Tag Archives: death

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moon in morning

For the weekly Photo Prompt: Ohh, Shiny!

But, you say, it isn’t shiny.

No, it isn’t. Because even shiny things today are not distracting me from my grief about our country, the lack of ethical morals in our government and twitterpated tweets going out daily.

And here is the moon watching as the sun rises and light and warmth fall over the earth. The mood matches mine: quiet and still thinking of the dark and of love and of hatred and of grief.

Moon in mourning.

 

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Forgiveness 2

I wrote this poem in 2009 when I was struggling with forgiveness and wanting to forgive. How do we forgive when someone does not apologize? When they do not explain nor listen to your hurt and grief? Yet forgiveness is internal in each of us. The external is reconciliation and that requires listening from both sides.

Forgiveness

I want to forgive something
Someone
In fact a group
Something that hurt a lot
I’ve tried logic
I tell myself
“It was an expression of concern”

My heart doesn’t agree
It is sullen
Immobile and grumpy
It whispers
“They have not apologized”
It whispers
“When people say you’re crazy
It could be a joke
An expression of concern
It wasn’t
It was a palm held out
At arm’s length
To distance me.”

My head argues
“That’s what it felt like to you.
You don’t know their intentions.”

I want to write
A poem of forgiveness
Hoping my heart will follow

My conscious doesn’t write my poems
My conscious wrestles with an idea
The poem comes out of this struggle
I look at the poem I’ve written
I think,
“That is what I would like
my conscious heart to feel.”
My poem is often more generous
than my conscious feels

My poems are not mine
They are a gift
From the unconscious
It is much larger
Than the small conscious me
I dream of feeling envy
I climb into a bathtub
And transform myself
To battle a trickster
We are transported
To the bottom of the ocean

In the ocean
The trickster and I are one
It is unlimited
It is not my unconscious
There is no separation
It is all unconscious

I did not think
A poem would give forgiveness
But pain drove me
Into the sea
I am connected
You gave me these pearls
Thank you

 

I am submitting this to the Daily Prompt: jiffy. I wish this could happen in a jiffy…. but it is slow….

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There is no blame

This article came up yesterday on Facebook:

http://articles.latimes.com/2013/apr/07/opinion/la-oe-0407-silk-ring-theory-20130407

How never to say the wrong thing….

Well, now, wait. What the hell is your goal? To always comfort people? To always say the right thing? Peaceful and sweet and niceness all the time?

Why?

And isn’t it dishonest?

Isn’t a true friend that loves you the friend who says, hey, this guy you are dating sounds just like the last one, didn’t you say you weren’t going to do that again?

Even if it makes you mad. And you forgive them because damn it, they are RIGHT. You might not forgive them right away. It might take a while. You might shun them and then have to do some crawling and apologizing.

Our society is terribly afraid of emotion. Don’t say the wrong thing. Do not make someone angry, afraid, never ever hurt anyone.

Except…. I am a physician. And I’ve had my mother and then my little sister die of cancer.

With my mother, we did what she wanted. She was home for 6 weeks in hospice. My sister and I cried for two minutes after I told her the surgeon said feeding her iv would kill her faster. We took her home on iv fluid and morphine to starve. She was tough tough tough. We had over thirty visitors from as far away as London.

My partner was her doctor. She did a home visit and she cried. Afterwards my mother said, “I didn’t appreciate that.” So we did not cry.

My sister did one day when I was at work. She started crying after my mother was asleep in the hospital bed. She called me. “I started crying. And everyone left. Everyone left the room. Not one person stayed with me.”

Ouch. Now I can see that once my sister started, everyone was afraid that they would start too. So they all left.

I stopped talking. In the fifth week, family called and I was handed the phone. “How is she? Are you ok?” I just held the phone. I knew I was supposed to say reassuring things, I am ok, she is ok, but I wasn’t and she wasn’t. She was dying and I was broken, weeping inside. So I just held the phone, silent.

My mother died. We were all exhausted. And for the next two years I thought about it…. and one thing that I thought was, I wish she had let me cry. I did what she wanted. We all did. But in the end, I never got to cry with my mother and say how much I was going to miss her.

And maybe she would not have appreciated it. But I am her daughter! Don’t my feelings and wishes matter? There are two of us in this relationship!

Then my sister got breast cancer. At age 41. Stage IIIC. And this time I thought, I will be different.

I refused to do what she wanted. I told her I loved her, I told her when I was mad at her, I told her when she was hurting my feelings and when she was being wonderful. I held BOTH of us close. I held her close but I refused to let her go into the cancer bubble where no one was telling her the truth.

I was dating a man who complained. He told a couple’s counselor: “I want her to do what her sister wants or cut her off.” I explained about my mom. I explained about the cancer bubble, where people stop being honest and only do what they think you want. The counselor defended me.

And I think I did the right thing. For me. AND for my sister. Because our last day together, she thanked me and she even apologized for something… and I got to say “I love you anyhow.” I meant it to my bone marrow. People yelled at me for being grumpy, bitchy, not doing what she said…. but I was my real self with her. And she knew it. And she also knew I love her and stayed real with her.

In the hospital when someone is very sick, families fight. They argue. They get angry. The emotions are running high. The doctors, the nurses, the janitors, the desk people, we are used to it. People yell, they cry, they behave badly. But their hearts are breaking, why would we expect them or order them to behave well? Honestly, sometimes they work off some of the anger part of grief by fighting with each other.

In clinic sometimes I am handling a room: a person with cancer with a spouse and one or more children. Adult children. People handle death in different ways. Siblings fight before and after a death, “You aren’t doing right.” We are all different. The way I grieve is different from the way you grieve. There is no wrong, there is no blame.

My sister wanted to handle her cancer with grace. Grace, it’s complicated. For me, the greatest grace is honesty.

I want to die singing, crying, going to see the people I love that are gone, and honestly. The I Ching sometimes says there is no blame. Think if we could all accept each other’s honest emotions. The most beautiful harmony is sometimes the resolution of dissonance. Goodbye, goodbye, I will miss you so….and there is no blame.

 

For the Daily Prompt: harmonize. I took the photograph of my sister four days before she died.

 

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Templates and the death of medicine

One of the many problems that are killing medicine in the US and especially primary care is templates.

Templates are a nightmare.

Why?

In a template, for back pain, there is a list of questions and in some there is also a list of answers. The “provider” asks the questions on the list and then checks off the answers. This is absolutely terrible brainless stupid failure of medicine. Because the most important answer that the patient gives is the one that does not fit the routine pattern of back pain or ear pain.

For example, I saw a woman for a new patient visit for back pain. Years ago. Half way through the questions about back pain I say, “How long have you been hoarse?”

She stops. She has to think about it. “Three months.”

“Continuously or does it come and go?”

Again, thought. “Continuously.”

On with the back pain. But she gets TWO referrals, one to an otolaryngologist. I ask other voice and throat questions.

When she returns she thanks me. Continuous hoarseness is worrisome for vocal cord cancer. You have to rule it out. She did not have vocal cord cancer. She did have vocal cord polyps and was going to have laser surgery.

But as a physician or “provider” you have to PAY ATTENTION. And ignoring the thing that doesn’t “fit” or isn’t relevant or isn’t on the god damned template — just don’t do it.

Another new patient. Back pain. Routine, routine, routine, one in four people get it in their lives. All the questions indicating that it’s musculoskeletal, not a disc, 99% are not discs, until:

“Sometimes my leg goes numb from the knee down.”

I stop. “How often? The whole leg?”

“Whole leg, yes.” She doesn’t know how often.

“If that happens I want to see you right away. Call.”

…because that is not a disc and it’s not musculoskeletal. And people say that but usually it can’t be confirmed on exam.

She calls. “Both legs are numb from the knee down.”

“Get in here.”

On exam she is not only numb but the muscles of her feet and ankles are weak and the reflexes don’t work right. I call neurology, anxious. “MRI from her head to her tailbone.”

She has multiple sclerosis lesions, more than one, in her brain. And a normal brain MRI from a few years before when she also had weird symptoms….

So it is NOT the template, the routine questions, that diagnose odd things in medicine. It’s the off hand comment, the puzzle piece that doesn’t fit, the symptom or sign that I notice and that gets my attention.

I hate the templates when we first get an electronic medical system. It sucks. It generates unreadable generic sentences: “The patient has ear pain. The quality of the ear pain is sharp. The ear pain has gone on for 6 weeks. The level of the ear pain is high.” Etc. Ok, that patient sounds like a robot. I quickly figure out how to type into the stupid boxes and avoid the templates as much as possible. I also start offering additions to the templates. “Ok, add this to quality of ear pain: It feels like being kicked over and over with the metal pointed tip of a cowboy boot.” Also to tachycardia: “It feels like a salmon is swimming upstream in my chest.”

See patients for one thing only. That would have really helped the hoarse woman, right?Β  Do the template. Do 10, 15, or 20 minute visits. The best doctors are rebelling and quitting, especially in primary care, because this is killing medicine. Why see people for one thing only? MONEY. MONEY MONEY MONEY. No. I like to work in medicine and I like to dig down, pay attention, listen and watch for the little details that stick out, the puzzle pieces that don’t fit….

….because that is what real medicine is. Not template robot medicine.

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portal cup

If this cup is a portal,Β  where does it take you?

I took the photograph at the Renwick. I asked the guard if I could take photographs. He smiled and said, “We encourage it.” And it’s part of the Smithsonian….free. I could not take my tea inside, and that seems entirely fair….but, free, that is, paid for by the citizens of the United States with our taxes and welcoming people from all over the world to step in and see what is there…..

…..and where does this cup take each of us?

…..and does this fit the Daily Prompt?

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new growth

I’ve been thinking about the A to Z challenge again. I did it last year, with 7 sins and friends. I wrote about an emotion each day…. and I planned to do it this year starting with the 7 virtues. Bet you can’t name as many virtues as sins…. though I don’t think any of the emotions are sins. They are part of us. They are part of the way we respond to the world and survive. We have to learn to pay attention to them and not label any of them as negative or bad. We cannot excise grief or fear or anger from our psyche and remain human. Instead we need to learn to be curious about each emotion….

…..and there has been a shift in my life, three parts all shifting at once, this week. It is very odd to have all three go at once. I may leave the virtues until next year, because this sudden freedom is strange, peculiar, unfamiliar…. I need to expand in it and explore it….

New growth….