Dusted

dustybee

beeweed

 

“Bees do have a smell, you know,
and if they don’t they should,
for their feet are dusted with spices from a million flowers.”

― Ray Bradbury, Dandelion Wine

 

beeblu

bee

 

I admire the honey bee as pollinator and pollen gatherer simultaneously, facilitating new fruit from the blossom as well as taking away that which will become sweet honey tasting of the spicy essence of the flower touched.

As a physician, I can only hope to be as transformative in the work I do every day.  I carry with me tens of thousands of patients I’ve seen over thirty five years of medical practice.  There is no way I can touch another human being without keeping some small part of them with me – perhaps a memory of an open wound or the residual scar it left behind, a word of sorrow or gratitude, a grimace, a tear or a smile.

Each patient is a flower visited, some still in bud, some in full bloom, some seed pods ready to burst, some spent and wilting and ready to fall away.  Each patient carries a spicy vitality, even in their illness and dying, that is unforgettable and still clings to me. Each patient changes me, the doctor, readying me for the next patient by teaching me a gentler approach, a clearer explanation, a slower leave-taking.  Each patient becomes part of my story, adding to my skill as a healer, and is never to be forgotten.

It has been my privilege to be thoroughly dusted by those I’ve loved and cared for.  I want to carry that on to create something wonderful that reflects the spice of living.

Nothing could smell or taste as sweet.

 

beechestnut

cornbee

beebye

wwubusybees

A Furry, Finned or Feathered Treatment Plan

leafanclub

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.

josekelsy

Be Open for Business

treehousejanuary

rapelje

 

Astonishing material and revelation appear in our lives all the time. Let it be. Unto us, so much is given. We just have to be open for business.
~Anne Lamott from Help Thanks Wow: Three Essential Prayers

 

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same abandoned Montana schoolhouse as above a few years later (this photo by Joel DeWaard)

windowview

 

I have the privilege to work in a profession where astonishment and revelation awaits me behind each exam room door.

In a typical busy clinic day, I open that door 36 times, close it behind me and settle in for the ten or fifteen minutes I’m allocated per patient.  I need to peel through the layers of a person quickly to find the core of truth about who they are and why they’ve come to me.

Sometimes what I’m looking for is right on the surface: in their tears, in their pain, in their fear.  Most of the time, it is buried deep and I need to wade through the rashes and sore throats and coughs and headaches to find it.

Once in awhile, I can actually do something tangible to help right then and there — sew up a cut, lance an abscess, splint a fracture, restore hearing by removing a plug of wax from an ear canal.

Often I find myself giving permission to a patient to be sick — to take time to renew, rest and trust their bodies to know what is best for a time.

Sometimes, I am the coach pushing them to stop living sick — to stop hiding from life’s challenges, to stretch even when it hurts, to get out of bed even when not rested, to quit giving in to symptoms that can be overcome rather than overwhelming.

Always I’m looking for an opening to say something a patient may think about after they leave my clinic — how they can make better choices, how they can be bolder and braver in their self care, how they can intervene in their own lives to prevent illness, how every day is a thread in the larger tapestry of their lifespan.

Each morning I rise early to get work done before I actually arrive at work,  trying to avoid feeling unprepared and inadequate to the volume of tasks heaped upon the day.   I know I may be stretched beyond my capacity, challenged by the unfamiliar and stressed by obstacles thrown in my way.  It is always tempting to go back to bed and hide.

Instead, I go to work as those doors need to be opened and the layers peeled away.  I understand the worry, the fear and the pain because I have lived it too.   I am learning how to let it be, even if it feels miserable.  It is a gift perhaps I can share.

No matter what waits behind the exam room door,  it will be astonishing to me.

I’m grateful to be open for business.  The Doctor is In.

 

brokenbarn

cabincentra

Good to Melt

darkhedgesantique

 

How exactly good it is
to know myself
in the solitude of winter,

my body containing its own
warmth, divided from all
by the cold; and to go

separate and sure
among the trees cleanly
divided, thinking of you

perfect too in your solitude,
your life withdrawn into
your own keeping

–to be clear, poised
in perfect self-suspension
toward you, as though frozen.

And having known fully the
goodness of that, it will be
good also to melt.
~Wendell Berry “The Cold”

frost1411

Man has places in his heart which do not yet exist,
and into them enters suffering,
in order that they may have existence.
~
Leon Bloy

ice321419

I watch new heart chambers form every day
too frozen solid, too overwhelmed
with hurt
and loss
and despair
to continue to pulse warm.
So I try
to help patients let go of
their suffering,
let it thaw to liquid, let the ice melt down,
allow it to pass through freely
forgiving, forgiven~
a heart changed
by winter transformed to spring,
flowing warm from new found grace.

frozenpineneedles

A Calling Out

geese113162

geesev6

A psalm of geese
labours overland

cajoling each other
near half…

The din grew immense.
No need to look up.

All you had to do
was sit in the sound

and put it down
as best you could…

It’s not a lonesome sound
but a panic,

a calling out to the others
to see if they’re there;
~Dermot Healy from A Fool’s Errand

geese913

geese113165

We are here to witness the creation and abet it. We are here to notice each thing so each thing gets noticed. Together we notice not only each mountain shadow and each stone on the beach but, especially, we notice the beautiful faces and complex natures of each other. We are here to bring to consciousness the beauty and power that are around us and to praise the people who are here with us. We witness our generation and our times. We watch the weather. Otherwise, creation would be playing to an empty house.
~Annie Dillard from The Meaning of Life
edited by David Friend

geese1119152

By the time Saturday rolls around, I am overwhelmed by the amount of “noticing” I needed to do in the course of my work that week.  Each patient, and there are so many,  deserves my full attention for the few minutes we are together.  I start my clinical evaluation the minute I walk in the exam room and begin taking in all the complex verbal and non-verbal clues sometimes offered by another human being.

How are they calling out to me?

What someone tells me about what they are feeling may not always match what I notice:  the trembling hands, the pale skin color, the deep sigh, the scars of self injury.  I am their audience and a witness to their struggle; even more, I must understand it in order to best assist them.  My brain must rise to the occasion of taking in another person, offering them the gift of being noticed and being there for them, just them.

This work I do is distinctly a form of praise: the patient is the universe for a few moments and I’m grateful to be watching and listening. When my patient calls out to me, may they never feel they are playing to an empty house.

evening113163

geesesouth

geese11516

Enter a Closing Door

autumnmorning92416

sunrise92416

Enter autumn as you would
a closing door.  Quickly,
cautiously.  Look for something inside
that promises color, but be wary
of its cast–a desolate reflection,
an indelible tint.
~Pamela Steed Hill from “September Pitch”

webs

webs3

The door of summer has closed quickly behind me;
I am back to long days and interrupted evenings,
of worried voices and midnight calls with over-the-phone sobs,
of emergency room referrals and work-them-in schedules.

I want to tell them it’ll be okay, hug away their anguish
despite the encroaching lengthened nights;
that winter coming does not mean
the end of all.
It takes a background of darkness
for the light to shine brightest
Shadows are borne from illumination~
It will be okay, even now, even so.

webs7

weedybaker

webs5

Places in the Heart

frost1411

Man has places in his heart which do not yet exist,
and into them enters suffering,
in order that they may have existence.
~
Leon Bloy

I see these new heart chambers forming every day.
Spaces filling overwhelmed as if water frozen,
with hurt
and loss
and despair.
So I try
to help patients let go of
their suffering,
let it pass, let its ice melt down,
allow it to pass through,
forgiving, forgiven,
their hearts changed
by a grace
flowing warm
from new found gratitude.