Monday, May 27, 2013

Photo of me in my apron, in the office

Today is Memorial Day.
Diane Lindsay is visiting.  We have been talking about that deep prayerful connection to the God who is beyond all telling, who is the upwelling of the creative and healthy and joy-filled Spirit.  It is a miracle to have a friend come to visit, to have such a conversation,  to sit on the balcony, to listen to birdsong, to watch the hawks over the redwood trees, to be able to walk on the beach with Isis, and to eat grapefruit which is ripe and juicy! Yesterday Diane played Nana's piano for me-- it is a Chickering, and about 100 years old.  The insides got rebuilt about 15 years ago, by a lovely piano-builder here, named Beth.  It sounds so great!  Diane played my grandmother's songs.  They are also 100 years old, and they belong with this piano.  It is a waking dream, a miracle, that I am here, listening to this music, which I so dearly love.  I am remembering, and I am remembering all the soldiers who have given their lives for our country.  God bless them!  I hope for them a true heaven, a place of infinite fun.  Not just peace, because for some, peace sounds boring.  But for the kind of peace which is fun, and  truly heavenly!  Today I am feeling that grace, which is the joy and peace and miraculous fullness.  I so wish it for everyone, especially for those who have given their lives in service.

Saturday, May 4, 2013

Compassion in Medical Care

"What is to give life must endure burning".  Viktor Frankl

I read a story about a woman doctor in labor,  in the online medical magazine "Pulse" which  makes my heart crumple and cry.  I want to STOP it!   I want to punish the docs; a whole team who did not attend to her needs in labor-- as though it didn't matter,  as though the woman and family's complex needs during this intense time of pain and worry are not important. What does it make me, if I become as violent and indifferent as they are?  What has angered me most in my life,---where I kneel down and beg forgiveness, is this kind of insensitivity and callousness to suffering, especially in women.  Women who seem invisible to the treating doctor.  And my great terror is of becoming like this, having it rub off with the precious training.

 I worry that there are people like this in the training institutions. I worry that the whole 3rd world is still full of this kind of autocratic behavior, even though the need for doctors is so overwhelming that the patients must stand our cruelty, and even though the greatest cruelty may be to just be indifferent to  suffering, and turn away and refuse to try to help.

 I am completely raw from reading Abraham Verghese's book, "Cutting for Stone".  The beginning of the story is the completely nightmare-frightening delivery of the conjoined twins and the death of the mother.  Later,  there is the issue of vesico-vaginal fistulae, and the need all over Africa for repairs.  My heart was in my throat for the whole book!  And in my own life, to justify having a middle-class life, here in the USA, where I really try my best to take care of my poor Mexican and Mexican-American patients--- even though I am getting paid for it, it feels like
missionary medicine;  the issues of women everywhere are similar, and pregnancy makes almost all women aware that they are vulnerable and have insufficient resources, because it takes a whole community to raise a child, and stability is so hard to achieve.

This doctor (in the story in "Pulse") had her whole community of doctors let her down.  It is comforting to read my friend's words, about the essential goodness of the medical students.  It is good to remember that there are teaching physicians who model respect and compassion.  It is good that there are docs who have maintained the trust of their patients, and been faithful to the injunction to "first, do no harm."  And it is still so harrowing to read these stories, and know how vividly the person who
experienced that will remember it, her whole life.  And that the
stories reverberate through the culture, making it harder for patients to trust that we will "do the right thing"-- respond with love and care and competent action to their needs and sufferings.
I have heard that many patients are getting experiences of sitting in a room with a doctor typing on a computer, without eye contact through the whole visit.  And physicians who have gone to a doctor who has not EXAMINED them, not even touched them-- listened to their heart, checked their pulse, put a hand on their shoulder.  I can understand not doing a pelvic exam, but I cannot understand not touching the patient.  This story just blew all my fuses again.  I pray and hope to never be so callous.
Since medicine is a PRACTICE, we need to begin again each day, and we can so easily fail to meet the daily need--- we miss the mark.  But bleeding and labor insists on our immediate emergency response, and critical skills.  In the novel, "Cutting for Stone", Dr. Stone vomits before each day's first surgery.  He is so scared of making a mistake.
Once he touches the flesh, he knows where he is, and he can do it.  I understand that terror, of walking into the surgical lounge and vomiting, each morning, unsure of what will need to be faced.
I hope this story provides a background of a cautionary tale. It is a good starting place, and I wish to God it would never happen again.

Psalm 139
You have traced my journey and my resting places and are familiar with
all my paths.  If I take my flight to the frontiers of the morning or
dwell at the limit of the western sea, even there your hand will meet
me and your right hand will hold me fast.