Merry Christmas!

     Today is Christmas, and I am waiting in joyful hope for my boys to come home.  Isis is gnawing on a bully-stick, which is her favorite indoor thing to do.  Greg is working in the kitchen, getting the leg of lamb ready for supper.  I have lit candles, reminding me of all the people I am trying to remember clearly to pray for.  The delight of the morning was a call from Michael Oswanski on facebook.  I didn't know you could have a real-time aural chat--- I thought it was still the "typing messages" thing.  But somehow, because I don't know the technology, I couldn't see him.  So he always is pushing my technological skills a notch higher.  We talked about organ music, how hard it is to describe the beauty of those sounds! ... choral music, and the message of Christmas;  and the way time circles into the eternal NOW.  All the Christmases past, present and future--- and the moment when God breaks into history.
     I always come back to the fact that God chooses to come as a baby-- a just-born infant with eyes opening onto the big wide world--- and it fills me with such intense awe--- that God comes without words or dogma, in human skin-- baby skin, which smells heavenly-- and in those tiny hands and feet, those big eyes, full of wonder.  And such vulnerability--- no armies of angels in full battle gear!   God is willing to come to us, to let us be abusive parents, in all our self-absorbed egotism; God lets us fail to see the miracles.  He waits for us to get it.  He lets time spin out like yards of ribbons, or like the blown dandelion seeds in the dry summer--- waiting for us to come closer to the moment when we hold the baby in our own arms, let it fall asleep on our shoulder, or nestle it against our breast.
     No other religion really focuses on the human baby.  No other religion really brings our attention to the quality of our parenting a baby-- the thought of Joseph taking Mary into his home, because an angel told him to.  How Mary and Joseph together raise this child, in the hidden years--- and hide him from Herod and the slaughter of the innocents.  Most  religions start with a person in adulthood, exhorting us to connect our spirits to the Great Spirit.  But Jesus is also that baby.  He is coming in the most vulnerable, innocent, helpless way He can, to let us possess God, in the child.
     Last night we had singing carols before Mass.  A guy with a great voice sang "Mary, did you know that your baby boy..."  with several verses.  It makes me cry.  I think that we do not know.  We certainly do not know that our children are going to be piercing our hearts with sorrow and fear.  We think they will bring us joy, and we hope they will bring us honor.  We do not want to consider the way of the cross.  We certainly cannot contain, in our becoming parents, the suffering likely to come, as our children move forward toward God in their own journeys, falling and failing as we have fallen and failed.  And yet, Jesus has given us the path, shown us, in a few brush-strokes of the story, what we must endure.  "Did you not know that I must be about my father's business?"  Even if the child does not know it is about his father's business, even if he thinks he can do it with his own WILL, God will be the alpha and omega of his path.  We are in our orbits, like atoms, on our pilgrimage toward the God who made us.  I have walked the labyrinth with this so clearly in mind-- that I am being called back to the center.  The still-point in time,  the mystical rose, the existential moment, the Eternal NOW.  And my child is also called, though he does not know it clearly, is not watching for signs, is not following the stars, is not sure of his way.  And maybe that is also the point.  We see the stars, we begin to watch for wise men, we begin to hear the message in a deeper way, a new way. We begin to think it is amazing and miraculous that shepherds were the ones to see the glory first.  We begin to understand that you have to be cold and lonely and outside at night, to SEE the stars.  And that when you are watching the stars, you begin to hear choirs of angels!  And that you have to listen to your dreams, like Joseph did.  It is amazing that the messages that come in the dreams are the most important guides to your life.  And that the baby will be born without a safe place in the world, because God is always being born in new and amazing ways, outside the ordered world, outside the circle of power and influence;  NOT born to the Rabbi;  NOT born in the Temple precincts or the palace.  The whole thing is amazing.  The whole thing calls us to be filled with wonder and awe.  I circle around it again, and am glad I was able to sing along, in the cold night, in our everyday community, filled with people struggling to be good;  with those dear carols I have loved all my life--- especially the one which says "gloria in excelsis Deo!"

Discernment

This morning I got up early and did my morning meditation, then came to the computer to read another article and answer questions to maintain my board certification.  I am nervous, because the deadline is in 1 week, and I have to read a lot of articles and answer very nit-picky questions about them, to keep being a fellow of the American College of Ob-Gyn.   My mind does not seem as able to retain the details as it used to.   I am feeling old;  and I remember my mother, who probably was beyond 80 when we had this conversation.  I told her that sometimes I think of St. Paul, saying "When you are young you can put on your belt and sandals and go where you want, but when you are old, someone will put on your belt and lead you where you do not wish to go."  My mom was amazed, she had forgotten that saying, and said she didn't know that St. Paul was that smart.  I have been feeling that they have put on my belt and are leading me where I do not wish to go, and my current task is to try to go along as gracefully as possible with this agenda.  I had a joy-filled weekend at the Jesuit Retreat house, with Fr. Tom Weston SJ, on the Thanksgiving weekend.  He is a great teacher, and the more I listen to the Serenity prayer, the more I like it--- I want to have COURAGE to change the things I can, and the Serenity to accept the things I can't change;  and I really want to have the WISDOM to know the difference.  I have always believed that the world is more mysterious and flexible than we think--- and that there is a lot of yeast in the dough.  So almost always, the most important thing is the gift of DISCERNMENT.  I think this is very interesting, and brings back to me the importance of St. Ignatius and the Spiritual Exercises, which have to do with Discernment.  One of the things St. Ignatius said is that we have to put faith into action, and not worry about either consolation or desolation--- they are not to be grasped at, or avoided-- we are just moving through them.  So there is no big confirmation when we are consoled, that it is truly God's will.  In fact, it may just be a false sense of security, that our ego has put there to trip us up.  Lately I have been really conscious of this problem.  Doing the best one can, on a daily basis, is enough work-- and we have to leave the judgement of it up to God.
I need to take Isis for a run down the hill and back, and my joints are feeling arthritic.  Originally I was going to try to walk her on the beach today;  but yesterday,  she got into a big argument with another dog over who is the most in charge, and I tried to pull her away, and she lunged;  and I fell over and bumped my head.  She stood by me then, as I was ignominiously replacing my glasses, and trying to get back onto my feet.  And so I am calculating whether I have the energy to deal with her ego today;  and also, it is cold out, and my joints are stiff.  So I am going to wait til it is warmer to try to walk.  Ever since I came home from the Camino, I have yearned to walk, and it has been wonderful to walk on the beach when I am energetic enough.  I really think that a 3 and a half hour walk is just about right for me.  Sometimes 2 hours is good, but 3 and a half is tiring, but not to the point of exhaustion, and I feel I am maybe able to reclaim some of the fitness and stamina I had when we were in Spain.  I also think that I will have to get a muzzle for Isis, as she is too strong for me to hold back, and I don't want her getting into battles on the beach.  She can run fast, and get in the water, which a lot of the other dogs don't do-- and the water cools her off.
I am going to be thinking about discernment a lot now.  Advent is always a time for me to feel deeply  integrated into the joyful hope of waiting for a baby-- so my whole life and job make sense.   Waiting for God in the way that God usually comes-- in tiny seeds, full of yeast and creative wonder!

Burn out

Today I read that the burn-out rate in physicians is 50%. Depending on the time of day you ask, we probably have sometimes even more than that. The pace is fast, and the ongoing load is now accompanied by more and more documentation on the computer-- and follow-up charting and phone- calls--- til one just can't stand any more. Wednesday I got out of the office at 7:30 and finished up the labor room at 8:30 pm. Back again today at 7:30 am for rounds and c/section before office hours at 9. On-call tonight and watching over a laboring patient-- not likely to go home before 11 pm--- but will be lucky if no one else delivers tonight. The burden of doing so much extra paperwork for the hospital charts, and reading journals ( skimping lately in comparison to earlier in my life) and phone calls for lab reports seems like it has made double the workload. I have been lucky to have the doctors in ISHI the institute started by Rachel Remen MD, as my friends, companions and Colleagues. We have tried to stay focused on the doctor-patient relationship, and the need for compassion and integrity, in our work. I know the young doctors are much better at the computer interface than am I; and I keep hoping the reforms of how we do things will increase both safety and quality-- which everyone says is the goal. Still I worry about the high amount of burn-out and numbness in myself and my colleagues. Trying to maintain work-life balance is hard.

poem video from Burgos

http://youtu.be/btnU0r7zA-Y

I can't seem to upload this video clip onto the blog site, but it was successfully loaded to You Tube.  So this is the link!

Bread for the Stardust Pilgrims

This is me reading the poem "Bread for the Stardust Pilgrims" in front of the cathedral in Burgos.  THANKS to Andy for filming it!  A highlight of my life!!

Immigration and Pilgrimage

The immigration issue is really hard.  I think it is another iceberg-- where all you see is the tip-- while the big pieces are that the employers can use the cheap labor, and get away with not providing the "living wages" which would cover the healthcare, housing, social services, infrastructure needs of the towns, and the education needs of the families who take these low-paying jobs.  Meanwhile there are big money sponsors eager to to help conservative politicians like Scott Walker, who want to "remove social services" from the agenda of the government.  To me this is egregious behavior.  It is also narrow-minded and short-term thinking.  We have to hope that there are more people who see "the big picture", and can mentallly construct the rest of the iceberg from the tip they can see- so we don't sink the country on it!   Once a Mexican woman asked me to write a letter to the immigration authorities for her, begging for medical amnesty.  This was because she was afraid that if she went home to deliver her baby, she would likely die.  There is no hospital, no running water, no doctor, no midwife, no electricity, no help in the rural farm she came from.  She begged to have her baby here, where we have these services.
I was just reading that Partners In Health has been figuring out how to give cesarean deliveries in rural places where OB help is needed, and how much it would cost-- something like $300.   I keep hoping that their model, and also help from the World Bankers through the new job of Jim Young Kim, will make it possible.  When I was young, cervical cancer was the biggest killer of women.  We are now at the edge of wiping out HPV-related cervical cancer with a vaccine.  May it also be true that in my lifetime, we can bring OB care and CSections to the vast majority of the world's women who need a safe passage to motherhood.  May we not have so many orphans.  May we not have the need for so many vesico-vaginal fistulae, as women get timely surgical deliveries.  May I live to see it!
I hope that we as Americans can begin to turn the tide toward recognition that social services and health care and education are actually part of "providing for the general welfare"-- as stated in the constitution.  I believe  the common good, and the consensus needed, will help propel us into the better government, with more transparency and more flexibility to meet the needs of the citizenry, to really make us a nation looking forward for the 21st century.
 I have been reading the Tikkun magazine, and thinking of the idea of Tikkun Olam--to repair the world.  I also have been thinking about the experience of walking the Camino, of being a pilgrim, needing support and help as we went along.  How easy it was to get tired and hungry and frightened that our needs might not be met!  Needing shelter and food, and "dying" to lie down with our feet up, were the topmost thoughts of the day.  I was listening to David Steindl-Rast and David Whyte, at the Gratefulness.org colloquium, online.  David's new poems about the Camino are just fabulous.  He says what I wanted to say.  I wanted to talk about the sense of the sacred, of the importance of always feeling like we were walking on holy ground.  When they talked about shedding the old skin, the dead skin, like shoe leather, in the way Moses was told to shed his shoes before the burning bush, Fr. David Steindl-Rast talked about how "to get our living skin onto the living earth" is what is meant-- because we KNOW in our flesh that we are always on holy ground.  Also, he pointed out that it was not so miraculous that the bush was burning, but that it was burning without being consumed.  The joy in life, the pleasure and passion and engagement, are when we are burning but not being burnt out or used up.  Gratefulness helps us to recognize the vitality and passion in ourselves.  We bring new life, new energy to our daily world if we can feel that we are on holy ground, and that we are pilgrims, moving toward the sacred with gratitude, and with wonder and curiosity.  I can hardly say enough how grateful I am to have had the month to walk the Pilgrimage path.  I am still joyful, at the gift it was!

The Spiritual Gift of the Camino

A week ago, a patient of mine almost died of an amniotic fluid embolism, and I am so grateful that she lived.  This is a complication at the end of pregnancy that we cannot predict, and the kind of care that is needed is supportive-- but if the injury is massive enough, it will kill the patient, no matter what we do.  So I was again confronted with the hardest thing in my life as a doctor-- my helplessness to control outcomes.  In our case, we had great teamwork, and it was a gift, to have such excellent colleagues helping me, and helping her.   This was a reflection on the greatest of the many gifts the Camino gave me.

 I feel the helplessness of being a person holding the hand of a person at the edge of death;  the marveling, that we cannot know if we will be enough;  and that we do what we can, and we must do it as well as we can, and only stop to feel the self-doubt later, after we have done all we can.  I was thinking a lot, on my walk, about the Gospel story where they ask Jesus why a man was born blind.  "Was it his sin, or the sin of his parents?" they ask.  He answered them "Neither.  It was so that the glory of God could be revealed through him."

I keep thinking of that story, as the answer to a lot of what happens in medicine.  At the edge where we work, we can only try, wittingly or un-wittingly, to be instruments for the glory of God to be revealed.  Which is another way of saying that miracles do occur.  When someone says that they don't believe in miracles, I think of Einstein, who said "either everything is a miracle, or nothing is."  But we cannot command them.  This is a hard thing for some skeptical people to entertain.  But with or without our awareness, many amazing and wondrous things happen.  What I think happened to me as time went by, in practicing medicine, was that fear of bad outcomes became pretty overwhelming, making me become over-controlling.  I knew I needed to let go and recognize that it is beyond me,— up to God, or what Rachel would call Mystery, or Life itself.  But to let go of the sense of control and over-responsiblility for the outcomes was impossible.

I really felt the difference, after this month of walking the Camino.  I took two rocks with me, one for the broken-hearted people I know, and one for the seriously ill people I know.  And I held them in my hands for many hours of the day, as I walked along– trying to get ready to leave them, loaded with prayers, at the foot of the iron cross, ('cruz de ferro"), which is on a mountain about two-thirds through the pilgrimage.  I also had been carrying a very special rock from a physician friend with a heartache which has been immensely difficult to overcome.  These three rocks were my meditation tools, as I walked along.  I started seeing that most of the things I was praying about were things which only God could fix.  I slowly felt myself letting my hands hold them less tightly, and my prayers around them becoming more "into Thy hands…"   I started retracting myself more into the small Hobbit-like woman walking along this ancient path.  Nobody asked for my advice or help.  I was carrying my pack, and my legs were aching.  And I was truly grateful for good weather, good food, and the simple but great gift of a place to lie down, and a shower.   I think for anyone who has gotten to a place of almost paralysis with the need to control, it is worth considering doing this kind of pilgrimage.  Perhaps even a shorter time would do– but the month was such a great gift, to be able to reach for a different rhythm, and give time for it to take hold.  One of my friends sent me an article about a new book written by a woman physician about the Laguna Honda Hospital in San Francisco, in the 70s and 80s, and how it was such a gift for patients to have adequate time to heal– sometimes months, for slow recovery.   I thought about that gift of slow time to heal.  I feel so blessed, that I got that whole month, to be able to uncurl from the false sense of control.  It gave me a new ballast, and a new center of gravity.  And the vivid remembrance of leaving those stones at the foot of the cross.