Startled By the Sun, Not By the Eclipse

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

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

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

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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Reflecting Back…

The Pacific Medical Center (2012) Photo by Joe Mabel
http://www.pactower.org

Some years ago, while sitting with my husband and young family high in the upper reaches of Seattle’s (then) Safeco Field watching the Mariners lose to the Cleveland (then) Indians, my attention diverted from the baseball game to the expansive view of the surrounding city.

In particular, I couldn’t help but place myself back inside the old Art Deco building that sits up on Beacon Hill (now known as the Pac Tower.) I had spent a hundreds of hours of my life in that building in the late 1970s; it was easy imagine my younger self in those hallways and rooms.

The 90 year old building had a number of different purposes since originally being constructed to provide hospital care for the region’s Merchant seamen. By 1999, it had become the home of a five year old business that had outgrown Jeff Bezos’ garage — Amazon.com. 

I trained inside the walls of that Public Health Hospital, back in the days when it was the hospital in the region for not only Merchant Marines, but many of the indigenous people of the Pacific northwest and Alaska, in addition to local folks who needed affordable (as in free) health care. I had opportunity to work several clinical rotations in this building as a University of Washington medical student, and to think of it being Amazon’s first (but not last) major headquarters for Amazon made my brain do twists. 

I remembered so much life and death happening inside those walls over the years. 

I first walked into this building as a very green 24 year old med student beginning a surgical rotation in fall 1976, knowing only which end of the stethoscope to put in my ears and which end rests on the patient. On the first day I was shown how to put on a surgical gown, masks and sterile gloves without contaminating myself and the people around me. I never have forgotten that sequence of moves, even though my opportunity to go into an operating room (other than as a patient) became rare after my training days. My chief surgical resident was an exceptionally talented young man who worked himself and everyone working with him around the clock caring for his patients. This brilliant surgeon could only operate on patients while listening and singing to the music of Elvis Presley. I can’t hear any Elvis Presley songs to this day without smelling the odors of surgery–cauterized blood vessels and pus. 

He was soon to become a leading trauma surgeon in a city known for its fine surgeons. The pressure was too much for him. He experienced a personal crisis for which he sought treatment. When he returned to medicine, he abandoned his incredible surgical skills to train as a psychiatrist and still remains an authority on helping impaired physicians, assisting other care providers to acknowledge and deal with addiction and mental health burnout before they harm a patient. 

Those endless clinical rotation days and nights meant witnessing the misery of the most vulnerable of humanity in desperate need of healing, and sometimes we succeeded, but often we did not.  I still have a recurring dream of running up and down the staircases of the Public Health Hospital, bringing pint after pint of blood to the OR from the lab as our team operated on an Alaskan indigenous patient bleeding from dilated esophageal varices, developed as a result of a damaged liver from chronic alcohol dependency. We did not save her, nor have I saved her even once in my dreams over the decades, though I keep trying to run faster. My response to her death was to spend 20 years of my clinical career working with patients in an alcohol and drug treatment program, hoping to prevent her fate in others.

Nor did we save a classmate of mine, on a rotation on a different service, the daughter of a beloved radiologist in this very hospital, who for reasons unknown, had a cardiac arrest while napping briefly during her 32 hour shift.  Another medical student sleeping in the same room heard her odd breathing, found her unresponsive and all medical interventions were employed, to no avail. Even when all the right people, and the right equipment, and the right medicine is seconds away, death can still come, even to healthy people in their 20s.  This was a shock to us all, and an extraordinarily humbling lesson to the pompous and overconfident among us. We might die, in our sleep, whenever it is our time. Years later, I still remember that in my evening prayers.

There was also the young surgical resident who was hospitalized there with jaundice and subsequently died of Hepatitis B, contracted from a blood exposure during his training. No vaccination was available in those days, but was in development. And it was in this and other hospitals in the city, we began to see unusual cases of gay men with severe wasting, rare skin cancers and difficult to treat pneumonias. Initially called GRID (gay-related immune deficiency), it was renamed AIDS as it began appearing in the general population as well, and for too long was a death sentence for anyone infected.

One on-call night in particular is memorable. It was Christmas Eve, and a heavy snowstorm had brought the city to a standstill.  We had very little to do that night in the hospital as the elective surgeries were all postponed until after the holiday and no ambulance could easily make it up the steep drive to the ER, so they were being diverted to other hospitals. As a result, our patient load was light. I was in my tiny sleeping room, on the 14th floor of the tower, facing out north to the city of Seattle, able to enjoy the view of the city, everything blanketed under snow, so peaceful and very quiet.  The freeway, ordinarily so busy day and night, was practically abandoned, and the lights of the city were brighter from the snowfall. It was an enchanting vision of a city forced to slow itself and be still, so anticipatory on a sacred and holy night.

I remember thinking about how young and inexperienced I was, and how very little I knew. My chief resident thought I’d make a good surgeon – I was a diligent worker and technically very good with my hands. My heart told me that I’d be better as a generalist/family doctor. The city held many attractions and excitement, but I longed to return to a farm and a someday family. It was a wistful bittersweet night and I slept very little, perched on that little bed overlooking the sleeping snowy city. I wondered where life might take me, as I reflected on who I was becoming and where I was meant to be.

Forty five years later, I still am reminded every day at how little I know,  but I do realize this:
for however long we’re on this earth, each day we have a distinct purpose and reason for being.

That day, my purpose was to be snowbound on that Christmas day at the old Public Health Hospital, unable to go home from my shift because my car was stuck in the parking lot. Instead, I covered for others who couldn’t make it in to work, singing Christmas carols for all the patients who had to stay put in their hospital beds.

Soon, my purpose was to meet the man I was to marry, eventually living with three beloved children on a little farm 100 miles to the north while practicing medicine in a variety of primary care roles for over forty years. 

And perhaps, my purpose now in retirement is to share a few stories while reflecting on a life still in progress.

Only the Lord knows why He places us where He does.

view from the “sleeping room” at the top of the tower
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The Rising Tide

As the tide rises, the closed mollusc
Opens a fraction to the ocean’s food,
Bathed in its riches. Do not ask
What force would do, or if force could.


A knife is of no use against a fortress.
You might break it to pieces as gulls do.
No, only the rising tide and its slow progress
Opens the shell. Lovers, I tell you true.

You who have held yourselves closed hard
Against warm sun and wind, shelled up in fears
And hostile to a touch or tender word—
The ocean rises, salt as unshed tears.

Now you are floated on this gentle flood
That cannot force or be forced, welcome food
Salt as your tears, the rich ocean’s blood,
Eat, rest, be nourished on the tide of love.

~May Sarton “Of Molluscs” from Complete Poems

photo by Josh Scholten

No question when I was younger, I tried to be a tough shell to crack. Over my years of medical training, I was warned to keep what is soft and tender closed and protected, or I would be picked clean, with my hard remains exposed and emptied.

Yet during those stressful years as a young physician, as one of a handful of female students, I didn’t feel attacked, nor was I forced to float through battering tides to hostile shores. Bathed in salty tears at times, I was comforted when the stormy winds came. My teachers were kind and gentle. Soothing words and heartfelt praise flowed around and through me.

I was treated just as I wanted to treat my patients: with respect and nurture.

All these years later, I have not forgotten this gift of love I was shown by my teachers and colleagues. Even when buried in the muck and sand up to my eyeballs, I could trust enough to open up my hard and crusty parts so I could feel the tide rise over and carry me home.

Hey little boy, whatcha got there?
Kind sir it’s a mollusk i’ve found
Did you find it in the sandy ground?
Does it emulate the ocean’s sound?
Yes I found it on the ground
Emulating the ocean’s sound
Bring forth the mollusk cast unto me
Let’s be forever let forever be free

Hey little boy come walk with me
And bring your new found mollusk along
Does it speaketh of the trinity
Can it gaze at the sun with its wandering eye
Yes it speaks of the trinity
Casting light at the sun with its wandering eye
Bring forth the mollusk, cast unto me
Let’s be forever let forever be free

You see there are three things that spur the mollusk from the sand
The waking of all creatures that live on the land
And with just one faint glance, back into the sea
The mollusk lingers, with it’s wandering eye
~Gene Ween

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My Own Usefulness

I’ve learned that even when I have pains,
I don’t have to be one …
I’ve learned that:
people will forget what you said,
people will forget what you did,
but people will never forget
how you made them feel.
~
Maya Angelou on her 70th birthday, citing a quote from Carl Buehner

I learned from my mother how to love
the living, to have plenty of vases on hand
in case you have to rush to the hospital
with peonies cut from the lawn, black ants
still stuck to the buds. I learned to save jars
large enough to hold fruit salad for a whole
grieving household, to cube home-canned pears
and peaches, to slice through maroon grape skins
and flick out the sexual seeds with a knife point.
I learned to attend viewings even if I didn’t know

the deceased, to press the moist hands

of the living, to look in their eyes and offer
sympathy, as though I understood loss even then.
I learned that whatever we say means nothing,

what anyone will remember is that we came.
I learned to believe I had the power to ease
awful pains materially like an angel.
Like a doctor, I learned to create

from another’s suffering my own usefulness, and once
you know how to do this, you can never refuse.
To every house you enter, you must offer

healing: a chocolate cake you baked yourself,
the blessing of your voice, your chaste touch.
~Julie Kasdorf– “What I Learned from my Mother”

Moms often know best about these things — how to love others when and how they need it — the ways to ease pain, rather than become one. Despite years of practice, I don’t always get it right; others often do it better.

Showing up with food is always a good thing but it is the showing up part that is the real food; bringing a cake is simply the icing.

Working as a physician over four decades, my usefulness tended to depend on the severity of another’s worries and misery. If no illness, no symptoms, no fear, why bother seeing a doctor? Since retiring, the help I offer no longer means writing a prescription for a medication, or performing a minor surgery. I have to simply offer up me for what it’s worth, without the M.D.

To be useful without a stethoscope, I aim to be like any good mom or grandma. I press my hand into another’s, hug when needed, smile and listen and nod and sometimes weep when someone has something they need to say. No advanced degree needed.

Oh, and bring flowers. Cut up fruit. Bake a cake.
Leave the ants at home.

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Trusting Angels in the Wilderness

…any father, particularly an old father, must finally give his child up to the wilderness and trust to the providence of God.

It seems almost a cruelty for one generation to beget another when parents can secure so little for their children, so little safety, even in the best circumstances. Great faith is required to give the child up, trusting God to honor the parents’ love for him by assuring that there will indeed be angels in that wilderness.
~Marilynne Robinson, Gilead

A reassuring truth for many families during this graduation season – 
in past years, we too watched our children leave home to begin a life of their own. We trusted in God’s providence that in our absence, there would be angels in the wilderness waiting to guide them.

Indeed there have been angels and continue to be –
you know who you are!

In turn, over thirty two years of clinical work in a university health center, I had opportunity to be that refuge in the wilderness for thousands of young adults who had left their parents’ home to seek out their own journey. Sometimes they found themselves stranded on a path that was twisting, rocky, full of pitfalls and peril. 

Despite plenty of my own limitations over those years, I found keeping this perspective helped me greet each new face, not only with a physician’s skill and knowledge, but always with a mother’s embrace.

Are there angels in the wilderness? I don’t know
I’ve got my doubts, but if you say so
But I’ve got a feeling we’re doing ok
We’re doing our part, to make the brambles seem less sharp

Beneath the wing of an angel
Far away from the night
Carry me till I am able
Beneath the wing of an angel

On the wing of an angel
Fly me on to the light
Hold me close till I’m able
Beneath the wing of an angel

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Breaking the Lock

And yes it is necessary to admit
walking in the forest
the heart is a lock


it has inviolable chambers
like the woods, fallen trees
that block


access to the river
snowdrops surprising its edges
moss crystalline with frost

What I thought I wanted what I have tried to be
was the slender instrument that opened

a key: presence moving deeper into the forest
that releases the birds from the trees
and sends them   ascends them
to sky   by definition
open

but now there is nothing left to be solved like a riddle

this time the lock must be broken
what’s left has to be seized

because God only loves the strong thief
I mean the man who breaks his heart for God
~Jennifer Grotz, “Locked” from Window Left Open

All my life I wanted to be an effective key, unlocking life’s mysteries and opening up the world to those who are hopeless, stifled and trapped. Doctor training gave me a few locksmith tools. I found my patients taught me far more about their pain and suffering than my professors did.

Yet profound mysteries remain: some illnesses are rare or unique enough to defy diagnosis, some just don’t respond to available tools, while illnesses as well understood and treatable as depression or COVID infection still kill and incapacitate with abandon. The keys I may have accumulated don’t fit every lock. They don’t necessarily open the doors to freedom from fear or worry.

At times I feel aimless, wondering what tools I still have and if I remember how to use them. Simple knowledge is only one key, while brute force – breaking and entering – may be necessary to break the hardest lock of all – access to the troubled heart and soul.

God wants in, to pick up our broken pieces and put us back together. He doesn’t need a key to enter what He Himself has built from scratch. He owns the place.

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Still Here, Giving Warmth Before Going Cold Again

When I was sick with a head cold, my head
full of pressure, my father would soak a washcloth
in hot water, then ball it up, ring it out. He would
open it above my head, then place it against
my face like a second skin, the light around me
disappearing entirely except through the spaces
between the stitching. I would inhale the steam
in that darkness, hearing his voice on the other side,
otherwise almost devoid of any other bodily sense
but the warmth and depth of his voice, as if
I had already died and was on the other side
of life waiting for the sickness to lift, but I wasn’t.
I was still on this earth, the washcloth going cold
on my face, my body still sick, and my father still
there when I opened my eyes, as he always was,
there to give me warmth before going cold again.

~William Fargason “Elegy with Steam”

A common clinic conversation this time of year:

I’ve been really miserable with a cold for three days, and as my COVID test is negative, I need that 5 day Z-pack antibiotic to get better faster.

It really can be miserable suffering from cold symptoms. Ninety eight percent of the time these symptoms are due to a viral infection and since your rapid RSV and influenza nasal swab tests are also negative today, your illness should resolve over the next few days without you needing a prescription medication.

But I can’t breathe and I can’t sleep.

You can use salt water rinses and a few days of decongestant nose spray to ease the congestion.

But my face feels like there is a blown up balloon inside.

Try applying a warm towel to your face – the heat will help improve circulation in your sinuses and ease your discomfort. When it cools off, warm it up again – basically rinse and repeat.

And I’m feverish and having sweats at night.

Your temp today is 99.2 so not a concern. You can use ibuprofen or acetominophen to help the feverish feeling.

But my snot is green.

That’s not unusual with viral upper respiratory infections and not necessarily an indicator of a bacterial infection.

And my teeth are starting to hurt and my ears are popping.

Let me know if that is not resolving over the next few days.

But I’m starting to cough.

Your lungs are clear today so it is likely from post nasal drainage irritating your upper airway. Best way to help that is to breathe steam to keep your bronchial tubes moist, push fluids and prop up with an extra pillow.

But sometimes I cough to the point of gagging. Isn’t whooping cough going around?

Your illness doesn’t fit the typical timeline for pertussis.  You can consider using an over the counter cough suppressant if needed.

But I always end up needing antibiotics. This is just like my regular sinus infection thing I get every year.

There’s plenty of evidence antibiotics can do more harm than good, eliminating healthy bacteria in your gut.  They really aren’t indicated at this point in your illness and could have nasty side effects.

But I always get better faster with antibiotics. Doctors always give me antibiotics.

Studies show that two weeks later there is no significant difference in symptoms between those treated with antibiotics and those who did self-care without them.

But I have a really hard week coming up and my whole family is sick and I won’t be able to rest.

This could be your body’s way of saying that you need to take the time you need to recover – is there someone who can help pick up the load your carry?

But I just waited an hour to see you.

I really am sorry about the wait; we’re seeing a lot of sick people with so much viral illness going around and needing to test to rule out COVID and influenza.

But I paid a $20 co-pay today for this visit.

We’re very appreciative of you paying so promptly on the day of service.

But I can go down the street to the urgent care clinic or do one of those telehealth doctor visits and for $210 they will write me an antibiotic prescription without making me feel guilty for asking.

I wouldn’t recommend taking unnecessary medication that can lead to bacterial resistance, side effects and allergic reactions. I truly believe you can be spared the expense, inconvenience and potential risk of taking something you don’t really need.

So that’s it?  Salt water rinses, warm towels on my face and just wait it out?  That’s all you can offer?

Let me know if your symptoms are unresolved or worsening over the next few days.

So you spent all that time in school just to tell people they don’t need medicine?

I believe I can help most people heal themselves with self-care at home. I try to educate my patients about when they do need medicine and then facilitate appropriate treatment. Also, I want to thank you for wearing your mask today to reduce the chance of transmitting your virus to those around you.

I’m going to go find a real doctor who will actually listen to me and give me what I need.

It certainly is a choice you can make. A real doctor vows to first do no harm while always listening to what you think, what your physical examination shows, then takes into account what evidence-based clinical data says is the best and safest course of action. I realize you want something other than what I’m offering you today. If you are feeling worse over the next few days or develop new symptoms, please let me know so we can reevaluate how best to treat you.

I’ll bet you’ll tell me next you want me to get one of those COVID vaccines too, won’t you?

Actually, I prefer you be feeling a bit better before you receive both the COVID and influenza vaccines. That would offer extra immunity protection for you through the next few months. Shall we schedule you for a time for your vaccination updates next week? Remember, I’m still here if you need to review your options again…

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