An Unblinking Fermata

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In science
we have been reading only the notes to a poem:

in Christianity
we find the poem itself.

~C.S. Lewis from Miracles

 

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Science fails
to love us,
to reach out and grasp the hand of the dying,
to give hope to the weak and afraid,
to become sacrifice for our sin,
to be our rescue by offering everlasting grace.

Science is merely the end-of-day footnote
to a Word far greater~
an unblinking fermata within
His ultimate symphonic Work.

 

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A Field To Go Back To

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You wake wanting the dream
you left behind in sleep,
water washing through everything,
clearing away sediment
of years, uncovering the lost
and forgotten. You hear the sun
breaking on cold grass,
on eaves, on stone steps
outside. You see light
igniting sparks of dust
in the air. You feel for the first
time in years the world
electrified with morning.

You know something has changed
in the night, something you thought
gone from the world has come back:
shooting stars in the pasture,
sleeping beneath a field
of daisies, wisteria climbing
over fences, houses, trees.

This is a place that smells
like childhood and old age.
It is a limb you swung from,
a field you go back to.

~Scott Owens “The Arrival of the Past” from Down to Sleep

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Returning to my mother’s Palouse country to meet again with my aunt and cousins:

(her brother’s widow, now 97, her nieces and nephews–those who still farm and those who wish they still could)

I know these wheat fields lie deep in my DNA and my heart is comforted by the familiarity of the tone and hue of the soil, the freshness of the breezes, the undulation of the grain over the hillsides, the lilt of the meadowlark’s song.

This is always a welcome return home as I feel my mother’s genes rise up within me to greet this family, and know that yes, to this too I belong.

It is a rare and abiding comfort.

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An Audience of Terminal Patients

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Write as if you were dying. At the same time, assume you write for an audience consisting solely of terminal patients. That is, after all, the case.
~Annie Dillard from “Write Till You Drop”

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You’re going to feel like hell if you wake up someday and you never wrote the stuff that is tugging on the sleeves of your heart: your stories, memories, visions, and songs–your truth, your version of things–in your own voice. That’s really all you have to offer us, and that’s also why you were born.

~Anne Lamott in a recent TED Talk

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I began to write after September 11, 2001 because that day it became obvious to me I was dying, albeit more slowly than the thousands who vanished that day in fire and ash, their voices obliterated with their bodies.   So, nearly each day since, while I still have voice and a new dawn to greet, I speak through my fingers and my camera lens to others dying around me.

My good friend, Sara, who I’ve known and loved half my life, is fighting for her life in an all day cancer surgery today, having fought a chronic disease and a totally different cancer once before and won.  She knows well the hard cost of winning even when the odds aren’t good,  yet still has a courage in her to fight once again.

That will to fight is heavy on my mind today.

We are, after all, terminal patients, some more imminent than others, some of us more prepared to move on, as if our readiness had anything to do with the timing.

Each day I too get a little closer, so I write and share photos of my world in order to hang on awhile longer.  Each day I must detach just a little bit, leaving a small trace of my voice and myself behind.  Eventually, through unmerited grace, so much of me will be left on the page there won’t be anything or anyone left to do the typing.

There is no moment or picture or word to waste.

 

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Doc Season

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It may not be rabbit season or duck season but it definitely seems to be doc season, especially as the next version of the American Health Care Act is unveiled today. This (and the Affordable Care Act which preceded it) is not about patients — it is about how to keep doctors and the health care industry under reasonable cost control and maintain some semblance of quality service.

Physicians are lined up squarely in the gun sights of the media, government agencies and legislators, as well as our employers and coworkers, not to mention our own professional organizations, our Board Certifying bodies, and our dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim. It’s not enough any more to wear a bullet proof white coat. It’s driving doctors to hang up their stethoscope much earlier than they expected just to get out of the line of fire. Depending on who is expressing an opinion, doctors are seen as overcompensated, demanding, whiny, too uncommitted, too over-committed, uncaring, egotistical, close-minded, inflexible, and especially, and most annoyingly – perpetually late.

One of the most frequent complaints expressed about doctors is their lack of sensitivity to the demands of their patients’ schedule. Doctors do run late and patients wait. And wait. And wait some more. Patients get angry while waiting and this is reflected in patient (dis)satisfaction surveys which are becoming one of the tools the industry uses to judge the quality of a physician’s work and character as well as their salary compensation.  It is considered basic Customer Service 101.

I admit I’m one of those late doctors. I don’t share the reasons why I’m late with my patients as I enter the exam room apologizing for my tardiness. Taking time to explain takes time away from the task at hand: taking care of the person sitting or lying in front of me. At that moment, they are the most important person in the world to me. More important than the six waiting to see me, more important than the several dozen emails and calls waiting to be returned, more important than the fact I missed lunch or need to go to the bathroom, more important even than the text message from my daughter from school or the worry I carry about my dying mother.

I’m a salaried doctor, just like more and more of my primary care colleagues these days, providing more patient care with fewer resources. I don’t earn more by seeing more patients. There is a work load that I’m expected to carry and my day doesn’t end until that work is done. Some days are typically a four patient an hour schedule, but most days my colleagues and I must work in extra patients triaged to us by careful nurse screeners, and there are only so many minutes that can be squeezed out of an hour so patients end up feeling the pinch. I really want to try to go over the list of concerns some patients bring in so they don’t need to return to clinic for another appointment, and I really do try to deal with the inevitable “oh, by the way” question when my hand is on the door knob. Anytime that happens, I run later in my schedule, but I see it as my mission to provide essential caring for the “most important person in the world” at that moment.

The patient who is angry about waiting for me to arrive in the exam room can’t know that I’m late because the previous patient just found out that her upset stomach was caused by an unplanned and unwanted pregnancy. Perhaps they might be more understanding if they knew that an earlier patient came in with severe self injury so deep it required repair. Or the woman with a week of cough and new rib pain with a deep breath that could be a simple viral infection is showing signs of a pulmonary embolism caused by oral contraceptives. Or the man with blood on the toilet paper after a bowel movement finding out he has sexually transmitted anal warts when he’s never disclosed he has sex with other men, or the woman with bloating whose examination reveals an ominous ovarian mass, or finding incidental needle tracks on arms during an evaluation for itchiness, which leads to a suspicion of undiagnosed chronic hepatitis.

Doctors running late are not being inconsiderate, selfish or insensitive to their patients’ needs. Quite the opposite. We strive to make our patients feel respected, listened to and cared for. Most days it is a challenge to do that well and stay on time. For those who say we are being greedy, so we need to see fewer patients, I respond that health care reform and salaried employment demands we see more patients in less time, not fewer patients in more time. The waiting will only get longer as more doctors hang up their stethoscopes rather than become a target of anger and resentment as every day becomes “doctor season.”

Patients need to bring a book or catch up on correspondence,  bring knitting, schedule for the first appointment of the day. They also need to bring along a dose of charitable grace when they see how crowded the waiting room is. It might help to know you are not alone in your worry and misery.

But your doctor and health care team is very alone, scrambling to do the very best healing they can in the time available.

I’m not hanging my stethoscope up anytime soon though some days I’m so weary by the end, I’m not sure my brain between the ear tips is still functioning. I don’t wear a bullet proof white coat since I refuse to be defensive. If it really is doctor season, I’ll just continue on apologizing as I walk into each exam room, my focus directed to the needs of the “most important person in the whole world.”

And that human being deserves every minute I can give them.

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Why Do We Bother?

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Why do we bother with the rest of the day,
the swale of the afternoon,
the sudden dip into evening,
then night with his notorious perfumes,
his many-pointed stars?
This is the best—
throwing off the light covers,
feet on the cold floor,
and buzzing around the house on espresso—
maybe a splash of water on the face,
a palmful of vitamins—
but mostly buzzing around the house on espresso,
dictionary and atlas open on the rug,
the typewriter waiting for the key of the head,
a cello on the radio,
and, if necessary, the windows—
trees fifty, a hundred years old
out there,
heavy clouds on the way
and the lawn steaming like a horse
in the early morning.
~Billy Collins “Morning”
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Dawn is a new gift every day,
even if the shortest night was sleepless,
and the longest day won’t return for another year.We get up
to see just what might happen
as you never know what might be
just over the horizon
as we round the solstice corner
to face the darkening.That’s why we bother.

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A Patch of God Light

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Any patch of sunlight in a wood will show you something about the sun which you could never get from reading books on astronomy.
These pure and spontaneous pleasures are ‘patches of Godlight’ in the woods of our experience.

~C.S. Lewis

 

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A solstice moment
when light replaces
where darkness thrives:
there is a wounding
that tears us open,
cleaving us,
so joy can enter the cracks
that hurt the most.

 

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Snake Skin

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Pruning back the old spirea bushes
that sprawled for years in summer’s heat,
I bared the snake skin, a yard and a half long:
its naked empty length rippled in the streaming wind
lifting its ghostly coils from the dead shoots
that scraped the slough from the slithering body
that shed it in that narrow, shaded space.

I paused—who wouldn’t?—shears poised,
slipped off gray canvas gloves, extracted
the sere, striated casing from the brown stalks
that had held it, silent, hidden.

I coiled the paper-thin curling sheath with care,
delicately, eased it into a simple squatty box
for keeping, for care, for my daughters
to take to school, to show, to explain
how some sinuous body we’ve never glimpsed,
that haunts about our shrubs, our porch,
left for us this translucent, scale-scored wrapper,
this silent hint of all that moves unseen.
~Stephen Behrendt “Snakeskin”

 

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Cast off on a sunny spring day
onto a warm manure pile,
a wriggled-free fresh molt snakeskin,
nearly covered by my fresh load~
lay blended with old hay, horse hair, shavings,
tucked among what is already digested,
dumped and discarded.
This, an intact hollowed shadow
of a still living creature
who has moved on:
I too need to leave my old self
shrugged off onto the manure pile,
shed when it no longer fits
the ways I’ve grown hallowed,
a fitting remembrance of
who I once was,
yet left behind.
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