We Lean Lest We Fall

Today we both fell.

Eventually balance moves
out of us into the world;
it’s the pull of rabbits
grazing on the lawn
as we talk, the slow talk
of where and when,
determining what
and who we will become
as we age.

We admire the new plants
and the rings of mulch you made,
we praise the rabbits eating

the weeds’ sweet yellow flowers.

Behind our words the days
serve each other as mother,
father, cook, builder, and fixer;
these float like the clouds
beyond the trees.

It is a simple life, now,
children grown, our living made
and saved, our years our own,
husband and wife,

but in our daily stride, the one
that rises with the sun,
the chosen pride,
we lean on our other selves,
lest we fall
into a consuming fire
and lose it all.
~Richard Maxson, “Otherwise” from  Searching for Arkansas

Our days are slower now, less rush, more reading and writing, walking and sitting, taking it all in and wondering what comes next.

I slowly adapt to not hurrying to work every other day, looking to you to see how I should parcel out each moment. Should I stay busy cleaning, sorting, giving away, simplifying our possessions so our children someday won’t have to? Or should I find some other kind of service off the farm to feel worthy of each new day, each new breath?

It is an unfamiliar phase, this facing a day with no agenda and no appointments. What comes next is uncertain, as it always has been but I didn’t pay attention before.

So I lean lest I fall. I breathe lest I forget how.

Freed into the Wider World

photo by Nate Gibson

When the wall
between the worlds
is too firm,
too close.

When it seems
all solidity
and sharp edges.

When every morning
you wake as if
flattened against it,
its forbidding presence
fairly pressing the breath
from you
all over again.

Then may you be given
a glimpse
of how weak the wall

and how strong what stirs
on the other side,

breathing with you
and blessing you
still,
forever bound to you
but freeing you
into this living,
into this world
so much wider
than you ever knew.
~Jan Richardson from The Cure for Sorrow: A Book of Blessings for Times of Grief

On Halloween day in 1985, I packed up my clothes, a roll up mattress,  grabbed one lonely pumpkin from our small garden, locked our rental house door for the last time, climbed in my car and headed north out of Seattle. I never looked back in the rear view mirror at the skyline after nine years living in the city. My husband had moved to Whatcom County two months earlier to start his new job. I had stayed behind to wrap up my Group Health family practice in the Rainier Valley of Seattle, now leaving the city for a new rural home and a very uncertain professional future.

Never before had I felt such exhilaration at breaking through one wall to discover the unknown that lay on the other side.

I knew two things for sure:
I was finally several months pregnant after a miscarriage and two years of infertility, so our family had begun.
We were going to actually live in our own house, not just a rental, complete with a few acres and a barn.

A real (sort of) starter farm.

Since no farm can be complete without animals, I stopped at the first pet store I drove past and found two tortoise shell calico kitten sisters peering up at me,  just waiting for new adventures in farmland. Their box was packed into the one spot left beside me in my little Mazda. With that admittedly impulsive commitment to raise and nurture those kittens, life seemed brand new.

I will never forget the feeling of freedom on that drive north out of the traffic congestion of the city. The highway seemed more open, the fall colors more vibrant, the wind more brisk, our baby happily kicking my belly, the kittens plaintively mewing from their box. There seemed to be so much potential even though I had just left behind the greatest job that could be found in any urban setting (the most diverse zip code in the United States): an ideal family practice with patients from all over the world: Muslims from the Middle East and Indonesia, Orthodox Jews, Italian Catholics, African Americans, Cambodians, Laotians, Vietnamese. I would never know so much variety of background and perspective again and if I could have packed them all into the Mazda and driven them north with me, I would have.

We started our farm with those kittens dubbed Nutmeg and Oregano, soon adding an ethnic diversity of farm animals:  Belgian Tervuren dog Tango, Haflinger horse Greta, Toggenburg goats Tamsen and her kids, a few Toulouse geese, Araucana chickens, Fiona the Scottish Highland cow, then another Haflinger Hans and another, Tamara. I worked as a fill in locums doctor in four different clinics before our first baby, Nate, was born. We soon added little brother Ben and seven years later,  sister Lea. We settled happily into parenthood, our church community, serving on school and community boards, gardening, and enduring the loss of our parents one by one.

Thirty four years later our children have long ago grown and gone to new homes of their own, off to their own adventures beyond the farm.  Our sons married wonderful women, moving far away from home, our daughter teaches a fourth grade classroom a few hours away and we have two grandchildren with the third expected any moment.

A few cats, two Cardigan Corgi dogs, and a hand full of ponies remain at the farm with us. We are now both gray and move a bit more slowly, enjoy our naps and the quiet of the nights and weekends.  My work has evolved from four small jobs to two decades of two part time jobs to one more than full time job that fit me like a well worn sweater 24 hours a day for thirty years. With retirement looming, I’m trying out a three day a week schedule and the old sweater doesn’t fit quite so comfortably.

My happily retired husband finds he is busier than ever:  volunteering, serving on boards and being a full time farmer on our larger 20 acre place of fields and woods. 

That rainy Halloween day over three decades ago I was freed into a wider world. I would no longer sit captive in freeway rush hour bumper to bumper traffic jams.  Instead I celebrate my daily commute through farm fields, watching eagles fly, and new calves licked by their mamas. I am part of a broader community in a way I never could manage in the city, stopping to visit with friends at the grocery store, playing piano and teaching at church. Our home sits in the midst of woods and corn fields, with deer strolling through the fields at dawn, coyotes howling at night, Canadian and snow geese and trumpeter swans calling from overhead and salmon becoming more prolific every year in nearby streams. The snowy Cascades greet us in the morning and the sunset over Puget Sound bids us good night.

It all started October 31, 1985 with two orange and black kittens and a pumpkin sitting beside me in a little Mazda, my husband waiting for my homecoming 100 miles north. Now, thirty four years and three grown children and three (almost) grandchildren later, we celebrate this Halloween transition anniversary together. We’re still pregnant with the possibility that a wide world is waiting, just on the other side of the wall.

Something Finished

Gold of a ripe oat straw, gold of a southwest moon,
What is there for you in the birds, the birds, the birds, crying
down on the north wind in September, acres of birds spotting
the air going south?

Is there something finished? And some new beginning on the
way?

I cried over beautiful things knowing no beautiful thing lasts.
~Carl Sandburg from “Fall Time” and “Autumn Movement”

My summer of “no doctoring” finishes today. I return to part-time clinical work tomorrow; a new beginning is on the way.

I am readying myself.

I consider how it will feel to put the stethoscope back on and return to spending most of my daylight hours in window-less rooms. Several months of freedom to wander and wonder will be tough to give up.

However, when I meet my first patient of the day, I’m “all in.” Someone is needing my help more than I need time off. The wind has shifted, it is time to migrate back to the work I was called to do over forty years ago.

Still I will look for beautiful things where I can find them, knowing that even though they don’t last, they will always be well worth the weeping.

Take the Hand You Know Belongs in Yours

I think of the story
of the storm and everyone
waking and seeing
the distant
yet familiar figure
far across the water
calling to them…

…so that when 
we finally step out of the boat 
toward them, we find
everything holds
us, and everything confirms
our courage, and if you wanted 
to drown you could, 
but you don’t 
because finally 
after all this struggle
and all these years
you don’t want to any more
you’ve simply had enough
of drowning
and you want to live and you 
want to love and you will
walk across any territory
and any darkness
however fluid and however
dangerous to take the
one hand you know
belongs in yours.
~David Whyte from “The Truelove” in The House of Belonging

Yesterday was the wrap-up to my thirtieth academic year working as a college health physician.  Despite budget challenges, inadequate staffing, a higher severity of illness in a patient population with burgeoning mental health needs,  our staff did an incredible job this year serving students and their families with the resources we do have.  

Reaching the end of the school year is always poignant: we will miss the graduating students we have gotten to know so well over four or five (or six!) years,  while we watch others leave temporarily for the summer, some to far away places around the globe.

We weep for those who have failed out, given up or fallen away from those who care deeply about them, some never to return to school again, and a few giving up on life itself. They did not take the hand offered to guide them through, even though they tired of drowning.

In my work I have tried to do what is needed when it is needed no matter what time of the day or night.  There are obviously times when I fall short– too vehement when I need to be quiet, too urgent and pressured when I need to be patient,  too anxious to do something/anything when it is best to simply do no harm.

I can only hold out my hand and wait. 

Each year I learn enough from each patient to fill volumes, as they speak of their struggles, their pain, their stories and sometimes hearing, most tragically, their forever silence.

I honor you, our students, on this day, to confirm your courage stepping out from the safety of the boat — not to drown, never to drown — but wanting to live, wanting to love, wanting to move healthier, better equipped and joyful into the rest of your lives.

Just take the outreached Hand that belongs in yours.


Where Morning Lies

Will there really be a “Morning”?
Is there such a thing as “Day”?
Could I see it from the mountains
If I were as tall as they?

Has it feet like Water lilies?
Has it feathers like a Bird?
Is it brought from famous countries
Of which I have never heard?

Oh some Scholar! Oh some Sailor!
Oh some Wise Man from the skies!
Please to tell a little Pilgrim
Where the place called “Morning” lies!
~Emily Dickinson

You are the future, the immense morning sky
turning red over the prairies of eternity…

You are the meaning deepest inside things
that never reveals the secret of its owner.
And how you look depends on where we are:
from a boat, you are shore, from the shore a boat.
~Rainer Maria Rilke,  from Love Poems to God from the Book of Hours

I know now what weariness is when the mind stops
and night is a dark blanket of peace and forgetting
and the morning breaks to the same ritual and the same
demands and the silence.
~Jane Clement from No One Can Stem the Tide

I head to clinic this morning
knowing from now on
my work will feel different after today,
no longer the same ritual,
no longer the same demands.

Mornings will be more resonant, depending on where I am:
from the boat I no longer must be shore,
from the shore I no longer need to row the boat.

I can simply be what the patient needs in the moment
and the patient is all I need.

Amen and amen.


Your Days Are Short Here

Your days are short here; this is the last of your springs.
And now in the serenity and quiet of this lovely place,
touch the depths of truth, feel the hem of Heaven.
You will go away with old, good friends.
And don’t forget when you leave why you came.

~Adlai Stevenson, to the Class of ’54 Princeton University

I was eight years old in June 1963 when the Readers’ Digest arrived in the mail inside its little brown paper wrapper. As usual, I sat down in my favorite overstuffed chair with my skinny legs dangling over the side arm and started at the beginning,  reading the jokes, the short articles and stories on harrowing adventures and rescues, pets that had been lost and found their way home, and then toward the back came to the book excerpt: “The Triumph of Janis Babson” by Lawrence Elliott.

Something about the little girl’s picture at the start of the story captured me right away–she had such friendly eyes with a sunny smile that partially hid buck teeth.  This Canadian child, Janis Babson, was diagnosed with leukemia when she was only ten, and despite all efforts to stop the illness, she died in 1961.  The story was written about her determination to donate her eyes after her death, and her courage facing death was astounding.  Being nearly the same age, I was captivated and petrified at the story, amazed at Janis’ straight forward approach to her death, her family’s incredible support of her wishes, and especially her final moments, when (as I recall 54 years later) Janis looked as if she were beholding some splendor, her smile radiant.

”Is this Heaven?” she asked.   She looked directly at her father and mother and called to them:  “Mommy… Daddy !… come… quick !”

And then she was gone.  I cried buckets of tears, reading and rereading that death scene.  My mom finally had to take the magazine away from me and shooed me outside to go run off my grief.  How could I run and play when Janis no longer could?  It was a devastating realization that a child my age could get sick and die, and that God allowed it to happen.

Yet this story was more than just a tear-jerker for the readers.  Janis’ final wish was granted –those eyes that had seen the angels were donated after her death so that they would help another person see.  Janis  had hoped never to be forgotten.  Amazingly, she influenced thousands of people who read her story to consider and commit to organ donation, most of whom remember her vividly through that book excerpt in Readers’ Digest.  I know I could not sleep the night after I read her story and determined to do something significant with my life, no matter how long or short it was.  Her story influenced my eventual decision to become a physician.  She made me think about death at a very young age as that little girl’s tragic story could have been mine and I was certain I could never have been so brave and so confident in my dying moments.

Janis persevered with a unique sense of purpose and mission for one so young.  As a ten year old, she developed character that some people never develop in a much longer lifetime.  Her faith and her deep respect for the gift she was capable of giving through her death brought hope and light to scores of people who still remember her to this day.

Out of the recesses of my memory, I recalled Janis’ story a few years ago when I learned of a local child who had been diagnosed with a serious cancer.  I could not recall Janis’ name, but in googling “Readers’  Digest girl cancer story”,  by the miracle of the internet I rediscovered her name, the name of the book and a discussion forum that included posts of people who were children in the sixties, like me,  who had been incredibly touched by Janis when they read this same story as a child.  Many were inspired to become health care providers like myself and some became professionals working with organ donation.

Janis and family, may you know the gift you gave so many people through your courage in the midst of suffering, and the resulting hope in the glory of the Lord.  Your days were short here, but you touched the depth of truth and touched the hem of heaven.
~~the angels are coming indeed.

We who have been your old good friends,  because of your story,  have not forgotten how you left us and why you came in the first place.

For excerpts from “The Triumph of Janis Babson”, click here

Finding Out Who the Patient Is

Portrait by Norman Rockwell

If you want to identify me, 
ask me not where I live, 
or what I like to eat, 
or how I comb my hair, 
but ask me what I am living for, 
in detail, 
ask me what I think is keeping me 
from living fully 
for the thing I want to live for. 
~ Thomas Merton from My Argument with the Gestapo

As a patient waiting to see my health care provider,  I would adapt Merton’s template of personal revelation this way:

If you want to know who I am,
ask me not about my insurance plan,
or what is my current address,
or whether I have a POLST on file,
or whether I have signed the Notice of Privacy Practice,
or whether I’ll accept a message on my phone —
but ask me what I am most concerned about,
in detail,
ask me what I think is causing my symptoms
and what I think is keeping me
from eating healthy, exercising regularly,
and choosing moderation in all things
so that I can live fully
for the thing I want to live for.

As a physician in the midst of a busy clinic day, I struggle to know who my patients are beyond their standard medical history and demographics.  One of my goals in our primary care clinic, now sixteen years into electronic medical record (EMR) use,  is to create a way for our patients to provide their personal history online to us via their password secured web portal.   These are the questions our clinic staff may not have opportunity to ask or record during clinic visits.  Having the patient personally document their social history and background for us to have in the chart –in essence, telling us their story in their own words–can be very helpful diagnostically and for individualizing the best treatment approach for each unique individual.

There needs to be an “About me” section in the EMR that would contain biographical and personal history information the patient could provide online via writing or video.

Tell us about yourself

This is your own personal history in your own words to be added to your electronic medical record in the folder “About Me”. You can edit and add information at any time via this secure patient portal to update it.

We want to know your story.  Only you can tell us what you think is most important for us as your health care providers to know about you.  We may not always have the time to ask and document these detailed questions in a brief clinic visit, so we are asking for your help.  

Why do we want to know your non-medical background as well as medical background?

We evaluate a patient’s symptoms of concern but we also are dedicated to helping our patients stay healthy life long.  To assist us in this effort, it is very helpful to know as much about you as possible, in addition to your past medical history.   It is crucial also to understand your family background and social history.  We want to know more about your personal goals, and what you think may be preventing you right now from living fully for the things you consider most important to you. 

This is your opportunity to tell us about yourself, with suggested questions below that you can consider answering.  This information is treated as a confidential part of your medical record, just like all information contained in your record.  You can add more at any time by returning to this site.

1)      Tell us about your family—who raised you and grew up with you, and who currently lives with you– including your racial/ethnic/cultural heritage. If relevant,  tell us whether you have biological beginnings outside of your family (e.g. adopted, egg donation, surrogate pregnancy, artificial insemination, in vitro fertilization)    Provide information on any illnesses in your biologic family.

2)     List the states or countries you have lived in, and what countries outside the U.S. you have lived in longer than a month.  Have you served in the military or another government entity, like the Peace Corps?

3)      Tell us about your educational and job background. This could include your schooling or training history,  paid or volunteer work you’ve done.  What are your hobbies, how do you spend your leisure time, what are your passions and future goals.  Where do you see yourself in ten years?

4)      Tell us about your sexual orientation and/or gender preference.

5)      Tell us about your current emotional support system—who are you most likely to share with when things are going very well for you and especially when things are not going well.

6)      Tell us about your spiritual background,  whether you are part of a faith or religious community and if so, how it impacts your life.

7)       Tell us what worries you most about your health.

8)      What would you have done differently if you could change things in your life?  What are you most thankful for in your life?

9)      What else do you feel it is important for us to know about you?

Thank you for helping us get to know you better so we can provide medical care that best meets your unique needs.

As our clinic is moving to an updated EMR, I’m interested in hearing feedback from patients and health care providers.  What additional questions would you want asked as part of personal history documentation in a medical record?

Electronic medical records allow us, as never before, the ability to share information securely between patients and their health care providers.
Patients want to tell us their story and we want to know more about them. 

It is time we asked them and truly listen to what they have to say.