Tag Archives: death

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Wings and fog ferry

Wings

I try out
for a solo
singing

my director
is pleased
I am growing

she says
I am beautiful

she says
I look like a different person

she knows
a little of what I have weathered

 
my patient
is 86

and her husband died
in December

she misses him so

as she comes into the room
one day

she says
you look as if you have wings
and are ready to take off

and I freeze
for a moment

in surprise

that she can see
my wings.

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Loved

It’s ok

I just want you to know

even if I never see you again
even if I never touch your hand
even if I never hug you again
even if you don’t answer
even if you don’t let me in
even if you are deaf to anything I say
even if you forget the moment you stop reading
even

I just want you to know

you are loved you are loved you are loved

always

even if

for my lost ones, living and dead 9/15/16

The photograph is from 2004, in the Hoh Rain Forest.

I am submitting this to the Friday Night Music Prompt #62 : Never too late for love & Keep me in your heart

 

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End of Life Plan

My End of Life Plan and Wishes are as follows:

1. My plan is that my life should end after a half day of skiing for free at age 125 or 126.
2. My wish is to ski quite brilliantly, smoothly and gracefully, though not as aggressively as at age 110 and below.
3. My plan is that other skiers will ask who that brilliant skier is and that all the lift operators will know.
4. My plan is that I will have a delicious lunch, with a glass of champagne, in a condo overlooking the slopes.
5. I plan to have a hot tub and then a massage from one of the many handsome men who flirt with me.
6. My plan is that I will sit in a comfortable leather armchair with my feet on a foot stool, while three of my male friends vie to be the one to bring me the second glass of champagne.
7. My wish is that I will not need any cosmetic surgery or false eyes or ears or teeth or joints or heart valves and will retain my spleen, teeth, gall bladder, appendix and brain in full operating order.
8. My plan is that I will not be on prescriptions, medicines, vitamins, supplements, medical foods, or nutraceuticals nor under the care of any quacks of any sort.
9. My wish is that my male flirts will all think that I am not a day over 75.
10. My wish is that I will be listening to live music, a woodwind quartet or string quartet, just dropped in to say hello, along with three of my great grandchildren, showing off their olympic ski medals, summa cum laude graduation documents, or Nobel prizes.
11. My plan is that after the quartet leaves, I will fall asleep….
12. ….and not wake up, and that though my attendants are sad, none of them throws themselves off the balcony over the cliff and are all surprised at my true age and at the bountiful gifts I have left to each of them with proof that a long life and compounded interest have excellent results. My children, grandchildren and great grandchildren will live long and prosper as well.

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death in childbirth

When I was in residency, one of the obstetrics-gynecology faculty asked us, “Women died in childbirth. What did they die of?”

We were silent. Stumped. Infection? Well, when there was no infection control and the male physicians went from room to room with no hand washing, yes… but….

Preeclampsia? No. Not that common. Eclampsia? Ditto.

“What if a woman is in labor and the baby is stuck? What do they die of?”

Ick. “Bleeding?”

“The uterus contracts until it ruptures. It contracts until it is thinner and thinner. If there is fetal malposition or a hand presentation or transverse or certain breech positions, the uterus ruptures and both bleed to death.”

We were all silent.

When I hear people bemoaning caesarean section and too much surgery and too many interventions…. I remember what women died of. All the stepmother stories. In the 1797 diary I am reading, the “lady” dies of a fever. She is 24 years old. There is no surprise, just sorrow. The author writing is the same age and grew up with her and grieves, but goes on.

We would like to think this is in the past, but it isn’t. It still is going on, right now, in  poverty stricken areas and war zones where the hospitals have been destroyed, the medical people have left, there are no services…

When I was still delivering babies, I would tell patients: my ideal labor plan is the baby comes out and I hand it to you. And the placenta comes out and the baby nurses and I don’t seem to be doing much. But that is not always what happens. I do not have control nor do you. I will only intervene if I think it is your life or the babies life or both….

http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-14-43

http://www.msf.org/en/article/perils-childbirth-democratic-republic-congo

http://www.who.int/maternal_child_adolescent/documents/childbirth/en/

http://www.who.int/mediacentre/factsheets/fs348/en/

Donate:  http://www.doctorswithoutborders.org/

The picture is me on my maternal grandfather’s lap. I was one very lucky baby. My mother had tubuculosis through the pregnancy. She coughed blood in her 8th month. If there had not been medical care and a Tuberculosis Sanitorium to be born in, I would not be here.

 

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Break your own rules

If I say “Food fight.” you may think of Animal House.

I think of my mother.

I am in high school in Alexandria, Virginia. My sister is three years younger. We are in the kitchen, it is hot. 99 degrees F and 98 percent humidity and the back door is open. We do not have air conditioning. We are eating watermelon. The old kind: with seeds.

My mother holds up a seed, pinched between her fingers, looking wicked.

My eyes narrow. “If you shoot that, you started it.” …. not in the house, is the unspoken rule that echoes.

She shoots it at me.

We all three start pinching the slick black watermelon pits at each other, laughing like hyenas. In a large kitchen with open shelves and dishes placed on all the shelves, often nested. It devolves into small chunks of watermelon, hurled at each other. No rinds, because of the open shelves. At last we all run out of pits and watermelon and stopped

There is silence while we survey the very impressive mess. There are watermelon seeds everywhere. And the floor is pretty wet.

Watermelon is STICKY.

We laugh more and start cleaning up. I leave for work or school or something.

Later my mother says, “I washed the floor three times before it stopped feeling sticky. And I kept finding watermelon seeds in the dishes on the shelves for the next two years.”

And: “It was worth it.”

The photograph is of my mother in high school.

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Beast Cthulhu and bone metastases

In 2011, when my sister wrote  Beast Cthulhu and bone metastases,  about her breast cancer being a treatable chronic illness, I was so sad…..

….because it was not true, even though I wished it was.

The perils of being the doctor sister.

It was clear that her cancer was progressing. Yes, she could request to continue treatment. Yes, they would keep treating her….

….but it wasn’t working.

The hematologist-oncologist chooses the best treatment first. Chris Grundoon was 41 and very strong and healthy so they hit the cancer as hard as they possibly could. Chemotherapy, mastectomy, radiation therapy, a second degree burn on her chest wall. It was stage IIIB to start with. Cancer is staged 0 to IV. Zero is “carcinoma in situ”, cancerous cells that have not even invaded their neighbors. Stage I is very local. Stage IV is distant metastases. Stage IIIB of ductal breast carcinoma means multiple lymph nodes, but not the ones above the collarbone, and no cancer in bone, brain, lungs or liver.

She had two years in remission.

The cancer recurred with a metastasis above the collarbone. The cancer had morphed as well, as it often does. Most, most, most of the cells were killed… but those that survived… were different. Now she was estrogen receptor negative, progesterone receptor negative and her2 negative. All genetic markers which help decide which treatment is best and how to target the cells. More and more are being found.

Our mother died of ovarian cancer. I went with her to her oncologist only once. My mother said that her CA 125 was rising, and of course she could do more treatment if she needed to. The doctor said something positive. I followed her out of the room. Once the door was shut I said, “My mother is talking about another clinical trial! She can’t do that, can she?”

“No,” said the oncologist, “Of course not. She is too advanced. But we will treat her for as long as she wants.”

Whether it works or not. Because she wants to be treated. In spite of diminishing returns.

My sister passed her five years from the day treatment ended. So technically she is in the five year survival group even though then she died. When she was diagnosed, the five year survival for her type of breast cancer and stage was about 5%. It had improved to 17% by 2011.

Her oncologist told her “I am referring you to hospice.” in the spring of 2012. She went to San Francisco to talk to another group about a clinical trial. But it was too far and too late. She refused hospice until about two weeks before she died. Fight to the end, she was willing to fight even when the oncologist said, “You are dying.” She had promised her daughter and promised her husband.

I saw her three times in the last two months before she died. She seemed angry to me on the last visit, glittering, knife edged. I tried to sing a lullaby, but she wanted something else. “Samuel Hall?” I guessed. She smiled and I sang it. My name is Samuel Hall and I hate you one and all. To the gallows I must go, with my friends all down below. Hope to see you all in hell, hope to hell you sizzle well, damn your eyes, damn your eyes. Then she trusted me to be present whether she was angry or sad or confused or once even happy, glowing, transported, transformed….

Some people do not go gentle. That is their right. It is their death, not ours, not mine.

The photograph is from the memorial here… My father had end stage emphysema, on steroids and oxygen, and I was hospitalized with strep sepsis the weekend of her first memorial in California. We could not go. Many people from our chorus Rainshadow Chorale came and we are singing the Mozart: Requiem Aeternum. My father died fourteen months later.

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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