Suds in the Sink

She rarely made us do it—we’d clear the table instead—
so my sister and I teased that some day
we’d train our children right and not end up like her,
after every meal stuck with red knuckles,
a bleached rag to wipe and wring.
The one chore she spared us:
gummy plates in water greasy
and swirling with sloughed peas,
globs of egg and gravy.                               
Or did she guard her place at the window?
Not wanting to give up the gloss of the magnolia,
the school traffic humming.
Sunset, finches at the feeder.
First sightings
of the mail truck at the curb, just after noon,
delivering a note, a card, the least bit of news.
~Susan Meyers “Mother, Washing Dishes”

My thoughts went round and round and it occurred to me that if I ever wrote a novel it would be of the ‘stream of consciousness’ type and deal with an hour in the life of a woman at the sink.

….I had to admit that nobody had compelled me to wash these dishes or to tidy this kitchen. It was the fussy spinster in me, the Martha who could not comfortably sit and make conversation when she knew that yesterday’s unwashed dishes were still in the sink.
~Barbara Pym from Excellent Women

Even the mundane task of washing dishes by hand is an example of the small tasks and personal activities that once filled people’s daily lives with a sense of achievement.
~B.F. Skinner, behavioral psychologist

I trace the faltering American family to the invention of the automatic dishwasher.

What ever has happened to the human dishwasher with two hands full of wash cloth and scrubber, alongside a dish dryer armed with a towel?

Where is the list on the refrigerator of whose turn is next, and the accountability if a family member somehow shirks their washing/drying responsibility and leaves the dishes to the next day?

No longer do family members have to cooperate to scrub clean glasses, dishes and utensils, put them in the dish rack, dry them one by one and place them in the cupboard where they belong. If the washer isn’t doing a proper job, the dryer immediately takes note and recycles the dirty dish right back to the sink. Instant accountability. I always preferred to be the dryer. If I washed, and my sister dried, we’d never get done. She would keep recycling the dishes back for another going-over. My messy nature exposed.

The family conversations started over a meal often continue over the clean-up process while concentrating on whether a smudge is permanent or not. I learned some important facts of life while washing and drying dishes that I might not have learned otherwise. Sensitive topics tend to be easier to discuss when elbow deep in soap suds. Spelling and vocabulary and math fact drills are more effective when the penalty for a missed word is a snap on the butt with a dish towel.

Modern society is missing the best opportunity for three times a day family-together time. Forget family “game” night, or parental “date” night, or even vacations. Dish washing and drying at the sink takes care of all those times when families need to be communicating and cooperating.

It is time to treat the automatic dishwasher as simply another storage cupboard and instead pull out the brillo pads, the white cotton dishtowels and the plastic dishrack.

Let’s start tonight.

And I think it is your turn first…

Finding Out Who the Patient Is

Portrait by Norman Rockwell

If you want to identify me, 
ask me not where I live, 
or what I like to eat, 
or how I comb my hair, 
but ask me what I am living for, 
in detail, 
ask me what I think is keeping me 
from living fully 
for the thing I want to live for. 
~ Thomas Merton from My Argument with the Gestapo

As a patient waiting to see my health care provider,  I would adapt Merton’s template of personal revelation this way:

If you want to know who I am,
ask me not about my insurance plan,
or what is my current address,
or whether I have a POLST on file,
or whether I have signed the Notice of Privacy Practice,
or whether I’ll accept a message on my phone —
but ask me what I am most concerned about,
in detail,
ask me what I think is causing my symptoms
and what I think is keeping me
from eating healthy, exercising regularly,
and choosing moderation in all things
so that I can live fully
for the thing I want to live for.

As a physician in the midst of a busy clinic day, I struggle to know who my patients are beyond their standard medical history and demographics.  One of my goals in our primary care clinic, now sixteen years into electronic medical record (EMR) use,  is to create a way for our patients to provide their personal history online to us via their password secured web portal.   These are the questions our clinic staff may not have opportunity to ask or record during clinic visits.  Having the patient personally document their social history and background for us to have in the chart –in essence, telling us their story in their own words–can be very helpful diagnostically and for individualizing the best treatment approach for each unique individual.

There needs to be an “About me” section in the EMR that would contain biographical and personal history information the patient could provide online via writing or video.

Tell us about yourself

This is your own personal history in your own words to be added to your electronic medical record in the folder “About Me”. You can edit and add information at any time via this secure patient portal to update it.

We want to know your story.  Only you can tell us what you think is most important for us as your health care providers to know about you.  We may not always have the time to ask and document these detailed questions in a brief clinic visit, so we are asking for your help.  

Why do we want to know your non-medical background as well as medical background?

We evaluate a patient’s symptoms of concern but we also are dedicated to helping our patients stay healthy life long.  To assist us in this effort, it is very helpful to know as much about you as possible, in addition to your past medical history.   It is crucial also to understand your family background and social history.  We want to know more about your personal goals, and what you think may be preventing you right now from living fully for the things you consider most important to you. 

This is your opportunity to tell us about yourself, with suggested questions below that you can consider answering.  This information is treated as a confidential part of your medical record, just like all information contained in your record.  You can add more at any time by returning to this site.

1)      Tell us about your family—who raised you and grew up with you, and who currently lives with you– including your racial/ethnic/cultural heritage. If relevant,  tell us whether you have biological beginnings outside of your family (e.g. adopted, egg donation, surrogate pregnancy, artificial insemination, in vitro fertilization)    Provide information on any illnesses in your biologic family.

2)     List the states or countries you have lived in, and what countries outside the U.S. you have lived in longer than a month.  Have you served in the military or another government entity, like the Peace Corps?

3)      Tell us about your educational and job background. This could include your schooling or training history,  paid or volunteer work you’ve done.  What are your hobbies, how do you spend your leisure time, what are your passions and future goals.  Where do you see yourself in ten years?

4)      Tell us about your sexual orientation and/or gender preference.

5)      Tell us about your current emotional support system—who are you most likely to share with when things are going very well for you and especially when things are not going well.

6)      Tell us about your spiritual background,  whether you are part of a faith or religious community and if so, how it impacts your life.

7)       Tell us what worries you most about your health.

8)      What would you have done differently if you could change things in your life?  What are you most thankful for in your life?

9)      What else do you feel it is important for us to know about you?

Thank you for helping us get to know you better so we can provide medical care that best meets your unique needs.

As our clinic is moving to an updated EMR, I’m interested in hearing feedback from patients and health care providers.  What additional questions would you want asked as part of personal history documentation in a medical record?

Electronic medical records allow us, as never before, the ability to share information securely between patients and their health care providers.
Patients want to tell us their story and we want to know more about them. 

It is time we asked them and truly listen to what they have to say.


The Unblinking Fermata

In science
we have been reading only the notes to a poem:
in Christianity
we find the poem itself.
~C.S. Lewis from Miracles

Science – my life’s work – fails
to love unconditionally,
to grasp the hand of the dying,
to give hope to the weak and afraid,
to become sacrifice for sin,
to offer everlasting forgiveness and grace.

Science is mere end-of-the-day footnote
to the Word extending
beyond the here and now;
an unblinking fermata
within Creation, leading into
His ultimate symphonic Work.


Crossing Paths

Yet knowing how way leads on to way,
I doubted if I should ever come back…
I shall be telling this with a sigh
Somewhere ages and ages hence

~Robert Frost (1916) from “The Road Not Taken”

Two lonely cross-roads that themselves cross each other I have walked several times this winter without meeting or overtaking so much as a single person on foot or on runners. The practically unbroken condition of both for several days after a snow or a blow proves that neither is much travelled. Judge then how surprised I was the other evening as I came down one to see a man, who to my own unfamiliar eyes and in the dusk looked for all the world like myself, coming down the other, his approach to the point where our paths must intersect being so timed that unless one of us pulled up we must inevitably collide. I felt as if I was going to meet my own image in a slanting mirror. Or say I felt as we slowly converged on the same point with the same noiseless yet laborious stride as if we were two images about to float together with the uncrossing of someone’s eyes. I verily expected to take up or absorb this other self and feel the stronger by the addition for the three-mile journey home. But I didn’t go forward to the touch. I stood still in wonderment and let him pass by; and that, too, with the fatal omission of not trying to find out by a comparison of lives and immediate and remote interests what could have brought us by crossing paths to the same point in a wilderness at the same moment of nightfall. Some purpose I doubt not, if we could but have made out. I like a coincidence almost as well as an incongruity.
~Robert Frost (1911) from “Selected Letters”

Way leads on to way:
I am far enough down the road that I don’t recall all the options I have faced over the years of my journey. I know there were times I ran into an impossible sticky thicket, so had to double back and try a different route. Maybe I have learned since to choose more carefully.

I don’t believe in coincidence and I don’t believe our choices are randomly made. I believe I am shepherded in the direction I am meant to go. The issue is whether I listen or whether I bolt the opposite way, come what may.

Some roads need to grow up in weeds.

Grace Disguised

If grace is so wonderful, why do we have such difficulty recognizing and accepting it?

Maybe it’s because grace is not gentle or made-to-order.

It often comes disguised as loss, or failure, or unwelcome change.
For grace to be grace, it must give us things we didn’t know we needed
and take us places where we didn’t know we didn’t want to go.
~Kathleen Norris from Acedia and Me

I’ve been salvaged when I didn’t even know I needed saving.
I’ve been given what I didn’t think I needed so never had asked.
I’ve been taken places I never planned to be when I was sure things were fine right where I was.

Grace is not about giving me what I think I want;
it is not a reward for good behavior. 

It is giving me exactly what I need when I deserve nothing.

It is the thorny landing that catches me when I fall.
It is the tiny drop that spares me in drought.
It is scars formed as proof that healing happens to the deepest wounds.
It is being scattered when I planned to remain whole.

I am grateful, so very grateful, for what I didn’t know.
I am grateful, so very grateful, for grace disguised.

Waving Goodbye

A poem begins as a lump in the throat, a sense of wrong, a homesickness, a lovesickness.
~Robert Frost
in a letter to Louis Untermeyer

Spending time away from home has always been difficult for me. I was hopelessly homesick as a child whenever I stayed overnight with a friend or even with my grandma. Going to college two states away was a complete ordeal – it took me much longer than typical to let go of home and finally settle into a new life away from all that was familiar. I really did feel sick clinging too tightly to home base, unwilling to launch, barely able to wave good-bye.

Even now, as I travel away from the farm for a week for this or that, I sometimes get the lump-in-the-throat feeling that I remember keenly from my childhood years — knowing I am out of my element, stretching my comfort zone, not feeling at home away from home.

Will I ever grow out of this now that I’m in my mid-sixties or will it only get worse? Will I ever embrace a lovesickness for the rest of the world?

I keep trying – but the return trip is still the sweetest remedy for this sickness. There’s no place like home…

To Be Wild and Perfect

This morning the green fists of the peonies are getting ready
to break my heart
as the sun rises, 
as the sun strokes them with his old, buttery fingers

and they open —
pools of lace, 
white and pink —

and all day
under the shifty wind, 
as in a dance to the great wedding,

the flowers bend their bright bodies, 
and tip their fragrance to the air, 
and rise, 
their red stems holding

all that dampness and recklessness 
gladly and lightly, 
and there it is again — 
beauty the brave, the exemplary,

blazing open. 
Do you love this world? 
Do you cherish your humble and silky life? 
Do you adore the green grass, with its terror beneath?

Do you also hurry, half-dressed and barefoot, into the garden, 
and softly, 
and exclaiming of their dearness, 
fill your arms with the white and pink flowers,

with their honeyed heaviness, their lush trembling, 
their eagerness
to be wild and perfect for a moment, before they are
nothing, forever?
~Mary Oliver 
from New And Selected Poems 

It is not about love or sacrifice,
nothing vestal or sacred. The light
comes from an open window,
and perhaps a breeze too that
has caused the white peony to
drop three delicately curved
petals on the red jacquard.
They cast purple shadows. The
eye must seek them out, must
avert itself from the ceaseless
action in the midst of other
objects: a runcible spoon, a
quill, a tankard, two ripe quince.
Athena Kildegaard, “Still Life with Beating Heart” from Ventriloquy

White peonies blooming along the porch
send out light
while the rest of the yard grows dim.
Outrageous flowers as big as human

heads! They’re staggered
by their own luxuriance: I had
to prop them up with stakes and twine.
The moist air intensifies their scent,

and the moon moves around the barn
to find out what it’s coming from.
In the darkening June evening

I draw a blossom near, and bending close
search it as a woman searches
a loved one’s face.
~Jane Kenyon “Peonies at Dusk”

At the end of May, I bring our peonies to the graves
of those from whom I came,
to lay one after another exuberant head
upon each headstone,
a moment of connection between those in the ground
and me standing above, acknowledging its thin space before one more humble and silky life shatters
and becomes nothing,
its petals perfectly
scattered, lush and trembling,
to the wind.