A Deep Fear of Emptiness

dawn7251

 

marshmallowglow2

 

Wheels of baled hay bask in October sun:
Gold circles strewn across the sloping field,
They seem arranged as if each one
Has found its place; together they appeal
To some glimpsed order in my mind
Preceding my chance pausing here —
A randomness that also seems designed.
Gold circles strewn across the sloping field
Evoke a silence deep as my deep fear
Of emptiness; I feel the scene requires
A listener who can respond with words, yet who
Prolongs the silence that I still desire,
Relieved as clacking crows come flashing through,
Whose blackness shows chance radiance of fire.
Yet stillness in the field remains for everyone:
Wheels of baled hay bask in October sun.
~Robert Pack “Baled Hay” from Rounding it Out: A Cycle of Sonnetelles (1999).

 

mayfieldbales

 

marshmallows51116

 

Each day I am called to see and listen,
to open fully to all that is around me.
From the simple stillness of the fields
surrounding our farm,
to the weeping of those who sit with me
day after day
in their deep fear of emptiness,
their struggle with whether to try to live
or give up and die.

Their deep fear of emptiness renders me silent;
I struggle to respond with words
that might offer up a healing balm
assuring them even in the darkest time
hope lies waiting, wrapped and baled,
radiant as fire,
ready to spill out fragrant,
to bear us silently to a new morning,
to a stillness borne of grace.

 

lookingnortheastoct

 

centralroadoct

A Moment of Peace

sunrise10124

 

sunrise10126

 

It had happened many times before, but it always took me by surprise.

Always in the midst of great stress, wading waist-deep in trouble and sorrow, as doctors do, I would glance out a window, open a door, look into a face, and there it would be, unexpected and unmistakable. A moment of peace.  

The light spread from the sky to the ship, and the great horizon was no longer a blank threat of emptiness, but the habitation of joy. For a moment, I lived in the center of the sun, warmed and cleansed, and the smell and sight of sickness fell away; the bitterness lifted from my heart.  

I never looked for it, gave it no name; yet I knew it always, when the gift of peace came. I stood quite still for the moment that it lasted, thinking it strange and not strange that grace should find me here, too.   Then the light shifted slightly and the moment passed, leaving me as it always did, with the lasting echo of its presence. In a reflex of acknowledgment, I crossed myself and went below, my tarnished armor faintly gleaming.
~Diana Gabaldon – Claire’s observations from Voyager

 

sunrise10128

 

 

I’ve known this moment of peace in the midst of my work; it comes unexpectedly after a day of immersion in troubles and anguish.  As I leave the clinic and breathe in a sudden rush of fresh air, and as I drive down our country road as the sun is setting, I remember that for all of us, the sick and the not-yet-sick, there still are moments of grace and beauty.

It isn’t all sad, it isn’t all anxious, it isn’t all anguish. The moment may be brief, it may be elusive.

But it is there. And I seek it out every day.

 

 

cloudmountain4

 

(written with gratitude to author Diana Gabaldon for her insights into the complex workings of an innovative physician’s mind in her Outlander series of novels, for Caitriona Balfe‘s insightful characterization and understanding of Claire and for Sam Heughan‘s sensitive portrayal of the man who loves her beyond the boundary of time in Starz’ Outlander  – if you don’t know these stories yet, you should.)

 

sunrise105174

 

 

Just Sad

prairie10

 

carousel1

 

We didn’t say fireflies
but lightning bugs.
We didn’t say carousel
but merry-go-round.
Not seesaw,
teeter-totter
not lollipop,
sucker.
We didn’t say pasta, but
spaghetti, macaroni, noodles:
the three kinds.
We didn’t get angry:
we got mad.
And we never felt depressed
dismayed, disappointed
disheartened, discouraged
disillusioned or anything,
even unhappy:
just sad.
~Sally Fisher “Where I Come From”  from Good Question.

 

morning823172

 

sunset830176

 

I felt sadness in that moment because, having been raised in a certain culture, I learned long ago that “sadness” is something that may occur when certain bodily feelings coincide with terrible loss. Using bits and pieces of past experience, such as my knowledge of shootings and my previous sadness about them, my brain rapidly predicted what my body should do to cope with such tragedy. Its predictions caused my thumping heart, my flushed face, and the knots in my stomach. They directed me to cry, an action that would calm my nervous system. And they made the resulting sensations meaningful as an instance of sadness. In this manner, my brain constructed my experience of emotion.

…if you could distinguish finer meanings within “Awesome” (happy, content, thrilled, relaxed, joyful, hopeful, inspired, prideful, adoring, grateful, blissful.. .), and fifty shades of “Crappy” (angry, aggravated, alarmed, spiteful, grumpy, remorseful, gloomy, mortified, uneasy, dread-ridden, resentful, afraid, envious, woeful, melancholy.. .), your brain would have many more options for predicting, categorizing, and perceiving emotion, providing you with the tools for more flexible and functional responses.
~Lisa Feldman Barrett from How Emotions Are Made: The Secret Life of the Brain

 

sunset81617

 

sunset720176

 

Emotions are fleeting. But they are unavoidable and they are the most human of all things. They are not universals; they are arbitrary. But if we feel them deeply and we share them with others, nothing in this life is more real.
~Eric Barker on his blog Barking Up the Wrong Tree

 

cobblersky78171

 

morning719172

 

If there is anything I’ve come to understand over the decades I’ve been a physician, it is that human beings have emotions that make them uncomfortable and that makes them more difficult to share with others.  Sometimes those feelings become so locked up that they leak out of our cells as physical symptoms: headaches, muscle tightness, stomach upset, hypertension.  Other times they are so overwhelming we can no longer function in a day to day way – labeled as rage, panic, mood disorder, depression, self-destructive, suicidal.

Somehow we’ve lost the ability to be just sad.  Just sad.  Sad happens and it happens to us all, some longer than others, some worse than others, some deeper than others.  What makes sad more real and more manageable is if we can say it out loud — whatever ‘sad’ means to us on a given day and to describe the feeling in detail can categorize and manage it — and explain it to others who can listen and help.

Strong emotions don’t always need a “fix”, particularly chemical,  but that is why I’m usually consulted.  Alcohol, marijuana and other drugs tend to be the temporary self-medicated anesthesia that people seek to stop feeling anything at all but it only rages stronger later.

Sometimes an overwhelming feeling just needs an outlet so it no longer is locked up, unspoken and silent, threatening to leak out in ways that tear us up and pull us apart.

Just tell me where you come from, who you are and who you are becoming and then, only then, we might be able to understand why you feel what you do today.  Then, armed with that understanding and how you might respond in a different way,  tomorrow may well feel a bit better.

 

morning7917

Take My Waking Slow

morning823171

I wake to sleep, and take my waking slow.   
I feel my fate in what I cannot fear.   
I learn by going where I have to go.
We think by feeling. What is there to know?   
I hear my being dance from ear to ear.  
I wake to sleep, and take my waking slow.
Of those so close beside me, which are you?   
God bless the Ground!   I shall walk softly there,   
And learn by going where I have to go.
Light takes the Tree; but who can tell us how?   
The lowly worm climbs up a winding stair;   
I wake to sleep, and take my waking slow.
Great Nature has another thing to do   
To you and me; so take the lively air,   
And, lovely, learn by going where to go.
This shaking keeps me steady. I should know.   
What falls away is always. And is near.   
I wake to sleep, and take my waking slow.   
I learn by going where I have to go.
~Theodore Roetke “TheWaking”

 

sunrise818172

tennant20171

 

In my rush to get from there to here
I missed some things.  The solitary song
of the chickadee; the play of winter light
on kitchen walls; the smell of fresh-raked leaves;
the summer days of childhood, stretched slow
from dawn to dusk, no need to know the date
or time, only the sound of a silver swung bell
to call me in for supper.

Could I re-learn to navigate by phases
of the moon, the ebb and flow of tides,
the rhodies budding out today before
the fall’s first snow?  Could I re-learn
to take my waking slow?
~Ted McMahon, M.D. “Slow Season”

 

sunset817

eveningrun

I took an unscheduled landing while wheelbarrowing hay to our horses in the field yesterday morning.

In my rush to get from there to here I missed some things.

I stumbled on uneven ground and fell hard, badly injuring my elbow.  Finishing chores afterward was a challenge and a necessity, wrapping my broken wing up tight in my jacket, doing what was needed before my husband came home to take me to the ER where good people who know me took great care of me.

Of those so close beside me, which are you?   
God bless the Ground!   I shall walk softly there,   
And learn by going where I have to go.

Even though no bones were broken, it was dislocated, so my elbow (and I) needed to be put back together.  The miracle of “conscious sedation” IV medication let my body “think” I was awake – I was surrounded by a swirling round of voices telling me to take deep breaths and constantly reassuring me–while the ER doctor and nurse put traction on my arm and shoulder, then twisting and turning my elbow back into proper position with a “clunk”.  I was blissfully unaware of the tugging and torque, paying attention only to the swirling sounds in my head, then waking slow to find my arm splinted and wrapped from mid-humerus to fingers — all fixed but now typing is also slow.

This shaking keeps me steady. I should know.   
What falls away is always. And is near.   
I’m walking more carefully now, paying attention to exactly where my feet land and what is around me.
The ground is near yet still can be a hard and abrupt landing;
I celebrate the good clinicians who put broken people back together again.
Great Nature has another thing to do   
To you and me; so take the lively air,   
And, lovely, learn by going where to go.
tammingasunset

 

 

Removing the Splinter

 

 

To pull the metal splinter from my palm
my father recited a story in a low voice.
I watched his lovely face and not the blade.
Before the story ended, he’d removed
the iron sliver I thought I’d die from.

I can’t remember the tale,
but hear his voice still, a well
of dark water, a prayer.
And I recall his hands,
two measures of tenderness
he laid against my face,
the flames of discipline
he raised above my head.

Had you entered that afternoon
you would have thought you saw a man
planting something in a boy’s palm,
a silver tear, a tiny flame.
Had you followed that boy
you would have arrived here,
where I bend over my wife’s right hand.

Look how I shave her thumbnail down
so carefully she feels no pain.
Watch as I lift the splinter out.
I was seven when my father
took my hand like this,
and I did not hold that shard
between my fingers and think,
Metal that will bury me,
christen it Little Assassin,
Ore Going Deep for My Heart.
And I did not lift up my wound and cry,
Death visited here!
I did what a child does
when he’s given something to keep.
I kissed my father.
~Li-Young Lee, “The Gift” from Rose

 

 

I did, without ever wanting to, remove my child’s splinter, lance a boil, immobilize a broken arm, pull together sliced skin, clean many dirty wounds. It felt like I crossed the line between mommy and doctor.  But someone had to do it, and a four hour wait in the emergency room didn’t seem warranted.

My own child learned to cope with hurt made worse by someone they trusted to be comforter.
I dealt with inflicting pain, temporary though it may be, to flesh that arose from my flesh.  It hurt as much as if it were my own wound needing cleansing, not theirs.

Our wounds are His – He is constantly feeling our pain as He performs healing surgeries in our lives, not because He wants to but because He must, to save us from our own destruction.
Too often we yell and kick and protest in our distress, making it all that much more difficult for both of us.

If only we can come to acknowledge His intervention is our salvage:
our tears to flow in relief, not anguish,
we cling to His protection rather than pushing Him away,
we kiss Him in gratitude as we are restored again and yet again.

 

 

 

 

 

 

An Audience of Terminal Patients

chelanblooms1

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”

chelanducklings5

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

chelanspirea

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.

 

chelanpoppies

 image1

 

Doc Season

duckchelan2

img_0761


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.

chelanbirches2

chelanshadows