Category Archives: Beloved

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Demon Chainers

And you thought the hard work was over
Finding your demons
Facing them
Adopting them
Comforting them
Learning to love the parts that no one loved
That you hid as a child
Mothering your own unloved self
Fathering the parts he couldn’t love
And to surface knowing that you are a child of God
And lovable
Only to be attacked
With a concerted effort
To return you to what you were before

Don’t be frightened enough to give up
You are right
You are still a child of God
Lovable
In your wholeness
Talents and faults

Those who attack
Feel their demons
Clamoring at them
Clawing
When you learned to love your demons
Theirs want to be loved too
So badly
But their keepers are frightened
They are pressing their demons back into the depths
Desperate
Attack you for you have made them feel their sorrows
All unaware

Seek those who have also
Dealt with their demons
And they will welcome you
You are not crazy
To feel the euphoria
Of surfacing
But do not get carried away
And be kind to the demon chainers
Remember where you were before.

8/16/05

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Trust in the dark

Writing201’s prompt today is trust. This article in the NY Times about how there is no right way to grieve moves me: http://opinionator.blogs.nytimes.com/2015/01/10/getting-grief-right/?_r=0

Trust in the dark

Oh Beloved
   Help me to trust in the dark
      Help me to take each step
         Down into grief
            As needed
Oh Beloved
   Help me walk in the caverns of despair
      Each step slow
         As if I walk through molasses
            The air is thickened
               My chest hurts
Oh Beloved
   Help me to trust you
      That just as I descend into grief
         That just as I move through despair
            That the steps will someday lead up again
               That I will rise and spring will come
Oh Beloved
   Help me to thank you
      For tears and joy
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Angel Witness

Sometimes
Even as you make
The same mistake
Cross the threshold
Open the door
Lift the glass

You feel the presence
Of angels
Drawn by the seriousness
Of your decision

Present
Not to pull you away
From the cup
The drug
The wrong man
The dire pattern
You feel their intensity
The presence
As if outer space
Has clung to their wings
Or motes from heaven
Alien
The weight of their gaze
And their interest

Sometimes
Even as you make
The same mistake
It’s not the same
To sense an angel
Witness

previously published on an obscure writing site

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Family rebels

On my father’s side, his father’s branch are English. Most families would boast of the illustrious ancestors, but mine boast about the black sheep. I am related to the last man to be publicly hanged for poaching in Sherwood Forest. My father’s father’s sister’s child, who is my age, went to Nottingham to check this legend and said that it appears to be true. I do not know his name. After his hanging, there were still hangings but they were not public. You couldn’t gather up your children and a picnic and go to see the punishment and gruesome death.

My father’s mother’s side are the Scots. My greatgrandfather is in the 1901 census in Halifax, Nova Scotia, in his late teens, with his father, a French stepmother and many half siblings. He played saxophone in John Phillip Sousa’s band and toured the world. Links in the Sousa website lead to a book with my greatgrandfather in the index. I have a very newsy letter that he wrote to me in the early 1970s.

My mother’s grandparents were Congregationalist Ministers, at least the males. The women were ministers’ wives. They were in Iowa and one was part of the Iowa Band, a group of twelve ministers from Andover that went to the wild frontier to spread the gospel: the frontier was Iowa, Kansas and Nebraska. They started Iowa College that later became Grinnell. I have lots of relatives that went to Grinnell, including a first cousin. My mother’s mother’s father went off to Turkey with his family to help start Anatolia College, that moved to Greece at the start of World War I.

morris temple and cornelia

The photographs are Cornelia Temple and Morris Temple “about 1860”. They were in my mother’s father’s lineage, and my middle name is Temple.

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Weekly Angel/Devil Fight: Love everyone

This is my weekly (biweekly, snarls my devil) blog about the arguments between the devil on one shoulder and the angel on the other.

Do I really see an angel and a devil? Well, no. But we all use archetypes and we all have all of the archetypes within us. So when I have a dilemma or something comes up, I call the angel and the devil to the internal conference table of my mind and ask for their advice. They are going to give it to me whether I ask or not, so it’s more effective to be polite!

Ok, sometimes it isn’t a conference table. Sometimes it’s a hell scenario with bubbling lava or the fire forest from A Princess Bride… or it could be a field with daisies and a blue sky….

Today I am thinking about what we are supposed to do: Love everyone.

How good are we at that? Not very! Or are we?

My angel: You can love everyone. (The angel is kind and completely confident.)

My devil: Yeah, til they knife you in the back. Right. Go ahead, love them and they’ll treat you like dirt!

My angel: You can love them anyway.

My devil: Paula Pell said, “Be nice to all assholes because it disables them!”

My angel: Yes. You should be nice to those people too. (She doesn’t approve of swearing.)

Devil: sulking.

In my job, I get to love everyone. That is, as a doctor I want to be able to treat everyone and anyone who walks in my office. They can be talking about aliens or refuse to do what I suggest or they can say, “I hate doctors especially YOU.” and I am still supposed and do try to help them. Sometimes it doesn’t work very well. Sometimes we don’t connect or they are going to do the opposite of whatever I say or they return to using heroin. But I still get to try.

In my personal life, I would like to be the same. I am not there yet.

Devil: yeah, and don’t want to be….

Angel: keep trying….

But I can bring something from my job to my personal life. I don’t have to love what people DO and they can be MEAN and I don’t have to LIKE IT. But that is separate from the person themselves: I can still love the person even if they seem to be acting like an idiot and my devil wants to strangle them…..

Devil: oooo, strangle, I like it

Angel: separate the person from the action. Love them anyway.

Keep on trying…..

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Adverse Childhood Experiences 3: Attachment Disorder

I ought to have an attachment disorder, which now is called “separation anxiety disorder” in the DSM IV, now redefined in the DSM IV-TR and then the DSM V. That is, they keep changing the definition of psychiatric disorders. It’s a bit unnerving, isn’t it? Not only the brain is “plastic” and can be rewired throughout our lives, but the psychiatric diagnosis manual is being updated.

When I went into allopathic medicine, I was under the impression that I needed to learn everything I could and apply it. Spectacularly wrong. I needed to learn everything and then track everything because at least one fourth of what I learned was wrong or was going to change. I just didn’t know WHICH 25% was wrong.

This is why older doctors have a healthy skepticism towards new medicines, new equipment, new ideas. Older doctors are more likely to use old cheap medicines and eschew the new-fangled samples. It’s not just that the pharmaceutical companies only give us samples of the new expensive stuff. It’s also that some of the new expensive stuff is not as good as advertised and has a chance of hurting people. I still would advise my patients to use coumadin (warfarin) if they have a clotting disorder. Yes, you can take the new drugs without doing a monthly blood test — BUT if you bleed, I can’t reverse the new medicines. So I wouldn’t take them: if I need a medicine to keep me from clotting, I want coumadin. I will decide about the new medicines in 5-10 years. Old and cynical, that’s me….

As previously written, I had five “experiences” under age three that left me not trusting adults. However, the adults seemed to love me, even though they kept abandoning me to other adults. At under three, this did not make sense. I could have decided never to trust anyone and presumably would have really gone off into some sociopathic bad place, but I didn’t do that.

The clue to what I did is in my mother’s stories. My sister was born five days before my 3rd birthday. She came home right by my birthday, at Easter.

My mother said, “You asked if you could dress Chris. She was two days old. She was nearly ten pounds and had a triple chin. You wanted to put a lacy dress on her. I decided that you could try and told you to be very gentle.

You put Chris into the newborn baby dress. She was so big that it barely fit and in fact, that was the only time she ever wore it. You had to stuff her arms through the sleeves. She cracked her eyes and looked at you, but she did not object at all. You were gentle.”

That doesn’t seem like much. Next story:

My mother said, “You would meet visitors who came to see Chris at the door. You would say “Come see my baby.” I let you open presents for Chris because she didn’t care. You would show the visitors your sister.”

My baby. That is the key.

I think what happened is this:
1. The adults who took care of me did seem to love me.
2. Even though they loved me, they kept abandoning me, or giving me to other adults. I really really disliked this.
3. I thought that adults were misguided and wrong to give me away. I thought there must be some explanation. I would try to figure it out. Meanwhile, I was going to take care of my sister: she was MY BABY. I was going to show those stupid, loving, confused adults how to take care of a baby and NO ONE was going to give HER away. I could love adults but no way was I going to trust them.

That was my crisis brain wiring by age 3. Adults are loving and untrustworthy. You can love them back but they may abandon you to someone else at any moment. You can’t predict what they will do. They may be even LESS trustworthy if they are loving and you know them, than if it is a stranger.

My mother again, “When I got you back at nine months, you didn’t know me. You wanted to be as independent as possible. You missed your (maternal) grandmother. In the grocery store, you would cry if you saw a white haired woman. We couldn’t comfort you.

I thought that you didn’t like us at all until you ate a cigarette butt and got really sick. You let us take care of you. Then we left you with friends for a night. You were absolutely furious when we got back and I thought that you really did like us….”

Poor young mom, 23 and recovering from tuberculosis and still not strong, with an angry and grieving nine month old who really didn’t want much to do with her and didn’t trust her at all…..

Changes from the DSM IV-TR to the DSM V: http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf

The DSM IV criteria for separation anxiety: http://behavenet.com/node/21498

Theme song: The Devil Makes Three “All Hail”

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My weekly demon

I am in blogging 101.Today is the last day and the assignment: to create a recurring feature. A weekly or monthly or repeating feature. I thought, no, no, I don’t want to do that….

Then I read this blogpost: http://findingmyinnerzen.com/me-mantras/

I like the list. I sent the author a link to my poem “Say yes“. I made this comment:

“I would add one more thing to my list: keep my devils close. Remember the old cartoons with the angel on one shoulder and the devil on the other? I listen to my devil and I acknowledge what she says. She is riotously and evilly funny, with a running commentary on everything. She will also suggest totally evil over the top inappropriate responses to any time I feel hurt, sad, put upon, cut off by another car, you name it. By listening, I don’t project her onto other people and I don’t do what she says….. but sometimes it really adds perspective when someone says something thoughtless or mean and she goes into Samurai mode, shouting in my ear, β€œGet the sword! Get the sword! Off with their head!” I go from feeling surprised and hurt to internal laughter at how mean and inappropriate my inner demons are…… It is hard to stay angry and react to others when you are sitting there telling your demon that chopping someone’s head off is not socially acceptable and is unreasonable and is nasty and so forth…..”

Ah. There it is, the idea for my weekly post. I will write a weekly post about some internal inappropriate over reaction from my inner devil. And maybe from the angel too. We all have both. Sometimes the angel and the devil get to arguing and they are just over the top and the whole thing is silly. And the thing is, they cheer me up. The devil suggests doing terrible things but it’s usually a reaction to feeling hurt or sad. The angel tries to protect everyone else from that awful devil. And sometimes they just put an arm around each other and watch the beautiful sunrise and shut up for a bit….

The angel says, “Say thank you to everyone, it’s been a wonderful course!”

Thank you, everyone! Teachers, fellow bloggers, angels, devils, random strangers who stumbled on my blog…..

And my devil whispers, “Not weekly. Biweekly. No way weekly….”

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Please allow me to introduce myself

I have joined blogging 101 and missed yesterday’s assignment: to introduce myself.

Hello. I curtsy, but have to look up the spelling, because I spell it curtsey initially. So: I am not a great speller.

Hello. I am a mom, divorced, with two children, one over 21 and in college and one in 11th grade.

I am a rural family doctor.

I had strep A in my lungs and muscles in June and am just now getting permission to return to work part time. I had more time to blog.

I have been writing on everything2 since 2007. My sister started there in 2001 and became an editor. She married a Brit that she met on line. He was a “god” on the site. She was diagnosed with breast cancer between when they were engaged and when they were married. She died in 2012. I only had one sibling.

I write poetry, fiction and non-fiction, the latter mostly about medicine.

I am a madashell doctor, and traveled across the US in 2009 with the Oregon madashell doctors, giving talks about single payer health care, medicare for all. The United States health system is a terrible mess, geared for profit not people. It is amazingly awful and unfair. My sister had all the care in the world because she worked for Cal-trans, so was part of the largest Union on the planet, the California state government union. But she could have worked elsewhere, lost her job, lost her health insurance and died much sooner.

I have a cat and a fish.

I am very interested in the sufis and the zen buddhist teachings and some of my poems reference the Beloved.

Thank you.

http://madashelldoctors.com/

http://everything2.com/

<a href=”http://Blogging U.” title=”Blogging 101: Introduce yourself”>

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Adverse Childhood Experiences

I went to a sparsely attended lecture about the Adverse Childhood Experiences Study, or ACE Study, in 2005 and it blew my mind. I think that it has the most far reaching implications of any medical study that I’ve read. It makes me feel hopeful, helpless and angry at God.

The lecture was at the American Academy of Family Practice Scientific Assembly. That year, it was in Washington, DC. There are 94,000 plus Family Practice doctors and residents and students in the US, the conference hall had 10,000 seats and the exhibition hall was massive. At the most recent assembly, there were more than 2600 exhibitors.

I try to attend the lectures numbered one through ten, because they are the chosen as the information that will change our practices, studies that change what we understand about medicine.

The ACE Study talk was among the top ten. Yet when I walked in, the attendees numbered in the hundreds, looking tiny in three joined conference rooms that could seat 10,000. The speaker was nervous, her image projected onto a giant screen behind her. My experience has been that doctors don’t like to ask about child abuse and domestic violence: I thought, they don’t want to go to lectures about it either.

The initial part of the study was done at Kaiser Permanante, from 1995-1997, with physicals of 17,000 adults. The adults were given a confidential survey about childhood maltreatment and family dysfunction. A simpler questionnaire is at http://www.acestudy.org/files/ACE_Score_Calculator.pdf, but it is not the one used in the study. Over 9000 adults completed the survey and were given a score of 0-7, their ACE score. This was a score for childhood psychological, physical or sexual abuse, domestic violence, or living in a household with an adult who was a substance abuser, mentally ill or suicidal, or ever imprisoned.

Half of the adults reported a score over 2 and one fourth over 4. The scores were compared with the risk factors for “the leading causes of death in adult life”. They found a graded relationship between the scores and each of the adult risk factors studied. That is, an increase in addiction: tobacco, alcohol and drugs. An increase in the likelihood of depression and suicide attempt. And an increase in heart disease, cancer, chronic lung disease, fractures and liver disease. The risk of alcoholism, drug addiction and depression was increased four to twelve times for a score of four or more.

The speaker said that the implications were that the brain was much more malleable in childhood than anyone realized. She said that much of the addictive behaviors and poor health behaviors of adults could be self-medication and self-care attempts as a result of the way the brain tried to learn to cope with this childhood damage.

I left the lecture stunned. How do I help heal an adult who is smoking if part of it is related to childhood events? From there I went to a lecture about ADHD, where the speaker said that MRIs and PET scans were showing that children with ADHD had brains that looked different from children without ADHD. I thought that speaker should have come to the other lecture. And I did not much like my ACE score, though it does explain some things.

I feel hopeful because we can’t address a problem until we recognize it.

I feel helpless because I still do not know what to do. The World Health Organization has used the ACE Study in their Preventing Child Maltreatment monograph from 2006. But it is not very cheerful either: “There is thus an increased awareness of the problem of child maltreatment and growing pressure on governments to take preventive action. At the same time, the paucity of evidence for the effectiveness of interventions raises concerns that scarce resources may be wasted through investment in well-intentioned but unsystematic prevention efforts whose effectiveness is unproven and which may never be proven.”

Do I do ACE scores on my patients? With the new Washington State opiate law, we do a survey called the Opiate Risk Tool. It includes parental addiction in scoring the person’s risk of opiate addiction. But not the rest of the ACE test. At this time, I don’t do ACE scores on my adult patients. I don’t like to do tests where I don’t know what to do with the results. “Wow, you have a high score, you will probably die early,” does not seem very helpful. But I remain hopeful that knowledge can lead to change. And it makes me more gentle with my smoking patients, my addicted patients, the depressed, the heart patient who will not exercise.

I am angry at God, because it seems as if the sins of the fathers ARE visited upon the children. It is the most vulnerable suffering children who are most damaged. That does not seem fair. It makes me cry. I would rather go to hell then to the heaven of a God who organized this. I stand with the Bodhisattva, who will not leave until every sufferer is healed.

1. ACE study   http://www.cdc.gov/ace/about.htm

2. American Academy of Family Practice   http://www.aafp.org/events/assembly.html

3. ACE questionaire   http://www.cdc.gov/ace/questionnaires.htm

4. Score correlation with health in adults   http://www.ajpmonline.org/article/PIIS0749379798000178/abstract

5. WHO preventing child mistreatment   http://whqlibdoc.who.int/publications/2006/9241594365_eng.pdf

6. Washington State Opiate Law   http://www.agencymeddirectors.wa.gov/

7. Opiate Risk Tool   http://www.partnersagainstpain.com/printouts/Opioid_Risk_Tool.pdf

First published on everything2 November 2011.