in the ground, more blissing out over sunrises and sunsets and more hanging laundry on the clothesline.

My dear friends know where they can find me – on the hill above our farm – we may or might never, meet here again but it was such a fine time together yesterday, thank you!

Kind Friend and Companions, Come join me in rhyme,
Come lift up your voices, In chorus with mine,
Come lift up your voices, all grief to refrain,
For we may or might never, all meet here again
Here’s a health to the company and one to my lass,
Let us drink and be merry, all out of one glass,
Let us drink and be merry, all grief to refrain
For we may or might never, all meet here again
Here’s a health to the dear lass, that I love so well,
For her style and her beauty, sure none can excel,
There’s a smile on her countenance, as she sits on my knee,
There’s no man in this wide world, as happy as me,
Here’s a health to the company, and one to my lass
Let us drink and be merry, all out of one glass,
Let us drink and be merry, all grief to refrain
For we may or might never, all meet here again,
Our ship lies at anchor, she’s ready to dock,
I wish her safe landing, without any shock,
If ever I should meet you, by land or by sea,
I will always remember, your kindness to me,
Here’s a health to the company and one to my lass,
Let us drink and be merry, all out of one glass,
Let us drink and be merry, all grief to refrain
For we may or might never, all meet here again
Here’s a health to the company and one to my lass,
Let us drink and be merry, all out of one glass,
Let us drink and be merry, all grief to refrain
For we may or might never, all meet here again

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Supposing a Tree Fell

“Supposing a tree fell down, Pooh, when we were underneath it?”

“Supposing it didn’t,” said Pooh after careful thought.

Piglet was comforted by this.
~A.A. Milne from The Complete Tales of Winnie-the-Pooh

our friends’ bedroom after a tree fell through their roof in a windstorm – thankfully, no one was hurt

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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Seeing Clearly

To see clearly,
not needing a drink
or pill or puff
of any pipe
to know I’m alive.
To come home,
peel off sandals
and step onto
the cool tile floor
needing only
the rush of water
over strawberries
I picked myself
and then a knife
to trim the dusty
green heads
from each one,
to watch them
gleam cleanly
in a colander
in a patch of sun
near the sink.
~James Crews “Clearly” from Healing the Divide: Poems of Kindness and Connection

As a child, I could see some people I loved struggling with daily life like a never-ending wrestling match.

Can’t relax? Have a drink.
Feeling irritable? Have a smoke.
Can’t wake up? Strong coffee.
Can’t lose weight? Amphetamines.
Can’t sleep? Valium.

I watched as one after another after another lost the wrestling match with the life’s sharp edges, sometimes dying too young from their self-medication.

As a result, I never could reconcile experimenting with my brain, staying stone cold sober throughout 21 years of school, bored to tears at parties watching others get hammered and stoned. As a physician, I spent half my career trying to help people stop wrestling with life and find their sober selves again.

Like berries picked into a colander, we all need gentle handling, rinsing and hulling, to wash away the dust of the field, the spiders and slug slime.

No more wrestling. Restored to sweetness and sparkling beauty.

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The Importance of Doing Nothing

He thought of all the time he wasted
being good. Clutched by the guilt
of excellence. Polite.
Well-trained. But when
the long summer afternoons came,
too hot to move
from the window fan, scent
of vapor rising
from water jackets, he found pleasure
in doing the nothing that had no regrets–
wasted afternoons
under the Wisteria vine when no one
was watching. Aroma thick
as a breeze on his shoulder.
Thinking of women constantly, forgetting
to water the chickens
in the barn. He was beginning to feel
the release of duty, to feel
what it’s like to feel.
Demands waiting like barking dogs
at the periphery. His good intention
to visit the sick woman
falling aside
as he listened to the rattle of starlings
in the rafters––discovering that strange lightness
of the body. And the new importance
of oak branches
where they separate from the trunk.
How far out the leaves
begin to spread.
The startling arrangement
of moss
like whiskers without discipline.
The long plains of earth
reaching to the clouds
behind the back yard fence.
How the ground pushes back when you walk.

~David Watts, M.D. – “Another Side of Transgression” from Having and Keeping

Decades of demands and responsibilities become a falling-down fence line with no end in sight. Having been raised an obedient person with a heightened sense of obligation about constantly fixing what needs repair, I’ve done what I could, where I could, when I could, how I could, though too often ineffective in my efforts.

I’ve always moved from task to task to task – life’s string of fence posts held wires that always needed stretching and patching and straightening. By continually working, I hoped I too would remain standing and functional.

It’s clear the fence isn’t perfect, nor will it ever be. It has served a purpose, as have I. Now I wander along the fencerow, focusing on the walk and the view rather than searching out every little thing which is leaning or loose or gaping.

This walk feels good, lighter, almost cushiony, almost like rolling with joy in the freedom of it. I’m ambling along for no particular reason at all, which is almost intoxicating.

I think I’ll get used to the importance of doing nothing whatsoever.

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This Garden Entrusted to Me

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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