For Wordless Wednesday.
Happy things starting with D:
Discrimination, death, delight.
I am happy that slowly, slowly, it feels as if there is change in the world and a decrease in discrimination. It is NOT gone by any means, but I think it is slowly being eroded.
My parents had a party when I was two and they were both in college. The party was raided in Knoxville, Tennessee in 1963 and my father was taken to jail. My mother and I were left alone and she was afraid we would be lynched by the neighbors. The next morning the paper wrote about a MIXED RACE COLLEGE STUDENT PARTY possibly with orgies. My parents were both suspended from the University of Tennessee.
They were both reinstated after a hearing, because there were no drugs, no underage drinkers, and it was not illegal to have a mixed race party. My parents never touched marijuana ever and I think it was because of that party. I don’t remember it, but I still feel cautious at parties and in crowds. My mother refused to return to the U. of TN and eventually finished her undergraduate degree at Cornell. My parents were so notorious that we left Knoxville as soon as my father graduated.
I grew up learning protest songs and work songs and joke songs. My mother joked about the party and it was years before I found out how terrifying it was. My mother joked that they sat at the one liberal table at the University of Tennessee. I hate discrimination and I do not understand it.
Death: is death a happy thing? Death is as much a mystery as life, and we cannot have one without the other. How could we value life if it were eternal? And we’d also get awfully crowded. I have the privilege of caring for all ages in clinic, all genders, any race that comes in the door, age newborn to 104, what joy! I get to be present when someone is dying and try to help the person and the family. There is no single idea about death or about how to “do it right” and often families struggle with multiple opinions and ideas and feelings. Death is as intense as birth and I have had the privilege to attend both.
Delight: there are many things that I find difficult and depressing, but I find delight too! The latest morbidity and mortality report from the CDC on overdose deaths, up from 52K in the US in 2015 to 62K in the US in 2016: Overdose deaths involving opioids, cocaine and psychostimulents — United States, 2015-2016. We have to work harder to prevent addiction, why do we choose addictive substances, why do people think it won’t happen to THEM?
And yet, I still find delight, taking photographs of bird, seeing patients that I know well in clinic, we laugh often, finding joy walking outside, my family and friends.
The photograph is from Mauna Loa last week. It is not a giant dinosaur nest, it’s a cinder cone. At least, that’s what a geologist claims….
What is wellness and what is illness?
Many of the people that I see in clinic want healing. But healing is complicated. Many people define healing as “I want to be the way I was six years ago when I felt good.”
I delve into the time when they felt good. Sometimes when I start asking about it, they were very busy. Often very stressed. Often not paying attention to their own care, caring for someone else, a parent, a child, a partner. Or overworking with great intensity. “But I could do it!” they say, “I didn’t feel bad!”
…Maybe not. But the self care was deferred. The body struggled on as best it could, absorbing trauma after trauma, being ignored until a tipping point was reached. Then the switch was thrown and the system crashed…
When my sister died of cancer at 49, the family fought. Lawsuits. I promptly crashed and was out sick for two months. I nearly died too, of sepsis. I thought, I’m not going to be that stupid again. Well, except I was. My father died fourteen months after my sister and I was executor, dealing with a 1979 will. I was sure that I would be sued. I did not cut back work and I didn’t rest. I worked on the estate and cried, evenings and weekends.
After a year, I crashed again. Sepsis, again. I did not die, but this time I was out for ten months and then had to work half time for ten months. And I thought, oh, am I stupid or what? I didn’t take time off when my father died. I just pulled my boots up and kept working, two jobs. Executor and physician.
I made the rounds of specialists. I coughed for six months. Pulmonary. My lungs were slowly improving, very slowly. My muscles were lagging: neurology said they would get better. “When?” I said. “We don’t know,” said the neurologist, grinning. “I hate doctors,” I said. He laughed. On to Ear, nose and throat, then Asthma/Allergy, then Infectious Disease. “We don’t know how to keep you from getting it again.” says the Infectious Disease specialist cheerfully. “No idea.”
Back to work. Half time for ten months. And now my new “full time”. My goal is not to work more than forty hours a week. I spend 4.5-5 hours seeing patients and 3 hours reading and making decisions about labs, specialist notes, ER notes, inpatient notes, pharmacy notes, garbage from insurance companies, medicare’s new and improved impossible rules, continuing medical education, pathology reports, notes from patients and phone calls. And then I go home.
I would have qualified for a diagnosis of chronic fatigue six months into the illness. I didn’t seek it because I didn’t care. I was quite certain that I would get better, though I didn’t know how long it would take. I was quite certain that I would have to behave differently or I would crash again. If I get it again, I don’t think I will be able to do medicine and I like doing medicine. Also, if I get it again, there is a 28-50% mortality rate. Not good odds. So I need to pay attention, rest when the stress reaches the level of stupid, and take care of myself.
It is now thirty months since I got sick. I do actually feel like my muscles are back to normal. My lungs aren’t quite. I can tell when I play the flute that there is some scarring, after three bad pneumonias. But I can play and sing and I am slowly getting back to shape.
But note: I am NOT going back to where I was. I am paying attention. I am changing my job and my life so that I stay healthier. I am not returning to unhealthy levels of work and stress. And if stress in my personal life flips to high, I take time off from work. I have to, to stay healthy.
When I meet a new patient, the ones that are hardest to help are the ones who want to turn back the clock. They want the exact same life back that crashed them. The life that they got sick in. Think of a veteran getting blown up: we don’t expect them to be the same. Think of my 90 year old patient who went through both brain and heart surgery. He was better. He was able to hunt again which was his goal. But he said, “You have not made me feel that I am 20 again.” I laughed and said “And I am not going to. Talk to your higher power.” He was teasing me, but he was also acknowledging that his body and his endurance and his health at 90 was different than at age 20.
We need a new paradigm of wellness. Wellness is not staying the same for one’s entire life. You will not be 20 for 70 years. Wellness is changing as your life changes and paying attention to what you and others need. Wellness is accepting illness and deciding how our life needs to be changed to be well.
I took the photograph of Mount St Helen’s five years ago. The mountain changed too, as we all do.