Be Obscure Clearly

thanksgiving20173

 

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

 

thanksgiving20172

 

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.

 

thanksgiving20174

Be On My Best Behavior

frozenpineneedles

 

Find a quiet rain.  Then a green spruce tree.  You will notice that nearly every needle has been decorated with a tiny raindrop ornament.  Look closely inside the drop and there you are. In color. Upside down. Raindrops have been collecting snapshots since objects and people were placed, to their surprise, here and there on earth.

…even if we are only on display for a moment in a water drop as it clings to a pine needle, it is expected that we be on our best behavior, hair combed, jacket buttoned, no vulgar language.  Smiling is not necessary, but a pleasant attitude is helpful, and would be, I think, appreciated.
~Tom Hennen from “Outdoor Photos”

 

rainjewels

 

… We are, as we have always been, dangerous creatures, the enemies of our own happiness. But the only help we have ever found for this, the only melioration, is in mutual reverence. God’s grace comes to us unmerited, the theologians say. But the grace we could extend to one another we consider it best to withhold in very many cases, presumptively, or in the absence of what we consider true or sufficient merit (we being more particular than God), or because few gracious acts, if they really deserve the name, would stand up to a cost-benefit analysis. This is not the consequence of a new atheism, or a systemic materialism that afflicts our age more than others. It is good old human meanness, which finds its terms and pretexts in every age. The best argument against human grandeur is the meagerness of our response to it, paradoxically enough.

And yet, the beautiful persists, and so do eloquence and depth of thought, and they belong to all of us because they are the most pregnant evidence we can have of what is possible in us.
~ Marilynne Robinson from “What Are We Doing Here?”

 

rainykale4

 

Some days I choose to trudge along dry and cranky — each step an effort, each thought a burden, each moment an opportunity to grump about myself and my fellow man.  It is good to be reminded I am preserved, as is, for an instant, in the camera eye of the raindrops I pass, each snapping an instagram photo of my attitude.

It wouldn’t hurt me to smile out of a sense of grace and forgiveness, even if the events of the day may not call for it.  At least those smiles, reflected in the lens of each raindrop, will soak the soil at the moment it is let go to fall earthward.

There is no better place for the gift of grace to bloom and grow, ready for a new day.

 

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novemberdropclose

I Keep Looking Within

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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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sunrisepond22115

 

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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scatter

 

 

Among the Hunted

ahmama

 

wwudeer2

 

My first time ever
seated next to my mother
in a movie theater, just
a skinny four year old girl
practically folded up in half
by a large padded chair
whose seat won’t stay down,
bursting with anticipation
to see Disney’s Bambi.

Enthralled with so much color,
motion,  music, songs and fun
characters, I am wholly lost
in a new world of animated
reality when suddenly
Bambi’s mother looks up,
alarmed,  from eating
a new clump of spring grass
growing in the snow.

My heart leaps
with worry.
She tells him
to run
for the thicket,
the safest place where
she has always
kept him warm
next to her.

She follows behind,
tells him to run faster,
not to look back,
don’t ever look back.

Then the gun shot
hits my belly too.

My stomach twists
as he cries out
for his mother,
pleading for her.
I know in my heart
she is lost forever,
sacrificed for his sake.

I sob as my mother
reaches out to me,
telling me not to look.
I bury my face
inside her hug,
knowing Bambi
is cold and alone
with no mother
at all.

My mama took me home
before the end.
I could not bear to watch
the rest of the movie 
for years.

Those cries
still echo
in my ears
every time someone hunts and shoots
to kill the innocent.

Now, my own children are grown,
my mom is gone from this earth,
I can even keep the seat from folding
me up in a movie theater.

I return Sunday after Sunday
to the killing fields of the church pew
knowing mothers and fathers
sons and daughters
grandmothers and grandfathers
sisters and brothers
and babies were hunted down
inside the supposed safety
of the sanctuary,
taken from the warmth of the human thicket
where we hold each other close.

Their cries echo in my ears
where there is no longer innocence.

 

wwudeer1

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A Deep Fear of Emptiness

dawn7251

 

marshmallowglow2

 

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).

 

mayfieldbales

 

marshmallows51116

 

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.

 

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centralroadoct

The Shadow’s the Thing

myohmy

 

Be comforted; the world is very old,
  And generations pass, as they have passed,
  A troop of shadows moving with the sun;
Thousands of times has the old tale been told;
  The world belongs to those who come the last,
  They will find hope and strength as we have done.
~Henry Wadsworth Longfellow “A Shadow”

 

 

sunriseshadow

 

The shadow’s the thing. 
If I no longer see shadows as “dark marks,” 
as do the newly sighted,
then I see them as making some sort of sense of the light.
They give the light distance;
they put it in its place.
They inform my eyes of my location here, here O Israel,
here in the world’s flawed sculpture,
here in the flickering shade of the nothingness
between me and the light.
~Annie Dillard from Pilgrim at Tinker Creek

 

shadow closeup

 

A shadow is hard to seize by the throat and dash to the ground.
~Victor Hugo from Les Miserables

 

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In faith there is enough light for those who want to believe and enough shadows to blind those who don’t.
~Blaise Pascal

 

These days I find myself seeking safety hiding in the shadows under a rock where lukewarm moderates tend to congregate.

Extremist views predominate simply for the sake of differentiating one’s political turf from the opposition.  There is no discussion of compromise, negotiation or collaboration as that would be perceived as a sign of weakness.  Instead it is “my way or the wrong way.”

I’m ready to say “no way,” as both sides are intolerably intolerant of the other.

The chasm is most gaping in any discussion of faith issues.  Religion and politics have become angry neighbors constantly arguing over how high to build the fence between them, what it should be made out of, what color it should be, should there be peek holes, should it be electrified with barbed wire to prevent moving back and forth, should there be a gate with or without a lock and who pays for the labor.   In a country founded on the principle of freedom of religion, there are more and more who believe our forefathers’ blood was shed for freedom from religion.

Give us the right to believe in nothing whatsoever or give us death. Perhaps both actually go together.

And so it goes.  We bring out the worst in our leadership as facts are distorted, the truth is stretched or completely abandoned, unseemly pandering abounds and curried favors are served for breakfast, lunch and dinner.

Enough already.

In the midst of this morass, we who want to believe still choose to believe.

There is just enough Light for those who seek it.  No need to remain blinded in the shadowlands of unbelief.

I’ll come out from under my rock if you do.

In fact…I think I just did.

 

morninglightoctober

To Thank the Light

octevening2912

 

evening1119153

sunset811153

 

Now a red, sleepy sun above the rim 
Of twilight stares along the quiet weald, 
And the kind, simple country shines revealed 
In solitudes of peace, no longer dim.
The old horse lifts his face and thanks the light, 
Then stretches down his head to crop the green. 
All things that he has loved are in his sight; 
The places where his happiness has been 
Are in his eyes, his heart, and they are good.
~Siegfried Sassoon from “Break of Day”

 

 

morninglight

 

octpasture

 

 

I am growing older along with my horses. I think of them out to pasture throughout my workday as I continue to climb in the harness to pull the load as fast and hard as I can muster, returning home in the evening sore and weary.

I think of them with the morning sun on their withers, the green blades under their feet, as they search for the sweetest tender patch to munch.

They remind me to bring the calm of the pasture inside to balance the noise and bustle and troubles found in the clinic.  There still is peace and light to be found; I have only to look for it.

 

“To practice medicine with good spirit does not mean to be in a place where there is no noise, trouble or hard work. It means to bring your calm and loving heart right into the midst of it.” from www.theheartofmedicine.org

 

 

 

wallysunset

 

sunsettony2

 

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