Half a Lifetime Ago

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On Halloween day in 1985, I packed up my clothes, a roll up mattress,  grabbed one lonely pumpkin from our small garden, locked our rental house door for the last time, climbed in my car to head north out of Seattle. I don’t recall looking back in the rear view mirror at the skyline after nine years living in the city. My husband had moved to Whatcom County two months earlier to start his new job. I had stayed behind to wrap up my Group Health family practice in the Rainier Valley of Seattle. I was leaving the city for a new rural home and a very uncertain professional future.

I knew two things for sure: I was finally several months pregnant after a miscarriage and two years of infertility, so our family was on its way, and we were going to actually live in our own house, not just a rental, complete with a few acres and a barn. A real (sort of) starter farm. Since no farm can be complete without animals, I stopped at the first pet store I drove past and found two tortoise shell calico kitten sisters peering up at me,  just waiting for new adventures in farmland. Their box was packed into the one spot left beside me in my little Mazda. With that simple commitment to raise and nurture those kittens, life seemed very complete.

I will never forget the freedom I felt on that drive north. The highway seemed more open, the fall colors more vibrant, the wind more brisk, our baby happily kicking my belly, the kittens plaintively mewing from their box. There seemed to be so much potential even though I had just left behind the greatest job that could be found in any urban setting (the most diverse zip code in the United States): an ideal family practice with patients from all over the world: Muslims from the Middle East and Indonesia, Orthodox Jews, Italian Catholics, African Americans, Cambodians, Laotians, Vietnamese. I would never know so much variety of background and perspective again and if I could have packed them all into the Mazda and driven them north with me, I would have.

We started our farm with those kittens dubbed Nutmeg and Oregano, soon adding an ethnic diversity of farm animals:  Belgian Tervuren dog Tango, Haflinger horse Greta, Toggenburg goats Tamsen and her kids, a few Toulouse geese, Araucana chickens, Fiona the Scottish Highland cow, then another Haflinger Hans and another, Tamara. I worked as a fill in locums doctor in four different clinics before our first baby, Nate, was born. Again, we had new commitments and life felt complete– but not for long, as we soon added little brother Ben and seven years later,  sister Lea. Then it really was complete. Or so I thought.

Thirty three years later our children have long ago grown and gone to new homes of their own, off to their own adventures beyond the farm.  Our sons married wonderful women, our daughter is in her third year of teaching fourth grade a few hours away and we have a granddaughter growing up in Tokyo.

A few cats, two Cardigan Corgi dogs, and a hand full of ponies remain at the farm with us. We are now both gray and move a bit more slowly, enjoy our naps and the quiet of the nights and weekends.  My work has evolved from four small jobs to two decades of two part time jobs to one more than full time job that fits me like a well worn sweater 24 hours a day.

My husband is happily retired now,  volunteering, serving on boards and being a full time farmer on our larger 20 acre place of fields and woods.  Retirement looms closer for me:  I have never not worked outside the home and don’t know how I can stop when the need in health care is greater than ever.

There was freedom that rainy Halloween day over three decades ago as Seattle disappeared in the rear view mirror. I would no longer sat captive in freeway rush hour bumper to bumper traffic jams.  I celebrate my daily commute through farm fields, watching eagles fly, and new calves licked by their mamas. I am part of a community in a way I never could manage in the city, stopping to visit with friends at the grocery store, playing piano and teaching at church and serving on various community boards. Our home sits in the midst of woods and corn fields, with deer strolling through the fields at dawn, coyotes howling at night, Canadian geese and trumpeter swans calling from overhead and salmon becoming more prolific every year in nearby streams. The snowy Cascades greet us in the morning and the sunset over Puget Sound bids us good night.

It all started October 31, 1985 with two orange and black kittens and a pumpkin sitting beside me in a little Mazda, my husband waiting for my homecoming 100 miles north. Now, thirty three years and three grown children and one granddaughter later, we celebrate this Halloween transition anniversary together, still pregnant with the possibility that life is never truly complete when there is always a new day just around the corner.

 

 

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October

Returning on Foot

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They work with herbs
and penicillin.
They work with gentleness
and the scalpel.
They dig out the cancer,
close an incision
and say a prayer
to the poverty of the skin.

…they are only human
trying to fix up a human.
Many humans die.

But all along the doctors remember:
First do no harm.
They would kiss if it would heal.
It would not heal.

If the doctors cure
then the sun sees it.
If the doctors kill
then the earth hides it.
The doctors should fear arrogance
more than cardiac arrest.
If they are too proud,
and some are,
then they leave home on horseback
but God returns them on foot.
~Anne Sexton “Doctors” from The Awful Rowing Toward God.

 

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Let me not forget how humbling it is
to provide care for a hurting person
and not be certain that what I suggest
will actually work,

to be trusted to recommend the best option
among many~
including tincture of time,
wait and see,
try this or that.

Like other physicians who tumble off
at a full gallop, having lost balance
between confidence and humility,
I sometimes find myself unseated and unsettled,
returning on foot to try again to make a difference.

 

 

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Last Year’s Mistakes Wiped Clean

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That old September feeling, left over from school days, of summer passing… Another fall, another turned page: there was something of jubilee in that annual autumnal beginning, as if last year’s mistakes had been wiped clean by summer.
~Wallace Stegner from Angle of Repose
 
 
 
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Sixteen thousand students have appeared magically overnight on the campus where I’ve worked for three decades.  Unfortunately a record was set for the number who ended up in the emergency room last night due to their celebrating the start of the school year a bit too aggressively.

How is it the start of a new school year can be wistful, jubilant and potentially hazardous all at the same time?  There are always plenty of mistakes to be made and plenty to learn from, though sometimes at tremendous cost.  This is a risky way to start an education.

More than New Year’s Day, the beginning of autumn represents so many turned-over new “leafs”.  We are reminded of this whenever we look at the trees all over our beautiful campus and how their leaves are turning and letting go, seemingly joyful as they make way for the next stage of growth, the slate wiped clean and ready to be scribbled on once again.

Every autumn each emerging adult comes to the university with a similar clean slate, hoping to start fresh, leaving behind what has not worked well for them in the past.  These are our future patients who we hope are open to change because they are dedicating themselves to self-transformation through knowledge and discipline.

It is a true privilege, as a college health doc, to participate in our students’ transition to become autonomous critical thinkers striving to better the world as compassionate global citizens.  Their rich colors deepen when they let go to fly wherever the wind may next take them.

We who remain rooted in place celebrate each new beginning, knowing we nurture the hoped-for transformation…

…as long as we can keep them out of the emergency room.

 

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Get On With Work or Take It Slow

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Sweet smell of phlox drifting across the lawn—
an early warning of the end of summer.
August is fading fast, and by September
the little purple flowers will all be gone.
Season, project, and vacation done.
One more year in everybody’s life.
Add a notch to the old hunting knife
Time keeps testing with a horny thumb.
Over the summer months hung an unspoken
aura of urgency. In late July
galactic pulsings filled the midnight sky
like silent screaming, so that, strangely woken,
we looked at one another in the dark,
then at the milky magical debris
arcing across, dwarfing our meek mortality.
There were two ways to live: get on with work,
redeem the time, ignore the imminence
of cataclysm; or else take it slow,
be as tranquil as the neighbors’ cow
we love to tickle through the barbed wire fence
(she paces through her days in massive innocence,
or, seeing green pastures, we imagine so).
In fact, not being cows, we have no choice.
Summer or winter, country, city, we
are prisoners from the start and automatically,
hemmed in, harangued by the one clamorous voice.
Not light but language shocks us out of sleep
ideas of doom transformed to meteors
we translate back to portents of the wars
looming above the nervous watch we keep.
~Rachel Hadas from “The End of Summer”
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In observance of Labor Day:
I did not grow up in a household that took time off.  Time was redeemed by work, and work was noble and honorable and proved we had a right to exist.
Vacation road trips were rare and almost always associated with my father’s work.  When he came home from his desk job in town, he would immediately change into his farm clothes and put in several hours of work outside, summer or winter, rain or shine, light or dark.
My mother did not work in town while we were children, but worked throughout her day inside and outside the house doing what farm wives and mothers need to do: growing, hoeing, harvesting, preserving, washing, cleaning, sewing, and most of all, being there for us.
As kids, we had our share of chores that were simply part of our day as our work was never done on a farm. When we turned twelve, we began working for others: babysitting, weeding, barn and house cleaning, berry picking.  I have now done over 52 years of gainful employment – there were times I worked four part-time jobs at once because that was what I could put together to keep things together.
The thought of “retirement” is anathema for me but that time will come for me when I am ready to take it slow. I know I’ve missed out on much of life being a “nose to the grindstone” person.
I wish there had been more times I had taken a few moments to be more like the cows I see meandering, tranquil and unconcerned, in the surrounding green pastures. Part of every day now I pull myself away from the work to be done, the work that is always calling and staring me in the face, and try a different way to redeem my time: to notice, to record, to observe, to appreciate beauty that exists in the midst of chaos and cataclysm and neverending portents of war.
Life isn’t all about non-stop labor, yet we get on with our work because work is about showing up when and where we are needed. Not being cows, we may feel we have no choice in the matter. Just maybe, like cows, we can manage to slow down,  watch what is happening around us, and by chewing our cud, keep contemplating and digesting whatever life feeds us, the sweet and the sour.
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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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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.

 

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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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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