Tag Archives: gentle

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On guard

My nurse’s breath catches. “Oh, no,” she says.

I am new here. Less than a year. “What?” I say.

“We have Janna Birchfield on the schedule.”

“Who is Janna Birchfield?”

Tonna leans back in her chair at the nurse’s station, a high set desk that runs behind the front office. We have new glass barriers along it to make it more hipaa compliant. It is also more claustrophobic. She throws her pen down. “She’s one of the most hostile people here. She’s known for throwing a brick through her second doctor’s plate glass window.”

“Ah,” I say.

“She was Dr. M’s patient but apparently she and Dr. K got in a screaming fight in the hallway. She is banned from that clinic. So we are the last clinic in town.”

My nurse knows the local stories and she has seen a lot. She doesn’t have a lot of unconscious monsters. Yeah, there is some impatience and some anger there, but she’s pretty good. No real fear, nothing cringing at her feet.

“Hmm. Let me talk to Marnie.” Marnie is our office manager.

Marnie and I talk. I read the last notes from Dr. M and an account of the screaming fight with Dr. K. I call Dr. K. I don’t know of anything that scares her and she is tough. I rather enjoy envisioning her yelling back at this patient.

The day arrives and Mrs. Birchfield is put in a room. Vitals are done. I go in.

Janna Birchfield is big. She weighs about twice what I do, and it’s muscle rather than fat. She looks solid. Not like a body builder, just strong. She tops me by nearly a foot. She looks sullen and unfriendly.

And I am looking at her monsters. Three are guarding a fourth, at her feet. Fear is there, anger is the biggest and posturing, like a body builder, in front. The third is morphing back and fourth: envy and hostility. The fourth is in a stroller, guarded by the other three. Asleep? Unconscious? Well, yes, duh, but it’s not often that a monster is so undeveloped that it is still an infant. Not good.

“Hi, Miz Birchfield. I am Dr. Gen.” I hold out my hand, moving slowly and smoothly. Her monsters alert, fear flinching and anger ready to punch. I stand with my hand out. She eventually touches it, glaring.

“Hi,” sullen.

“We need to talk about the clinic rules first.” I say calmly. Anger puffs up and her shoulders rise as the monster swells and takes control, her elbows rising and hands are fists. Her eyes don’t turn red, but nearly. “I have heard about your argument with Dr. K.”

Furious voice, “She screamed at me. She’s a horrible doctor! She got me thrown out!”

I am smooth and calm, “I am not going to discuss Dr. K,” I say. Honestly, it’s even more fun to think of Dr. K taking this on and not budging an inch. Dr. K is my size, small. “In this clinic, I need you to understand that you are not allowed to yell at anyone at the front desk, in the hallways or on the phone.” Anger flees immediately, small again and she looks confused. “You may not yell at the staff, at the other patients, or at anyone on the clinic property.”

“Why would I agree to that?” she says. She is mostly confused because I am not scared or angry. I am not behaving the way she expects, the way most people behave around her.

“If you are upset, the only people you can yell at are me or the office manager and you need an appointment.”

“They are rude to me!” Basically she means everyone. “You can’t make me do that!”

“Take it or leave it.” I say. “You need to agree and keep the agreement, or we will discharge you immediately. If you say no, leave now, and I won’t charge for the visit.”

Her monsters are confused. Anger has shrunk back down and they are conferring, heads together. Confusion has shown up as well, morphing though different colors and stripes, stars and paisleys. She stares at me, frozen hostility. I just wait, sitting in front of my laptop, serene. This is going well. She isn’t yelling and she hasn’t left.

“What if they are mean?” she says.

“You will make an appointment with me or the office manager, and we will help you.”

“Ok,” she says. The monsters are still surrounding the carriage, but really, now confusion is in charge. We work through the rest of the visit, as I get to know her a little. She has had a hard, hard life.

I let the front office and the nurses know the rules. The office manager and I let them know that this is a contract with the patient and she has agreed. They feel protected. They feel protected enough that they are nice to her. She behaves and starts, infinitesimally, to relax. She is still angry and hostile in the exam room but it’s not directed at me. It is directed at the entire world, the rest of the world outside the clinic. I try to help her medically but also let the monsters have their say. The visits start with anger and hostility but tend to subside into confusion. I am not getting at the fear or whatever is in the stroller. It is one of the large old fashioned ones, heavy, navy blue, where an infant can lie flat. Clearly it does not fold up to go in a car or anywhere else convenient. There are no toys hanging from the top or across it, no stuffed animals. Only a form under the blankets, always still.

I may reach that form, or not. I do not know.

For the Ragtag Daily Prompt: paleontology.

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Love gently

Honey is older, nearly thirty years since that first feeling of being bitten by ants. She is back in corporate medicine, as a temp. Temporary, short term, maybe that will work better.

It is a joy to go in a room and be alone with a person and their monsters. Theirs and hers. Sometimes the younger ones haven’t experienced it, they are terrified if one of their monsters becomes a little bit visible, they hate seeing them. Honey tries to be gentle. If they only want to talk about the sore shoulder and not the stress and violence, well, she leaves the door open a crack. Sometimes the monsters cry.

Older people may be stiff to start with, but when they realize their monsters are seen, acknowledged, this isn’t another robot doctor in to say increase your diabetes medicine, lower your diabetes medicine, tell them a plan without ever connecting, the older ones lean back, sigh, and relax. The monsters play on the floor, Honey’s monsters playing with theirs, happy, engaged.

The hard part is the clinic staff. Honey is with them daily. The medical assistants are young. They kick their monsters aside as they walk down the hall. It is terribly hard and heartbreaking to work at her desk, with the medical assistants’ monsters cowering under their desks, kicked, abused, silent tears and holding bruises. Honey’s monsters mind. They climb into her lap and hide their faces in her shirt, under her jacket, peer over her shoulder. They don’t understand! Why can’t she be nice to THESE monsters?

Honey whispers to her monsters when the medical assistants are rooming patients. “I am so sorry, loves. If I acknowledge these, the monsters of the women working, I become a demon. It is very hard to share an office, no wonder I worked in a clinic alone for eleven years.” Honey has been through that. It is still inconceivable that some people don’t see the monsters at all. Is it learned blindness? Or just not developed unless someone had to learn it? Unless someone grows up in terror and seeing the monsters is the only way to survive.

Honey thinks some people learn to see them as adults, at least their own monsters. Hard enough to do that, without seeing the monsters clinging to other people.

Honey is tired of her monsters crying in sympathy with the staff’s monsters. She thinks maybe there are small crumbs that she can leave for these demons. Little gifts. Her monsters can creep under the desk when she is the only one in the room and leave something. A flower. A dust bunny. A crumb of a crisp. A small rock. A little gift to let them know they are seen and loved. A poem. A prayer. Just a tiny bit of love.

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For the Ragtag Daily Prompt: crisp.

The photograph is me all dressed up for the 1940s ball.

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On meditation and breathing

In college at the University of Wisconsin, I dated a gentleman who was following the Zen Buddhist tradition.

He meditated daily, for forty minutes, facing a wall.

I was quite intrigued. I did not think I could do that. I am a fidgety person and can’t sit still. I promptly tried it.

Forty minutes is a long time facing a wall at age 19.

I would fall asleep. I would start tilting to one side or the other on my zafu and jerk back up. I knew I was not supposed to follow thoughts, but I couldn’t not think. It is more subtle than that: I slowly figured out that I can let the thoughts pop up from the toaster brain, but try not to follow them. Wave at the thought. Let it go.

One day there was a small hole in the wall when I faced it. A tiny spider came out and went back in. I was very happy about the spider.

The next day the spider came out and waved one leg at me. Then it went back in the hole. The end of the 40 minutes is signaled by a chime. I got suspicious afterwards and went back to the wall. Not only was there no spider, but there was no hole, either. I did not see any more holes or spiders.

I meditated regularly daily for two years. After that I would return to practice intermittently. Meditation trained my breathing: my breathing slows way down during meditation.

I use that breathing when I have pneumonia. In the worst episode, I was in the hospital and disbelieved. I slowed my breath way way down to calm myself and so that I could think. Eight counts in, eight counts out. Then ten, then twelve. I needed to focus and figure out what was causing sepsis symptoms. And I did figure it out. The provider sent me home that morning, septic and 6 liters behind on fluid, but I was able to survive.

Now the pain clinics are teaching slow breathing. Five seconds in and five seconds out. Start with a few minutes and work up to twenty minutes. “Almost everyone goes from high sympathetic nervous system fight or flight state to the parasympathetic relaxed nervous system state.” I think we need more of that, don’t you? This is being taught for anxiety, for chronic pain, for fear and depression. I asked a veteran to try it. His response: “I hate to admit it but it works.” Also, “I’m not used to being relaxed. It feels weird.” I laughed and said, “I think it might be good if you get used to it.” He reluctantly agreed and continued the practice.

Peace you, peace me.

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Covid-19: Emotional weather

I do not think of emotions as bad or good. None of them are bad or good. They are information, controlled by electrical impulses and hormones, evolved over millions of years (or endowed by our creator, for those who swing that way).

I don’t dismiss emotions. I listen to them.

I think of myself as an ocean. There is all sorts of stuff happening in the depths that I don’t understand. Probiotics, for example. I don’t take them. If not for penicillin, I’d be dead many times over, from strep A pneumonia twice and other infections. I don’t think we understand probiotics yet. We don’t understand the brain, either.

The emotions are the weather in my life. I don’t really control them but they don’t control my ocean, either. Some days are sunny and gorgeous and then a storm may blow up. I am afraid of hurricanes, one destroyed my grandparents’ house in North Carolina, on the outer banks. I think all the cousins still mourn that house. And I miss my grandparents too, all of them. And my parents and my one sister.

See? The weather got “bad” there for a moment, but it isn’t bad. Storms have their own beauty though we hope to batten the hatches and that not too much damage is done. Maybe there is rain, scattered showers, sun breaks, a lenticular cloud. In the Pacific Northwest on the coast, the weather can change very quickly and we have microclimates. My father lived 17 miles away, but inland from me and in a valley. It was warmer in the summer and colder in the winter.

My goal with my weather emotions is to pay attention to them, let the storms blow in and out, and try not to harm anyone else because of my weather. When my sister was in hospice, we had a sign up in my small clinic. It said that my sister was in hospice with cancer and that clinic would be cancelled at some point with little warning. Patients were kind and gentle with me. And then it was cancelled, when she died. I got cards from people. They were so kind, thank you, thank you, and I could barely take it in. My maternal family then dealt with grief by having lawsuits. I don’t think that is a good way to deal with grief, but we just see things differently. Maybe it’s the right way for them. I don’t know.

Whenever I was having internal emotional weather that stirred me up, I would tell my nurse or office manager. Because they will sense my weather and need to know what is up. I had enormous support from them during a divorce, while my partners treated me horribly. My nurses and office manager knew me and my partners didn’t. My partners distanced me as if a divorce were catching. Whatever. Their loss.

Sometimes patients sensed that I was upset. I could tell by their faces. If they didn’t ask, I would. Bring the emotions out. Reassure them that I AM grumpy but not at them. Stuff in my own life. No worries.

Sometimes clinic is about a patient’s weather. They ask if they can tell me something. Often it is prefaced by “Maybe I need an antidepressant.” or “I feel really bad.” When they tell the story, usually I would say, “I think it is perfectly reasonable and normal that you feel angry/hurt/shocked/horrified/grieved/upset.” And then I would ask about an antidepressant or a counselor and most of the time, the person would say, “Well, I don’t think I need it right now.” What they needed was to know that their weather was NORMAL and REASONABLE.

I am seeing things on Facebutt and on media saying that mental health problems and behavioral health problems are on the rise. Maybe we should reframe that. Maybe we could say, “The weather is really bad right now for everyone and it’s very frightening and it is NORMAL and REASONABLE to feel frightened/appalled/angry/in denial/horrified/confused/agitated/anxious or WHATEVER you feel.” This weather is unprecedented in my lifetime, but as a physician who had very bad influenza pneumonia in 2003 and then read about the 1918-19 influenza, I have been expecting this. Expecting a pandemic. Expecting bad weather. This will pass eventually, we will learn to cope, be gentle with yourself and be gentle with others. Everyone is frightened, grieving, angry, in denial or in acceptance. The stages of grief are normal.

Hugs and prayers for all of us to endure this rough weather and help each other and ourselves..

I took the photograph in color. My program made a black and white version. It looks like the back of a stegosaurus to me, a dinosaur now living as a mountain.

For the Ragtag Daily Prompt: rainbow. Because sometimes the rain and sun combine to make a rainbow.

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Covid-19: A gentle answer

I went to have a hair cut today and went in three shops since I was downtown anyhow.

There are lots of tourists and visitors walking around without masks.

In one shop the owner asks if I am Dr. O, and it turns out her daughter babysat for my children 19-20 years ago. We had a nice discussion about our offspring. We are both wearing masks.

In a mineral store somehow the covid-19 subject comes up. I say that I am wearing a mask because I am on oxygen and vulnerable, and even though I am vaccinated, if I get covid-19, it might kill me.

The two owners are not wearing masks. The woman says, “We are both vaccinated, but I am just really confused about what to do.”

I say, “Well, I am a Family Physician. Let’s take chicken pox. If someone is exposed, it can take 21 days for them to break out in the rash. They will be contagious for 1-2 days before they have symptoms. The problem is that it can be ANY of those 21 days. After they break out in the rash, they are contagious until every pox is crusted over. So it can be six weeks that they are possibly or certainly contagious. With Covid-19, the Delta Variant is so infectious and again people may not have symptoms yet, so I am wearing a mask any time I am around strangers.”

The woman says, “Thank you for telling me about it. It’s helpful to hear from a professional.”

“You’re welcome.” I say, gathering my bag to go.

“Look,” she says, “I am putting on my mask now!”

I look and she is.

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prayer for gentle earth

For the Ragtag Daily Prompt: monsoon.

Today’s prompt of monsoon makes me think both of the fires burning all over, California, eastern Washington, and of the floods in other places.

I took this on a vacation, two days on Herron Island. In the morning we were relaxed on the porch when I spotted smoke on the other side of the cabin. A lot of smoke. My friend explained that sometimes people burn slash, including tires. I was unreassured and insisted on going to look.

It was a house burning down.

The firetrucks must come from the mainland by ferry.

It was terrifying. I took this within 5 minutes of getting there, within 10 minutes of seeing smoke. There were oxygen tanks, live ammunition and propane, exploding.

At first we didn’t know if there was anyone inside. It was clear that we were not getting to them and that they were gone. The only person home had escaped, with the help of a neighbor on the other side. The house burned to the ground very quickly. I had our things loaded back in the car as soon as it was clear that the island responders were waiting for the fire trucks. This house was across the street and one door down.

Prayers for the flooded and the fires. Prayers for us to care for the earth and the earth to be gentle with us.

 

 

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the deer remind me

the deer remind me

the deer are not a metaphor
nor simile
they don’t mean anything
they are in town
because we don’t shoot them
outside the town limits
they are shy

here they cross at the crosswalks
and teach their young
about cars and trucks

the deer remind me

each time I see them
they have no voice
I remember
we think of bambi, gentle
and tragedy of a mother’s death

are deer gentle?
they are strong
fast, we are told hooves can kick
sharp and wound

I sing to deer
when I come across them
almost daily

they look at me
singing, watch me

the deer want to live
as I do too

the deer are not a metaphor
and yet they remind me
to be gentle
and that I am strong
and fleet
and can run when I have to

even when I do not have a voice

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prayer for the gentle

Oh small gentle heart, small self, young one. May I listen to you, may I hold you close, may I let your innocent heart be open and joyful, may I not fear contact with others. May I let you open. May I open without fear or in spite of fear. May I be generous and kind. May I listen with you, oh gentle self, and may I hear the gentle self of others: the gentle self of a friend, of a loved one, of an acquaintance, of a stranger, and even of those who have hurt me. May I have no enemies. May my heart shine with your glory, oh small gentle heart, small self, young one. May I stay connected with you, open to you and open through you to the Beloved, to all beings and all things.

Blessings and thank you, Beloved.

 

For the weekly prompt: satisfaction.