A Speech About Compost

(I gave this speech at the annual medical staff dinner last night when asked to “say a few words” (well, it ended up being more than a *few* words) after being selected as one of two “Physicians of Excellence” for 2010 at St. Joseph Hospital, Bellingham)

It was quite unexpected to get a call from Jim Hopper two months ago asking me if I was planning to attend tonight’s dinner.   The usual answer to that question would be  “uh, no…that’s my barn cleaning time…” , but he told me it would be a good idea for me to show up.   So, I’m quite humbled that the medical staff leadership would acknowledge a doctor who tries hard to fly under the radar by attending as few dinner meetings as possible due to farm and family obligations…

Dan and I arrived in Whatcom County  25 years ago; at that time I was a pregnant family doc having trained at Group Health Cooperative, and left behind one of the most diverse and wonderful practices in the Rainier Valley in Seattle.  We had decided we didn’t want to raise our family in the city, so we moved to a farm north of Bellingham, only a few miles from his parents and back to a part of the state where my grandparents had grown up.  I began practice by filling in as a locums for whoever would have me, and it was no time at all that I had more jobs than I knew what to do with.  I filled in at Intalco doing worker physicals, was a supervisor of the nurse practitioners at Planned Parenthood for several years, was the first doctor at the Interfaith Clinic, and soon was managing detox for Whatcom County at Olympic Treatment Center.  I also started seeing children who needed an evaluation for sexual abuse, ending up seeing over 1000 children over 10 years, and testifying in over 100 trials in a 5 county region.

The chemical dependency work moved to the Recovery Center at St. Joseph Hospital in 1988, and I’ve continued to do medical detox as well as my work at the Student Health Center at WWU for over 20 years.

I am not as skilled a diagnostician as many of you.  I’m not as good at surgical procedures, nor am I a wiz at administration.  What I am good at is making compost, which is really what I’ve done when I’ve taken care of thousands of chemical dependency inpatients over the last twenty years.

As a farmer, I spend over an hour a day cleaning my barn, and wheel heavy loads of organic material to a large pile in our barnyard which composts year round.  Piling up all that messy stuff that is no longer needed is crucial to the process: it heats up quickly to the point of steaming, and within months, it becomes rich fertilizer, ready to help the fields to grow grass, or the garden to produce vegetables, or the fragrant blooms in the flower beds.  It becomes something far greater and more productive than what it was to begin with.  That’s what intensively managed detox and treatment of addictions is like.

As clinicians, we help our patients “clean up” the parts of their lives they really don’t need, that they can’t manage any longer, that are causing problems with their health, their families and jobs, and most of all, their relationship with their Creator.  There isn’t a soul walking this earth who doesn’t struggle in some way with things that take over our lives, whether it is work,  computer use, food, gambling, you name it.  For the chemically dependent, it comes in the form of smoke, a powder, a bottle, a syringe or a pill.  There is nothing that has proven more effective than “piling up together” learning what it takes to walk the road to health and healing, “heating up”, so to speak, in an organic process of transformation that is, for lack of any better description, primarily a spiritual treatment process.  When a support group becomes a crucible for the “refiner’s fire”,  it does its best work melting people down to get rid of the impurities before they can be built back up again, stronger than ever.  They become compost, productive, ready to grow others.

This work with a spectrum of individuals of all races, professional and blue collar, rich and homeless,  coming from all over the state for help,  has been transforming for me.  I have worked with incredibly gifted nursing and counseling staff, some recovering themselves, who have dedicated their careers to this work. Over twenty years, I’ve been on call for detox 24/7 for  90% of those days, nights, holidays and weekends, and I thank Dr. Bob Watson and Dr. Tim Buckley for covering for me every once in awhile so I can turn off my pager.  I thank my husband, Dan Gibson, and our three children for letting me commit to this work.

As Jesus says in Matthew 25: 40–‘I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.’

We must not turn away from those who are our most vulnerable, who clearly need our help the most.   I certainly could not over the past twenty years.

Thank you for acknowledging that.

The Horse of Few Words

He was a horse of few words. After twenty five years of living with human beings, he didn’t find it necessary to call or greet us as the other Haflingers did when they were hungry. He stood patiently despite his voracious appetite, waiting his turn, knowing and trusting he would always be fed. He knew his family took care of him, no matter what.

Amos was a do-it-all Haflinger. He could be ridden, driven in a cart, taken on trail rides, jump in a show, and even was the platform for horse back gymnastics, or “vaulting.” He knew his job, did it well, and raised many children in the process.

One night, while I was heading to the barn for evening chores, my husband greeted me at the barn door with a concerned look on his face.

“We’ve got trouble. Amos is down.”

Sure enough, he was cast up against the wall of his huge double stall and, covered in sweat, and clearly had been there for some time. Incredibly, when he saw us, he nickered a “huh huh huh huh” greeting in his deep throaty voice. When we approached the stall with lead ropes ready to loop around his legs, it was if his “huh?” was clearly saying, “whatever took you so long?”

He lay still as we snugged the ropes on his legs and using every ounce of strength, we hauled him over. He lay on his side, breathing heavily, then pulled himself up, put his front legs out in front of him and staggered to his feet. Every muscle was quivering.

He had never had a bout of colic before so I called the vet as our daughter, his biggest fan, started walking him. He passed several loose stools but whenever he stopped walking, he was ready to lie down again, or would paw or kick at this belly. However, even with such bad cramping, he also tried to snatch at hay bales as he passed them and nibbled clumps of grass in the lawn.

By the time the vet arrived, Amos was not as shaky and looking brighter eyed. The vet was quite impressed by Amos’ strength for his age and was very amazed at his appetite in spite of being in pain. I reminded him he was dealing with no ordinary horse.  This was a Haflinger. The vet chuckled, “I guess maybe he would be chewing during his dying breath if he could, wouldn’t he?”

Once the necessary medication was administered, we allowed him back to his stall to lie down and rest. He no longer needed to roll in pain. He was exhausted and wanted to sleep. I cut up some apple pieces and a few carrots from our garden and put them in his food bin in case he decided he wanted to have a treat to eat. Then we went to bed too.

At 2 AM I got up to check on him. When I turned on the barn aisle lights and started toward his stall down at the end, I heard his low nickering “huh huh huh huh” again. What a wonderful sound! And then I saw his velvety nose poking out of his stall window by his food bin, grabbing for apple pieces lying on the sill. There is no better sight than a hungry horse after such an ordeal!

He was absolutely fine for seven weeks when it happened again, but worse. This time, nothing the vet could do could turn things around for Amos. He remained in pain despite all our efforts, and the vet told us we were at the end. My daughter and I stroked his sweaty neck, seeing the fear and agony in his eyes, and knew the time had come. Amos took his final walk with us out to a grassy slope in the moonlight. We offered him a bite of grass; his big lips picked it up and held it for a moment, but then he let it drop.

He sighed, giving us one more “huh huh huh huh” as the vet prepared to administer the sedative. Soon he would be lifted to a place where the sun would forever shine warm on his withers, the tender spring grass was always tasty, and there would never again be a need for goodbyes.

Someday again we will see him galloping toward us, his mane flying in the wind, calling out with the few words he knows, as if to say, “whatever took you so long?”


The Tree of Lights

“[M]any newly sighted people speak well of the world, and teach us how dull is our own vision.  To one patient, a human hand, unrecognized, is “something bright and then holes.”  Shown a bunch of grapes, a boy calls out “It is dark, blue and shiny….It isn’t smooth, it has bumps and hollows.”  A little girl visits a garden.  “She is greatly astonished, and can scarcely be persuaded to answer, stands speechless in front of the tree, which she only names by taking hold of it, and then as “the tree with the lights in it.”

When the doctor took her bandages off and led her into the garden, the girl who was no longer blind saw “the tree with the lights in it.”  It was for this tree I searched through the peach orchards of summer, in the forests of fall and down winter and spring for years.  Then one day I was walking along Tinker Creek thinking of nothing at all and I saw the tree with the lights in it.  I saw the backyard cedar where the mourning doves roost charged and transfigured, each cell buzzing with flame.  I stood on the grass with the lights in it, grass that was wholly fire, utterly focused and utterly dreamed.  It was less like seeing than like being for the first time seen, knocked breathless by a powerful glance.  The lights of the fire abated, but I’m still spending the power.  Gradually the lights went out in the cedar, the colors died, the cells unflamed and disappeared.  I was still ringing.  I had my whole life been a bell, and never knew it until at that moment I was lifted and struck.  I have since only rarely seen the tree with the lights in it.  The vision comes and goes, mostly goes, but I live for it, for the moment when the mountains open and a new light roars in spate through the crack, and the mountains slam.” Annie Dillard 1974, Pilgrim at Tinker Creek

Ever since reading about the “The Tree of Lights” in Pilgrim at Tinker Creek in 1975, I’ve been keeping a look-out  for it. Like Dillard, I want to be “lifted and struck”, to resonate in a new awareness, no longer be blinded,  to see everything in a sharper focus.

It can happen unexpectedly.  The first time was in an art class in 1980.  My artistic ability was limited to stick figures so a doctor friend and I decided to take her art teacher husband’s evening “Drawing from the Right Side of the Brain” class.  Robert Fulghum was an unorthodox teacher—not just an artist, but a Unitarian pastor, a story teller, and a musician.  He was, in his entertaining and inimitable way,  able to teach us how to look at the world in terms of shadow and light, solid and air, space and density, patterns and plain.  He put a drawing of an old cowboy boot, hung upside down in front of the class, and asked us to draw it that way.  We were not to think “boot”, but to think of it as lines and shadow, empty space and full shape,  dark against light.

I drew what I “saw”, focusing on the small detail rather than my expectation of the “whole”.  At the end of class, Fulghum asked us to turn our drawing right side up, and as I turned the paper around, I was astonished that I had a distinctly recognizable cowboy boot, my first real drawing.  It stayed on my refrigerator for four years.  I was so proud that I had been taught a new way to “see”.

It was a much less dramatic moment than Dillard’s story of the girl whose cataract removal changed her perception of familiar objects to unfamiliar.  But I did feel that distinct sense of being “lifted and struck” like a bell.

Not long after, Fulghum wrote a little meditation on what he had learned in kindergarten for his church’s weekly Sunday bulletin.  That bulletin somehow found its way to the desk of Washington State Senator Dan Evans, who read it into the Congressional Record.  From there it was reprinted, passed around and eventually made it home in the school backpack of an editor’s son.  That mother, going over the school papers, sat down to read “All I Need to Know, I Learned in Kindergarten” by Robert Fulghum and set out to track down the author.  He soon received a call from her, and the first thing she asked was “do you have anything else like this you’ve written?”   The answer was an emphatic “yes” from a pastor with years of sermons and church bulletins in his files.  His first book of collected essays was published a year later.   His life was never to be the same.

I keep looking for the “tree of lights” but it is elusive because I’m blinded most of the time.  Maybe, just maybe,  I’ll find it if I can only turn the world upside down…

One January Afternoon

Surfacing to the street from a thirty two hour hospital shift usually means my eyes blink mole-like, adjusting to searing daylight after being too long in darkened windowless halls.  This particular January day is different.   As the doors open, I am immersed in a subdued gray Seattle afternoon, with horizontal rain soaking my scrubs.

Finally remembering where I had parked my car in pre-dawn dark the day before, I start the ignition, putting the windshield wipers on full speed.  I merge onto the freeway, pinching myself to stay awake long enough to reach my apartment and my pillow.

The freeway is a flowing river current of head and tail lights.  Semitrucks toss up tsunami waves cleared briefly by my wipers frantically whacking back and forth.

Just ahead in the lane to my right, a car catches my eye as looking just like my Dad’s new Buick.  I blink to clear my eyes and my mind, switching lanes to get behind.  The license plate confirms it is indeed my Dad, oddly 100 miles from home in the middle of the week.  I smiled, realizing he and Mom have probably planned to surprise me by taking me out for dinner.

I decide to surprise them first, switching lanes to their left and accelerating up alongside.  As our cars travel side by side in the downpour,  I glance over to my right to see if I can catch my Dad’s eye through streaming side windows.  He is looking away to the right at that moment, obviously in conversation.  It is then I realize something is amiss.  When my Dad looks back at the road, he is smiling in a way I have never seen before.  There are arms wrapped around his neck and shoulder, and a woman’s auburn head is snuggled into his chest.

My mother’s hair is gray.

My initial confusion turns instantly to fury.  Despite the rivers of rain obscuring their view, I desperately want them to see me.  I think about honking,  I think about pulling in front of them so my father would know I have seen and I know.  I think about ramming them with my car so that we’d perish, unrecognizable, in an explosive storm-soaked mangle.

At that moment, my father glances over at me and our eyes meet across the lanes.  His face is a mask of betrayal, bewilderment and then shock, and she straightens up and looks at me quizzically.

I leave them behind, speeding beyond, splashing them with my wake.  Every breath burns my lungs and pierces my heart.  I can not distinguish whether the rivers obscuring my view are from my eyes or my windshield.

When I walk into my apartment, the phone is ringing, futilely.  I throw myself on my bed, bury my wet face in my pillow and pray for sleep without dreams.

Sorting the Laundry

(published in Country Magazine August/September 2007 and selected for possible use by the Educational Testing Service for standardized tests, like the SAT for Reading Comprehension)

Settling into the straw, I am grateful for this quiet moment after a 12 hour workday followed by all the requisite personal conversations that help mop up the spills and splatters of every day life. My family verbally unloads their day like so much stored up laundry needing to be washed and rinsed with the spin cycle completed before tomorrow dawns. I move from child to child to child to husband to grandmother, hoping to help each one clean, dry, fold and sort everything in their pile. Not to be outdone, I pile up a little dirty laundry of my own as I complain about my day.

By that time I’m on “spent” cycle myself.  I retreat to the barn where communication is less demanding and requires more than just my ears and vocal cords.   Complaints are meaningless here. In this place a new foal and his vigilant mama watch my every move.

This colt is intrigued by my intrusion into his 12′ x 24′ world. His mother is annoyed. He comes over to sniff my foot and his mother swiftly moves him away with a quick swing of her hips, daunting me with the closeness of her heels. Her first instinct insists she separate me from him and bar my access. My mandate is to woo her over. I could bribe her with food, but, no,  that is too easy.

A curry comb is best. If nothing else will work, a good scratching always does. Standing up, I start peeling sheets of no longer needed winter hair off her neck,  her sides, her flank and hindquarter.  She relaxes in response to my efforts,  giving her baby a body rub with her muzzle, wiggling her lips all up and down from his back to his tummy. He is delighted with this spontaneous mommy massage and leans into her, moving around so his hind end is under her mouth and his front end is facing me. Then he starts giving his own version of a massage too, wiggling his muzzle over my coat sleeve and wondrously closing this little therapeutic triangle.

Here we are, a tight little knot of givers/receivers with horse hair flying in a cloud about us. One weary human, one protective mama mare and one day-old foal, who is learning so young how to contribute to the well being of others. It is an incredible gift of trust they bestow on me like a blessing.  I realize this horse family is helping me sort my own laundry in the same way I had helped with my human family’s load.

Too often in life we find ourselves in painful triangles, passing our kicks and bites down the line to each other rather than providing needed relief and respite. We find ourselves unable to wrench free from continuing to deliver the hurts we’ve just received.  What strength it takes to respond with kindness when the kick has just landed on our backside. How chastened we feel when a kindness is directed at us, as undeserving as we are after having bitten someone hard.

Instead of biting, try massaging.  Instead of kicking, try tickling. Instead of fear, try acceptance.  Instead of annoyance, try patience. Instead of piling up so much laundry of your own, try washing, folding and sorting what is given to you by others, handing it back all ready for the next day.

If you just settle into the straw and wait, amazing things can happen.

We Have Big Trouble…

My husband, who I’ve loved for nearly thirty years, has one (and only one) little annoying habit.  He says “oops!” for almost any reason.  It ends up being a generic exclamation that could mean anything from “I just spilled a little milk” to “There is a fire on the stove”.    If I’m driving and he’s a passenger, an “oops” from him might mean an impending crash or just a plastic bag flying across the road.  It is unnerving, to say the least,  to not know immediately what he is exclaiming about, or its significance.

What he doesn’t realize is that “oops!” can cause post traumatic stress disorder response in someone like me…

I was a very nervous third year medical student when I walked through the doors of the giant hospital high on a hill for the first day of my Surgical Rotation.  I had never been in an operating room other than to have my own tonsils removed at age four, and that was not exactly my happiest memory.  I worried I was not “cut out” for the OR, and wondered if I would faint watching patients being opened up, smelling the cautery burning bleeding vessels, or hearing the high pitched bone cutter saw.

The first lesson on my first day was to learn how to gown and glove up without contaminating anything or anyone.  It took several hours for an extremely patient nurse to get me to the point of perfection.  She taught me what to do if my nose itched (ask a circulating “non-sterile” nurse to scratch it over my mask), or if I thought I felt woozy (back away from the operating table so I don’t fall on the patient!).  I was ready to watch my first surgery by the afternoon.

It was fascinating!  I wasn’t lightheaded.  I could handle the sight of blood, wounds and pus, and the sounds and smells didn’t phase me.  I went home elated, eager for the next six weeks of caring for patients in a wholly new way.

Each day I helped in three or four surgeries, being asked to do different tasks by the surgeon, from holding retractors so he could see what he was doing, to doing the suctioning of blood in the surgical field, cauterizing blood vessels, and putting staples and sutures in the skin at the end.  The chief resident I worked with most frequently was a very high energy guy, talking non-stop during the surgeries, sometimes teaching (“what’s this that I’m holding? what does this connect to? tell me the blood supply to this?”), all the while listening to Elvis Presley tapes blasting over the sound system.  He’d dance in place sometimes, and sing along.  To this day, I can’t think of gall bladders without hearing “You Ain’t Nothin’ But  A Hound Dog” in my head.

So when the surgery got complicated, I could tell because all the surgeon’s antics stopped.  He got very quiet, and he focused on his hands, including getting more demanding of the staff around him.  Shadow swept in, covering his normally sunny personality, and he’d bark orders, and sometimes grab my gloved hands and move them where he needed them.

One day, we were involved in a high risk surgery on a patient with late stage liver disease, who had a recent near fatal bleed from dilated blood vessels in her esophagus, caused by back up of circulation that could not easily pass through her scarred liver.  The blood vessel shunt procedure the surgeon was doing would allow the esophageal varices to deflate with less chance of breaking open again.   The surgeon had been intently working, without singing or dancing that day, so when I heard him softly exclaim “oops!”, I looked up at his face.  His eyes were big and round, his forehead sweating.  I looked down at the large blood vessel he had just nicked accidentally, and then the wound filling rapidly with blood.

“We have big trouble here!” he shouted.  I was moved out of the way, and the surgical team launched into action.  I was sent five floors down to the lab to retrieve as much blood for transfusion as I could hold in my arms, and spent the next hour running blood up those five flights of stairs.

The patient didn’t make it.

Sometimes in my dreams, I am still running those hospital stairs carrying bags of blood.  I never do save the patient.

And “oops” will always mean big trouble…

Another Manure Tale

I spend about an hour a day shoveling manure out of eight horse stalls.  Wheeled to a mountainous pile in our barnyard,  it happily composts year round, becoming rich fertilizer in a matter of months through a crucible-like heating process of organic chemistry, bacteria and earthworms.  Nothing mankind has achieved quite matches the drama of useless and basically disgusting stuff transforming into the essential elements needed for productive growth and survival.  I’m in awe, every day, at being part of this process.  The horses, major contributors that they are, act underwhelmed by my enthusiasm.  I guess some miracles are relative, depending on one’s perspective, but if the horses understood that the grass they contentedly eat in the pasture, or the hay they munch on during the winter months, was grown thanks to their carefully recycled manure, they might be more impressed.

Their nonchalance about the daily mucking routine is understandable.  If they are outside, they probably don’t notice their beds are clean when they return to the stalls at night.  If they are inside during the heavy rain days, they feel duty-bound to be in my face as I move about their stall, toting my pitchfork and pushing a wheelbarrow.  I’m a source of constant amusement as they nose my jacket pockets for treats that I never carry, as they beg for scratches on their unreachable itchy spots, and as they attempt to overturn an almost full load, just to see balls of manure roll to all corners of the stall like breaking a rack of billiard balls in a game of pool.  Good thing I’m a patient person.

So my stallion discovered a way to make my life easier rather than complicating it.  He hauled a rubber tub into his stall from his paddock, by tossing it into the air with his teeth and throwing it, and it finally settled against one wall.  Then he began to consistently pile his manure, with precise aim, right in the tub.  I didn’t ask him to do this.  It had never occurred to me.  I hadn’t even thought it was possible for a horse to house train himself.  But there it is, proof that some horses prefer neat and tidy rather than the whirlwind eggbeater approach to manure distribution.  After a day of his manure pile plopping, it is actually too heavy for me to pick up and dump into the wheelbarrow all in one tub load, but it takes 1/4 of the time to clean his stall than the others, and he spares all this bedding.  What a guy.

Now, once I teach him to put the seat back down when he’s done, he’s welcome to move into the house…