Tag Archives: death is part of life

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Frail

I wrote this two years before my father died. I did find him…..

Frail
We are going sailing
My partner says to me
“Invite him if you want.”

Then I am busy for a while

I think of calling, then forget

He was not at chorus on Monday

At last I say,
“I haven’t called. We’ll just sail.
Just us today.”

I haven’t called
because he was not at chorus on Monday

He is frail
55 years of camels
two packs a day
as if each cigarette
destroyed one alveolus
in his lungs
one tiny air/blood interface
built to exchange oxygen
and carbon dioxide
the loss is cumulative
He is frail
he is proud that the choral director
says, “I need you.”
He can’t sustain
but his entrances and time
are the best
among the basses.
They need him.

Chorus
is our winter link
two introverts
we hug at the start of chorus
sing for two hours
and talk for a few minutes at the end

Occasionally we go for a beer
I invite him for dinner
but he comes less and less
he often does not feel well at night

He looks smaller at chorus
this season
this is normal in emphysema
the body sheds weight
too much tissue to oxygenate
too hard for the lungs
and the heart, working overtime
to make up the difference
he is blessed with low blood pressure
genetic, from his father,
tough English stock,
otherwise I think he’d be dead

I didn’t call
before we went sailing
because I am afraid

I’ve driven out before
when he has not answered the phone
for a day or two
wondering if I would find him dead

I didn’t call
before we went sailing
because he was not at chorus on Monday
because if he didn’t answer today
I would not go

 
I took the photograph in 2009

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label

Quick: label

It is because he was (label)
but he really was (label)
and hated himself
so he killed  (label)

the labels
create a safe distance

we think
we are not in those (label)s

drop the labels

a person
was sad and lonely and grieving and enraged

he took a gun
he shot many other people

bow our heads

and grieve

 

I took the photograph with my phone last night on the beach.

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Emergency preparedness

In Venezuela now
some people get water once a week
and sicken from it

First, withdrawal
When we have our eathquake
Tsumani and roads and bridges are gone

If one in three adults in Utah
Got an opioid prescription in 2014
What are the numbers here?
Opioids
Alcohol
Benzos
Caffeine
After the first wave of death
and grief, withdrawal begins
Not just addictive drugs
from insulin
from blood pressure meds
anticoagulants
seizure medicine
chemo ground to a halt
I read that alcohol is best to trade in disaster
and chaos and loss
Guarded by guns in small gangs
We are told to store water
Where?
If the house falls down
and I can get out, where would I put water?
A bunker in the ground?
I stock straws for water
I wish I could buy 9000
for my town
I stock books for when the computers
go silent
I stock songs in my head
memorized all
I fight for all my patients
Who would I not fight for?
Maybe it would be better to die
or be captured early
I stock love not guns.

http://www.nytimes.com/slideshow/2016/05/26/world/americas/desperate-times-in-venezuela/s/27VENEZUELA-SS-slide-3ZIT.html?_r=0

http://www.theguardian.com/us-news/2016/may/26/utah-mormons-prescription-painkiller-addiction

http://www.newyorker.com/magazine/2015/07/20/the-really-big-one

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Katy B’s Fruit Torte

Katherine White Burling was my maternal grandmother, and this recipe is attributed to her. I still have the small three ring binder that my mother gave me when I was in high school, explaining that my sister and I had to do some of the cooking. We told her what we wanted to make and she would write the recipe in our book and help us. I wrote this recipe out in the 1970s.

preheat the oven to 350 F

cream: 1 C sugar
1/2 C butter

while the butter is softening enough to cream, cut up fruit: apples, pears, peaches, rhubarb, or use berries…

Add: 1 C flour
1 tsp baking powder
salt
2 eggs

Spread in in a buttered, floured pan. Cover with chopped fruit: apples, pears, peaches. Today I am using rhubarb and a peach. I particularly like the tartness of rhubarb.

Sprinkle with sugar and lemon juice
Dot with butter on top.
Bake for 30-40 minutes, depending on your oven.
Cook until browned a little in the part that rises around the fruit, and when a toothpick comes out clean.

mmmmmm

For a while I lived at 7500 feet and had to alter recipes:
subtract 3 tablespoons sugar
use 3/4 tsp baking powder

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does chronic pain kill you?

Another writer sent me this story, saying that chronic pain killed Prince, not an overdose.

http://www.rawstory.com/2016/05/prince-did-not-die-from-pain-pills-he-died-from-chronic-pain/

My response is complex.

1. Is chronic pain an “illness” in it’s own right?

My answer is yes and no. It’s complicated and our understanding is evolving. Right now I think of chronic pain as a switch in the brain that gets thrown. It can be thrown by adverse childhood experiences, by infection, by trauma or war or abuse, by too much stress… or a combination of any of these.

2. Why a switch in the brain?

In fibromyalgia patients we can’t find much on physical exam, except that the pain seems out of proportion to the exam. Ditto with chronic fatigue, reflex sympathetic dystrophy, TMJ, etc. However, now we can image the brain with a functional MRI and watch which parts are lighting up and how much. A study of “normal” and fibromyalgia patients involved a standardized pain stimulus: a thumbscrew. (Kinky, right?) The normal patients said the pain stimulus was 3-4 out of 10 and their brains lit up a certain amount. The fibromyalgia patients said the same pain stimulus was 7-8 out of 10 and the pain parts of the brain lit up MORE corresponding to their pain level. So they are not lying… and it IS in their heads. Sort of. We aren’t sure whether the muscle is yelling more than normal or whether the brain is hypersensitive or both. My guess would be both.

And I think this is an adaptation. It is to get us to rest, heal, calm down, introspect, stop being type A, etc. Boy, do we suck at it. Though recently I had a person in clinic who said what their body wanted to do was nothing. They just wanted to lie around. I said, well, ok, so when can you do that? They did, for two weeks, at the holidays. And my patient said, “One day I had a cup of tea and a book and the cat on my lap and the dog at my feet. I realized that my adrenaline system was turning off and I felt calm and relaxed. Healed.” Back at work the person cannot always maintain it but is getting better at it.

3. What does this have to do with Prince?

The problem is that for 20 years we treated chronic pain with opiates. Unfortunately on continuous opiates, the brain cells change in many people and “down-regulate” the opiate receptors. Less receptors, the pain rises. The person needs more opiate. The brain removes more receptors. So two myths: one that if you have chronic pain and take medicine as directed, you can’t get addicted. Only dependent. Since that is a myth, the DSM-V has combined addiction and dependence into one diagnosis: opioid overuse syndrome. It is a spectrum, not two separate responses.

The second myth is that if you give enough opioid, it will help the pain. Well, no. UW Pain and Addiction Clinic says that on average pain is reduced about 30% by opiods, whatever the dose. And high doses start causing some weird  hyperalgesias. I’ve weaned two people from over 100mg methadone daily down to 20-30mg. It took two years. They felt better on the lower dose after they got through withdrawal symptoms and a short term increase in the pain receptors complaining at them. And they are much less likely to overdose and die.

Page two here http://www.supportprop.org/wp-content/uploads/2014/01/PROP_OpioidPrescribing.pdf discusses current knowledge about opioids.

4. So like, Prince?

He may have died from a combination of fatigue and sedating drugs. If you get enough sedating drugs, then you stop breathing. Opioids are the biggest offenders combined with alcohol or sleep medicine like ambien or benzodiazepines like valium or ativan or alprazolam or muscle relaxants like methacarbomal or a combination of all of the above. I am a strict physician about urine drugs screens and I do the dip in clinic in front of the person. Way too often, the person does not tell me about the alprazolam or whatever until I am holding the dip over the cup…. and that’s when they tell me. They got it from the ER or a friend or two years ago or … took their dog’s. Really.

He may have died from influenza, if he had it, with sedating drugs. Bad influenza causes lung tissue swelling and can mess up your oxygenation. Your heart has to take up the slack and go faster. If you are trying to work and your heart rate is well above normal, it’s exhausting. It can kill you.

He may have died from overwork, another infection, sedating medicines…. but not directly from chronic pain. Chronic pain slows us but I do not think it kills us*. What kills us is trying to treat it with a pill instead of resting and doing gentle exercise and saying: What does my body want?

 

5. Overdose?

Also, are we talking about an accidental overdose? Are we talking about drug abuse? Are we talking about accidental death or suicide or do we as a society think that addiction deserves overdose death but a person taking medicine for chronic pain is a tragedy? Aren’t we a bit judgemental?

Prince may have taken a pain pill as directed but taken it with too many other controlled substances or with alcohol or while sick and exhausted. Overdose means too high a dose. If it was two percocets, alcohol, flu and xanax…. it could be an accidental poisoning.

6. Are you sure?

No. Medicine changes. Our understanding of the brain changes. Science is about change and deepening understanding. We are barely getting started on the brain and I would say that we are in preschool there.

 

http://www.doh.wa.gov/LicensesPermitsandCertificates/MedicalCommission/MedicalResources/PainManagement

http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/PainManagement/FrequentlyAskedQuestionsforPatients

*And on the other hand: http://www.practicalpainmanagement.com/sudden-unexpected-death-chronic-pain-patients

 

*Stress alone can cause heart attacks and sudden death:    http://www.health.harvard.edu/blog/stress-cardiomyopathy-a-different-kind-of-heart-attack-201509038239

The photograph is from a week ago, part of my Maxfield Parish cloud series, zoomed way in to the mountains across the water.

 

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Advice to young people

My biggest piece of advice to young singles and young couples is: put half of each take home salary away. Married or not married, and I don’t care how committed you are.

I know people who lose their house when one half of a couple is sick, and the other can’t pay all the bills on one salary. We don’t want to think about illness or cancer, but it happens. Young parents, with one very ill and the other with a job, children and a sick spouse. Having a reserve is way more important than keeping up with the Joneses, unless you happen to inherit like Mr. Trump.

If you each put half of your take home salary away, then when life throws surprises at you, you will have a reserve. A big reserve if the surprises hold off for a while. Divide that half into retirement and half into money that you have access to in emergencies.

I listed the top ten causes of death in the US in 2012 here, but lets look by age: http://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2012-a.pdf.

From age 1 to 44 the top cause of death is accidents, unintentional injuries.

Suicide is second from age 15 to 44.

Cancer takes over as number one, malignant neoplasms, at age 45 to 65.

After 65, the number one cause of death is the heart, and that is where the biggest numbers are. But if a younger cause of death affects your family, it feels unfair, wrong, as if we all expect to like to age 78 or beyond.

Untintentional injury, that is, accidents, are broken down here: http://www.cdc.gov/injury. When I do physicals on teens, I ask them what the number one cause of death is for teens. They all know the answer, even if they have to think for a moment: motor vehicle accidents.

But lets look at accidents in the age 25-65 age group: poisonings. What? Poisoning? And NOT intentional…. what is going on there? It is drugs, legal and illegal, but more legal. Sedating drugs in combination are effective at sedating people enough to stop breathing and die. Alcohol with benzodiazepines (valium, ativan, etc.), opiates and opioids, sleep medicines such as ambien and sonata, withdrawal from methamphetamines, cocaine, crack….people die. And supplements may be contributing as well.

75 years of US mortality data: http://www.cdc.gov/nchs/data/databriefs/db88.pdf#x2013;2010%20

At birth now in the US the life expectancy averages 78, but not everyone reaches that….some people still die younger and some live longer.

The age of death is rising, world wide. In the US, many of us have a world envied standard of living and yet we have a significant number of people who are anxious and depressed and way too high a rate of substance abuse, alcohol, opiates and opioids, benzodiazepines and yes, marijuana is addictive. How do I reconcile this? How do you reconcile this?

Keep your reserve, young singles and young couples…..

http://www.worldlifeexpectancy.com/usa-cause-of-death-by-age-and-gender
As of the day I am writing this on 5/2/16:

POPULATION
318,857,056

Numbers to be corrected, first set was wrong, wrong, wrong.

I took the photograph yesterday evening: there were the most amazing Maxfield Parish clouds…. life and death are a mystery.

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W is for wrath

W is for wrath, the seventh sin.

From Webster 1913:

Wrath

1. Violent anger; vehement exasperation; indignation; rage; fury; ire.
Wrath is a fire, and jealousy a weed. Spenser.
When the wrath of king Ahasuerus was appeased. Esther ii. 1.
Now smoking and frothing Its tumult and wrath in. Southey.

2. The effects of anger or indignation; the just punishment of an offense or a crime.
“A revenger to execute wrath upon him that doeth evil.” Rom. xiii. 4.
Syn. — Anger; fury; rage; ire; vengeance; indignation; resentment; passion. See Anger.

 

Wrath is a sin, yet is it ever justified?

I am wrathful about this: http://www.npr.org/sections/health-shots/2016/03/23/471595323/drug-company-jacks-up-cost-of-aid-in-dying-medication

In my state a terminally ill patient may choose Death with Dignity: http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct

The person must be terminally ill, must not be suicidal and must go through a process. But one of the tablets prescribed, which only the person may administer to themselves, has had a price increase from $200.00 to over $3000.00.

I heard this from another physician, who has a patient who is going through the process.

I feel wrath and anger and hurt and rage that a corporation is choosing to make an enormous profit from terminally ill patients.

And so wrath may be a sin, but it is also an appropriate feeling at times.

In a sermon about forgiveness, hate is also discussed:

“Let me also say a word here about hatred, since I am speaking of forgiveness as being the release of hatred. Many  of us,  I suppose, like myself, have been taught not to hate.  We have been taught that hatred is always a bad thing and there is no place for it.  Thus, we feel uncomfortable in the face of this intense emotion and attitude.  Many times I have stumbled on the line from the biblical book of Ecclesiastes which reads, “There’s a time to love and a time to hate.”

Can there be  a time to hate?  Ironically, when  reflecting on the subject of forgiveness, I see that there is a place for hatred.
 
First,  your  hatred  lets  you  know  that  you  are  feeling  diminished  and  perhaps  being stepped on and treated as no human being ought to be treated.

Secondly,  your  hatred  lets  you  know  that  you’re  fighting  back  and  that  you  have something  to  fight  back  with.    It  lets  you  know  that  the  situation  is  intolerable  and  you will not put up with it.

And  so  hatred  can  be  a  natural  and  even  necessary  response  to  situations  that  threaten human dignity.  Says one author, “Not to feel resentment when resentment is called for is a sign of servility,… a lack of self-respect.”  (Forgiveness, Haber)”

From: November 15, 2009, here: http://www.quuf.org/index.php?page=2009—2010-sermons

p7
http://www.quuf.org/uploads/Sermons/Is%20Forgiveness%20Always%20Called%20For%20Part%20II%20Nov%2015%2009%20print.pdf

I took the picture in 2007. No wrath here, but three different expressions, and all complex….

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Q is for querulous

Welcome back to 7 sins and friends…. Have you ever felt querulous?

1. full of complaints; complaining.

2. characterized by or uttered in complaint; peevish:

a querulous tone; constant querulous reminders of things to be done.
Querulous is like a sophisticated version of whiny.
I used it in an alphabet poem, for querulous quail. And the truth is that I thought of myself and my sister as the quail. Right before that was One old orangutan’s pompous pronouncements were being ignored by many merry meercats. My sister and I and our cousins again… and the orangutan was my father. My mother did the illustration…. and it does look like my father when he was in THAT mood….
Alphabeasts

ambulating antelopes
bellies bearing beer
carrying cantelopes
deride damp deer

elegant elephants
feeling fitly fat
give generous gifts
handing hippos hats

ignorant iguanas
jealously jeer
keen kindly kites
lilting laughing leers

many merry meerkats
nearly never notice
one old orangutan’s
pompous pronouncements

querulous quail
reject reports regarding
shimmering snow snakes
tearing through tunnels

undulating ungulates
veer vivaciously
wondering why whales
xerox xylophones

yellow yaks yell
zip zap zoo!

Q

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P is for pride

Pride is the fifth of the seven sins, in our seven sins and friends.

Which of the following is a sin?

1. a high or inordinate opinion of one’s own dignity, importance, merit, or superiority, whether as cherished in the mind or as displayed in bearing, conduct, etc.
2. the state or feeling of being proud.
3. a becoming or dignified sense of what is due to oneself or one’s position or character; self-respect; self-esteem.
4. pleasure or satisfaction taken in something done by or belonging to oneself or believed to reflect credit upon oneself:civic pride.
5. something that causes a person or persons to be proud: His art collection was the pride of the family.
6. the best of a group, class, society, etc.: This bull is the pride of the herd.
7. the most flourishing state or period: in the pride of adulthood.

Two quotations come to my mind:
Pride goes before a fall.
Death be not proud.

Pride goes before a fall: Proverbs 16:18, King James Version, Pride goeth before destruction, and an haughty spirit before a fall.

Here is the whole chapter: http://www.christianity.com/bible/bible.php?q=Proverbs+16&ver=kjv

Proverbs 16:5 is also relevant. Every one that is proud in heart is an abomination to the Lord: though hand join in hand, he shall not be unpunished.

And then Death be not proud is from John Donne: http://www.poetryfoundation.org/poems-and-poets/poems/detail/44107

Death, be not proud, though some have called thee
Mighty and dreadful, for thou art not so;
For those whom thou think’st thou dost overthrow
Die not, poor Death, nor yet canst thou kill me.
From rest and sleep, which but thy pictures be,
Much pleasure; then from thee much more must flow,
And soonest our best men with thee do go,
Rest of their bones, and soul’s delivery.
Thou art slave to fate, chance, kings, and desperate men,
And dost with poison, war, and sickness dwell,
And poppy or charms can make us sleep as well
And better than thy stroke; why swell’st thou then?
One short sleep past, we wake eternally
And death shall be no more; Death, thou shalt die.

___________________________________________

I am ambivalent about pride. I have mixed feelings. I find it easier to be proud of my children than myself. I am aware of my faults. Also, when I am really proud of something, I am more liable to mess up! To say something arrogant, to not pay attention, to lose my keys, to hurt someone’s feelings not on purpose! An analyst wrote that in their household, whoever has the best week, the most accolades, has gotten a prize or had a really good week: that person is in charge of the cat litter box for the next week. I think that is so sensible, to keep everyone grounded and connected to the daily tasks and remind us that even if we do something brilliant, the cat litter box still needs attention and the bathroom still needs to be cleaned. It is hard to keep a swelled head while scrubbing the toilet. I am proud that my children both did chores every weekend and my son still pitches in when he is home from college!

And now… the cat is reminding me….

I took the photograph in 2012 and came across it yesterday. Sometimes we get lost in a fog of pride or fantasy or emotion……. service to others and basic tasks like cleaning ground us again…..

 

 

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M is for mourn

M is for mourn. We mourn for losses. Mourning is part of being human and we have to give grief room and space. How can we love and feel intimacy without also feeling grief and mourning?

M

I wrote a poem the day my sister died. I had flown home four days before, after seeing her in hospice, 7 years of cancer. I flew home the day before her birthday. My birthday is three days after hers. She died the day after my birthday. It has now been four years.

An apology, a love note and a remembrance

I step outside into a fine mist rain.

I am enfolded in cloud.

The dog still wants to be walked.
The cats want their treats.
The bunny rattles her cage.
The fish will want feeding at the usual time.

My heart lies stunned in my chest.
The dog does not pull.
I walk measured.
He waits.

The rain comes harder.

I hope that where you are, is joy.

The crows harsh caws comfort me.
I answer.
They watch from the tree tops as we circle.

I am enshrouded in cloud.

We are back to the house.

I try to remember.
I have the birds.
I have the trees.

We go in.

first published on everything2.com with other poems for her here: http://everything2.com/title/An+apology%252C+a+love+note+and+a+remembrance

I don’t know who took the photograph. Probably my grandparents.