Life Steps Almost Straight

We grow accustomed to the Dark —
When Light is put away —
As when the Neighbor holds the Lamp
To witness her Good bye —

A Moment — We Uncertain step
For newness of the night —
Then — fit our Vision to the Dark —
And meet the Road — erect —

And so of larger — Darknesses —
Those Evenings of the Brain —
When not a Moon disclose a sign —
Or Star — come out — within —

The Bravest — grope a little —
And sometimes hit a Tree
Directly in the Forehead —
But as they learn to see —

Either the Darkness alters —
Or something in the sight
Adjusts itself to Midnight —
And Life steps almost straight.

~Emily Dickinson

So few grains of happiness
measured against all the dark
and still the scales balance.

The world asks of us
only the strength we have and we give it.
Then it asks more, and we give it.

~Jane Hirschfield from “The Weighing”

A true revolution of values will soon cause us to question
the fairness and justice of many of our past and present policies.
On the one hand, we are called to play the good Samaritan

on life’s roadside;
but that will be only an initial act.
One day the whole Jericho road must be transformed
so that men and women will not be beaten and robbed
as they make their journey through life.
True compassion is more than flinging a coin to a beggar;
it understands that an edifice that produces beggars needs restructuring.
America, the richest and most powerful nation in the world,
can well lead the way in this revolution of values.
There is nothing, except a tragic death wish,
to prevent us from reordering our priorities…

~Martin Luther King, Jr. from a speech April 4, 1967

We live in a time where the groaning need
and dividedness of humankind
is especially to be felt and recognized.
Countless people are subjected to hatred,
violence and oppression which go unchecked.
The injustice and corruption which exist today
are causing many voices to be raised to protest
and cry out that something be done.
Many men and women are being moved to sacrifice much
in the struggle for justice, freedom, and peace.
There is a movement afoot in our time,
a movement which is growing, awakening.

We must recognize that we as individuals are to blame
for every social injustice, every oppression,
the downgrading of others
and the injury that man does to man,
whether personal or on a broader plane.…
God must intervene with his spirit and his justice and his truth.
The present misery, need, and decay must pass away
and the new day of the Son of Man must dawn.
This is the advent of God’s coming.
~Dwight Blough from the introduction to When the Time was Fulfilled (1965)

I weep to see such bitter divisions still exist in our country,
an echo of over fifty years ago
as we fail again and again to learn from past errors.

Here we are, groaning divided once more,
walking this Jericho Road together.
We cannot pass by our brother, our sister, our child~
anyone who lies dying in the ditch.
We must stop and help.

The world asks only for the strength we have
and so we give it,
but then we are asked to give more
and so we will.

We must illuminate the advance of darkness
even when, blinded as we are,
we run forehead-first into the Tree
which has always been there
and always will be
because of who we are and Who loves us.

It could be you or me bleeding, beaten, abandoned, dying
until Someone takes our place
so we can get up, free and forgiven,
and walk Home.

Maranatha.

A Synonym for Light

I hope my life was penned
in such a way that when time

comes to write my epitaph
someone might think to say
not that I was good so much
as kind and that I wrote
quite well beyond my means
because it was the wind of grace
blown down that gave me words
and moved my sluggish hands,
and that I always sought
to know the unseen things
and though I loved the breadth
of language for my art,
my heart always seemed fixed
on a day when all the sound
and words would fall away,
and that I was quite hopeful
to the last if anyone would choose
one line to inscribe my memory
in stone it surely should be
the simple supposition I know right:
there merely is no synonym for light.
~Margaret Ingraham “Epitaph” from Exploring This Terrain

The world can feel like a fearsome place
with endless stories of tragedy and loss,
so much pain and suffering,
blinding me in darkness
so I fail to see the light all around me.

How to describe a Light
that transforms all that is bleak?

With these Words:

Be not afraid
Come have breakfast

Touch and see
Follow me

Do you love me?
Feed my sheep
Peace be with you


As I am mere breath and bone,
a wisp in a moment of time,
His truth anchors my heart
and illuminates my soul:
I am called forth into His Light.

He Does Not Leave Us Where We Are: The Storm Within

Beneath our clothes, our reputations, our pretensions,
beneath our religion or lack of it,
we are all vulnerable both to the storm without
and to the storm within.
~Frederick Buechner – from Telling the Truth

This past month’s storms have been tumultuous on the outside:
heavy winds toppling a large tree into our friends’ bed room at midnight narrowing missing the bed in which they slept, unexpected regional snowfall, torrential showers, dark threatening clouds on the horizon.

Yet March’s storms are not limited to just the weather:
hundreds of thousands of people sickened by a virus that can kill within days or simply be spread by unwitting asymptomatic people, businesses shut down, hospitals and clinics overwhelmed, hoarding behavior resulting in shortages of products addressing basic needs.

And storms inside my cranium:
at times I feel fearful for myself and my extended family living far away, my words fly out too quickly, my anxiety mixes with frustration, my tears spill too easily, I am immobilized by limitations on where I can go and who I can visit.

This past month and the months to come may well be filled with continued hardship, but I won’t blame the calendar for what has happened. I am not so easily excused from responsibility.  I end up lying awake at night with regrets, wondering if I should be doing more than just telemedicine from home, yet wanting to hide myself and my M.D. degree under a rock until this unending storm blows over.

While the storm rages on, a miracle of grace is happening in many places:
generous people are making a difference in small and large ways all around the world. Some take enormous personal risks to take care of strangers and loved ones. Some work endless hours and when they come home, they remain isolated to avoid contaminating their families.

Such grace only happens when the storm is confronted head on by the brilliant light of sacrifice, when the heaviest most threatening clouds begin to weep from illumination that creates a rainbow dropped from heaven.

So we know God cries too. 
His wept tears light the sky in a promise of salvation.
He assures us of this because He won’t leave us in the darkness:
His Light will prevail and this storm too shall pass.

God sees us as we are,
loves us as we are,
and accepts us as we are.
But by His grace,
He does not leave us where we are.
~Tim Keller

He Loves Us As We Are: Being Watched Over

As a father steals into his child’s half-lit bedroom
slowly, quietly, standing long and long
counting the breaths before finally slipping
back out, taking care not to wake her,

and as that night-lit child is fully awake the whole
time, with closed eyes, measured breathing,
savoring a delicious blessing she couldn’t
name but will remember her whole life,

how often we feel we’re being watched over,
or that we’re secretly looking in on the ones
we love, even when they are far away,
or even as they are lost in the sleep

no one wakes from—what we know
and what we feel can fully coincide, like love
and worry, like taking care in full silence
and secrecy, like darkness and light together.

~David Graham “Listening for Your Name

“How I long for the months gone by,
    for the days when God watched over me,
when his lamp shone on my head
    and by his light I walked through darkness!
Job 29:2-3

Someone I loved once gave me
a box full of darkness.

It took me years to understand
that this, too, was a gift.
~Mary Oliver, “The Uses of Sorrow”


The season of Lent
is a box full of darkness
given to us by Someone who loves us
enough to watch over us even as we sleep.

The Light is already here
but the darkness has not yet dissipated.

It takes a lifetime to understand,
if we ever do:
we are watched over
as we watch over one another.

By opening the gift of darkness,
we allow a Light in
where none was before.

Light pours through the cracks
of our sorrow and brokenness
as we are watched with care,
as we illuminate amid the shadows,
as we are loved with the deepest of concern.

This year’s Lenten theme for Barnstorming:

God sees us as we are,
loves us as we are,
and accepts us as we are.
But by His grace,
He does not leave us where we are.
~Tim Keller

Another sleepless night
I’m turning in my bed
Long before the red sun rises

In these early hours
I’m falling again
Into the river of my worries

When the river runs away
I find a shelter in your name

Jesus, only light on the shore
Only hope in the storm
Jesus, let me fly to your side
There I would hide, Jesus

Hear my anxious prayer
The beating of my heart
The pulse and the measure of my unbelief
Speak your words to me
Before I come apart
Help me believe in what I cannot see
Before the river runs away
I will call upon your name

Jesus, only light on the shore
Only hope in the storm
Jesus, let me fly to your side
There I would hide, Jesus
~Elaine Rubenstein, Fernando Ortega

Running Back Up the Sunbeam

photo by Nate Gibson

One’s mind runs back up the sunbeam to the sun…
~C.S. Lewis

photo by Nate Gibson

photos by Nate Gibson

 

We so easily forget from Whom and Where we come,
the purpose for which we are created and sent forth,
how bright and everlasting our origins.
If we fail to live and serve as intended,
it is from our own frailty,
not that of the Creator.

When light shines so that others might see,
we are simply the beam and not the source.
The path leads back to the Triune God
and we are but a mere pathway.

May we illuminate as we are illuminated.

Amen.

sunbeams2

Faultless Light

Once in your life you pass
Through a place so pure
It becomes tainted even
By your regard, a space
Of trees and air where
Dusk comes as perfect ripeness.
Here the only sounds are
Sighs of rain and snow,
Small rustlings of plants
As they unwrap in twilight.
This is where you will go
At last when coldness comes.
It is something you realize
When you first see it,
But instantly forget.
At the end of your life
You remember and dwell in
Its faultless light forever.
~Paul Zimmer “The Place” from Crossing to Sunlight Revisited

I am astonished
by an ever-changing faultless light
and don’t want to ever forget
my thirst for its illumination:
slaked by such simple glories
as transcendent orange pink
a shift of shadows
the ripeness of fluff about to let go,
all giving me a glimpse of tomorrow over the horizon of today.

Written as with a Sunbeam

The sacred rights of mankind are not to be rummaged for, among old parchments, or musty records. They are written, as with a sun beam, in the whole volume of human nature, by the hand of the divinity itself; and can never be erased or obscured by mortal power.
~Alexander Hamilton, “The Farmer Refuted”

One’s mind runs back up the sunbeam to the sun…
~C.S. Lewis

photo by Nate Gibson

We so easily forget from Whom and Where we come, the purpose for which we are created and sent forth, how bright and everlasting our origins.  If we fail to live and serve as intended, it is our own failing, fault and responsibility, not that of the Creator.

When our light shines so that others see, we are the beam and not the source.  The path leads back to the Son and the Father and we are a mere pathway.

May we illuminate as we have been illuminated.

photo by Nate Gibson

Holding Surprise Wide Open

You were the one for skylights. I opposed
Cutting into the seasoned tongue-and-groove
Of pitch pine. I liked it low and closed,
Its claustrophobic, nest-up-in-the-roof
Effect. I liked the snuff-dry feeling,
The perfect, trunk-lid fit of the old ceiling.
Under there, it was all hutch and hatch.
The blue slates kept the heat like midnight thatch.

But when the slates came off, extravagant
Sky entered and held surprise wide open.
For days I felt like an inhabitant
Of that house where the man sick of the palsy
Was lowered through the roof, had his sins forgiven,
Was healed, took up his bed and walked away.
~Seamus Heaney from Opened Ground.

These moments of summer revealed
as if the roof has been ripped open and the light let in~
the veil is torn down and
dark corners lit up in early morning glow~

the sky suddenly enters into unexpected spaces,
an extravagant grace opens wide
and the miraculous happens
because we are bold enough to invite ourselves inside.

A Multitude of Flashing Torches

And as you sit on the hillside, or lie prone under the trees of the forest, or sprawl wet-legged on the shingly beach of a mountain stream, the great door, that does not look like a door, opens.
~Stephen Graham from The Gentle Art of Tramping

That great door opens on the present, illuminates it as with a multitude of flashing torches.
~Annie Dillard (in response to the Graham’s quote) from Pilgrim at Tinker Creek

When I pay attention
(and usually I don’t),
each day offers up a moment of illumination
like a multitude of flashing torches,
when we sense something beyond what is here and now.

It feels like an unspoken promise.

When I miss it,
this opened door that is not a door~
too busy to notice-
too blinded to see-
having turned my face away,
nevertheless it happens without my witness.

It saddens and gladdens my heart to know that
it will be offered up again tomorrow,
even though I once again may forget.

Opening Up the Medical Chart

The thing to cling to is the sense of expectation.
Who knows what may occur in the next breath?
In the pallor of another morning we neither
Anticipated nor wanted!

… we live in wonder,
Blaze in a cycle of passion and apprehension
Though once we lay and waited for a death.

~Carolyn Kizer from “Lines to Accompany Flowers For Eve”

Over seventy years ago my maternal grandmother, having experienced months of fatigue, abdominal discomfort and weight loss, underwent exploratory abdominal surgery, the only truly diagnostic tool available at the time. One brief look by the surgeon told him everything he needed to know: her liver and omentum were riddled with tumor, clearly advanced, with the primary source unknown and ultimately unimportant.  He quickly closed her up and went to speak with her family – my grandfather, uncle and mother.  He told them there was no hope and no treatment, to take her back home to their rural wheat farm in the Palouse country of Eastern Washington and allow her to resume what activities she could with the time she had left.  He said she had only a few months to live, and he recommended that they simply tell her that no cause was found for her symptoms.

So that is exactly what they did.  It was standard practice at the time that an unfortunate diagnosis be kept secret from terminally ill patients, assuming the patient, if told, would simply despair and lose hope.  My grandmother passed away within a few weeks, growing weaker and weaker to the point of needing rehospitalization prior to her death.  She never was told what was wrong and,  more astonishing, she never asked.

But surely she knew deep in her heart.  She must have experienced some overwhelmingly dark moments of pain and anxiety, never hearing the truth so that she could talk about it with her physician and those she loved.  But the conceit of the medical profession at the time, and indeed, for the next 20-30 years, was that the patient did not need to know, and indeed could be harmed by information about their illness. 

We modern more enlightened health care professionals know better.  We know that our physician predecessors were avoiding uncomfortable conversations by exercising the “the patient doesn’t need to know and the doctor knows better” mandate.  The physician had complete control of the health care information–the details of the physical exam, the labs, the xray results, the surgical biopsy results–and the patient and family’s duty was to follow the physician’s dictates and instructions, with no questions asked.

Even during my medical training in the seventies, there was still a whiff of conceit about “the patient doesn’t need to know the details.”   During rounds, the attending physician would discuss diseases right across the hospital bed over the head of the afflicted patient, who would often worriedly glance back and worth at the impassive faces of the intently listening medical student, intern and resident team.   There would be the attending’s brief pat on the patient’s shoulder at the end of the discussion when he would say, “someone will be back to explain all this to you.” But of course, none of us really wanted to and rarely did.

Eventually I did learn how important it was to the patient that we provide that information. I remember one patient who spoke little English, a Chinese mother of three in her thirties, who grabbed my hand as I turned to leave with my team, and looked me in the eye with a desperation I have never forgotten.   She knew enough English to understand that what the attending had just said was that there was no treatment to cure her and she only had weeks to live.  Her previously undiagnosed pancreatic cancer had caused a painless jaundice resulting in her hospitalization and the surgeon had determined she was not a candidate for a Whipple procedure.  When I returned to sit with her and her husband to talk about her prognosis, I laid it all out for them as clearly as I could.  She thanked me, gripping my hands with her tear soaked fingers.  She was so grateful to know what she was dealing with so she could make her plans, in her own way.

Forty years into my practice of medicine,  I now spend a significant part of my patient care time providing information that helps the patient make plans, in their own way.  I figure everything I know needs to be shared with the patient, in real time as much as possible, with all the options and possibilities spelled out.  That means extra work, to be sure,  and I spend extra time on patient care after hours more than ever before in my efforts to communicate with my patients.  I’m not alone as a provider who feels called to this sharing of the medical chart – the nationwide effort is referred to as Open Notes.

Every electronic medical record chart note I write is sent online to the patient via a secure password protected web portal, usually from the exam room as I talk with the patient.  Patient education materials are attached to the progress note so the patient has very specific descriptions, instructions and further web links to learn more about the diagnosis and my recommended treatment plan.  If the diagnosis is uncertain, then the differential is shared with the patient electronically so they know what I am thinking.  The patient’s Major Problem List is on every progress note, as are their medications, dosages and allergies, what health maintenance measures are coming due or overdue,  in addition to their “risk list” of alcohol overuse, recreational drug use including marijuana, eating and exercise habits and tobacco history.  Everything is there, warts and all, and nothing is held back from their scrutiny.

Within a few hours of their clinic visit, they receive their actual lab work and copies of imaging studies electronically, accompanied by an interpretation and my recommendations.  No more “you’ll hear from us only if it is abnormal” or  “it may be next week until you hear anything”.   We all know how quickly most lab and imaging results, as well as pathology results are available to us as providers, and our patients deserve the courtesy of knowing as soon as we do, and now regulations insist that we share the results.   Waiting for results is one of the most agonizing times a patient can experience.   If it is something serious that necessitates a direct conversation, I call the patient just as I’ve always done.  When I send electronic information to my patients,  I solicit their questions, worries and concerns by return message.  All of this electronic interchange between myself and my patient is recorded directly into the patient chart automatically, without the duplicative effort of having to summarize from phone calls.

Essentially, the patient is now a contributor/participant in writing the “progress” (or lack thereof) note in the electronic medical chart.

In this new kind of health care team, the patient has become a true partner in their illness management and health maintenance because they now have the information to deal with the diagnosis and treatment plan.  I don’t ever hear “oh, don’t bother me with the details, just tell me what you’re going to do.”  

My patients are empowered in their pursuit of well-being, whether living with chronic illness, or recovering from acute illness.  No more secrets.  No more power differential.  No more “I know best.”

After all, it is my patient’s life I am impacting by providing them open access to the self-knowledge that leads them to a better appreciation for their health and and clearer understanding of their illnesses.

As a physician, I am impacted as well; it is a privilege to live and work in an age where such illumination in a doctor~patient relationship is possible.