Just Sad

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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.

 

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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

 

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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

 

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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.

 

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Missing the Knock on the Door

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When a great moment knocks on the door of your life,
it is often no louder than the beating of your heart,
and it is very easy to miss it.
~Boris Pasternak

 

 

 

Years ago, a young woman I’d been treating for depression for several weeks in my clinic called unexpectedly on a Friday afternoon and canceled an upcoming appointment for the following Monday and did not reschedule. The receptionist sent me a message as is our policy for patients who “cancel and do not reschedule”. It gave me a bad feeling that she was turning her back on her treatment plan and I was uneasy about the upcoming weekend without knowing what was going on with her.

I could have just put on my coat and headed home at the end of that long Friday after a very stressful work week and even more stressful year. I was discouraged about many aspects of the clinic work load and the after-hours responsibilities only seemed to get heavier.  I was frustrated at how ineffectively I was communicating to administrative supervisors about the need for change.  I was ready to quit and walk away.

Instead I decided to call my patient to find out how she was doing.  She didn’t answer her phone. I mulled over my options, looked up her apartment address and drove the few blocks to get there. As I approached her door, I could hear someone moving around in her apartment, but she ignored my knocks and my voice and when I tried the door, it was locked.

So I stayed right there, talking to her through the door for about 15 minutes, letting her know I wasn’t leaving until she opened up the door. I finally told her she could decide to open the door or I would call 911 and ask the police to come to make sure she was okay. She then unlocked the door, tears streaming down her face. She had been drinking heavily, with liquor bottles strewn around on the floor. She admitted an intent to overdose on aspirin and vodka. The vodka was already consumed but the unopened aspirin bottle was in her hand. I was the last person she expected to see at her door.

Miraculously the mental health unit at the local hospital had an open bed. I told my patient that we could save time and hassle by heading over there together right then and there, and avoid the emergency room mess, and the possibility of an involuntary detainment.

She agreed to come with me and be admitted voluntarily for stabilization. I visited the hospital the next day and she greeted me with a hug and thanked me for not giving up on her when she had given up on herself. In sobriety, her eyes were brighter and she was more hopeful. She never expected anyone to care enough to come knock on her door when she was at her lowest point,  and she struggled to answer, as consumed as she was in her own painfully beating heart.

She was astounded and grateful and frankly, by deciding to do what I knew was necessary and right even though it disregarded every workplace policy, so was I.

Four years later, a small card arrived in my clinic mailbox on another most challenging work day from an unfamiliar address two thousand miles away. The name looked vaguely familiar to me but when I opened and read the contents, this time the knock on the door was to get my attention, to focus the beating of my heart on what was most important – not the stresses of my work place — and it was my turn to let tears flow:

 

“Dear Doctor,

I am not sure if you will remember me considering you see a number of patients daily; however, I am a patient whose life you changed in the most positive way. I never truly THANKED YOU for listening to me and hearing my silent words of grief and hearing my cries for help. If it had not been for you, had you not knocked on my door, I would not be writing this letter to you today. I don’t know exactly what to say to the person who saved me from hurting myself fatally. You were a stranger in my life, but a dear friend in my time of need. THANK YOU, for everything that you did for me. You have a permanent place in my heart, you have given my spirit hope, you have reminded me that a life is worth living. Thank you, thank you, thank you! Sincerely, L_____”

 

I’m grateful 4 years ago I had the sense to go knock on her door when all she could hear was the beating of her own painful heart. I had the stubbornness to stay put until she responded, and most of all, I’m appreciative for her gracious note letting me know it made a difference. When I needed it the most, she made a difference for me that has kept me on the job all these years later.

She knocked, oh so gently, on my door and I opened it, amazed that someone cared, and found me awash in my own tears.

 

 

Not Just Another Day

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“This is another day, O Lord…
If I am to stand up, help me to stand bravely.
If I am to sit still, help me to sit quietly.
If I am to lie low, help me to do it patiently.
And if I am to do nothing, let me do it gallantly.”
— Kathleen Norris citing the Book of Common Prayer

 

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This day is the wrap-up to my twenty-eighth academic year working as a college health physician,  the most demanding so far.  Despite budget challenges, inadequate staffing, a higher severity of illness in a patient population with burgeoning mental health needs,  our staff did an incredible job this year serving students and their families with the resources we do have.   Reaching this day today is poignant: we will miss the graduating students we have gotten to know so well over four or five years,  we watch others leave temporarily for the summer, some to far away places around the globe, and we weep for those who have failed out, given up or fallen away from those who care deeply about them, some never to return to school again.

In my work I strive to do what is needed when it is needed no matter what time of the day or night.  There are obviously times when I fall short– too vehement when I need to be quiet, too urgent and pressured when I need to be patient,  too anxious to do something/anything when it is best to courageously do nothing.  It is very difficult for any doctor to choose to do nothing but I vowed in my own graduation ceremony over forty years ago to “First do no harm.”  And I’ve tried hard to live up to that vow.

In a sense I graduate as well on this last day of the school year– only not with cap and gown and diploma in hand.  Each year I learn enough from each patient to fill volumes, as they speak of their struggles, their pain, their stories and sometimes hearing, most tragically, their forever silence.

I honor our students and their families on this day, sharing the blessings from us who work toward the goal of sending them healthier and better equipped and joyful into the rest of their lives.

It is not just another day.

 

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Supposing It Didn’t

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“Supposing a tree fell down, Pooh, when we were underneath it?”

“Supposing it didn’t,” said Pooh after careful thought.

Piglet was comforted by this.
~A.A. Milne

 

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It is the final week of a very long academic year and tension is running high.

Among those students to whom I provide care,
there are many who dwell deeply in “what if?” mode,
immobilized in their anticipation of impending disaster.

I understand this line of thinking,
particularly in this day and age of
“in the moment” tragedy
played out real-time in the palm of our hand
and we can’t help but watch as it unfolds.

Those who know me well
know I can fret and worry
better than most.
Medical training only makes it worse.
It teaches one to think catastrophically.
That is what I do for a living,
to always be ready for the worse case scenario.

When I rise, sleepless,
to face a day of uncertainty
as we all must do at times~
after careful thought,
I reach for the certainty I am promised
over the uncertainty I can only imagine:

What is my only comfort in life and in death?
That I am not my own, but belong
—body and soul, in life and in death—
to my faithful Savior, Jesus Christ.

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“Supposing it didn’t” — He says to reassure us.

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Fully Sufficient

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There are a thousand thousand reasons to live this life, every one of them sufficient.
Marilynne Robinson in Gilead

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There are a thousand thousand people on any given day who cannot think of one sufficient reason to live this life.
There are a few thousand who will decide this is their last day.
There are a few who say goodbye.

It is enough for me to find just one reason to live today.
It is enough for me to help someone else find just one reason today.
One is enough.
Fully sufficient.

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Music Against the Hard Edges

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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”

 

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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”

 

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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.

 

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A Furry, Finned or Feathered Treatment Plan

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Due to changes in Fair Housing Act laws, clinicians are experiencing a significant increase in requests from patients for medical documentation to keep emotional support animals with them in “no-pets policy” rental housing. On a college campus, this leads to far more than just two-legged mammals inhabiting dorm rooms.  There has been an animal explosion on our University campus with over seventy animals of various types approved as an “ESA” in the residence halls and unknown dozens more who live with their owners off campus yet still frequent campus.  Only a small minority of these animals are actually trained and certified as service animals with the right to accompany their owner on public transportation to any public place, including classrooms and eating establishments.  The rest are approved only for housing purposes, yet they are regularly showing up in airplane cabins and grocery stores, dressed in little jackets that are easily purchased along with “certification letters” for big prices on the internet.  ESAs have become part of the campus and community landscape.

As a relatively outdoorsy, green and tolerant northwest University campus, the presence of animals on our campus has yet to seem like a big deal, but as the animal numbers inevitably increase due to 25% of the college student population nationwide currently eligible for an animal due to a mental health diagnosis, it is becoming a big deal as individuals insist on exercising their civil rights along with their dogs.

And it isn’t always dogs.  There are cats, along with the occasional pocketed rat, hamster, guinea pig, flying squirrel, and ferret not to mention emotional support pot bellied pigs, tarantulas, and various types of birds.  And at least one snake.

Yes, a snake.

As a physician farmer concerned with stewardship of the patients I treat and the land and animals I care for, I’m emotionally caught and ethically bound in this treatment trend.  The law compels clinicians to provide the requested documentation to avoid  potential law suits alleging discrimination, yet I’m also concerned for the rights of the animals themselves.   I’ve loved, owned and cared for animals most of my sixty two years and certainly missed my pets during the thirteen years I was in college, medical school, residency and doing inner city work (my tropical fish and goldfish notwithstanding).  I neither had the time, the money, the space nor the inclination to keep an animal on a schedule and in an environment that I myself could barely tolerate, as stressed as I was.   That is not stopping the distressed college student of today from demanding they be able to keep their animals with them in their stress-mess.

As a clinician, I’d much prefer writing fewer pharmaceutical prescriptions and help individuals find non-medicinal ways to address their distress.   I’d like to see my patients develop coping skills to deal with the trouble that comes their way without falling apart, and the resilience to pick themselves up when they have been knocked down and feel broken.   I’d like to see them develop the inner strength that comes with maturity and experience and knowing that “this too will pass.”  I’d like individuals to see themselves as part of a diverse community and not a lone ranger of one, understanding that their actions have a ripple effect on those living, working, eating, riding and studying around them. Perhaps corporate work places, schools and universities should host a collaborative animal center with rotating dogs and cats from the local animal shelter, so those who wish to may have time with animals on their breaks without impacting others who aren’t animal fans, or with potentially life threatening animal dander allergies.

So I find myself reluctantly writing a prescription for a living breathing creature perceived by the law as a “treatment” rather than a profound responsibility that owners must take on for the lifetime of the animal.   With great gravity, I always let my patients know an animal is not disposable like a bottle of pills (or a human therapist) when no longer needed and must have a lifelong commitment from its owner beyond a particular time of high personal stress.

Pardon me now while I go take care of my dogs, my cats, by birds, and my horses and yes, my goldfish.  They are my joy to support for decades and for as long as they need me.

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