Whispers Made of Thunder

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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

 

As I wander my yard
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,
waiting patiently for the shimmer of connection:
my rumbling thunder has been seen.
~EPG

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Fickle, Freckled

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Glory be to God for dappled things –
   For skies of couple-colour as a brinded cow;
      For rose-moles all in stipple upon trout that swim;
Fresh-firecoal chestnut-falls; finches’ wings;
   Landscape plotted and pieced – fold, fallow, and plough;
      And áll trádes, their gear and tackle and trim.
All things counter, original, spare, strange;
   Whatever is fickle, freckled (who knows how?)
      With swift, slow; sweet, sour; adazzle, dim;
He fathers-forth whose beauty is past change:
                                Praise him.
~Gerard Manley Hopkins “Pied Beauty”
When, finally in mid-life,  I began to appreciate the unconventional and unnoticed beauty around me, it helped me –freckled, spare and strange– feel beautiful too.  Life is all about the interplay of light and shadow within every moment of our existence, some moments darker than others, some brilliant and dazzling.
So now, each day I reach out to capture the sweet and sour of my surroundings, knowing I’m capturing my own dappled essence.   It is a reflection of the Fathering that loves us even in our fickleness, who possibly could know how?
Glory be.
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What Oops Means to Me

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My husband, who I’ve loved for over three decades, 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 a PTSD response in someone with my history.

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 experience 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 thin trail of smoke of 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.

That patient didn’t make it.

Sometimes in my dreams, now thirty five years later, I am running those hospital stairs carrying bags of blood, swirling in a vortex of red.   I never do save the patient.

And “oops” always means big trouble.

Of Marijuana and Moss

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Washington state grows marijuana crops almost as prolific as it grows moss, particularly since legalization of recreational weed last year.  Retail marijuana outlets now are a common sight on our commute to work, complete with their warm glowing lighting, inviting interiors, plush furniture and fancy display cases.  These are not fringy scruffy deadhead establishments but surprisingly upscale.

It has become a brave new retail world for a drug with side effects as varied as the bodies and brains ingesting it.

As a physician working daily with adolescents and young adults in a college health center, there is no question in the last few months retail marijuana is now the cannabis equivalent to the  growing market for artisan beers and local microbreweries.  There are distinct brands and strengths to attract users of all types and needs.  Yet one thing hasn’t changed with legalization: marijuana is not for everyone, and particularly not for young developing brains.  That caution is given lip service in state laws, though little attention has been paid to the effects on underage users until now.

The American Academy of Pediatrics has developed a statement about the health effects of changes in marijuana legality and made recommendations about enforcement policies here.  Seattle pediatrician Dr. Wendy Sue Swanson offers an excellent summary of the concerns over marijuana safety in youth here.

My daily clinical work in a university health center confirms my belief that marijuana is a far more complicated drug than a society desiring legalization chooses to believe.

Cannabis use has become normalized (thanks to NORML) to the point of some parents smoking or ingesting THC with their adolescent and adult children as part of holiday gatherings, special family events (Super – Bowl, anyone?) and evenings-at-home  “wind-down” routines.  It is a challenge for a clinician to question the judgment of a parent who sees no problem in their 18 year old using marijuana to help sleep or reduce their stress level, especially since that is exactly what the parent is doing themselves.  After all, some parents reason, it is safer than alcohol and has never “killed” anyone in an overdose, right?

I guess it depends on the definition of “safer” when comparing two very different mood-altering drugs, both of which have been shown in studies to cause significant potentially long-lasting damaging effects in developing brains.  True, alcohol poisoning carries imminent risk of death and injury while heavy marijuana use may simply cause acute and chronic physical and mental health disorders.

Marijuana often exhibits paradoxical effects and is unpredictable even in experienced users.  It is a common factor in the history of adolescents and young adults with anxiety disorders, paranoia, recurring dissociative episodes and increasingly persistent depressive symptoms.  Beyond the mental health impacts,  I’m seeing puzzling morning nausea and abdominal discomfort in some regular users, sometimes to the point of vomiting, which prompts the user ingest even more marijuana to “help improve appetite”.  This appears to me to be a mild version of cannabinoid hyperemesis syndrome as GI workups, antiemetics and other meds fail to help until marijuana use is discontinued completely.  Many regular users remain unconvinced about the connection —  anecdotally I’m convinced we are seeing a pseudo-withdrawal syndrome from routine use of high THC concentration marijuana.

Other states considering legalization of recreational marijuana will learn a great deal from the Colorado and Washington experiment of growing, regulating, and taxing retail recreational marijuana.  I hope they will look carefully at the effects such laws have on the attitude and habits of youth who are now adopting life-long use patterns and are too often harmed by regular use of powerful chemicals that “older and wiser”  society members have deemed “safe” without sufficient data to back those claims.

Maybe we in Washington state should simply stick to growing moss.

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No Longer the Killers of Yesteryear

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Disneyland is in the news, and not because it is the most magical place on earth.   It also is the origin of the most recent rubeola measles outbreak, now spread to seven states and Mexico with over eighty cases diagnosed so far.  Unvaccinated children are being kept home from school in some California districts and vaccination requirements once again have become a battleground between  public health agencies and the “right to not vaccinate” community.

It’s been almost sixty years since vaccinations became routine for the childhood killers like polio, measles, mumps and whooping cough.  People my age and older had no choice but to suffer through childhood infectious diseases given how effectively and quickly they spread through a community.   Yes, most of us survived, subsequently blessed with life long natural immunity.  A significant number did not survive or suffered life-long complications from the effects of those diseases.

People living in wealthy and privileged first world countries have forgotten that harsh reality, and many have turned their backs on vaccinations, considering them “too risky” for themselves and their children when these diseases become less common in a mostly vaccinated society.  In contrast, millions of people without easy and affordable access to vaccines in third world countries have not forgotten what the devastation of these infections and gladly walk miles to get their children vaccinated to give them a better chance at a long life.

When measles or mumps or pertussis reemerges within our borders,  we act surprised when it becomes a major media event — but we shouldn’t be.  Diseases that were almost nonexistent are occurring with greater frequency again in modern societies due to misguided and misinformed anti-vaccination campaigns.

As a college health physician, I help enforce vaccination requirements for a state university.  A week doesn’t go by without my having a discussion with a prospective student (or more likely the student’s parent) about the necessity for our requirement for proof of mumps, measles, rubella vaccination immunity.  I have been accused of being a pawn of the pharmaceutical industry because I happen to believe in the evidence of the efficacy of modern vaccines to help keep a community free of infectious disease outbreaks that will kill people.  I also helped coordinate a public health response at our university in 1995 when we had a rubeola outbreak of eleven confirmed cases over a three week period, necessitating the mass vaccinations of over 8000 students and staff over three days in order to keep our institution open and safe.   I’ve experienced first hand what it takes to respond to a potentially lethal contagious disease outbreak.   Never again, if I can do whatever I must to prevent that from happening another time or place.

We have forgotten these vaccine-preventable bacterial and viral illnesses are honest to goodness killers of healthy human beings.   I’ve had caring loving parents of faith request a religious exemption as God will provide the needed immunity if their child gets sick so taking the risk of a vaccine is unnecessary.    I’ve had caring loving parents with no religious objection but who refuse vaccine on a personal basis, considering it a foreign substance that they do not want injected into their child and would rather “take their chances” by eating a healthy diet and other alternative prevention measures.

Actually they are banking that everyone else will be vaccinated.  The problem is:   guess again.  There are now too many deciding that they are the ones who can remain vaccine-free, so scenarios like Disneyland will happen again and again.  We’ve seen repeated pertussis outbreaks tragically causing infant deaths in several states over recent years.

I tell the doubting anti-vaccination families that indeed there is an alternate way to immunity – after suffering through a potentially lethal infection which threatens others who are unfortunately exposed.  I prefer the modern option of immunity in the form of a vial of vaccine, a needle and syringe.  I don’t think any one of these parents would deny the life saving miracle of injectable insulin for their child diagnosed with diabetes, nor would they fail to strap their child into a car seat for the rare but real possibility of a life-threatening collision on even the shortest car ride.

Vaccines are miracles and instruments of prevention too, but the rub is that we have to give them to healthy youngsters in order to keep them healthy.

I’m an old enough physician to have seen deaths from these diseases as well as the ravages of post polio paralysis, the sterility from mumps and deafness from congenital rubella.   My father nearly died from the mumps that I brought home from school when I was eight and he was in his early forties.   My sister-in-law almost didn’t pull through when she was an infant and contracted pertussis.  I’ve seen healthy people develop  encephalitis and pneumonia from chicken pox.    I’ve seen a healthy college student die of influenza within a week of getting ill despite everything modern medicine could offer him.

There is an epidemic of fear in our society that is unwarranted: as Seth Mnookin, a journalist covering science topics wrote in his book “The Panic Virus”,
“If only there were a shot for irrational fears.”  When I’ve written about my stance on vaccinations in various on-line forums, I’m astonished at the vehemence of the many responses from individuals who have no trust whatsoever in the advances of modern medicine to prevent the killers that have devastated mankind for centuries.

Sure, I wish vaccines were perfect with no side effects and conferring 100% immunity but as yet they aren’t.   I wish medications that are developed for treatment of some of these illnesses were perfect but we can’t depend on a 100% guarantee of cure once sickened.   I wish our immune systems were perfectly able to respond to infectious diseases, but they too fail and people do die.

There will always be a new plague – history has demonstrated that over and over with the appearance of  HIV, SARS, Avian flu, Ebola or multidrug resistant tuberculosis.   There is plenty to keep our immune systems at the ready because we don’t yet or may never have effective vaccines widely available.

But there is simply no good reason to invite the old plagues back into our homes, our schools,  our blood streams, and onto our death certificates.   They deserve to be considered the killers of yesteryear that are now overcome by modern medicine and resigned to be merely a footnote in the epidemiology history books.

Headed Home

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He wasn’t just any drunk.  He was a mean drunk.  Surly, cursing, prone to throwing things and people, especially at home.

My grandmother used to say he learned to drink in the logging camps and I suspect that is true.  He started working as a logger before he was fully grown, dropping out of school, leaving home around age sixteen and heading up to the hills where real money could be made.  He learned more than how to cut down huge old growth Douglas Fir trees, skid them down the hills using a team of horses, and then roll them onto waiting wagons to be hauled to the mills.  He learned how to live with a group of men who surfaced once or twice a month from the hills to take a bath and maybe go to church with their womenfolk. Mostly he learned how to curse and drink.

He headed home to the  farm with muscles and attitude a few years later, and started the process of felling trees there, creating a “stump farm” that was a challenge to work because huge stumps dotted the fields and hills.  He slowly worked at blasting them out of the ground so the land could be tilled.  It proved more than he had strength and motivation to do, so his fields were never very fruitful, mostly growing hay for his own animals.  He went to work in the local saw mill to make ends meet.

He cleaned up some when he met my grandmother, who at eighteen was twelve years younger, and eager to escape her role as chief cook and bottle washer for her widowed father and younger brother.   She was devout, lively and full of energy and talked constantly while he, especially when sober, preferred to let others do the talking.  It was an unusual match but he liked her cooking and she was ready to escape the drudgery of her father’s household and be wooed.

They settled on the stump farm and began raising a family, trying to eke out what living they could from the land, from the sporadic work he found at the saw mill, and every Sunday, took the wagon a mile down the road to the Summit Park Bible Church where they both sang with gusto.

He still drank when he had the money, blowing his pay in the local tavern, and stumbling in the back door roaring and burping, falling into bed with his shoes on.  Grandma was a teetotaler and yelled into his ruddy face about the wrath of God anytime he drank, their four children hiding when the dishes started to fly, and when he would whip off his belt to hit anyone who looked sideways at him.

When their eldest daughter took sick and died quickly of lymphoma at age eight despite the little doctoring that was available, Grandpa got sober for awhile.  He saw it as punishment from God, or at least that is what Grandma told him through her sobs as she struggled to cope with her loss.

Over the years, he relapsed many times, losing fingers in his work at the mill, and losing the respect of his wife, his children and the people in the community.  Grandma left with the kids for several months to cook in a boarding house in a neighboring town, simply to be able to feed her family while Grandpa squandered what he had on drink.   Reconciled over and over again, Grandma would come back to him, sending their growing son to fetch him from the tavern for the night.  My Dad would bicycle to that dark and smoky place,  stand Grandpa up and guide him staggering out to their truck for the weaving drive home on country roads.  On more than one occasion, Grandpa, belligerent as ever, would resist leaving and throw a punch at his boy, usually missing by a mile.

But once the boy grew taller and strong enough to fight back, managing to knock Grandpa to the ground in self-defense, the punching and resistance stopped.   The boozing didn’t.

Grandpa sobered up for good while his boy fought in the war overseas, striking a bargain with God that his boy would come home safe as long as Grandpa left alcohol alone.  It stuck and he stayed sober.  His boy came home.  Grandpa saw it as a promise kept and became an elder in his Bible Church, taught Sunday School and gave his extra cash to the church rather than the tavern.

Sitting in a Christmas Sunday School program one Christmas Eve, Grandpa leaned toward Grandma and she noticed his face broken out in sweat, his face ashen.

“It’s hot in here, “ he said and collapsed in her lap.    He was gone, just like that, and he left the rest of his family behind while sitting in church, sober as can be,  on the day before Christmas.

Finally everlastingly forgiven, he headed one more time, not weaving or swerving but on the straight and narrow,  home.