Breathing In and Out

What is there beyond knowing that keeps
calling to me?  I can’t
 
turn in any direction
but it’s there.  I don’t mean
 
the leaves’ grip and shine or even the thrush’s
silk song, but the far-off
 
fires, for example,
of the stars, heaven’s slowly turning
 
theater of light, or the wind
playful with its breath;
 
or time that’s always rushing forward,
or standing still
 
in the same — what shall I say —
moment.
What I know
I could put into a pack
 
as if it were bread and cheese, and carry it
on one shoulder,
 
important and honorable, but so small!
While everything else continues, unexplained
 
and unexplainable.
 
….mostly I just stand in the dark field,
in the middle of the world, breathing in and out…
~Mary Oliver from “What is there beyond knowing”
I’m reminded daily about how little I know and understand.  I work with people who are suffering, whose symptoms may fit prescribed diagnostic criteria but yet defy explanation or reason.  They care about what relief I might offer rather than a label that names the illness.
Like so much in medicine, what I witness daily is unexplained and unexplainable.  What I do know I carry with me, small and honorable and shareable.   I offer it up to each patient, one after another:  here is what I think might help.  here is your next step to take.  here is the hope that goes with taking each breath, the next and the next.
Even when standing in the dark, as we all do at times in our life, we just keep breathing.  In and out.  In and out.  We are filled even when empty.

Preparing Through Parable: Knock Like You Mean It

 

 

Then Jesus said to them, “Suppose you have a friend, and you go to him at midnight and say, ‘Friend, lend me three loaves of bread; a friend of mine on a journey has come to me, and I have no food to offer him.’
And suppose the one inside answers, ‘Don’t bother me. The door is already locked, and my children and I are in bed. I can’t get up and give you anything.’ I tell you, even though he will not get up and give you the bread because of friendship, yet because of your shameless audacity he will surely get up and give you as much as you need.
“So I say to you: Ask and it will be given to you; seek and you will find; knock and the door will be opened to you. 10 For everyone who asks receives; the one who seeks finds; and to the one who knocks, the door will be opened.”
Luke 11: 5-10

 

 

 

…we are faced with the shocking reality: 
Jesus stands at the door and knocks, in complete reality. 
He asks you for help in the form of a beggar, 
in the form of a ruined human being in torn clothing. 
He confronts you in every person that you meet. 
Christ walks on the earth as your neighbor as long as there are people. 
He walks on the earth as the one through whom 
God calls you, speaks to you and makes his demands. 
Christ stands at the door. 
Will you keep the door locked or open it to him?
~Dietrich Bonhoeffer from an Advent Sermon “The Coming of Jesus into our Midst”

 

 

Over ten years ago a young woman I’d been seeing for several weeks in my clinic for depression 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 but decided to call my patient. She didn’t answer her phone. I mulled over my options, looked up her apartment address and drove there. As I approached her door, I could hear someone moving around in her apartment, but she didn’t respond to my knocks or my voice.

I decided to stay 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 opened 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.

I called the mental health unit at the local hospital and they had an open bed. I told my patient that we could save time and hassle by heading over 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 went the following day to visit her 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 knocking on her door looking for her, and to stand firm when she was rejecting all approaches. She was astounded and grateful, and frankly, so was I.

Four years later, a small card arrived in my clinic mailbox on a 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 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 so many years ago I had the sense to go knock on her door, 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. Later, on a most difficult day, she made a difference for me.

She kept knocking on my door and I opened it, awash in my own tears.

 

May my eyes see, my ears hear, my heart understand.  He prepares me with parable.

Into Each Life Some Rain Must Fall

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The day is cold, and dark, and dreary;
It rains, and the wind is never weary;
The vine still clings to the mouldering wall,
But at every gust the dead leaves fall,
And the day is dark and dreary.

My life is cold, and dark, and dreary;
It rains, and the wind is never weary;
My thoughts still cling to the mouldering Past,
But the hopes of youth fall thick in the blast,
And the days are dark and dreary.

Be still, sad heart! and cease repining;
Behind the clouds is the sun still shining;
Thy fate is the common fate of all,
Into each life some rain must fall,
Some days must be dark and dreary.
~Henry Wadsworth Longfellow’s “The Rainy Day”

 

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One thing I notice about raindrops
(in a lifetime of paying attention)
~each holds within an inner light carried to earth from the heavens~
from remembered Sun above the clouds.
The Sun is still up there somewhere
and I just was sprinkled with it.
Drenched in fact.

 

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Foggy and Fine Days Within Me

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And so you have a life that you are living only now,
now and now and now,
gone before you can speak of it,
and you must be thankful for living day by day,
moment by moment …
a life in the breath and pulse and living light of the present…

~Wendell Berry from Hannah Coulter

 

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~Lustravit lampade terras~
(He has illumined the world with a lamp)
The weather and my mood have little connection.
I have my foggy and my fine days within me;
my prosperity or misfortune has little to do with the matter.
– Blaise Pascal from “Miscellaneous Writings”

 

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photo by Nate Gibson

 

Is my gloom, after all,
Shade of His hand,
outstretched caressingly?

~Francis Thompson from “The Hound of Heaven”

 

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My days are filled with anxious and sad patients, one after another after another.  They sit at the edge of their seat, struggling to hold back the flood from brimming eyes, fingers gripping the arms of the chair.   Each moment, each breath, each heart beat overwhelmed by questions:  will there be another breath?  must there be another breath?   Must life go on like this in fear of what the next moment will bring?

The only thing more frightening than the unknown is the knowledge that the next moment will be just like the last or perhaps worse.  There is no recognition of a moment just passed that can never be retrieved and relived.   There is only fear of the next and the next so that the now and now and now is lost forever.

Worry and sorrow and angst are contagious as the flu.
I mask up and wash my hands of it throughout the day.
I wish we could be vaccinated to protect us all from these unnamed fears.

I want to say to them and myself:
Stop this moment in time. Stop and stop and stop.
Stop expecting someone or some thing must fix this feeling.
Stop wanting to be numb to all discomfort.
Stop resenting the gift of each breath.
Just stop.
Instead, simply be.

I want to say:
this moment, foggy or fine, is yours alone,
this moment of weeping and sharing
and breath and pulse and light.
Shout for joy in it.
Celebrate it.
Be thankful for tears that can flow over grateful lips
and stop holding them back.

Stop me before I write,
out of my own anxiety,
yet another prescription
you don’t really need.

Just be–
and be blessed–
in the now and now and now.

 

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A Deep Fear of Emptiness

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Wheels of baled hay bask in October sun:
Gold circles strewn across the sloping field,
They seem arranged as if each one
Has found its place; together they appeal
To some glimpsed order in my mind
Preceding my chance pausing here —
A randomness that also seems designed.
Gold circles strewn across the sloping field
Evoke a silence deep as my deep fear
Of emptiness; I feel the scene requires
A listener who can respond with words, yet who
Prolongs the silence that I still desire,
Relieved as clacking crows come flashing through,
Whose blackness shows chance radiance of fire.
Yet stillness in the field remains for everyone:
Wheels of baled hay bask in October sun.
~Robert Pack “Baled Hay” from Rounding it Out: A Cycle of Sonnetelles (1999).

 

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Each day I am called to see and listen,
to open fully to all that is around me.
From the simple stillness of the fields
surrounding our farm,
to the weeping of those who sit with me
day after day
in their deep fear of emptiness,
their struggle with whether to try to live
or give up and die.

Their deep fear of emptiness renders me silent;
I struggle to respond with words
that might offer up a healing balm
assuring them even in the darkest time
hope lies waiting, wrapped and baled,
radiant as fire,
ready to spill out fragrant,
to bear us silently to a new morning,
to a stillness borne of grace.

 

lookingnortheastoct

 

centralroadoct

Just Sad

prairie10

 

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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.