Their Exuberant Souls

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Whatever he needs, he has or doesn’t
have by now. 
Whatever the world is going to do to him
it has started to do… 

…Whatever is 
stored in his heart, he can use, now. 
Whatever he has laid up in his mind
he can call on.  What he does not have
he can lack…

…Whatever his exuberant soul
can do for him, it is doing right now…

…Everything that’s been placed in him will come out, now, the contents of a trunk
unpacked and lined up on a bunk in the underpine light.
~Sharon Olds from “The Summer-Camp Bus Pulls Away from the Curb”

 

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orangepetals

 

This is the season for graduations, when children move into the adult world and don’t look back.

As a parent, as an educator, as a mentor within church and community, and after nearly thirty years as a college health physician witnessing this transition many times over, I can’t help but be wistful about what I may have left undone and unsaid with the generation about to launch.

In their moments of vulnerability, did I pack enough love into those exuberant hearts so he or she can pull it out when it is most needed?

When our three children traveled the world after their graduations, moving way beyond the fenced perimeter of our little farm, I trust they left well prepared.

As a school board member, I watched students, parents and teachers work diligently together in their preparation for that graduation day, knowing the encompassing love behind each congratulatory hand shake.

When another batch of our church family children say goodbye, I remember holding them in the nursery, listening to their joyful voices as I played piano accompaniment in Sunday School, feeding them in innumerable potlucks over the years.  I pray we have fed them well in every way with enough spiritual food to stick to their ribs in the “thin” and hungry times.

When hundreds of my student/patients move on each year beyond our university and college health clinic, I pray for their continued emotional growth buoyed by plenty of resilience when the road inevitably gets bumpy.

I believe I know what is stored in the hearts of graduates because I, among many others, helped them pack it full of love.   Only they will know the time to unpack what is within when their need arises.

 

yellowpetals

 

farmroad

 

wwugrass

 

Heaven-Handling Flung

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Not, I’ll not, carrion comfort, Despair, not feast on thee;
Not untwist — slack they may be — these last strands of man
In me ór, most weary, cry I can no more. I can;
Can something, hope, wish day come, not choose not to be.
But ah, but O thou terrible, why wouldst thou rude on me
Thy wring-world right foot rock? lay a lionlimb against me? scan
With darksome devouring eyes my bruisèd bones? and fan,
O in turns of tempest, me heaped there; me frantic to avoid thee and flee?
   Why? That my chaff might fly; my grain lie, sheer and clear.
Nay in all that toil, that coil, since (seems) I kissed the rod,
Hand rather, my heart lo! lapped strength, stole joy, would laugh, chéer.
Cheer whom though? the hero whose heaven-handling flung me, fóot tród
Me? or me that fought him? O which one? is it each one? That night, that year
Of now done darkness I wretch lay wrestling with (my God!) my God.
~Gerard Manley Hopkins “Carrion Comfort”

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These mounting deaths by one’s own hand
make grim headlines and solemn statistics.

In my clinic, patient after patient says the same thing:

this struggle with life
makes one frantic to avoid the fight and flee
to feel no more bruising and bleed no more,
to become nothing but chaff and ashes.

they contemplate suicide as
they can not recognize the love of
a God who cares enough to
wrestle them relentlessly–
who heaven-handling flung them here by
breathing life into their nostrils

Perhaps they can’t imagine
a God
(who He Himself created
doubters
sore afraid
of His caring
enough to die for us)

so no one
is ever now,
nor ever will be

~nothing~

such darkness
now done
forever.

 

 

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sunrise109159

Why I’m Running Late

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It may not be rabbit season or duck season but it definitely seems to be doctor season.  Physicians are lined up squarely in the gun sights of the media,  government agencies and legislators, our health care industry employers and coworkers, not to mention our own 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 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 overcommitted, uncaring, egotistical, close minded,  inflexible, and especially– 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.

I admit I’m one of those late doctors.  Perpetually 20-30 minutes behind.

I don’t share the reasons why I’m late with my patients as we sit down together in the exam room but I do apologize for my tardiness.  Taking time to explain why takes time away from the task at hand: taking care of the person sitting or lying in front of me.   At that moment, that is the most important person in the world to me.  More important than the six waiting to see me, more important than the dozens of emails, electronic portal messages 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 of concern from my daughter or the worry I have about a ill relative.

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 three patients before them I saw a woman who 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, but is showing potential 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 suspected 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, 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 is very alone, scrambling to do the very best healing he or she can in the time available.

I’m not yet hanging my stethoscope up though some days I’m so weary by the end, I’m not sure my brain between the ear buds 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 for that moment 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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The Doctor’s Waiting Room Vladimir Makovsky 1870

This Doctor is Open For Business

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Astonishing material and revelation appear in our lives all the time.
Let it be.
Unto us, so much is given.
We just have to be open for business.

~Anne Lamott from Help Thanks Wow: Three Essential Prayers

 

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I have the privilege to work in a profession where astonishment and revelation awaits me behind each exam room door.

In a typical clinic day, I open that door up to thirty plus times, close it behind me and settle in for the ten or fifteen minutes I’m allocated per patient.  I need to peel through the layers of each person quickly to find the core of truth about who they are and why they’ve come to clinic that day.

Sometimes what I’m looking for is right on the surface: in their tears, in their pain, in their fears.  Most of the time, it is buried deep, often beneath a scar I must search to find. I need to wade through the rashes and sore throats and coughs and headaches and discouragement to find it.

Once in awhile, I actually do something tangible to help right then and there — sew up a cut, lance a boil, splint a fracture, restore hearing by removing a plug of wax from an ear canal.

Often I find myself giving permission to a patient to be sick — to take time to renew, rest and trust their bodies to know what is best for a time.

Sometimes, I am the coach pushing them to stop living sick — to stop hiding from life’s challenges, to stretch even when it hurts, to get out of bed even when not rested, to quit giving in to symptoms that are to be overcome rather than become overwhelming.

Always I’m looking for an opening to say something a patient might think about after they leave my clinic — how they can make different choices, how they can be bolder and braver in their self care, how they can intervene within their own finite timeline to prevent illness, how every day is just one thread in the larger tapestry of their lifespan.

Each morning I rise early to get work done at home before I actually arrive at my desk at work, trying to avoid feeling unprepared and inadequate to the volume of tasks heaped upon each day.   I know I will be stretched beyond my capacity, challenged by the unfamiliar, the unexpected and will be stressed by obstacles thrown in my way.  I know I will be held responsible for things I have little to do with, simply because I’m the one who often acts as decision-maker.

It is always tempting to go back to bed and hide.

Instead of hiding,  I go to work as the exam room doors need to be opened and the layers peeled away.  I understand the worry, the fear and the pain because I have lived it too.   I know the limitations of a body that wants to consume more than it needs, to sleep rather than go for a walk, to sit rather than stand.

Even now in my seventh decade of life,  I am continually learning how to let it be, even if it is scary.  It is a gift perhaps I can share.

No matter what waits behind the exam room door,  it will be astonishing to me.

I’m grateful to be open for business.  The Doctor is In.

 

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A Bleeding Heart

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Love your neighbor as yourself is part of the great commandment.

The other way to say it is, ‘Love yourself as your neighbor.’ Love yourself not in some egocentric, self-serving sense but love yourself the way you would love your friend in the sense of taking care of yourself, nourishing yourself, trying to understand, comfort, strengthen yourself.

Ministers in particular, people in the caring professions in general, are famous for neglecting their selves with the result that they are apt to become in their own way as helpless and crippled as the people they are trying to care for and thus no longer selves who can be of much use to anybody. 

It means pay mind to your own life, your own health and wholeness, both for your own sake and ultimately for the sake of those you love too. Take care of yourself so you can take care of them.

A bleeding heart is of no help to anybody if it bleeds to death.
~Frederick Buechner from Telling Secrets

 

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We are reminded every time we hear safety instructions on an airplane before a flight takes off: “in the event of a sudden pressure change in the cabin, oxygen masks will appear – remember to put your own on before helping others with their masks.”   

If we aren’t able to breathe ourselves, we won’t last long enough to be of assistance to anyone around us.  Too often,  sacrificing self-care threatens others’ well-being.

A headline appeared in my email from the American Psychiatric Association this morning: “Physicians Experience the Highest Suicide Rate of Any Profession” – there is rampant depression and burn-out among those who should know best how to recognize and respond to the danger signs — for women physicians, nearly 1 out of 5 are afflicted.   Yet the work load only seems to increase, not diminish, the legal and moral responsibility weighs more heavily, and the hours available for sleep and respite shrink.  In forty years of practicing medicine (my father liked to remind me “when are you going to stop ‘practicing’ and actually ‘do’ it?”),  the work has never gotten easier, only harder and heavier.

I see suicidal patients all day and am immensely grateful I’ve never been suicidal, thank God, but anxiety is embedded deep in my DNA from my non-physician fretful farmer ancestors.  Anxiety becomes the fuel and driver of the relentless physician journey on long lonely roads, spurring us to stay awake too many hours and travel too far when we should be closing our eyes and taking a break to breathe, just breathe.

However, we are trained to respond to anxiety from the first day in anatomy class:
“and while you, Miss Polis, are trying to think of the name of that blood vessel, your patient is exsanguinating in front of you– drip, drip, drip….”

Terror-stricken at the thought I was inadequate to the task of saving a life, it took years for me to realize the name of the vessel didn’t bloody matter as long as I knew instinctively to clamp it, compress it, or by the love of the Living God, transfuse my own blood from my bleeding heart into my patient’s.

I learned well those many years ago:

To save a life, I must preserve my own.

 

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Two Kinds of Infection

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Good things as well as bad, you know are caught by a kind of infection.

If you want to get warm you must stand near the fire:
if you want to be wet you must get into the water.
If you want joy, power, peace, eternal life,
you must get close to, or even into, the thing that has them. 

They are not a sort of prize which God could, if He chose, just hand out to anyone.
They are a great fountain of energy and beauty spurting up at the very centre of reality.
If you are close to it, the spray will wet you: if you are not, you will remain dry.

Once a man is united to God, how could he not live forever?
Once a man is separated from God, what can he do but wither and die?

~C.S. Lewis- Mere Christianity

 

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Each Monday morning, as I transition once again from the observance of Sabbath with God’s people to move into the secular world of government work, I feel an acute separation.

I want to remain infected (and contagious) with the reality of God yet my life feels necessarily compartmentalized.

On Monday, I’m gloved and masked to prevent my infecting others.

All week I am exposed daily to the reality of the world and must defend myself from getting infected.

If I’m to be contagious, let it be because I’m overwhelmed with the Spirit, not the world.

 

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To Be Interruptible

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We must be ready to allow ourselves to be interrupted by God.
― Dietrich Bonhoeffer

 

 

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I’ve worked hard in my professional life to be easily interruptible;  my patients, colleagues and staff need to be able to stop my momentum at any time to ask a question, get an opinion or redirect my attention to something more important than what I’m doing at that time.  As a physician, it is crucial that I remain prioritized from outside my field of vision as I don’t always realize where I’m needed most until someone grabs me.

In my personal life, I struggle with interruptions happening outside my control.  I feel imposed upon when things don’t flow as I hoped or planned– after all,  this is MY life.

Yet God interrupts.  God interferes.  God intervenes.  God intrudes.  God intercedes.

As He must.

I must be ready, accepting, answering His grace with my grace.

It is HIS life living within me, His plan, His timing, His priorities, His story playing out in such a way that it becomes my story.

I can’t skip ahead to see what happens on the last page, but I hope it is one of those stories I don’t want to see end when the last word is written.

 

 

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