This Doctor is Open For Business

yinandyang

 

pinksunset52019

 

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

 

pinksunset520181

 

ticklethemoon

 

scar

 

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.

 

bleedingheartsclose

 

rosedepth

 

 

We Will Weep and Know Why

septleaves4

 

sunset10117

~to a young child~

Márgarét, áre you gríeving
Over Goldengrove unleaving?
Leáves like the things of man, you
With your fresh thoughts care for, can you?
Ah! ás the heart grows older
It will come to such sights colder
By and by, nor spare a sigh
Though worlds of wanwood leafmeal lie;
And yet you wíll weep and know why.
Now no matter, child, the name:
Sórrow’s spríngs áre the same.
Nor mouth had, no nor mind, expressed
What heart heard of, ghost guessed:
It ís the blight man was born for,
It is Margaret you mourn for.
~Gerard Manley Hopkins “Spring and Fall”
septleaves
This morning we weep and know why.
It is not simply the sorrowful loss
of the perfection of spring and childhood
giving way to the dying of the fall,
the last gasp coloring of leaves and skies.It is the loss of innocence, of sense of reverence for life,
this blight man was born for,
this bleeding out for no reason.

What must drive one man’s selfish rage, loneliness and despair to compel him to deprive innocent others of their blood and life?

What unexplained evil overtakes one heart that he seeks to stop the beating hearts of others before his own is stopped?


When will there ever be safe havens again in society?
Not schools, not churches, not hospitals, not concerts, not any place people gather.

This is a day for lament, for tears, and for prayers to God that we cry out and bleed out the spiritual sickness that is infecting us all.
madronajoint
moonrise10117
sunsetbarnlight

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

 

 

Dusted

dustybee

beeweed

 

“Bees do have a smell, you know,
and if they don’t they should,
for their feet are dusted with spices from a million flowers.”

― Ray Bradbury, Dandelion Wine

 

beeblu

bee

 

I admire the honey bee as pollinator and pollen gatherer simultaneously, facilitating new fruit from the blossom as well as taking away that which will become sweet honey tasting of the spicy essence of the flower touched.

As a physician, I can only hope to be as transformative in the work I do every day.  I carry with me tens of thousands of patients I’ve seen over thirty five years of medical practice.  There is no way I can touch another human being without keeping some small part of them with me – perhaps a memory of an open wound or the residual scar it left behind, a word of sorrow or gratitude, a grimace, a tear or a smile.

Each patient is a flower visited, some still in bud, some in full bloom, some seed pods ready to burst, some spent and wilting and ready to fall away.  Each patient carries a spicy vitality, even in their illness and dying, that is unforgettable and still clings to me. Each patient changes me, the doctor, readying me for the next patient by teaching me a gentler approach, a clearer explanation, a slower leave-taking.  Each patient becomes part of my story, adding to my skill as a healer, and is never to be forgotten.

It has been my privilege to be thoroughly dusted by those I’ve loved and cared for.  I want to carry that on to create something wonderful that reflects the spice of living.

Nothing could smell or taste as sweet.

 

beechestnut

cornbee

beebye

wwubusybees

Music Against the Hard Edges

galena

 

waterfalljasper1

 

In all the woods that day I was
the only living thing
fretful, exhausted, or unsure.
Giant fir and spruce and cedar trees
that had stood their ground
three hundred years
stretched in sunlight calmly
unimpressed by whatever
it was that held me
hunched and tense above the stream,
biting my nails, calculating all
my impossibilities.
Nor did the water pause
to reflect or enter into
my considerations.
It found its way
over and around a crowd
of rocks in easy flourishes,
in laughing evasions and
shifts in direction.
Nothing could slow it down for long.
It even made a little song
out of all the things
that got in its way,
a music against the hard edges
of whatever might interrupt its going.
~John Brehm “Passage”

 

waterfall

 

It may be that when we no longer know what to do
we have come to our real work,

and that when we no longer know which way to go
we have come to our real journey.

The mind that is not baffled is not employed.

The impeded stream is the one that sings.
~Wendell Berry “The Real Work”

 

mejierwaterfall

 

Who among us knows with certainty each morning
what we are meant to do that day
or where we are to go?
Or do we make our best guess by
putting one foot ahead of the other
until the day is done and it is time to rest.

For me, I wake baffled each day
that I am allowed
to eavesdrop on heartbeats,
touch tender bellies,
sew up broken skin,
listen to tearful stories
of those no longer wish to live
and those who never want to let go of life.

I wake humbled with commitment
to keep going even when too tired,
to offer care even when rejected.
to keep trying even if impeded.

It is only then I learn that
daily obstacles slow
but cannot stop
the offer of help,
the gift of caring,
the flow of time given freely
which overflows its banks with
uncertain certainty:
my real work and journey
through life.

May I wade in deep~
listening~
ready to raise my voice
for those who hurt
and sing along.

 

poliswaterfall2

The Mere Exception

broken

We should always endeavour to wonder at the permanent thing, not at the mere exception. We should be startled by the sun, and not by the eclipse. We should wonder less at the earthquake, and wonder more about the earth.
~ G.K. Chesterton

centralred

As a physician, I’m trained to notice the exceptions – the human body equivalent of
an eclipse or an earthquake,
a wildfire or drought,
a hurricane or flood,
or a simple pothole.

Ordinarily I’m not particularly attentive to everything that is going well with the human body, instead concentrating on what is aberrant, out of control or could be made better.

This is unfortunate; there is much beauty and amazing design to behold in every person I meet, especially those with chronic illness who feel nothing is as it should be and feel despair and frustration at how their mind or body is aging, failing and faltering.

To counter this tendency to just find what’s wrong and needs fixing, I’ve learned over the years to talk out loud as I do physical assessments:
you have no concerning skin lesions,
your eardrums look just as they should,
your eyes react normally,
your tonsils look fine,
your thyroid feels smooth,
your lymph nodes are tiny,
your lungs are clear,
your heart sounds are perfect,
your belly exam is reassuring,
your reflexes are symmetrical,
your emotional response to this stress and your tears are completely understandable.

I also write messages meant to reassure:
your labs are in a typical range
or are getting better
or at least maintaining,
your xray shows no concerns,
or isn’t getting worse,
those medication side effects are to be expected and could go away.

I acknowledge what is working well before attempting to intervene in what is not.

I’m not sure how much difference it makes to my patient.
But it makes a difference to me to wonder first at who this whole patient is before I focus in on what is broken and what is causing such dis-ease.

I just might be astonished.

fungaltree

lundetree

 

The Scars of Living and Dying

springboardtrunk

woods29

Scars come in various sizes and shapes, some hidden, some quite obvious to all.  How they are inflicted also varies–some accidental, others therapeutic, and too many intentional.  The most insidious are the ones so deep inside,  no one can see or know they are there.

Back in our woodlot stands a sawed off stump of a cedar that was old growth in virgin forest over a hundred years ago.  One day the clearcut loggers came through our part of this rural county and took every tree they could to haul to the local sawmills to become beams and lumber for the growing homesteading population in the region.  This cedar once was grand and vast, covering an immense part of the forest floor, providing protection to trillium at its feet and finches’ nests and raptors hunting in its branches.   It nurtured its environment until other plans were made, and one day, axes fell on its sides to cut out the notches for the springboards where two loggers stood to man the saw which brought the tree down.  Where the wood went is anyone’s guess.  It could be one of the mighty beams supporting our old hay barn roof or it could have become the foundation flooring of a nearby one room school house.  It surely had a productive and meaningful life as part of a structure somewhere until rot or carpenter ants or fire brought it once again to its knees.

But the stump remains, a tombstone of remembrance of a once grand tree, the notch scars embedded deep in its sides, nursing new seedlings from its center and moss, lichen and ferns from its sides.

I come from logger stock so I don’t begrudge these frontier settlers their hard scrabble living, nor minimize their dangerous work in order to feed themselves and their families.  It’s just I’m struck by those scars even one hundred years later — such a visible reminder of what once was a vital living organism toppled for someone’s need and convenience.

Trees are not unique.  It happens to people too.  Everyday scars are inflicted for reasons hard to justify.  Too often I see them self-inflicted in an effort to feel something other than despair.  Sometimes they are inflicted by others out of fear or need for control.

Sometimes they are simply the scars of living, wounds accumulated along the pathway we tread, often to letting in Light where there was none before.

None of them are as deep and wide as the scars that were accepted on our behalf, nor as wondrous as the love that oozed from them, nor as amazing as the grace that abounds to this day because of the promise spelled out by them.  These are scars from the Word made Flesh.

As a result, that Tree lives.

 

woods14

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loggers standing on springboards wedged into a large fir (courtesy of Campbell River Museum, British Columbia)