In Great Deeds, Something Abides

In great deeds, something abides. 
On great fields, something stays. 
Forms change and pass; bodies disappear; 
but spirits linger, to consecrate ground for the vision-place of souls. 
And reverent men and women from afar, 
and generations that know us not and that we know not of, 
heart-drawn to see where and by whom
great things were suffered and done for them, 
shall come to this deathless field, 
to ponder and dream; 

and lo! the shadow of a mighty presence shall wrap them in its bosom, 
and the power of the vision pass into their souls.
 
This is the great reward of service. 
To live, far out and on, in the life of others;
this is the mystery of the Christ,

–to give life’s best for such high sake
that it shall be found again unto life eternal.

~Major-General Joshua Chamberlain at Gettysburg, Pennsylvania 1889

Riley Howell and Kendrick Castillo were just regular high school students only a week ago – preparing for the end of the school year and for their long lives ahead of them.

Now their families and friends grieve their loss in the wake of more school shootings.

These two young men are now wrapped in the bosom of God forever; they gave their all and gave their best < themselves > to protect others when it was the right and brave thing to do. We can only stand in awe and reverence, heart-drawn at this act, in gratitude for their sacrifice.

Courage is not acting fearlessly. It is acting in spite of fear, knowing it may cost you everything.

May there never be another reason for someone to have to throw themselves at a shooter to stop the bullets. May evil intentions be crushed before they can ever be realized. May the selfless acts of brave souls abide in our hearts so we too will do the right thing to make sure this never happens again.

Why I’m Running Late

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It may not be rabbit season or duck season but it definitely seems to be doctor season.  Physicians are lined up squarely in the gun sights of the media,  government agencies and legislators, our health care industry employers and coworkers, not to mention our own dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim.   It’s not enough any more to wear a bullet proof white coat.  It’s driving doctors to hang up their stethoscope just to get out of the line of fire. Depending on who is expressing an opinion, doctors are seen as overcompensated, demanding, whiny, too uncommitted, too overcommitted, uncaring, egotistical, close minded,  inflexible, and especially– perpetually late.

One of the most frequent complaints expressed about doctors is their lack of sensitivity to the demands of their patients’ schedule.  Doctors do run late and patients wait.  And wait.  And wait some more.  Patients get angry while waiting and this is reflected in patient (dis)satisfaction surveys which are becoming one of the tools the industry uses to judge the quality of a physician’s work and character.

I admit I’m one of those late doctors.  Perpetually 20-30 minutes behind.

I don’t share the reasons why I’m late with my patients as we sit down together in the exam room but I do apologize for my tardiness.  Taking time to explain why takes time away from the task at hand: taking care of the person sitting or lying in front of me.   At that moment, that is the most important person in the world to me.  More important than the six waiting to see me, more important than the dozens of emails, electronic portal messages and calls waiting to be returned, more important than the fact I missed lunch or need to go to the bathroom, more important even than the text message of concern from my daughter or the worry I have about a ill relative.

I’m a salaried doctor, just like more and more of my primary care colleagues these days, providing more patient care with fewer resources.  I don’t earn more by seeing more patients.  There is a work load that I’m expected to carry and my day doesn’t end until that work is done.  Some days are typically a four patient an hour schedule, but most days my colleagues and I must work in extra patients triaged to us by careful nurse screeners, and there are only so many minutes that can be squeezed out of an hour so patients end up feeling the pinch.  I really want to try to go over the list of concerns some patients bring in so they don’t need to return to clinic for another appointment, and I really do try to deal with the inevitable “oh, by the way” question when my hand is on the door knob. Anytime that happens, I run later in my schedule, but I see it as my mission to provide essential caring for the “most important person in the world” at that moment.

The patient who is angry about waiting for me to arrive in the exam room can’t know that three patients before them I saw a woman who found out that her upset stomach was caused by an unplanned and unwanted pregnancy.   Perhaps they might be more understanding if they knew that an earlier patient came in with severe self injury so deep it required repair.   Or the woman with a week of cough and new rib pain with a deep breath that could be a simple viral infection, but is showing potential signs of a pulmonary embolism caused by oral contraceptives.  Or the man with blood on the toilet paper after a bowel movement finding out he has sexually transmitted anal warts when he’s never disclosed he has sex with other men,  or the woman with bloating whose examination reveals an ominous ovarian mass, or finding incidental needle tracks on arms during an evaluation for itchiness, which leads to suspected undiagnosed chronic hepatitis.

Doctors running late are not being inconsiderate, selfish or insensitive to their patients’ needs.  Quite the opposite.  We strive to make our patients feel respected, listened to and cared for.  Most days it is a challenge to do that well and stay on time.  For those who say we are being greedy, so we need to see fewer patients, I respond that health care reform and salaried employment demands we see more patients in less time, not fewer patients in more time.  The waiting will only get longer as more doctors hang up their stethoscopes rather than become a target of anger and resentment as every day becomes “doctor season.”  Patients need to bring a book, bring knitting, schedule for the first appointment of the day.  They also need to bring along a dose of charitable grace when they see how crowded the waiting room is.  It might help to know you are not alone in your worry and misery.

But your doctor is very alone, scrambling to do the very best healing he or she can in the time available.

I’m not yet hanging my stethoscope up though some days I’m so weary by the end, I’m not sure my brain between the ear buds is still functioning.  I don’t wear a bullet proof white coat since I refuse to be defensive.  If it really is doctor season, I’ll just continue on apologizing as I walk into each exam room, my focus directed for that moment to the needs of the “most important person in the whole world.”

And that human being deserves every minute I can give them.

 

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The Doctor’s Waiting Room Vladimir Makovsky 1870

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.

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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As the Light Went Out

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The second before the sun went out we saw a wall of dark shadow come speeding at us. We no sooner saw it than it was upon us, like thunder. It roared up the valley. It slammed our hill and knocked us out. It was the monstrous swift shadow cone of the moon. I have since read that this wave of shadow moves 1,800 miles an hour. Language can give no sense of this sort of speed—1,800 miles an hour. It was 195 miles wide. No end was in sight—you saw only the edge. It rolled at you across the land at 1,800 miles an hour, hauling darkness like plague behind it. Seeing it, and knowing it was coming straight for you, was like feeling a slug of anesthetic shoot up your arm. If you think very fast, you may have time to think, “Soon it will hit my brain.” You can feel the deadness race up your arm; you can feel the appalling, inhuman speed of your own blood. We saw the wall of shadow coming, and screamed before it hit.

This was the universe about which we have read so much and never before felt: the universe as a clockwork of loose spheres flung at stupefying, unauthorized speeds. How could anything moving so fast not crash, not veer from its orbit amok like a car out of control on a turn?

Less than two minutes later, when the sun emerged, the trailing edge of the shadow cone sped away. It coursed down our hill and raced eastward over the plain, faster than the eye could believe; it swept over the plain and dropped over the planet’s rim in a twinkling. It had clobbered us, and now it roared away. We blinked in the light. It was as though an enormous, loping god in the sky had reached down and slapped the Earth’s face.

When the sun appeared as a blinding bead on the ring’s side, the eclipse was over. The black lens cover appeared again, back-lighted, and slid away. At once the yellow light made the sky blue again; the black lid dissolved and vanished. The real world began there. I remember now: We all hurried away.

We never looked back. It was a general vamoose … but enough is enough. One turns at last even from glory itself with a sigh of relief. From the depths of mystery, and even from the heights of splendor, we bounce back and hurry for the latitudes of home.
~Annie Dillard from her essay  “Total Eclipse” in The Atlantic about the February 1979 eclipse in Washington State

 

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In February 1979, I was working as a medical student on an inpatient psychiatric unit in a large hospital in Seattle, less than a hundred miles from the band of total eclipse Annie Dillard describes above happening just to the south.

Our clinical team tried to prepare our mostly psychotic and paranoid schizophrenic patients for what was about to happen outside that morning.

Our patients were clearly more anxious than usual, pacing and wringing their hands as the light outside slowly faded, with high noon transformed gradually to an oddly shadowy dusk. The street lights turned on automatically and cars moved about with headlights shining.

We all stood at the windows in the hospital perched high on a hill, watching the city become dark as night in the middle of the day. Our unstable patients were sure the world was ending and certain they had caused it to happen.  Extra doses of medication were dispensed as needed while the light faded away and then slowly returned to the streets outside. Within an hour the sunlight was fully back, and most of the patients were napping soundly.

We all breathed a sigh of relief, having witnessed such glory from the heavens, acknowledging we did not cause it but a power far greater did.  The eclipse swept, with its racing shadow followed by restoration of light, the edge of our sanity to accept that our light can indeed be taken away.  For some, they live their whole lives consumed by shadow.

Miraculously, the Light has been returned to us.  We may not be able to look if in the Face —  too blinding — but we need never dwell in darkness again.

 

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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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Another Day

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Here dies another day
During which I have had eyes, ears, hands
And the great world round me;
And with tomorrow begins another.
Why am I allowed two?
~G.K. Chesterton

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Even on a Saturday,
usually catch-up on
everything I didn’t get done at work this week,
or cleaning house or barn at home,
instead today is spent
in state-mandated training
on suicide assessment and care.

Even though twenty times every day
I ask someone:
can tell me about your thoughts about ending your life?

Even so~~
there is more to learn
and to teach others.

I’ve been allowed
another day
to do my best
to be present
and maybe as this day dies
there will come
another
when I can help someone
choose to live another day.

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