Preparing Through Parable: Fertilize…

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Then he told this parable: “A man had a fig tree growing in his vineyard, and he went to look for fruit on it but did not find any. So he said to the man who took care of the vineyard, ‘For three years now I’ve been coming to look for fruit on this fig tree and haven’t found any. Cut it down! Why should it use up the soil?’

“‘Sir,’ the man replied, ‘leave it alone for one more year, and I’ll dig around it and fertilize it. If it bears fruit next year, fine! If not, then cut it down.’”
Luke 13:6-9

 

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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, thanks to transformation of muck to fruit.

That’s largely what I do in clinic as well.

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 relationships and obligations.  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 school, work,  computer use, food, gambling, porn, 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, backgrounds and creeds has transformed me.

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.’

It’s crucial to fertilize those who otherwise may be cut down.  Only then can they bear fruit.

May my eyes see, my ears hear, my heart understand.  He prepares me with parable.

 

 

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When Flesh and Heart Shall Fail

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(Ten years ago this week, this healthy young college student came to our clinic stricken with seasonal influenza complicated by pneumonia.  His family gave permission for his story to be told.)

 

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Nothing was helping.  Everything had been tried for a week of the most intensive critical care possible.  A twenty year old man, completely healthy only two weeks previously, was dying and nothing could stop it.

The battle against a sudden MRSA pneumonia precipitated by a routine seasonal influenza had been lost.   Despite aggressive hemodynamic, antibiotic, antiviral and ventilator management, he was becoming more hypoxic and his renal function was deteriorating.  He had been unresponsive for most of the week.

The intensivist looked weary and defeated. The nurses were staring at their laps, unable to look up, their eyes tearing. The hospital chaplain reached out to hold this young man’s mother’s shaking hands.

After a week of heroic effort and treatment, there was now clarity about the next step.

Two hours later, a group gathered in the waiting room outside the ICU doors. The average age was about 21; they assisted each other in tying on the gowns over their clothing, distributed gloves and masks. Together, holding each other up, they waited for the signal to gather in his room after the ventilator had been removed and he was breathing without assistance. They entered and gathered around his bed.

He was ravaged by this sudden illness, his strong body beaten and giving up. His breathing was now ragged and irregular, sedation preventing response but not necessarily preventing awareness. He was surrounded by silence as each individual who had known and loved him struggled with the knowledge that this was the final goodbye.

His father approached the head of the bed and put his hands on his boy’s forehead and cheek.  He held this young man’s face tenderly, bowing in silent prayer and then murmuring words of comfort:

It is okay to let go. It is okay to leave us now.
We will see you again. We’ll meet again.
We’ll know where you will be.

His mother stood alongside, rubbing her son’s arms, gazing into his face as he slowly slowly slipped away. His father began humming, indistinguishable notes initially, just low sounds coming from a deep well of anguish and loss.

As the son’s breaths spaced farther apart, his dad’s hummed song became recognizable as the hymn of praise by John Newton, Amazing Grace.  The words started to form around the notes. At first his dad was singing alone, giving this gift to his son as he passed, and then his mom joined in as well. His sisters wept. His friends didn’t know all the words but tried to sing through their tears. The chaplain helped when we stumbled, not knowing if we were getting it right, not ever having done anything like this before.

Amazing Grace, how sweet the sound,
That saved a wretch like me.
I once was lost but now am found,
Was blind, but now I see.

Through many dangers, toils and snares
I have already come;
‘Tis Grace that brought me safe thus far
and Grace will lead me home.

Yea, when this flesh and heart shall fail,
And mortal life shall cease,
I shall possess within the veil,
A life of joy and peace.

When we’ve been here ten thousand years
Bright shining as the sun.
We’ve no less days to sing God’s praise
Than when we’ve first begun.

And he left us.

His mom hugged each sobbing person there–the young friends, the nurses, the doctors humbled by powerful pathogens. She thanked each one for being present for his death, for their vigil kept through the week in the hospital.

This young man, now lost to this life, had profoundly touched people in a way he could not have ever predicted or expected. His parents’ grief, so gracious and giving to the young people who had never confronted death before, remains unforgettable.

This was their sacred gift to their son so Grace will lead us home.

 

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Watch Where I Step

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I watch where I step and see
that the fallen leaf, old broken glass,
an icy stone are placed in

exactly the right spot on the earth, carefully,
royalty in their 
own country.
~ Tom Hennen, “Looking For The Differences”
from Darkness Sticks To Everything: Collected and New Poems.
 spottedleaf
snowywoods
If the pebble, the leaf, the walnut shell, the moss, the fallen feather
are placed exactly right where they belong,
then so am I
~even when I may rather be elsewhere~
even when I could get stepped on,
even when I would rather hide in a hole,
even when exactly right feels exactly wrong.
I’m placed right here to watch where I step
for some reason beyond understanding:
a simple peasant
asked to serve a royal purpose.
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wheretheyland

In the Dark, Reconciled

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I am the rest between two notes,
which are somehow always in discord
because Death’s note wants to climb over—
but in the dark interval, reconciled,
they stay there trembling.
And the song goes on, beautiful.
~Rainer Maria Rilke from “My Life is Not This Steeply Sloping Hour”

 

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On Sunday evenings I often feel I’m the spot in the middle between discordant notes. There is on one side of me the pressure of catch-up from what was left undone through a too-brief weekend and on the other side is the anticipated demand of the coming week. As I prepare to sleep at the end of a Sabbath day, I feel uneasily in dead center, immobilized by the unknown ahead and the known behind.

This moment of rest in the present, between the trembling past and uncertain future, is my moment of reconciliation: my Sabbath extended.

This evening, I will allow myself a steeply sloping hour of silence and reflection before I surge ahead into the week, knowing that on my journey I’ll inevitably hit wrong notes, yet beautiful nevertheless.

Even the least harmonious notes resolve within the next chord. I will move from the rest of my Sabbath back into the rhythm of my life.

Trembling, still trembling, always trembling at what is to come.

 

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photo by Josh Scholten

 

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photo by Lea Gibson

 

 

 

 

Lost Inside This Soft World

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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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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.

 

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When Worry is a Terminal Disease

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Considering myself a Dr. Doolittle of sorts, always talking to the animals, I reached out to pet a stray cat sitting quietly outside our barn one evening while doing barn chores.  This is a grayish fluffy cat I see around the barns every few months or so–he doesn’t put in frequent appearances and reminds me of a kitten we raised on this farm a few years back, though his markings are a bit different,  so I know it is not our cat.

We have 6 cats to pet here who claim “us” as their home and family, so there is no lack of fur balls to love.  There are probably that many more who hang out,  now and then,  considering our farm fair game and looking for an occasional free meal.  This cat just seemed to need a reassuring pat at that moment or maybe I needed the reassurance.  Wrong.

I found myself with a cat attached to my wrist by teeth and claws.  It took a bit of an effort to shake him off and he escaped into the night. I then surveyed the damage he inflicted and immediately went to wash my wounds.  They were deep punctures near my wrist joint–not good.  Lucky for me I was up to date on my tetanus booster.

By the next day the wounds were getting inflamed and quite sore.  I know all too well the propensity of cat bites to get badly infected with Pasteurella Multocida, a “bad actor” bacteria that can penetrate deep tissues and bone if not treated with aggressive antibiotics.  After getting 6 opinions from my colleagues at clinic, all of whom stood solemnly shaking their heads at my 12 hour delay in getting medical attention,  I surrendered and called my doctor’s office.  I pleaded for a “no visit” prescription as I was up to my eyeballs in my own patients, and he obliged me.  I picked up the antibiotic prescription during a break, sat in the car ready to swallow the first one and then decided to wait a little longer before starting them, knowing they wallop the gut bacteria and cause pretty nasty side effects.  I wanted to see if my own immune system might just be sufficient.

So the bacterial infection risk was significant and real but I was prepared to deal with it.  For some reason I didn’t really think about the risk of rabies until the middle of the night when all dark and depressing thoughts seem to come real to me.

I don’t know this cat.  I doubt he has an owner and it is highly unlikely he is rabies vaccinated.  My own cats aren’t rabies vaccinated (and neither am I) though if I was a conscientious owner, they would be.  Yes, we have bats in our barns and woods and no, there has not been a rabid bat reported in our area in some time.

But what if this cat were potentially infected with the rabies virus but not yet showing symptoms?  Now my mind started to work overtime as any good neurotic will do.  Last summer a rabid kitten in North Carolina potentially exposed 10 people when it was passed around a softball tournament, no one aware it was ill until it died and was tested.  Lots of people had to have rabies shots as a result.

This cat who had bitten me was long gone–there was no finding him in the vast woods and farmland surrounding us.  He couldn’t be kept in observation for 10 days and watched for symptoms, nor could he be sacrificed to examine his neural tissue for signs of the virus.

I called the health department to ask what their recommendation was in a case like this.  Do they recommend rabies immune globulin injection which should have been done as soon as possible after the bite?   I talked with a nurse who read from a prepared script for neurotic people like me.  Feral cats in our area have not been reported to have rabies nor have skunks or raccoons.  Only local bats have been reported to have rabies but not recently.  This cat would have had to have been bitten by a rabid bat to be rabid.  This was considered a “provoked” attack as I had reached out to pet the cat.  This was not a cat acting unusually other than having wrapped itself around my arm.  No, the Health Dept would not recommend rabies immune globulin in this situation but I was free to contact my own doctor to have it done at my own expense if I wished to have the series of 5 vaccination shots over the next month at a cost of about $3000.   Yes, there would be a degree of uncertainty about this and I’d have to live with that uncertainty but she reassured me this was considered a very low risk incident.

I knew this was exactly what I would be told and I would have counseled any patient with the same words.  Somehow it is always more personal when the risk of being wrong has such dire consequences.  I could see the headlines “Local Doctor Dies From Rabid Cat Bite”.

This is not how I want to be remembered.

Rabies is one of the worst possible ways to die.  The cases I’ve read about are among the most frightening I’ve ever seen in the medical literature. Not only is it painful and horrific but it puts family and care providers at risk as well.  It also has an unpredictable incubation period of a up to a month or two, even being reported as long as a year after an exposure.  What a long time to wait in uncertainty.  It also has a prodrome of several days of very nonspecific symptoms of headache, fever and general malaise, like any other viral infection before the encephalitis and other bad stuff hits.  I was going to think about it any time I had a little headache or chill.  This was assuredly going to be a real test of my dubious ability to stifle my tendency for 4-dimensional worries.

I decided to live with the low risk uncertainty and forego the vaccination series.  It was a pragmatic decision based on the odds.  My wounds slowly healed without needing antibiotics.  For ten days I watched for my attacker cat whenever I went to the barn, but he didn’t put in an appearance.  I put out extra food and hoped to lure him in.  It would have been just be so nice to see his healthy face and not have to think about this gray cloud hanging over me for the next few months, as I wondered about every stray symptom.  No gray kitty to be seen.

Almost a month has gone by now and he finally showed up last night.  I could have grabbed him and hugged him but I know better now. No more Dr. Doolittle.

He is perfectly fine and now so am I, cured of a terminal case of worry and hypochondria which is not nearly as deadly as rabies but can be debilitating and life shortening none the less.

From now on, I’ll be contented to just “talk to the animals” like any good Dr. Doolittle.  I don’t need to cuddle them.

 

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photo by Nate Gibson

Foggy and Fine Days Within Me

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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”

 

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photo by Nate Gibson

 

Is my gloom, after all,
Shade of His hand,
outstretched caressingly?

~Francis Thompson from “The Hound of Heaven”

 

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My days are filled with anxious and sad patients, one after another after another.  They sit at the edge of their seat, struggling to hold back the flood from brimming eyes, fingers gripping the arms of the chair.   Each moment, each breath, each heart beat overwhelmed by questions:  will there be another breath?  must there be another breath?   Must life 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 the now and now and now is lost forever.

Worry and sorrow and angst are contagious as the flu.
I mask up and wash my hands of it throughout the day.
I wish we could be vaccinated to protect us all from these unnamed fears.

I want to say to them and myself:
Stop this moment in time. Stop and stop and stop.
Stop expecting someone or some thing must fix this feeling.
Stop wanting to be numb to all discomfort.
Stop resenting the gift of each breath.
Just stop.
Instead, simply be.

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,
yet another prescription
you don’t really need.

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

 

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