Never and Always At Home

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It is merely
a question of continuous
adjustment, of improvising a life. When I’m far from friends
or the easing of a wind
against my back, I think of lichen—
never and always true to its essence,
never and always at home.
~John McCullough from “Lichen”

 

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We are lichens on a grand scale.
~David Haskell

 

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Closer, with the glass, a city of cups!

Why are they doing this?

In this big sky and all around me peaks &
the melting glaciers, why am I made to
kneel and peer at Tiny?
~Lew Welch from “Springtime in the Rockies, Lichen”
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The lichen raised its fragile cup,
and rain filled it, and in the drop
the sky glittered, holding back the wind.

The lichen raised its fragile cup:
Now let’s toast the richness of our lives.
~Helvi Juvonen  “Lichen Cup”

 

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I’ve lived in the Pacific Northwest for most of 63 years, and on this farm for 24 years.  The grandeur of the snow-capped mountains to the east and the peaceful shore to the west overwhelms everything in between.  I’ve walked past these bare antique apple trees autumn after autumn, but had never stopped to really look at the landscape growing on their shoulders and arms.  There is a whole other ecosystem on each tree, a fairy land of earth bound seaweed, luxuriant in the fall rains, dried and hidden behind leaves and fruit in the hot summer.

This is the world of lichen, a mixed up cross between mold and fungus, opportunistic enough to thrive on rock faces, but ecstatic on absorbent bark.

I had never really noticed how proudly diverse they are.  I had walked right by their rich color and texture.

Yet it hasn’t bothered them not to be noticed as they are busy minding their own business.  As John McCullough says,  they thrive happily where they find themselves “never and always true to their essence, never and always at home.”

 

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But what is life to a lichen?
Yet its impulse to exist,
to be,
is every bit as strong as ours —
arguably even stronger.
If I were told that I had to spend decades
being a furry growth on a rock in the woods,
I believe I would lose the will to go on.

~Bill Bryson

 

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Be Obscure Clearly

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A wind has blown the rain away
and blown the sky away
and all the leaves away,
and the trees stand.
I think, I too,
have known autumn too long.
~e.e. cummings

 

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Be obscure clearly.
~E. B. White

 

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As a family doctor in the autumn of a forty year career, I work at clarifying obscurity about the human condition daily, dependent on my patients to communicate the information I need to make a sound diagnosis and treatment recommendation.  That is hard work for my patients, especially when they are depressed and anxious on top of whatever they are experiencing physically.

There is still much unknown and difficult to understand about psychology, physiology and anatomy.  Then throw in a disease process or two or three to complicate what appears to be “normal”, and further consider the side effects and complications of various treatments — even evidence-based decision making isn’t equipped to reflect perfectly the best and only solution to a problem.  Sometimes the solution is very muddy, not pristine and clear.

Let’s face the lack of facts.  A physician’s clinical work is obscure even on the best of days when everything goes well.  We hope our patients can communicate their concerns as clearly as possible, reflecting accurately what is happening with their health.  In a typical clinic day we see things we’ve never seen before, must expect the unexpected, learn things we never thought we’d need to know, attempt to make the better choice between competing treatment alternatives, unlearn things we thought were gospel truth but have just been disproved by the latest double blind controlled study which may later be reversed by a newer study.   Our footing is quicksand much of the time even though our patients trust we are giving them rock-solid advice based on a foundation of truth learned over years of education and training.   Add in medical decision-making that is driven by cultural, political or financial outcomes rather than what works best for the individual, and our clinical clarity becomes even further obscured.

Forty years of doctoring in the midst of the mystery of medicine: learning, unlearning, listening, discerning, explaining, guessing, hoping,  along with a little silent praying — has taught me the humility that any good clinician must have when making decisions with and about patients.  What works well for one patient may not be at all appropriate for another despite what the evidence says or what an insurance company or the government is willing to pay for.  Each person we work with deserves the clarity of a fresh look and perspective, to be “known” and understood for their unique circumstances rather than treated by cook-book algorithm.  The complex reality of health care reform may dictate something quite different.

The future of medicine is dependent on finding clarifying solutions to help unmuddy the health care decisions our patients face. We have entered a time of information technology that is unparalleled in bringing improved communication between clinicians and patients because of more easily shared electronic records.  The pitfall of not knowing what work up was previously done can be a thing of the past.  The risk and cost of redundant procedures can be avoided.  The time has come for the patient to share responsibility for maintenance of their medical records and assist the diagnostic process by providing online symptom and outcomes follow up documentation.

The benefit of this shared record is not that all the muddiness in medicine is eliminated, but that an enhanced transparent partnership between clinician and patient develops,  reflecting a relationship able to transcend the unknowns.

So we can be obscure with clarity.  Our lives depend on it.

 

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This Restless Heart

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The stripped and shapely
Maple grieves
The ghosts of her
Departed leaves.
The ground is hard,
As hard as stone.
The year is old,
The birds are flown.
And yet the world,
In its distress,
Displays a certain
Loveliness.
~John Updike from “A Child’s Calendar”
 
 
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Yea, I have looked, and seen November there;
The changeless seal of change it seemed to be,
Fair death of things that, living once, were fair;
Bright sign of loneliness too great for me,
Strange image of the dread eternity,
In whose void patience how can these have part,
These outstretched feverish hands, this restless heart?
~William Morris, “November”
 
 

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Even as worn and wrinkly I feel these days,
I know there still is beauty hidden within
as I look into your eyes that remember,
your eyes that saw me young
once so smooth and fresh and soft,
in yielding to fit you before we fall
together, beautifully in bloom.

 

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Not Burdock’s Blame But Mine

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A Burdock — clawed my Gown —
Not Burdock’s — blame —
But mine —
Who went too near
The Burdock’s Den —
~Emily Dickinson

 

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One day in 1948, an amateur Swiss mountaineer and naturalist, George de Mestral, went on a nature walk with his dog through a field of hitchhiking bur plants. He and his dog returned home covered with burs. With an intense curiosity, Mestral went to his microscope and inspected one of the many burs stuck to his pants. He saw numerous small hooks that enabled the seed-bearing bur to cling so tenaciously to the tiny loops in the fabric of his pants. George de Mestral raised his head from the microscope and smiled thinking, “I will design a unique, two-sided fastener, one side with stiff hooks like the burs and the other side with soft loops like the fabric of my pants. I will call my invention Velcro® a combination of the words velour and crochet. It will rival the zipper in it’s ability to fasten.”
From: The Mining Company (Feature 09/12/97)

 

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One moment you were just fine running ahead to the barn as I walked leisurely down hill to my chores – then I find you panting and miserable, immobilized on the ground, unable to get up or walk.

What could have happened to you in only a few short minutes?

I bent down expecting to discover the worst: I check your back and neck, your joints, your head for injuries. Instead I discover one front and one back leg glued to your body bound as if tied fast —  by dozens of sticky burdock.  You had taken a short cut through the weeds and the hooky plants hitchhiked onto your long flowing hair.  The more you moved the more bound up your fur became until you had painful prickle masses poking your armpit and groin.

You were only doing your farm dog duties and the burdock seeds were doing what they do: velcroing on to you to be carried to another place to germinate and make more prickles balls.

It took fifteen minutes of you lying upside down, with a barn cat warming herself on your chest to do scissor surgery to your fur to free you of the torture.   No longer immobilized, you ran free with your favorite cat in hot pursuit, and I noticed you gave wide berth to the burdock patch in the weeds.

Perhaps we all might be so quickly freed from our prickly immobilizing burdens when we wander too far into the weeds of life.

If only a mere hair cut could trim away all the troubles with which we are afflicted.

I know, in fact, our Rescuer is near at hand and I’m suspect when He needs to,  He wears muck boots.

 

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A Necklace of Days

 

 

It is a dark fall day.
The earth is slightly damp with rain.
I hear a jay.
The cry is blue.
I have found you in the story again.
Is there another word for “divine”?
I need a song that will keep sky open in my mind.
If I think behind me, I might break.
If I think forward, I lose now. 
Forever will be a day like this
Strung perfectly on the necklace of days.
Slightly overcast
Yellow leaves
Your jacket hanging in the hallway
Next to mine.
~Joy Harjo “Fall Song”

 

bluejay photo by Josh Scholten

 

 

In the string of fall days,
each differs from the one before
and the one that comes after,
a transitional linkage to winter
at once gradual and unrelenting.
If I were to try to stop time,
hold tight a particular moment,
this necklace of days would break and scatter,
as the connection depends
on what was before
what is now
and what is to come.

 

 

An Everyday Epiphany

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“Gratitude bestows reverence, allowing us to encounter everyday epiphanies,
those transcendent moments of awe that change forever how we experience life and the world.”
~ John Milton

 

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Our farm looked like it had a remodel update this past week by the winds and rain, covering the yard with a yellow brown shag carpet of leaves thicker than ever I remember in our two 25 years here.   This transformation is temporary until the leaves start to rot under the burden of endless days of wintry drizzle and freezing weather, but transcendent over plain green sod nevertheless.

I need to remind myself that only 8 months ago, none of these leaves even existed.  They were mere potential in bud form, about to burst and grow in a silent awesome explosion of green and chlorophyll.   After their brief tenure as shade and protection and fuel factory for their tree, last week they rained to the ground in torrents, letting go of the only security they had known.

Now they are compost, returning to the soil to feed the roots of the trees that gave them life to begin with.

Transcendent death.

 

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I Keep Looking Within

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Dawn comes later and later now,
and I, who only a month ago
could sit with coffee every morning
watching the light walk down the hill
to the edge of the pond and place
a doe there, shyly drinking,

then see the light step out upon
the water, sowing reflections
to either side — a garden
of trees that grew as if by magic —
now see no more than my face,
mirrored by darkness, pale and odd,

startled by time. While I slept,
night in its thick winder jacket
bridled the doe with a twist
of wet leaves and led her away,
then brought its black horse with harness
that creaked like a cricket, and turned

the water garden under. I woke,
and at the waiting window found
the curtains open to my open face;
beyond me, darkness. And I,
who only wished to keep looking out,
must now keep looking in.
~Ted Kooser “A Letter in October”

 

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God knows I miss the light
these autumn mornings,
especially when a storm blows
wet and wild in the dark
beyond the window pane.
I can only see myself
peering into the darkness;
I want to look beyond me.

God knows I need the light.

 

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