Thorny Doubts and Tangled Angers

I remember
the first day,
how I looked down,
hoping you wouldn’t see
me,
and when I glanced up,
I saw your smile
shining like a soft light
from deep inside you.

“I’m listening,” you encourage us.
“Come on!
Join our conversation,
let us hear your neon certainties,
thorny doubts, tangled angers,”
but for weeks I hid inside.


I read and reread your notes
praising
my writing,
and you whispered,
“We need you
and your stories
and questions
that like a fresh path
will take us to new vistas.”

Slowly, your faith grew
into my courage
and for you—
instead of handing you
a note or apple or flowers—
I raised my hand.

I carry your smile
and faith inside like I carry
my dog’s face,
my sister’s laugh,
creamy melodies,
the softness of sunrise,
steady blessings of stars,
autumn smell of gingerbread,
the security of a sweater on a chilly day.
~Pat Mora, “Ode To Teachers” from Dizzy in Your Eyes.

School is back in session for some and will be soon for others. We cross our fingers it can remain in person, masked face-to-masked face, rather than via screens.

Students and teachers will find their way back to one another – learning each other’s stories and how to transform one another through sharing those stories.

Two of our children are school teachers – one at elementary level and the other in high school, while the third spent two years teaching high school math on the Pine Ridge reservation in South Dakota. They were transformed by their own teachers, inspired to do what had made such a difference in their own lives. They have become the teachers who I wish would teach me.

Some of my own teachers helped transform me in those early years, encouraging me in my shyness to raise my hand despite my thorny doubts, tell my story despite my tangled angers, share something of myself when I felt I had nothing of value to give.

I think of you and thank you – Mrs. Neil, Mr. Duffy, Mrs. MacMurray – for helping me break out of my broken shell in my grade school years. You taught me to wholly trust to this day those who love enough to push me to become a better me.

Looking for a book of beauty in photos and words? Consider this book available for order here:

Absorbing the Shock

There are three kinds of men.
The ones that learn by reading.
The few who learn by observation. 
The rest of them have to pee on the electric fence for themselves.
~Will Rogers

Learning is a universal human experience from the moment we take our first breath.  It is never finished until the last breath is given up.  With a lifetime of learning, one would think eventually we should get it right.

But we don’t.  We tend to learn the hard way especially when it comes to matters having to do with our (or others’) health.

As physicians in training, we “see one, do one, teach one.”   That kind of approach doesn’t always go so well for the patient.   As patients, we like to eat, drink, and live how we wish, demanding what interventions we want only when we want them – this also doesn’t go so well for the patient.  You’d think we’d know better, but as fallible human beings, we may impulsively make decisions about our health without actually using our heads (is it evidence-based or simply an anecdotal story about what “worked” for someone else?).

The cows and horses on our farm need to touch an electric fence only once when reaching for greener grass on the other side.  That moment provides a sufficient learning curve for them to make an important decision.  They won’t try testing it again no matter how alluring the world appears on the other side.   Humans are smarter sentient beings who should learn as quickly as animals but unfortunately don’t.  I know all too well what a shock feels like and I want to avoid repeating that experience.  Even so, in unguarded careless moments of feeling invulnerable (it can’t happen to me!), and yearning to have what I don’t necessarily need,  I may find myself reaching for the greener grass (or another cookie) even though I know better.   I suspect I’m not alone in my surprise when I’m jolted back to reality when I continually indulge myself and climb on the scale to see the results.

Many great minds have worked out various theories of effective learning, but, great mind or not, Will Rogers confirms a common sense suspicion: an adverse experience, like a “bolt out of the blue,” can be a powerful teacher.  As clinicians, we call it “a teachable moment.”  None of us want to experience a teachable moment — none of us, and we resent it when someone points it out to us.

When physicians and patients learn the hard way, we need to come along aside one another rather than work at cross-purposes.

It just might help absorb the shock.

Nostalgic For What is to Come

sunset831183

 

sunseteast830181

 

sunset831181

 

Toward the end of August I begin to dream about fall, how
this place will empty of people, the air will get cold and
leaves begin to turn. Everything will quiet down, everything
will become a skeleton of its summer self. Toward

the end of August I get nostalgic for what’s to come, for
that quiet time, time alone, peace and stillness, calm, all
those things the summer doesn’t have. The woodshed is
already full, the kindling’s in, the last of the garden soon

will be harvested, and then there will be nothing left to do
but watch fall play itself out, the earth freeze, winter come.
~David Budbill “Toward the End of August”

 

augustleaf2

 

sunset830181

 

As the calendar page flips to September this morning, I feel nostalgic for what is coming.

Summer is filled with so much overwhelming activity due to ~18 hours of daylight accompanying weeks of unending sunny weather resulting in never-enough-sleep.  Waking on a summer morning feels so brim full with possibilities: there are places to go, people to see, new things to explore and of course, a garden and orchard always bearing and fruiting out of control.

As early September days usher us toward autumn, we long for the more predictable routine of school days, so ripe with new learning opportunities. This week my teacher friend Bonnie orchestrated an innovative introduction to fifth grade by asking her students, with some parental assistance, to make (from scratch) their own personalized school desks that will go home with them at the end of the year.  These students have created their own learning center with their brains and hands, with wood-burned and painted designs, pictures and quotes for daily encouragement.

For those students, their desks will always represent a solid reminder of what has been and what is to come.

So too, I welcome September’s quieting times ushering in a new cool freshness in the air as breezes pluck and toss a few drying leaves from the trees.  I will watch the days play themselves out rather than feeling I must direct each moment.  I can be a sponge.

I whisper hush … to myself.

Goodnight August, goodnight farm, goodnight air, goodnight noises everywhere.

 

40526707_10217538863569991_4157598582423158784_n
Mrs. Bonnie Patterson’s fifth graders’ handmade desks at Evergreen Christian School, Bellingham, Washington

 

foggylayers

 

autumn9271415

 

augustleaf3

Learning the Hard Way

photo by Nate Gibson

“There are three kinds of men. The ones that learn by reading. The few who learn by observation.  The rest of them have to pee on the electric fence for themselves.”
— Will Rogers

photo by Nate Gibson

Learning is a universal human experience from the moment we take our first breath.  It is never finished until the last breath is given up.  With a lifetime of learning, eventually we should get it right.

But we don’t.  We tend to learn the hard way when it comes to our health.

As physicians we “see one, do one, teach one.”   That kind of approach doesn’t always go so well for the patient.   As patients, we like to eat, drink, and live how we wish,  which also doesn’t go so well for the patient.  You’d think we’d know better, but as fallible human beings, we sometimes impulsively make decisions about our health without using our heads (is it evidence-based?) or even listening to our hearts (is this what I really must have right at this moment?).

The cows and horses on our farm need to touch an electric fence only once when reaching for greener grass on the other side.  That moment provides a sufficient learning curve for them to make an important decision.  They won’t try testing it again no matter how alluring the world appears on the other side.   Human beings should learn as quickly as animals but don’t always.  I know all too well what a shock feels like and I want to avoid repeating that experience.  Even so, in unguarded careless moments of feeling invulnerable (it can’t happen to me!), and yearning to have what I don’t necessarily need,   I may find myself touching a hot fence even though I know better.   I suspect I’m not alone in my surprise when I’m jolted back to reality.

Many great minds have worked out various theories of effective learning, but, great mind or not,  Will Rogers confirms a common sense suspicion: a painful or scary experience can be a powerful teacher and,  as health care providers, we need to know when to use the momentum of this kind of bolt out of the blue.  As clinicians, we call it “a teachable moment.”  It could be a DUI, an abused spouse finally walking out, an unexpected unwanted positive pregnancy test,  or a diagnosis of a sexually transmitted infection in a “monogamous” relationship.  Such moments make up any primary care physician’s clinic day, creating many opportunities for us to teach while the patient is open to absorb what we say.

Patient health education is about how decisions made today affect health and well being now and into the future.  Physicians know how futile many of our prevention education efforts are.  We hand out reams of health ed pamphlets, show endless loops of video messages in our waiting rooms, have attractive web sites and interactivity on social media, send out innumerable invitations to on-site wellness classes.  Yet until that patient is hit over the head and impacted directly– the elevated lab value, the abnormality on an imaging study, the rising blood pressure, the BMI topping 30, a family member facing a life threatening illness– that patient’s “head”  knowledge may not translate to actual motivation to change and do things differently.

Tobacco use is an example of how little impact well documented and unquestioned scientific facts have on behavioral change.   The change is more likely to happen when the patient finds it too uncomfortable to continue to do what they are doing–cigarettes get priced out of reach, no smoking is allowed at work or public places, becoming socially isolated because of being avoided by others due to ashtray breath and smelling like a chimney (i.e. “Grandma stinks so I don’t want her to kiss me any more”).  That’s when the motivation to change potentially overcomes the rewards of continuing the behavior.

Health care providers and the systems they work within need to find ways to create incentives to make it “easy” to choose healthier behaviors–increasing insurance premium rebates for maintaining healthy weight or non-smoking status, encouraging free preventive screening that significantly impacts quality and length of life, emphasizing positive change with a flood of encouraging words.

When there is discomfort inflicted by unhealthy lifestyle choices, that misery should not be glossed over by the physician– not avoided, dismissed or forgotten.  It needs emphasis that is gently emphatic yet compassionate– using words that say “I know you can do better and now you know too.  How can I help you turn this around?”

Sometimes both physicians and patients learn the hard way.  We need to come along aside one another to help absorb the shock.