Tag: Doctoring

Take My Waking Slow

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morning823171

I wake to sleep, and take my waking slow.   
I feel my fate in what I cannot fear.   
I learn by going where I have to go.
We think by feeling. What is there to know?   
I hear my being dance from ear to ear.  
I wake to sleep, and take my waking slow.
Of those so close beside me, which are you?   
God bless the Ground!   I shall walk softly there,   
And learn by going where I have to go.
Light takes the Tree; but who can tell us how?   
The lowly worm climbs up a winding stair;   
I wake to sleep, and take my waking slow.
Great Nature has another thing to do   
To you and me; so take the lively air,   
And, lovely, learn by going where to go.
This shaking keeps me steady. I should know.   
What falls away is always. And is near.   
I wake to sleep, and take my waking slow.   
I learn by going where I have to go.
~Theodore Roetke “TheWaking”

 

sunrise818172

tennant20171

 

In my rush to get from there to here
I missed some things.  The solitary song
of the chickadee; the play of winter light
on kitchen walls; the smell of fresh-raked leaves;
the summer days of childhood, stretched slow
from dawn to dusk, no need to know the date
or time, only the sound of a silver swung bell
to call me in for supper.

Could I re-learn to navigate by phases
of the moon, the ebb and flow of tides,
the rhodies budding out today before
the fall’s first snow?  Could I re-learn
to take my waking slow?
~Ted McMahon, M.D. “Slow Season”

 

sunset817

eveningrun

I took an unscheduled landing while wheelbarrowing hay to our horses in the field yesterday morning.

In my rush to get from there to here I missed some things.

I stumbled on uneven ground and fell hard, badly injuring my elbow.  Finishing chores afterward was a challenge and a necessity, wrapping my broken wing up tight in my jacket, doing what was needed before my husband came home to take me to the ER where good people who know me took great care of me.

Of those so close beside me, which are you?   
God bless the Ground!   I shall walk softly there,   
And learn by going where I have to go.

Even though no bones were broken, it was dislocated, so my elbow (and I) needed to be put back together.  The miracle of “conscious sedation” IV medication let my body “think” I was awake – I was surrounded by a swirling round of voices telling me to take deep breaths and constantly reassuring me–while the ER doctor and nurse put traction on my arm and shoulder, then twisting and turning my elbow back into proper position with a “clunk”.  I was blissfully unaware of the tugging and torque, paying attention only to the swirling sounds in my head, then waking slow to find my arm splinted and wrapped from mid-humerus to fingers — all fixed but now typing is also slow.

This shaking keeps me steady. I should know.   
What falls away is always. And is near.   
I’m walking more carefully now, paying attention to exactly where my feet land and what is around me.
The ground is near yet still can be a hard and abrupt landing;
I celebrate the good clinicians who put broken people back together again.
Great Nature has another thing to do   
To you and me; so take the lively air,   
And, lovely, learn by going where to go.
tammingasunset

 

 

To Labor and Not Seek Reward

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daylily7917

 

crow

 

And then there was St Kevin and the blackbird.
The saint is kneeling, arms stretched out, inside
His cell, but the cell is narrow, so

One turned-up palm is out the window, stiff
As a crossbeam, when a blackbird lands
And lays in it and settles down to nest.

Kevin feels the warm eggs, the small breast, the tucked
Neat head and claws and, finding himself linked
Into the network of eternal life,

Is moved to pity: now he must hold his hand
Like a branch out in the sun and rain for weeks
Until the young are hatched and fledged and flown.

*

And since the whole thing’s imagined anyhow,
Imagine being Kevin. Which is he?
Self-forgetful or in agony all the time

From the neck on out down through his hurting forearms?
Are his fingers sleeping? Does he still feel his knees?
Or has the shut-eyed blank of underearth

Crept up through him? Is there distance in his head?
Alone and mirrored clear in love’s deep river,
‘To labour and not to seek reward,’ he prays,

A prayer his body makes entirely
For he has forgotten self, forgotten bird
And on the riverbank forgotten the river’s name.
~Seamus Heaney “St. Kevin and the Blackbird”

 

yellowmorning2

 

Eternal Word, only begotten Son of God,
Teach me true generosity.
Teach me to serve you as you deserve.
To give without counting the cost,
To fight heedless of wounds,
To labor without seeking rest,
To sacrifice myself without thought of any reward
Save the knowledge that I have done your will.
Amen.
~St. Ignatius’ Prayer for Generosity

 

thistlegrass

 

Heaney shifts from the literal (if “imagined”) physical world to the metaphysical and symbolic. In the midst of burnout and mental detachment, Kevin is somehow returned to and reconnected with his calling at a level deeper than conscious thought. Indeed, in the span of one brief line break, it is as though he has become indistinguishable from his life’s mission itself: he is “mirrored clear” in the pure, deep waters of an empathetic love for the “network of eternal life” into which he is presently and vitally “linked.”

The way Heaney constructs the next two lines calls attention to the paradox of mindfulness he illuminates. Kevin “prays,” which perhaps most immediately suggests that he entreats God to help him “labour and not to seek reward.” But after the stanza break, Heaney reveals that this prayer is not at all what the reader might have expected; Kevin’s prayer is not conscious because he is no longer conscious in the workaday-world way. Rather, Kevin’s is

“A prayer his body makes entirely
For he has forgotten self, forgotten bird
And on the riverbank forgotten the river’s name.”

When he can no longer muster the energy to think of the life entrusted to him, his own delights and discomforts in fostering that life, or even the original life force (here, the “river”) that led to his vocation, it is as if a kind of autonomic spirituality kicks in to complement the compassionate detachment with which—or in which—he holds the blackbird. Body and soul and work are one.
~Kimberly R. Myers, PhD, MA from “Mindfulness and Seamus Heaney” from JAMA’s
A Piece of My Mind, Aug.1, 2017

 

hydrangeaaugust

…we have tried to do too much, pretending to be in such control of things that we are indispensible…

…if you’re like me, you take a kind of comfort in being busy. The danger is that we will come to feel too useful, so full of purpose and the necessity of fulfilling obligations that we lose sight of God’s play with creation, and with ourselves.
~Kathleen Norris from The Quotidian Mysteries

 

foothillssunset73117

 

 

Removing the Splinter

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To pull the metal splinter from my palm
my father recited a story in a low voice.
I watched his lovely face and not the blade.
Before the story ended, he’d removed
the iron sliver I thought I’d die from.

I can’t remember the tale,
but hear his voice still, a well
of dark water, a prayer.
And I recall his hands,
two measures of tenderness
he laid against my face,
the flames of discipline
he raised above my head.

Had you entered that afternoon
you would have thought you saw a man
planting something in a boy’s palm,
a silver tear, a tiny flame.
Had you followed that boy
you would have arrived here,
where I bend over my wife’s right hand.

Look how I shave her thumbnail down
so carefully she feels no pain.
Watch as I lift the splinter out.
I was seven when my father
took my hand like this,
and I did not hold that shard
between my fingers and think,
Metal that will bury me,
christen it Little Assassin,
Ore Going Deep for My Heart.
And I did not lift up my wound and cry,
Death visited here!
I did what a child does
when he’s given something to keep.
I kissed my father.
~Li-Young Lee, “The Gift” from Rose

 

 

I did, without ever wanting to, remove my child’s splinter, lance a boil, immobilize a broken arm, pull together sliced skin, clean many dirty wounds. It felt like I crossed the line between mommy and doctor.  But someone had to do it, and a four hour wait in the emergency room didn’t seem warranted.

My own child learned to cope with hurt made worse by someone they trusted to be comforter.
I dealt with inflicting pain, temporary though it may be, to flesh that arose from my flesh.  It hurt as much as if it were my own wound needing cleansing, not theirs.

Our wounds are His – He is constantly feeling our pain as He performs healing surgeries in our lives, not because He wants to but because He must, to save us from our own destruction.
Too often we yell and kick and protest in our distress, making it all that much more difficult for both of us.

If only we can come to acknowledge His intervention is our salvage:
our tears to flow in relief, not anguish,
we cling to His protection rather than pushing Him away,
we kiss Him in gratitude as we are restored again and yet again.

 

 

 

 

 

 

A Probe for Sweet Peas

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A white vase holds a kaleidoscope of wilting sweet peas
captive in the sunlight on the kitchen table while

wafting morning scent of pancakes
with sticky maple syrup swirls on the plate,

down the hall a dirty diaper left too long in the pail,
spills over tempera paint pots with brushes rinsed in jars after

stroking bright pastel butterflies fluttering on an easel
while wearing dad’s oversized shirt buttoned backwards

as he gently guides a hand beneath the downy underside
of the muttering hen reaching a warm egg hiding in the nest

broken into fragments like a heart while reading
the last stanza of Dover Beach in freshman English

Just down the hall of clanging lockers
To orchestra where strains of “Clair de Lune” accompany

the yearning midnight nipple tug of a baby’s hungry suck
hiccups gulping in rhythm to the rocking rocking

waiting for a last gasp for breath
through gaping mouth, mottled cooling skin

lies still between bleached sheets
illuminated by curtain filtered moonlight just visible

through the treetops while whoosh of owl wings
are felt not heard, sensed not seen.

Awaking to bright lights and whirring machines
the hushed voice of the surgeon asking

what do you see now, what can you hear, what odor
and flavor, what sensation on your skin

with each probe of temporal lobe, of fornix
and amygdala hidden deep in gray matter

of neurons and synaptic holding bins of chemical transmitters
storing the mixed bag of the past and present

to find the offending spot to be erased of electrical
impulses that seize up all remembrance, all awareness

and be free again to live, to love, to swoon at the perfume
of summer sweet peas climbing dew fresh at dawn,

tendril wrapping over tendril,
the peeling wall of the garden shed.

 

 

 

 

Missing the Knock on the Door

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barndoor

 

When a great moment knocks on the door of your life,
it is often no louder than the beating of your heart,
and it is very easy to miss it.
~Boris Pasternak

 

 

 

Years ago, a young woman I’d been treating for depression for several weeks in my clinic called unexpectedly on a Friday afternoon and canceled an upcoming appointment for the following Monday and did not reschedule. The receptionist sent me a message as is our policy for patients who “cancel and do not reschedule”. It gave me a bad feeling that she was turning her back on her treatment plan and I was uneasy about the upcoming weekend without knowing what was going on with her.

I could have just put on my coat and headed home at the end of that long Friday after a very stressful work week and even more stressful year. I was discouraged about many aspects of the clinic work load and the after-hours responsibilities only seemed to get heavier.  I was frustrated at how ineffectively I was communicating to administrative supervisors about the need for change.  I was ready to quit and walk away.

Instead I decided to call my patient to find out how she was doing.  She didn’t answer her phone. I mulled over my options, looked up her apartment address and drove the few blocks to get there. As I approached her door, I could hear someone moving around in her apartment, but she ignored my knocks and my voice and when I tried the door, it was locked.

So I stayed right there, talking to her through the door for about 15 minutes, letting her know I wasn’t leaving until she opened up the door. I finally told her she could decide to open the door or I would call 911 and ask the police to come to make sure she was okay. She then unlocked the door, tears streaming down her face. She had been drinking heavily, with liquor bottles strewn around on the floor. She admitted an intent to overdose on aspirin and vodka. The vodka was already consumed but the unopened aspirin bottle was in her hand. I was the last person she expected to see at her door.

Miraculously the mental health unit at the local hospital had an open bed. I told my patient that we could save time and hassle by heading over there together right then and there, and avoid the emergency room mess, and the possibility of an involuntary detainment.

She agreed to come with me and be admitted voluntarily for stabilization. I visited the hospital the next day and she greeted me with a hug and thanked me for not giving up on her when she had given up on herself. In sobriety, her eyes were brighter and she was more hopeful. She never expected anyone to care enough to come knock on her door when she was at her lowest point,  and she struggled to answer, as consumed as she was in her own painfully beating heart.

She was astounded and grateful and frankly, by deciding to do what I knew was necessary and right even though it disregarded every workplace policy, so was I.

Four years later, a small card arrived in my clinic mailbox on another most challenging work day from an unfamiliar address two thousand miles away. The name looked vaguely familiar to me but when I opened and read the contents, this time the knock on the door was to get my attention, to focus the beating of my heart on what was most important – not the stresses of my work place — and it was my turn to let tears flow:

 

“Dear Doctor,

I am not sure if you will remember me considering you see a number of patients daily; however, I am a patient whose life you changed in the most positive way. I never truly THANKED YOU for listening to me and hearing my silent words of grief and hearing my cries for help. If it had not been for you, had you not knocked on my door, I would not be writing this letter to you today. I don’t know exactly what to say to the person who saved me from hurting myself fatally. You were a stranger in my life, but a dear friend in my time of need. THANK YOU, for everything that you did for me. You have a permanent place in my heart, you have given my spirit hope, you have reminded me that a life is worth living. Thank you, thank you, thank you! Sincerely, L_____”

 

I’m grateful 4 years ago I had the sense to go knock on her door when all she could hear was the beating of her own painful heart. I had the stubbornness to stay put until she responded, and most of all, I’m appreciative for her gracious note letting me know it made a difference. When I needed it the most, she made a difference for me that has kept me on the job all these years later.

She knocked, oh so gently, on my door and I opened it, amazed that someone cared, and found me awash in my own tears.

 

 

Dusted

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dustybee

beeweed

 

“Bees do have a smell, you know,
and if they don’t they should,
for their feet are dusted with spices from a million flowers.”
― Ray Bradbury, Dandelion Wine

 

beeblu

bee

 

I admire the honey bee as pollinator and pollen gatherer simultaneously, facilitating new fruit from the blossom as well as taking away that which will become sweet honey tasting of the spicy essence of the flower touched.

As a physician, I can only hope to be as transformative in the work I do every day.  I carry with me tens of thousands of patients I’ve seen over thirty five years of medical practice.  There is no way I can touch another human being without keeping some small part of them with me – perhaps a memory of an open wound or the residual scar it left behind, a word of sorrow or gratitude, a grimace, a tear or a smile.

Each patient is a flower visited, some still in bud, some in full bloom, some seed pods ready to burst, some spent and wilting and ready to fall away.  Each patient carries a spicy vitality, even in their illness and dying, that is unforgettable and still clings to me. Each patient changes me, the doctor, readying me for the next patient by teaching me a gentler approach, a clearer explanation, a slower leave-taking.  Each patient becomes part of my story, adding to my skill as a healer, and is never to be forgotten.

It has been my privilege to be thoroughly dusted by those I’ve loved and cared for.  I want to carry that on to create something wonderful that reflects the spice of living.

Nothing could smell or taste as sweet.

 

beechestnut

cornbee

beebye

wwubusybees

Not Just Another Day

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budrain

 

“This is another day, O Lord…
If I am to stand up, help me to stand bravely.
If I am to sit still, help me to sit quietly.
If I am to lie low, help me to do it patiently.
And if I am to do nothing, let me do it gallantly.”
— Kathleen Norris citing the Book of Common Prayer

 

redrosedroplets

 

This day is the wrap-up to my twenty-eighth academic year working as a college health physician,  the most demanding so far.  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 this day today is poignant: we will miss the graduating students we have gotten to know so well over four or five years,  we watch others leave temporarily for the summer, some to far away places around the globe, and 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.

In my work I strive 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 courageously do nothing.  It is very difficult for any doctor to choose to do nothing but I vowed in my own graduation ceremony over forty years ago to “First do no harm.”  And I’ve tried hard to live up to that vow.

In a sense I graduate as well on this last day of the school year– only not with cap and gown and diploma in hand.  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 our students and their families on this day, sharing the blessings from us who work toward the goal of sending them healthier and better equipped and joyful into the rest of their lives.

It is not just another day.

 

drizzleiris

 

sunsetsky68173

 

 

Supposing It Didn’t

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leadogtree

sunset917168

 

“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

 

clouds101143

It is the final week of a very long academic year and tension is running high.

Among those students to whom I provide care,
there are many who dwell deeply in “what if?” mode,
immobilized in their anticipation of impending disaster.

I understand this line of thinking,
particularly in this day and age of
“in the moment” tragedy
played out real-time in the palm of our hand
and we can’t help but watch as it unfolds.

Those who know me well
know I can fret and worry
better than most.
Medical training only makes it worse.
It teaches one to think catastrophically.
That is what I do for a living,
to always be ready for the worse case scenario.

When I rise, sleepless,
to face a day of uncertainty
as we all must do at times~
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.

stormacoming1

“Supposing it didn’t” — He says to reassure us.

sunsetdogwood

Music Against the Hard Edges

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galena

 

waterfalljasper1

 

In all the woods that day I was
the only living thing
fretful, exhausted, or unsure.
Giant fir and spruce and cedar trees
that had stood their ground
three hundred years
stretched in sunlight calmly
unimpressed by whatever
it was that held me
hunched and tense above the stream,
biting my nails, calculating all
my impossibilities.
Nor did the water pause
to reflect or enter into
my considerations.
It found its way
over and around a crowd
of rocks in easy flourishes,
in laughing evasions and
shifts in direction.
Nothing could slow it down for long.
It even made a little song
out of all the things
that got in its way,
a music against the hard edges
of whatever might interrupt its going.
~John Brehm “Passage”

 

waterfall

 

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 come to our real journey.

The mind that is not baffled is not employed.

The impeded stream is the one that sings.
~Wendell Berry “The Real Work”

 

mejierwaterfall

 

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
until the day is done and it is time to rest.

For me, I wake baffled each day
that I am allowed
to eavesdrop on heartbeats,
touch tender bellies,
sew up broken skin,
listen to tearful stories
of those no longer wish to live
and those who never want to let go of life.

I wake humbled with commitment
to keep going even when too tired,
to offer care even when rejected.
to keep trying even if impeded.

It is only then I learn that
daily obstacles slow
but cannot stop
the offer of help,
the gift of caring,
the flow of time given freely
which overflows its banks with
uncertain certainty:
my real work and journey
through life.

May I wade in deep~
listening~
ready to raise my voice
for those who hurt
and sing along.

 

poliswaterfall2

The Art of Showing Up

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peonyshower
pears1
grapes2
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”

 

dandydew

lettinggo11

Usually a mom knows best about these things — how to love others when and how they need it.  Showing up with food you’ve made yourself is always a good thing but it is the showing up part that is the real food;  bringing along a cake is simply the icing.

This is a good reminder that as a doctor, my usefulness is completely dependent on others’ suffering. No illness, no misery, no symptoms and I’m out of a job.

If only.
What a world that would be.
And then I can still be a mom even if there is no more doctor work:

….if I’d known it could help, I’d have baked a cake…

 

 

dandydew5