Tag: mental health

Waiting in Wilderness: Heaven and I Wept Together

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And so you have a life that you are living only now,
now and now and now,
gone before you can speak of it,
and you must be thankful for living day by day,
moment by moment …
a life in the breath and pulse and living light of the present…
~Wendell Berry from Hannah Coulter

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~Lustravit lampade terras~
(He has illumined the world with a lamp)
The weather and my mood have little connection.
I have my foggy and my fine days within me;
my prosperity or misfortune has little to do with the matter.
– Blaise Pascal from “Miscellaneous Writings”

foggyfield
photo by Nate Gibson

I laughed in the morning’s eyes.
I triumphed and I saddened with all weather,
Heaven and I wept together,
and its sweet tears were salt with mortal mine.
Against the red throb of its sunset heart,
I laid my own to beat
And share commingling heat.

Rise, clasp my hand, and come.
Halts by me that Footfall.
Is my gloom, after all,
Shade of His hand, outstretched caressingly?
Ah, Fondest, Blindest, Weakest,
I am He whom thou seekest.
Thou dravest Love from thee who dravest Me.
~Francis Thompson from “The Hound of Heaven”

supermoonbarn

My days are filled with anxious and sad patients,
one after another after another. 
They sit in front of their screen
and I in front of mine,
so close yet so far from each another –
a wilderness of unexpressed emotions.

They struggle to hold back the flood from brimming eyes.  
Each moment, each breath, each heart beat overwhelmed by questions: 
How to take yet another painful breath of this sad life?  must there be another breath?  
Must things go on like this in fear of what the next moment will bring?

The only thing more frightening than the unknown is the knowledge
that the next moment will be just like the last or perhaps worse. 
There is no recognition of a moment just passed
that can never be retrieved and relived.  
There is only fear of the next and the next
so that now and now and now is lost forever.

Worry and sorrow and angst are more contagious than any viral pandemic.
I mask up and wash my hands of it throughout the day.
I wish there was a vaccine to protect us all from our unnamed fears in the wilderness.

I want to say to them and myself:
Stop this moment in time.
Stop and stop and stop.
Stop expecting this feeling must be “fixed.”
Stop wanting to be numb to all discomfort.
Stop resenting the gift of each breath.
Just stop.
Instead, simply be
in the now and now and now.

I want to say:
this moment, foggy or fine, is yours alone,
this moment of weeping and sharing
and breath and pulse and light.
Shout for joy in it.
Celebrate it.
Be thankful for tears that can flow over grateful lips
and stop holding them back.

Stop me before I write,
out of my own anxiety over you,
yet another prescription
you don’t really need.

Just be–
and be blessed–
in the now and now and now.

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I Wonder What I Owe

barnstormingblog1 Comment

At almost four in the afternoon, the
wind picks up and sifts through the golden woods.

The tree trunks bronze and redden, branches
on fire in the heavy sky that flickers

with the disappearing sun. I wonder
what I owe the fading day, why I keep

my place at this dark desk by the window
measuring the force of the wind, gauging

how long a certain cloud will hold that pink
edge that even now has slipped into gray?

Quickly the lights are appearing, a lamp
in every window and nests of stars

on the rooftops. Ladders lean against the hills
and people climb, rung by rung, into the night.
~Joyce Sutphen “On the Shortest Days” from Modern Love & Other Myths.

While spending my day at my desk talking to faces on a screen,
as I will today and every day,
the names and stories and symptoms change every half hour.
I sometimes glance up and out my window to the world beyond,
concerned not to break eye contact.

I want to say:
don’t you know this darkness surrounding you won’t last,
while this day is fading
you can turn on the light that you were given
to find your way out of this.

I wonder if I owe it to you to tell you
when I was young and afraid and away from home
I didn’t believe the light was there either,
or it wouldn’t turn on, or it burned out so I
I felt swallowed by the darkness.

Then someone gave me a ladder to climb out
and lit my light so I could see where I was going.

Here I am now,
handing you a working light and a sturdy ladder
and telling you how to use them.



He Accepts Us As We Are: Hiding Nothing

barnstormingblog4 Comments

You can hide nothing from God.
The mask you wear before men will do you no good before Him.
He wants to see you as you are,
He wants to be gracious to you.
You do not have to go on lying to yourself and your brothers,
as if you were without sin;
you can dare to be a sinner.
~Dietrich Bonhoeffer from Life Together


In your hands

The dog, the donkey, surely they know
They are alive.
Who would argue otherwise?

But now, after years of consideration,
I am getting beyond that.
What about the sunflowers? What about
The tulips, and the pines?

Listen, all you have to do is start and
There’ll be no stopping.
What about mountains? What about water
Slipping over rocks?

And speaking of stones, what about
The little ones you can
Hold in your hands, their heartbeats
So secret, so hidden it may take years

Before, finally, you hear them?
~Mary Oliver from Swan: Prose and Poems

When I myself go to the doctor, I am to trust I’m seeing someone who is meant to know me thoroughly enough that he or she will help me move out of illness into better health. This is how acceptance feels: trusting someone enough to come out of hiding.

As a physician myself, I am reminded by the amount of “noticing” I need to do in the course of my work.  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 we sit down together and I begin taking in all the complex verbal and non-verbal clues offered up, sometimes unwittingly, by another human being.

Now, during the COVID19 pandemic, my interactions with patients are all “virtual” so I don’t have the ability to observe as I usually do, so I need them to tell me outright what is going on in their lives, their minds and their hearts in spoken or written words. I can’t ‘see’ them, even on a screen, in the same way.

How might someone call out to me when their faces are hidden?

I can’t witness first hand the trembling hands, their sweatiness, the scars of self injury.  Still, 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, accepting them for who they are, offering them the gift of compassion and simply be there for them, just them, right now.

God doesn’t struggle in His Holy work as I do in my clinical duties. He knows us thoroughly because He made us; He knows our thoughts before we put them into words. There is no point in staying hidden from Him.

He holds us, little pebbles that we are, in His Hand, and He discerns our secret heartbeats.

We, the hidden, are His.

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

I will search in the silence for your hiding place.
In the quiet, Lord, I seek your face.
Where can I discover the wellsprings of your love?
Is my search and seeking in vain?
How can I recover the beauty of your word?
In the silence I call out your name.
Where can I find shelter to shield me from the storm?
To find comfort, though dark be the night?
For I know that my welfare is ever in your sight.
In the shadows I long for your light.
Lead me in your footsteps along your ancient way.
Let me walk in the love of the Lord.
Your wisdom is my heart’s wealth, a blessing all our days.
In the silence I long for Your world.
~Liam Lawton

He Sees Us As We Are: Called to Transformation

barnstormingblog1 Comment

…difficulties are magnified out of all proportion simply by fear and anxiety. From the moment we wake until we fall asleep we must commend other people wholly and unreservedly to God and leave them in his hands, and transform our anxiety for them into prayers on their behalf: 
With sorrow and with grief…
God will not be distracted.
~Dietrich Bonhoeffer in Letters from Prison

.…you mustn’t be frightened … if a sadness rises in front of you, larger than any you have ever seen; if an anxiety, like light and cloud-shadows, moves over your hands and over everything you do. You must realize that something is happening to you, that life has not forgotten you, that it holds you in its hand and will not let you fall. Why do you want to shut out of your life any uneasiness, any misery, any depression, since after all you don’t know what work these conditions are doing inside you?
~Rainer Maria Rilke from Letters to a Young Poet

Every day I see young adult patients who are so consumed by anxiety they become immobilized in their ability to move forward through the midst of life’s inevitable obstacles and difficulties.  They become so mired in their own overwhelming feelings, so distracted by their symptoms, they can’t sleep or eat or think clearly.  They self-medicate, self-injure and self-hate.  Being unable to nurture themselves or others, they wither like a young tree without roots deep enough to reach the vast reservoir that lies untapped beneath them. 

In epidemic numbers, some decide to die, even before life really has fully begun for them.

I grieve for them in their distress, my heart breaks daily.   My role is to help find healing solutions, whether it is counseling therapy, a break from academic and work pressures, or a medicine that may give some form of relief.  Yet I know all too well the ultimate answer is not as simple as the right prescription.

We who are anxious must depend upon a Creator who does not suffer from attention deficit disorder and who is not distracted from His care for us even when we turn away in worry and sorrow.  We magnify our difficult circumstances by staying so tightly into ourselves, unable to look beyond our own eyelashes.  We are called to be transformed, to reach higher and deeper, through prayer, through service to others, through acknowledging there exists a power greater than ourselves.

So we are called to pray for ourselves and for others,  and in doing so, we disable anxiety and fear as they meld into gratitude and grace.  

No longer withering, we drink deeply of the well, finally able to thrive.

This year’s Lenten theme on 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

It feels like falling.
It feels like rain.
Like losing my balance
Again and again.
It once was so easy;
Breathe in, breathe out.
But at the foot of this mountain,
I only see clouds.

I feel out of focus,
Or at least indisposed
As this strange weather pattern
Inside me takes hold.
Each brave step forward,
I take three steps behind.
It’s mind over matter –
Matter over mind.

Slowly, then all at once.
A single loose thread
And it all comes undone.

Where there is light,
A shadow appears.
The cause and effect
When life interferes.
The same rule applies
To goodness and grief;
For in our great sorrow
We learn what joy means.

I don’t want to fight, I don’t want to fight it.
I don’t want to fight, I don’t want to fight it.
I don’t want to fight, I don’t want to fight it.
But I will learn to fight, I will learn to fight,
‘Til this pendulum finds equilibrium.

Slowly, then all at once.
The dark clouds depart,
And the damage is done.
So pardon the dust
While this all settles in.
With a broken heart,
Transformation begins.
~Ryan O’Neal – Sleeping at Last “Sorrow”

Lost Inside This Soft World

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morning113159

 

 

goldenhaze3

 

Everyday
I see or hear
something
that more or less

kills me
with delight,
that leaves me
like a needle

in the haystack
of light.
It was what I was born for — 
to look, to listen,

to lose myself
inside this soft world —
~Mary Oliver from “Mindful”

 

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dawn7253

 

Some days I’m the needle
and other days I’m the pin cushion

Today I may be both,
probing into people’s lives and feelings,
moving beyond their sharp edges
to find the source of their pain.
They don’t realize I wince too,
remembering how it feels.

I choose the softness of the light
that floats close to the ground,
that reaches out with cloudy grasp.

This is what I was born for:
delighted to be lost
and then found.

 

reflecting1

 

foggyfrontyard

Be Obscure Clearly

barnstormingblog2 Comments

thanksgiving20173

 

A wind has blown the rain away
and blown the sky away
and all the leaves away,
and the trees stand.
I think, I too,
have known autumn too long.
~e.e. cummings

 

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Be obscure clearly.
~E. B. White

 

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As a family doctor in the autumn of a forty year career, I work at clarifying obscurity about the human condition daily, dependent on my patients to communicate the information I need to make a sound diagnosis and treatment recommendation.  That is hard work for my patients, especially when they are depressed and anxious on top of whatever they are experiencing physically.

There is still much unknown and difficult to understand about psychology, physiology and anatomy.  Then throw in a disease process or two or three to complicate what appears to be “normal”, and further consider the side effects and complications of various treatments — even evidence-based decision making isn’t equipped to reflect perfectly the best and only solution to a problem.  Sometimes the solution is very muddy, not pristine and clear.

Let’s face the lack of facts.  A physician’s clinical work is obscure even on the best of days when everything goes well.  We hope our patients can communicate their concerns as clearly as possible, reflecting accurately what is happening with their health.  In a typical clinic day we see things we’ve never seen before, must expect the unexpected, learn things we never thought we’d need to know, attempt to make the better choice between competing treatment alternatives, unlearn things we thought were gospel truth but have just been disproved by the latest double blind controlled study which may later be reversed by a newer study.   Our footing is quicksand much of the time even though our patients trust we are giving them rock-solid advice based on a foundation of truth learned over years of education and training.   Add in medical decision-making that is driven by cultural, political or financial outcomes rather than what works best for the individual, and our clinical clarity becomes even further obscured.

Forty years of doctoring in the midst of the mystery of medicine: learning, unlearning, listening, discerning, explaining, guessing, hoping,  along with a little silent praying — has taught me the humility that any good clinician must have when making decisions with and about patients.  What works well for one patient may not be at all appropriate for another despite what the evidence says or what an insurance company or the government is willing to pay for.  Each person we work with deserves the clarity of a fresh look and perspective, to be “known” and understood for their unique circumstances rather than treated by cook-book algorithm.  The complex reality of health care reform may dictate something quite different.

The future of medicine is dependent on finding clarifying solutions to help unmuddy the health care decisions our patients face. We have entered a time of information technology that is unparalleled in bringing improved communication between clinicians and patients because of more easily shared electronic records.  The pitfall of not knowing what work up was previously done can be a thing of the past.  The risk and cost of redundant procedures can be avoided.  The time has come for the patient to share responsibility for maintenance of their medical records and assist the diagnostic process by providing online symptom and outcomes follow up documentation.

The benefit of this shared record is not that all the muddiness in medicine is eliminated, but that an enhanced transparent partnership between clinician and patient develops,  reflecting a relationship able to transcend the unknowns.

So we can be obscure clearly.  Our lives depend on it.

 

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A Deep Fear of Emptiness

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dawn7251

 

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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” from Rounding it Out: A Cycle of Sonnetelles (1999).

 

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marshmallows51116

 

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 deep fear of emptiness renders me silent;
I struggle to respond with words
that might offer up a healing balm
assuring them even in the darkest time
hope lies waiting, wrapped and baled,
radiant as fire,
ready to spill out fragrant,
to bear us silently to a new morning,
to a stillness borne of grace.

 

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centralroadoct

To Thank the Light

barnstormingblog4 Comments

octevening2912

 

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sunset811153

 

Now a red, sleepy sun above the rim 
Of twilight stares along the quiet weald, 
And the kind, simple country shines revealed 
In solitudes of peace, no longer dim.
The old horse lifts his face and thanks the light, 
Then stretches down his head to crop the green. 
All things that he has loved are in his sight; 
The places where his happiness has been 
Are in his eyes, his heart, and they are good.
~Siegfried Sassoon from “Break of Day”

 

 

morninglight

 

octpasture

 

 

I am growing older along with my horses. I think of them out to pasture throughout my workday as I continue to climb in the harness to pull the load as fast and hard as I can muster, returning home in the evening sore and weary.

I think of them with the morning sun on their withers, the green blades under their feet, as they search for the sweetest tender patch to munch.

They remind me to bring the calm of the pasture inside to balance the noise and bustle and troubles found in the clinic.  There still is peace and light to be found; I have only to look for it.

 

“To practice medicine with good spirit does not mean to be in a place where there is no noise, trouble or hard work. It means to bring your calm and loving heart right into the midst of it.” from www.theheartofmedicine.org

 

 

 

wallysunset

 

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Just Sad

barnstormingblog4 Comments

prairie10

 

carousel1

 

We didn’t say fireflies
but lightning bugs.
We didn’t say carousel
but merry-go-round.
Not seesaw,
teeter-totter
not lollipop,
sucker.
We didn’t say pasta, but
spaghetti, macaroni, noodles:
the three kinds.
We didn’t get angry:
we got mad.
And we never felt depressed
dismayed, disappointed
disheartened, discouraged
disillusioned or anything,
even unhappy:
just sad.
~Sally Fisher “Where I Come From”  from Good Question.

 

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I felt sadness in that moment because, having been raised in a certain culture, I learned long ago that “sadness” is something that may occur when certain bodily feelings coincide with terrible loss. Using bits and pieces of past experience, such as my knowledge of shootings and my previous sadness about them, my brain rapidly predicted what my body should do to cope with such tragedy. Its predictions caused my thumping heart, my flushed face, and the knots in my stomach. They directed me to cry, an action that would calm my nervous system. And they made the resulting sensations meaningful as an instance of sadness. In this manner, my brain constructed my experience of emotion.

…if you could distinguish finer meanings within “Awesome” (happy, content, thrilled, relaxed, joyful, hopeful, inspired, prideful, adoring, grateful, blissful.. .), and fifty shades of “Crappy” (angry, aggravated, alarmed, spiteful, grumpy, remorseful, gloomy, mortified, uneasy, dread-ridden, resentful, afraid, envious, woeful, melancholy.. .), your brain would have many more options for predicting, categorizing, and perceiving emotion, providing you with the tools for more flexible and functional responses.
~Lisa Feldman Barrett from How Emotions Are Made: The Secret Life of the Brain

 

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sunset720176

 

Emotions are fleeting. But they are unavoidable and they are the most human of all things. They are not universals; they are arbitrary. But if we feel them deeply and we share them with others, nothing in this life is more real.
~Eric Barker on his blog Barking Up the Wrong Tree

 

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morning719172

 

If there is anything I’ve come to understand over the decades I’ve been a physician, it is that human beings have emotions that make them uncomfortable and that makes them more difficult to share with others.  Sometimes those feelings become so locked up that they leak out of our cells as physical symptoms: headaches, muscle tightness, stomach upset, hypertension.  Other times they are so overwhelming we can no longer function in a day to day way – labeled as rage, panic, mood disorder, depression, self-destructive, suicidal.

Somehow we’ve lost the ability to be just sad.  Just sad.  Sad happens and it happens to us all, some longer than others, some worse than others, some deeper than others.  What makes sad more real and more manageable is if we can say it out loud — whatever ‘sad’ means to us on a given day and to describe the feeling in detail can categorize and manage it — and explain it to others who can listen and help.

Strong emotions don’t always need a “fix”, particularly chemical,  but that is why I’m usually consulted.  Alcohol, marijuana and other drugs tend to be the temporary self-medicated anesthesia that people seek to stop feeling anything at all but it only rages stronger later.

Sometimes an overwhelming feeling just needs an outlet so it no longer is locked up, unspoken and silent, threatening to leak out in ways that tear us up and pull us apart.

Just tell me where you come from, who you are and who you are becoming and then, only then, we might be able to understand why you feel what you do today.  Then, armed with that understanding and how you might respond in a different way,  tomorrow may well feel a bit better.

 

morning7917

Missing the Knock on the Door

barnstormingblog6 Comments

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.