Prescribing Good Medicine

 

A good night sleep, or a ten minute bawl, or a pint of chocolate ice cream, or all three together, is good medicine.
~Ray Bradbury

 

 

 

If there is anything I’ve learned in over 40 years of practicing medicine, it’s that I still must “practice” my art every day.  As much as we physicians emphasize the science of what we do, utilizing “evidence based” decisions, there are still days when a fair amount of educated guessing and a gut feeling is based on past experience, along with my best hunch.  Many patients don’t arrive with classic cook book symptoms that fit the standardized diagnostic and treatment algorithms so the nuances of their stories require interpretation, discernment and flexibility.    I appreciate a surprise once in awhile that makes me look at a patient in a new or unexpected way and teaches me something I didn’t know before.   It keeps me coming back for more, to figure out the mystery and dig a little deeper.

I’ve also learned that not all medicine comes in pills or injections.  This isn’t really news to anyone, but our modern society is determined to seek better living through chemistry, the more expensive and newer the better, whether prescribed or not.  Chemicals have their place, but they also can cause havoc.  It is startling to see medication lists topping a dozen different daily pills.  Some are life-saving.  Many are just plain unnecessary.

How many people sleep without the aid of pill or weed or alcohol?  Fewer and fewer.  Poor sleep is one of the sad consequences of our modern age of too much artificial light, too much entertainment and screen time keeping us up late, and not enough physical work to exhaust our bodies enough to match our frazzled and fatigued brains.

How many of us allow ourselves a good cry when we feel it welling up?  It could be a sentimental moment–a song that brings back bittersweet memories, a commercial that touches just the right chord of feeling and connection.  It may be a moment of frustration and anger when nothing seems to go right.  It could be the pain of physical illness or injury or the stress of emotional turmoil.  Or just maybe there is weeping when everything is absolutely perfect and there cannot be another moment just like it, so it is tough to let it go unchristened by tears of joy.

And without a doubt, the healing qualities of chocolate are unquestioned by this doctor, however it may be consumed.  It can fix most everything that ails a person,  at least for an hour or two.

No, it doesn’t take an M.D. degree to know the best medicine.

Just remember: sleep, weep, reap (chocolate!)

 

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.

A World of Wet and Weeping

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My own heart let me more have pity on; let
Me live to my sad self hereafter kind,
Charitable; not live this tormented mind
With this tormented mind tormenting yet.
I cast for comfort I can no more get
By groping round my comfortless, than blind
Eyes in their dark can day or thirst can find
Thirst’s all-in-all in all a world of wet.
~Gerard Manley Hopkins

 

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January 1979
Surfacing to the street from a thirty two hour hospital shift usually means my eyes blink mole-like, adjusting to searing daylight after being too long in darkened windowless halls.  This particular January day is different.   As the doors open, I am immersed in a subdued gray Seattle afternoon, with horizontal rain soaking my scrubs.

Finally remembering where I had parked my car in pre-dawn dark the day before, I start the ignition, putting the windshield wipers on full speed.  I merge onto the freeway, pinching myself to stay awake long enough to reach my apartment and my pillow.

The freeway is a flowing river current of head and tail lights.  Semitrucks toss up tsunami waves cleared briefly by my wipers frantically whacking back and forth.

Just ahead in the lane to my right, a car catches my eye — it looks just like my Dad’s new Buick.  I blink to clear my eyes and my mind, switching lanes to get behind.  The license plate confirms it is indeed my Dad, oddly 100 miles from home in the middle of the week.  I smiled, realizing he and Mom have probably planned to surprise me by taking me out for dinner.

I decide to surprise them first, switching lanes to their left and accelerating up alongside.  As our cars travel side by side in the downpour,  I glance over to my right to see if I can catch my Dad’s eye through streaming side windows.  He is looking away to the right at that moment, obviously in conversation.  It is then I realize something is amiss.  When my Dad looks back at the road, he is smiling in a way I have never seen before.  There are arms wrapped around his neck and shoulder, and a woman’s auburn head is snuggled into his chest.

My mother’s hair is gray.

My initial confusion turns instantly to fury.  Despite the rivers of rain obscuring their view, I desperately want them to see me.  I think about honking,  I think about pulling in front of them so my father would know I have seen and I know.  I think about ramming them with my car so that we’d perish, unrecognizable, in an explosive storm-soaked mangle.

At that moment, my father glances over at me and our eyes meet across the lanes.  His face is a mask of betrayal, bewilderment and then shock. As he tenses, she straightens up and looks at me quizzically.

I can’t bear to look any longer.

I leave them behind, speeding beyond, splashing them with my wake.  Every breath burns my lungs and pierces my heart.  I can not distinguish whether the rivers obscuring my view are from my eyes or my windshield.

Somehow I made it home to my apartment, my heart still pounding in my ears.  The phone is ringing and ringing, and won’t be answered.

I throw myself on my bed, bury my wet face in my pillow and pray for a sleep without dreams.

 

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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”

 

foggyfield
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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The Long Road of Weariness and Want

snowyrose

 

The snow is melting
and the village is flooded
     with children.
~Kobayashi Issa (translated by Robert Haas)

 

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A voice is heard in Ramah,
    mourning and great weeping,
Rachel weeping for her children
    and refusing to be comforted,
    because they are no more.
Matthew 2:18 and Jeremiah 31:15

 

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Rachel weeping – Salvador Dali

 

We think of him as safe beneath the steeple,
Or cosy in a crib beside the font,
But he is with a million displaced people|
On the long road of weariness and want.
For even as we sing our final carol
His family is up and on that road,
Fleeing the wrath of someone else’s quarrel,
Glancing behind and shouldering their load.

Whilst Herod rages still from his dark tower
Christ clings to Mary, fingers tightly curled,|
The lambs are slaughtered by the men of power,
And death squads spread their curse across the world.
But every Herod dies, and comes alone
To stand before the Lamb upon the throne.
~Malcolm Guite from Waiting on the Word

 

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And the slaughter of innocents and weary road for refugees continues unabated-
In observance of The Feast Day of the Holy Innocents:

 

There is no consolation for the families of those lost:
Their arms ache with emptiness tonight,
beds and pillows lie cold and unused,
blankets and cuddlies await all night hugs
that never come again.

There can be no consolation;
only mourning and great weeping,
sobbing that wrings dry
every human cell,
leaving dust behind,
dust, only dust
which is beginning
and end.

He came to us
for times such as this,
born of
the dust of woman and
the breath of Spirit,
God who bent down to
lie in manger dust,
walk on roads of dust,
die and be laid to rest as dust
in order to conquer
such evil as this
that could displace masses
and massacre innocents.

He became dust to be
like us
He began a mere speck in a womb
like us
so often washed away from life
as unwanted.

His heart beat
like ours
breathing each breath
like ours
until a fearful fallen world
took His
and our breath
away.

He shines through
the shadows of death
to guide our stumbling uncertain feet.
His tender mercies flow freely
when there is no consolation
when there is no comfort.

He hears our cries
as He cried too.
He knows our tears
as He wept too.
He knows our mourning
as He mourned too.
He knows our dying
as He died too.

God wept
as this happened.
Evil comes not from God
yet humankind embraces it.
Sin is a choice
we made from the beginning,
a choice we continue to make.

Only God can glue together
what evil has shattered.
He just asks us to hand Him
the pieces of our broken hearts.

We will know His peace
when He comes
to bring us home,
our tears will finally be dried,
our cells no longer
just dust,
never only dust
as we are glued together
by the breath of God
forevermore.

 

freezedriedrose

 

the tender mercy of our God,
    by which the rising sun will come to us from heaven
to shine on those living in darkness
    and in the shadow of death,
to guide our feet into the path of peace.
Luke 1: 78-79

 

 

The Rain Drop Ploughs

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They sing their dearest songs —
    He, she, all of them — yea,
    Treble and tenor and bass,
        And one to play;
    With the candles mooning each face….
        Ah, no; the years O!
How the sick leaves reel down in throngs!

 

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They clear the creeping moss —
    Elders and juniors — aye,
    Making the pathways neat
        And the garden gay;
    And they build a shady seat….
        Ah, no; the years, the years;
See, the white storm-birds wing across!

 

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morningswans

 

    They are blithely breakfasting all —
    Men and maidens — yea,
    Under the summer tree,
        With a glimpse of the bay,
    While pet fowl come to the knee….
        Ah, no; the years O!
And the rotten rose is ript from the wall.

 

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    They change to a high new house,
    He, she, all of them — aye,
    Clocks and carpets and chairs
        On the lawn all day,
    And brightest things that are theirs….
        Ah, no; the years, the years;
Down their carved names the rain-drop ploughs.
~Thomas Hardy “During Wind and Rain”

 

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anna

 

A waning November moon reluctantly rose,
dimming from the full globe of the night before.
I drive a darkening country road, white lines sweeping past,
aware of advancing frost in the evening haze,
anxious to return home to familiar warmth and light.

Nearing a county road corner, slowing to a stop,
I glanced aside where
a lonely rural cemetery sits expectant.

Through open iron gates and tenebrous headstones,
there in the middle path, incongruous,
car’s headlights beamed bright.

I puzzled, thinking:
lovers or vandals would seek inky cover of night.

Instead, these lights focused on one soul alone,
kneeling graveside,
a hand resting heavily on a stone, head bowed in prayer.

This stark moment of solitary sorrow,
a visible grieving of a heart

illuminated by twin beams.

This benediction of mourning
as light pierced the blackness;

gentle fingertips traced
the engraved letters of a beloved name.

Feeling touched
as uneasy witness, I pull away 

to drive deeper into the night,
struggling to see despite
my eyes’ thickening mist.

~Emily Gibson – “Grief Illuminated”

 

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stonecone
a stone pinecone, environmental art by Andy Goldsworthy, rural Scotland

I Keep Looking Within

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rainstorm

 

rainywindow

 

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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