Golden Coloratura

All night the crickets chirp,   
Like little stars of twinkling sound  
In the dark silence.    

They sparkle through the summer stillness
With a crisp rhythm:
They lift the shadows on their tiny voices.

But at the shining note of birds that wake,
Flashing from tree to tree till all the wood is lit—
O golden coloratura of dawn!—
The cricket-stars fade slowly,
One by one.
~Leonora Speyer, “Crickets at Dawn” from A Canopic Jar

Most mornings here tend to be gray — primarily unassuming and humble. Sunrise usually happens without much visual fanfare – blink and I miss it.

Instead I listen for morning rather than watch for it.

As summer night sounds fade out, the dawn songs begin. Birds become the harbingers where frogs and crickets let off.

There are a few special days when the light ascends gilded and decides to linger while the whole atmosphere is transformed. The air itself is burnished and shining, and all that is touched turns to gold. Like a stage production about to begin, the curtain rises to the sounds of an overture while a resplendent backdrop is illuminated.

So I wait, a transfixed audience, for the day’s aria to begin.

Finding Out Who the Patient Is

Portrait by Norman Rockwell

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

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

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

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

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

Tell us about yourself

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Preparing Through Parable: Getting the Message

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Every happening, great and small, 
is a parable whereby God speaks to us, 
and the art of life is to get the message.
…Listening to great music, or reading great literature,

an inner rhythm is detected and the heart rejoices,
and a light breaks which is none other than
God’s love shining through all of creation.
~Malcolm Muggeridge from his lecture “Christ and the Media”

 

For Lent this year, each day will be devoted to a story Jesus told –his parables–
to help each of us “get the message” in a way we might not otherwise.

Whether about a lost coin, a wandering sheep, a light hidden from view,
or a hypercritical older brother:  the parable told is about me and choices I make.

 

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Every day is filled with stories told
and I feel too rushed to listen,
to take time for transformation
by what I see or feel or hear,
no matter how seemingly
small and insignificant.

When I pause
for the parable,
it makes all the difference:

A steaming manure pile
becomes the crucible for my failings
transformed into something useful,
a fertilizer to be spread
to grow what it touches.

An iced-over water barrel
reflects distant clouds
above me as I peer inside,
its frozen blue eye focused
past my brokenness
to mirror a beauty
far beyond.

An old barn roof awaiting repair
has gaps torn of fierce winds,
allowing rain and snow
and invading vines inside
what once was safe and secure,
a sanctuary exposed to storms.

I am looking.
I am listening.
Getting the message.
Badly in need of repair.
To be changed, transformed,
and to become part
of the story being told.

 

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Thunder Made of Whispers

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A poem is a spider web
Spun with words of wonder,
Woven lace held in place
By whispers made of thunder.
~Charles Ghigna

 

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I wander the barnyard
studying the complexities of web design,
marveling at a tiny creature’s creation
of connection by the slenderest thread.

Through words and pictures I whisper
from my own corner of the web
and wait patiently for the shimmer of connection:
my rumbling thunder has been heard.

 

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Pausing for the Parable

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Others taunt me with having knelt at well-curbs
Always wrong to the light, so never seeing
Deeper down in the well than where the water
Gives me back in a shining surface picture
Me myself in the summer heaven godlike
Looking out of a wreath of fern and cloud puffs.
Once, when trying with chin against a well-curb,
I discerned, as I thought, beyond the picture,
Through the picture, a something white, uncertain,
Something more of the depths—and then I lost it.
Water came to rebuke the too clear water.
One drop fell from a fern, and lo, a ripple
Shook whatever it was lay there at bottom,
Blurred it, blotted it out. What was that whiteness?
Truth? A pebble of quartz? For once, then, something.
~Robert Frost “For Once, Then, Something”

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Every happening, great and small,

is a parable whereby God speaks to us,
and the art of life is to get the message.
~Malcolm Muggeridge

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Every day is filled with one story after another
and I am too rushed to listen,
to stop and consider
what I see or feel or hear,
no matter how small and insignificant.

When I pause
for the parable,
it makes all the difference:

A shattered handmade pot
pieced together by a friend
who then became the glue
making my broken heart
more beautiful.

An iced-over water barrel
reflects distant clouds
above me as I peer deep inside,
its frozen blue eye mirroring
for once, then, something
far beyond me.

A steaming manure pile
becomes a crucible for my failings
transformed into something useful,
a fertilizer eventually spread
to grow whatever it touches.

An old barn roof awaits repair
of gaps torn of fierce winds,
allowing rain and snow
and invading vines inside
what once was safe and secure,
a sanctuary now storming.

I am looking.
I am listening.
I am these stories.
A broken pot made wholly beautiful.
A heating pile of failings becomes growth agent.
A leaking sanctuary needing repair.
A reflected something above, below and beyond me.

My life paused to really hear the stories,
to celebrate my transformation by parables,
one after another after another.

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A Calling Out

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A psalm of geese
labours overland

cajoling each other
near half…

The din grew immense.
No need to look up.

All you had to do
was sit in the sound

and put it down
as best you could…

It’s not a lonesome sound
but a panic,

a calling out to the others
to see if they’re there;
~Dermot Healy from A Fool’s Errand

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We are here to witness the creation and abet it. We are here to notice each thing so each thing gets noticed. Together we notice not only each mountain shadow and each stone on the beach but, especially, we notice the beautiful faces and complex natures of each other. We are here to bring to consciousness the beauty and power that are around us and to praise the people who are here with us. We witness our generation and our times. We watch the weather. Otherwise, creation would be playing to an empty house.
~Annie Dillard from The Meaning of Life
edited by David Friend

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By the time Saturday rolls around, I am overwhelmed by the amount of “noticing” I needed to do in the course of my work that week.  Each patient, and there are so many,  deserves my full attention for the few minutes we are together.  I start my clinical evaluation the minute I walk in the exam room and begin taking in all the complex verbal and non-verbal clues sometimes offered by another human being.

How are they calling out to me?

What someone tells me about what they are feeling may not always match what I notice:  the trembling hands, the pale skin color, the deep sigh, the scars of self injury.  I am their audience and a witness to their struggle; even more, I must understand it in order to best assist them.  My brain must rise to the occasion of taking in another person, offering them the gift of being noticed and being there for them, just them.

This work I do is distinctly a form of praise: the patient is the universe for a few moments and I’m grateful to be watching and listening. When my patient calls out to me, may they never feel they are playing to an empty house.

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Stillness in the Field

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Wheels of baled hay bask in October sun:
Gold circles strewn across the sloping field,
They seem arranged as if each one
Has found its place; together they appeal
To some glimpsed order in my mind
Preceding my chance pausing here —
A randomness that also seems designed.
Gold circles strewn across the sloping field
Evoke a silence deep as my deep fear
Of emptiness; I feel the scene requires
A listener who can respond with words, yet who
Prolongs the silence that I still desire,
Relieved as clacking crows come flashing through,
Whose blackness shows chance radiance of fire.
Yet stillness in the field remains for everyone:
Wheels of baled hay bask in October sun.
~Robert Pack “Baled Hay”

 

Each day I am called to see and listen,
to open fully to all that is around me.
From the simple stillness of the fields
surrounding our farm,
to the weeping of those who sit with me
day after day
in their deep fear of emptiness,
their struggle with whether to try to live
or give up and die.

Their profound emptiness renders me silent;
I struggle to respond with words
that offer up healing,
assuring them even in the darkest time
hope lies waiting, radiant as fire,
to bear us silently to a new morning,
to a stillness borne of grace.

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