I have been trying for 6 months to get myself ready, and to begin to know how to do this, how to "let go, and let God," in this part of me which always felt like the biggest part of me, and of what I was called to be and do. And yet, Rachel said, "walk out of your role and into your life". So there was a way to get past the feeling that I am dying-- it just was going to be hard. I have closely watched many people approach this change, and it is not easy to do this gracefully.
I know that my children have gotten less of me than some children have gotten from their mothers, and it was always the existential question-- "did they get ENOUGH?" even though it might be less than they wanted, was it sufficient for them? So it was even more tension, that Andy is leaving for Chile, just after the retirement party, but a great gift that he was willing to come, and hang out and just be there for me. And Sebastian, too--- now such a grownup, and able to bring the beer, and sit on the tailgate schmoozing with Dr. Garner.
The irony is that I had invited about 100 doctor-colleagues, and only Dr. Garner actually came, and Dr. McNamara, partly because the social worker Kim brought him along. I am so indebted to the labor nurses, who came and made merry, and were fun and strong and warm. These women have been the backbone of my life, and in real ways, being the team in OB, have made our work possible, and gotten me through a lot of crises, and helped babies arrive safely in their mother's arms.
I have been already trying for months to feel my way through this, saying to myself that this may be the last time I do this, and this may be the last time I see "her" face. Last week I worked very hard stuffing envelopes with the goodbye letter. I did it until my back was hurting so badly that I had to lie down, and again I knew deeply that it is time for me to go; and that these letters, my last attempt to give love and support to my patients, will need other hands to seal and mail them. I have tried to keep going so that the office will keep functioning and our staff can keep working, but we are being squeezed out by larger corporate structures, and we cannot make ends meet any more. So I am praying for each of my staff, to be able to get good jobs, and to fit into their new lives in ways even better than what they have now-- ways that God can move in their lives in mysterious ways which will strengthen all the good in them-- which I know and have loved, and have been blessed by.
I remember several other docs facing the dilemna; and one who couldn't leave, so she stayed until 3 days before she died, walking through the hospital, trying to function, and not willing to give up this identity.
I remember Joe Anzalone, who tried about 3 different times to retire, before he actually stopped walking in to do surgery or check on the office. I have heard that in big corporate practices you can retire at age 55 with full benefits, so there is nothing but the love of your patients to try to hold you there. And maybe it is easier, when there is a larger staff to take over the patient care, of those patients you have loved and taken care of for a long time. And I do know other docs who say "but I have been taking care of (her) for 30 years, it is so hard to say goodbye!". That is how I feel about each of my patients--- we have formed a doctor-patient relationship.
There are a few patients who had such severe stress and terror, and deep vaginismus, that to get an exam and pap smear was a major achievement. Slowly, slowly, they came to trust me, to believe I wouldn't hurt them; and that no question they asked would be unwelcome, that I would try to answer the best I could. And also, we who have been practicing a long time can see now, how much the real issue is FEAR--- so many questions and hesitation and blocked speech, all from the terror of "what does this mean?". Once we are able to give a diagnosis and tell them what it means, and to put it into a context, they can bear the next step.
I am going to miss that part, and also the part of helping women to have a normal vaginal delivery--- as the c/section rates rise higher and higher, and doctors are so scared of being sued, and the protocols get more rigid--- it becomes harder to take a chance, try a different position, see if maybe we are able to make a difference in some small way, so that this baby will come down through this mom's pelvis. I have written before about women who don't want to see us, don't want to come to the hospital, and who believe midwives will miraculously be able to do more than a doctor to help them get through a vaginal delivery. I am glad to know some excellent midwives, but they need us for the tough cases, and they recognize the difficulties inherent in childbirth.
I am glad that all around the world, better maternal-child health is happening. Although it has gotten worse in our country, because of loss of healthcare coverage, and women working so hard; so preterm labor has increased. And somehow we are having this epidemic of autism, and we don't know why! At least in the developing world, more money and training and help is happening, to get safer deliveries, and less mothers dying in childbirth, and more babies making it to childhood.
It is time for me to stop doing the 16 hour days, the nights on-call, and the need to jump out of bed and race to the hospital for someone whose baby's heartbeat suddenly isn't looking safe-- or a hemorrhage, or an ectopic pregnancy. I know that there are superbly trained young doctors out there, and I hope they will be willing to just be kind and compassionate and gentle, as they offer technically excellent care.
I feel the feeling of fellow-docs; that tiny unstated resentment, of abandoning them, leaving the team. I know that subtle turning away-- "you don't belong here anymore". No one knows how to do this when they are young, and even when you are old, it is very hard to be able to do it gracefully. When you are young and get sick, like one of my doctor friends who got a terrible case of chronic fatigue syndrome which has been unresponsive to every thing they have triend, she feels that they write her off, look at her as a victim and sad case, not as a doc who couldn't keep doing the medical role. I am afraid of being seen as an old fuddy-duddy, or someone who is just in the way, or "does it wrong".
I know that they are not going to come and ask my opinion, and that everyone has to learn to make their own mistakes. These are such hard lessons. I will keep doing the prayers, and trying to let go gracefully--- but I know so many times a day, I will have to open my hands again, and ask for help.
I feel so lucky to have the feeling God is walking this walk with me, through the valley of the shadow of death. I say the prayer from Thomas Merton hoping that I am listening hard enough to that real voice, which is calling me, to do what is best, which conforms best to God's plans, will, desires.
It is good I have another month to practice, another month of trying to get more graceful at trying to let go!
I read this wonderful quote today from another doc I have loved and respected, Ken Hamilton, who started a group called H.O.P.E.
"In closing, I share with you this thought—my “Prime Directive”—“First, do no harm; second, do some good; third, benefit someone; and fourth, be kind to them.”( Indeed, remember Anne Herbert’s “Practice random kindness and senseless acts of beauty,”) and work it at every conceivable opportunity… it is infectious."
my favorite prayer---
. “My Lord God, I have no idea where I am going. I do not see the road ahead of me. I cannot know for certain where it will end. Nor do I really know myself, and the fact that I think that I am following your will does not mean that I am actually doing so. But I believe that the desire to please you does in fact please you. And I hope I have that desire in all that I am doing. I hope that I will never do anything apart from that desire. And I know that if I do this you will lead me by the right road though I may know nothing about it. Therefore will I trust you always though I may seem to be lost and in the shadow of death. I will not fear, for you are ever with me, and you will never leave me to face my perils alone.”
Thomas Merton
Sunday, December 28, 2014
Wednesday, November 19, 2014
"The long and winding road"
coming to the end of the road...
Long and winding; just like that song--- and it feels like a footpath for deer, now-- not easy to see how to get gracefully past the twisting switchbacks. I am praying many more times in the day, opening the day with a sitting meditation, hands in lap, "head over shoulders" and thinking that the back should try to stay straight, and opening up into "heavenly Father, creator of the universe", and seeing that swirling cosmos across the Milky Way... how inconsequential these political machinations seem, then; and how unimportant these issues of how to assuage my anxiety in the face of the loss of the "persona" I was trying to be, all this time.
Rachel, my friend and mentor, has said to me that I should get out of the way, and let God do His work. It is amazing to think I have been blocking His work, rather than trying to assist it. But someone once said that religion is one of the best places to hide from God, from vulnerability and helplessness, and not knowing. And it was Rachel that said "we are not the tube God shouts down through." Sometimes we have substituted expertise for depth of commitment and integrity.
I was entranced, reading the book by Wallace Stegner, called "All the Little Live Things", how insightful he is, into the pompous mind of someone in our 60s, trying to put up with stuff we have seen before, think we understand, and perhaps unfairly wish to dismiss. I cannot stand listening to the radio in my work place--- it sounds heinous to have whiny voices or rap singing, especially if someone has a complex problem we are trying to address. I much prefer Bach, or quiet "music for people without teeth" as my husband calls the MUZAK that they pipe into office buildings. Still, a kinder,gentler universe is what we would really like to occupy. And what I love best, still, is Palestrina. I think now of T.S. Eliot's "Love song of J. Alfred Prufrock" --- "there will be time to murder and create; time for the taking of toast and tea; time for a vision and revision which a moment will reverse." And all of that is true; and still, one should not be silly with remembering the punctiliousness of our youth. And yet, we must be conscious and grateful for the miraculous gift of time which we have been given, whether or not we deserved it, or can still use it well.
Now it is November, and Sebastian is almost turning 23. I remember his birth, so awful, disastrously hard, a mid forceps delivery and lateral vaginal wall tear all the way to the cervix, and he was in the ICU for 5 days. I was raw, feverish, anemic, and bleeding. Dad and Mom were in the hall, pale as ashes. What an idiot I was to put my body through it; but it was arrogance, pride, belief that somehow I could get through it; and of course I made my patients do it, so it was a "holding of standards" which I was trying to do-- as if we all fit the protocols. Now I rail against the protocols, and some days I am wiser than others, in giving up on that ephemeral vaginal delivery dream and instinct. Greg said, "it looks like the Civil War"-- and I still remember how appalled he was!
People talk of leaving a legacy, but the whole thing of birth is tricky, humbling and humiliating, and it is something you just have to do one at a time, and there are too many variables. It is never the same. And it is something which requires skill, but now it is being left to the midwives, and the whole thing of skills and seasoned judgement in obstetrics is being a bit lost, as the cesarean rates climb, and there are more and more things to worry about in the protocols, which are built so that employed hospital doctors and nurses will not take medico-legal risks--- which always is what natural childbirth IS. We are hoisted on our petards. I read an article this week that said it really is not possible to achieve the standard of being able to do a CSection in 30 minutes, if one is assiduously attending to the number of minutes, and all the protocols that need to be done for surgery. Still, that poor baby--- Sebastian--- in the NICU with dents in his forehead, and his heart beating fast, after such a tough labor and forceps delivery; I am glad he grew up to be hard-headed, and strong, and good with his hands. It is also nice that his birthday is so close to Thanksgiving, and I do give thanks, over and over, that as old as I was-- 41, I was able to have him. I had 5 miscarriages, and it was hard, wanting them so much, to lose them, knowing there was no solution to being old. I am so grateful that Sebastian made it. I think of him in that little bumble bee outfit, and the little red jeep, when he was 3 or 4. It was such a gift to have such a happy child. How blessed, how lucky I have been! Whatever else, I am still so grateful for the two big gifts of my sons.
And if there is still time, I will try to write some more poems, and get that book about the Camino done. I just haven't been able to pull myself together to get it done-- the clinical work is taking all my energy. Although the latest Vienna reunion in Southern California was so wonderful; and I got the time boogie-boarding, and the walking on the beach, which always has helped revive me.
This week I read a blog about physician suicide, and a man wanted to know if it was possible to find a doctor who is HAPPY? I think maybe only the doctors who are in smaller towns, where they are still known, and have a stable life, and haven't had their wives divorce them, or their husbands, if they are women, and whose kids are not strung out on drugs are really happy. Some of the docs I know are glad to have carved a life which is bearable in a big corporate structure, and they get paid enough to go on nice vacations. They are learning how to work in teams, and have enough back-up so that they aren't completely missing from family life, and somehow the corporations are paying enough. So I guess you could say they are happy. But happiness is ephemeral, and maybe they are having a beast of a time, in some other facet of their lives. I know for me, that the hell of the computer system has broken my spirit. The thing freezes, it is awkward, and I cannot type quickly, and there is too much to do to fix each chart. And I do not want to do it in front of the patient, or have to interact with it instead of with the patient. So I sit there long after everyone has gone home, trying to get the charts right. And the big corporate practice near here has a better, more expensive system, which fills in the blanks in a way which makes it easier to bill the insurance-- which they can afford, but small practices like ours cannot afford. And the insurance companies and the pharmaceutical companies are running away with the store--- so that doctors and patients are all at their mercy, and they do not want to let me give my patients estrogen even if they need it, and the husbands are able to get Viagra. So we still are dealing with the ongoing structural inequality between men and women, and all that that entails. But I know, and the patients know, that we are trying to keep them as healthy as we can, and meet as many of their needs as we can, given all these uncertainties and inequities. And the patients understand that it matters, that the doctor actually KNOWS them. And CARES. So here I am, at almost-the-end of the long and winding road, in what has begun to look like a deer-path; saying my prayers, hoping for the best, putting it into God's hands.
Long and winding; just like that song--- and it feels like a footpath for deer, now-- not easy to see how to get gracefully past the twisting switchbacks. I am praying many more times in the day, opening the day with a sitting meditation, hands in lap, "head over shoulders" and thinking that the back should try to stay straight, and opening up into "heavenly Father, creator of the universe", and seeing that swirling cosmos across the Milky Way... how inconsequential these political machinations seem, then; and how unimportant these issues of how to assuage my anxiety in the face of the loss of the "persona" I was trying to be, all this time.
Rachel, my friend and mentor, has said to me that I should get out of the way, and let God do His work. It is amazing to think I have been blocking His work, rather than trying to assist it. But someone once said that religion is one of the best places to hide from God, from vulnerability and helplessness, and not knowing. And it was Rachel that said "we are not the tube God shouts down through." Sometimes we have substituted expertise for depth of commitment and integrity.
I was entranced, reading the book by Wallace Stegner, called "All the Little Live Things", how insightful he is, into the pompous mind of someone in our 60s, trying to put up with stuff we have seen before, think we understand, and perhaps unfairly wish to dismiss. I cannot stand listening to the radio in my work place--- it sounds heinous to have whiny voices or rap singing, especially if someone has a complex problem we are trying to address. I much prefer Bach, or quiet "music for people without teeth" as my husband calls the MUZAK that they pipe into office buildings. Still, a kinder,gentler universe is what we would really like to occupy. And what I love best, still, is Palestrina. I think now of T.S. Eliot's "Love song of J. Alfred Prufrock" --- "there will be time to murder and create; time for the taking of toast and tea; time for a vision and revision which a moment will reverse." And all of that is true; and still, one should not be silly with remembering the punctiliousness of our youth. And yet, we must be conscious and grateful for the miraculous gift of time which we have been given, whether or not we deserved it, or can still use it well.
Now it is November, and Sebastian is almost turning 23. I remember his birth, so awful, disastrously hard, a mid forceps delivery and lateral vaginal wall tear all the way to the cervix, and he was in the ICU for 5 days. I was raw, feverish, anemic, and bleeding. Dad and Mom were in the hall, pale as ashes. What an idiot I was to put my body through it; but it was arrogance, pride, belief that somehow I could get through it; and of course I made my patients do it, so it was a "holding of standards" which I was trying to do-- as if we all fit the protocols. Now I rail against the protocols, and some days I am wiser than others, in giving up on that ephemeral vaginal delivery dream and instinct. Greg said, "it looks like the Civil War"-- and I still remember how appalled he was!
People talk of leaving a legacy, but the whole thing of birth is tricky, humbling and humiliating, and it is something you just have to do one at a time, and there are too many variables. It is never the same. And it is something which requires skill, but now it is being left to the midwives, and the whole thing of skills and seasoned judgement in obstetrics is being a bit lost, as the cesarean rates climb, and there are more and more things to worry about in the protocols, which are built so that employed hospital doctors and nurses will not take medico-legal risks--- which always is what natural childbirth IS. We are hoisted on our petards. I read an article this week that said it really is not possible to achieve the standard of being able to do a CSection in 30 minutes, if one is assiduously attending to the number of minutes, and all the protocols that need to be done for surgery. Still, that poor baby--- Sebastian--- in the NICU with dents in his forehead, and his heart beating fast, after such a tough labor and forceps delivery; I am glad he grew up to be hard-headed, and strong, and good with his hands. It is also nice that his birthday is so close to Thanksgiving, and I do give thanks, over and over, that as old as I was-- 41, I was able to have him. I had 5 miscarriages, and it was hard, wanting them so much, to lose them, knowing there was no solution to being old. I am so grateful that Sebastian made it. I think of him in that little bumble bee outfit, and the little red jeep, when he was 3 or 4. It was such a gift to have such a happy child. How blessed, how lucky I have been! Whatever else, I am still so grateful for the two big gifts of my sons.
And if there is still time, I will try to write some more poems, and get that book about the Camino done. I just haven't been able to pull myself together to get it done-- the clinical work is taking all my energy. Although the latest Vienna reunion in Southern California was so wonderful; and I got the time boogie-boarding, and the walking on the beach, which always has helped revive me.
This week I read a blog about physician suicide, and a man wanted to know if it was possible to find a doctor who is HAPPY? I think maybe only the doctors who are in smaller towns, where they are still known, and have a stable life, and haven't had their wives divorce them, or their husbands, if they are women, and whose kids are not strung out on drugs are really happy. Some of the docs I know are glad to have carved a life which is bearable in a big corporate structure, and they get paid enough to go on nice vacations. They are learning how to work in teams, and have enough back-up so that they aren't completely missing from family life, and somehow the corporations are paying enough. So I guess you could say they are happy. But happiness is ephemeral, and maybe they are having a beast of a time, in some other facet of their lives. I know for me, that the hell of the computer system has broken my spirit. The thing freezes, it is awkward, and I cannot type quickly, and there is too much to do to fix each chart. And I do not want to do it in front of the patient, or have to interact with it instead of with the patient. So I sit there long after everyone has gone home, trying to get the charts right. And the big corporate practice near here has a better, more expensive system, which fills in the blanks in a way which makes it easier to bill the insurance-- which they can afford, but small practices like ours cannot afford. And the insurance companies and the pharmaceutical companies are running away with the store--- so that doctors and patients are all at their mercy, and they do not want to let me give my patients estrogen even if they need it, and the husbands are able to get Viagra. So we still are dealing with the ongoing structural inequality between men and women, and all that that entails. But I know, and the patients know, that we are trying to keep them as healthy as we can, and meet as many of their needs as we can, given all these uncertainties and inequities. And the patients understand that it matters, that the doctor actually KNOWS them. And CARES. So here I am, at almost-the-end of the long and winding road, in what has begun to look like a deer-path; saying my prayers, hoping for the best, putting it into God's hands.
Wednesday, September 3, 2014
Gene Burkhardt and the importance of deepening friendships
One of the classmates from my year in Vienna (1970) was Gene Burkhardt, from Holy Cross. Gene lived in Waltham Mass.; and was a great person-- phenomenally well-educated and ethically insightful, and a lawyer. His family and friends have produced a small book of his insights and writings, collected over the years. It is called "Bearing Witness, " published by Back Pages books. Sadly, he died in 2012. He wrote a column for the local paper, and he wrote with clarity and depth about everyday things which really DO affect how we see our world. One of his Holy Cross classmates, Bill Connors, sent me this little book. I am so glad, because I have been feeling angry, betrayed and bewildered by our society, and Gene has helped me see the reasons why I feel this way.
He speaks about the ways people engage in community life, and about valuing our interconnectedness. One of the things which was said about him in the introduction is that he winnowed down the lessons from Ivan Illyich (and also with a touchstone from the Gospels), to the formation and deepening of friendships. He was a very beloved and dear friend to many many people, and it seems to me an important insight which he has given us, to deepen our mastery of being friends. This also spilled over into what he says about politics, that we engage as voluntary participants, not as paid supporters of some cause which will actually bring profits to one side. The fact of wanting to do things impelled by our attention to the common good, and for the public weal, is a big part of what he attends to.
When we attend to being friends, there are some things we will see differently, and some things that we will learn from each other. But for many of us, it is a lesson of friendship that we do not have 100% agreement on things-- which stretches us, makes us want to understand the viewpoint of the other person, and teaches us to be "cultured" in the best sense. Wisdom grows when we learn to balance our self-interest by considering the good of our neighborhoods, and the needs of our friends. But also, Gene points out that it is wonderful to be known, and addressed by name, in our daily activities; whether going to a local farmer's market, participating in the life of our children's school, or any of the ways in which we voluntarily participate in local activities. Becoming friends to our neighbors, recognizing their needs as well as our own, and trying to work with our friends to accomplish mutually important goals, is a very healthy way to be human!
He gives a wonderful example of an inner city park which was blighted, and full of graffiti and drug-selling. Local people decided they wanted to have an annual Hispanic picnic, and that this park was the best location for it. And so, local people began pooling their attention and resources toward refurbishing, painting, and fixing up the park. It was not something imposed from the city ordinances, or the mayor's office. There was not an official budget. People all chipped in, with community volunteers doing the labor. The loving attention to the park paid off, and the celebration was a success. And it got better as the years went by. What he says about this is that instead of seeing the needs and the deficits, people were counting on the possibilities, and the talents and abilities in the people who live in the neighborhood. I love this, concentrating on the potential for good, and the abilities instead of the lacks. I also love that the community was able to reclaim this park from abusive people who had defaced it, and were making it uninhabitable and frightening. That local families were caring enough and able to do this together, is a great sign of health!
In a similar way, he talks about how economic power can be used to impoverish people, and aim more and more at corporate profits, which are often not reinvested in local communities; or to share, to attend to needs and limits, and find ways to make do with what we have. This fundamental economy, of recognizing that we cannot grow like cancer, and keep making more profits; we sometimes need to shrink, to conserve, to forego things in order to be good stewards of the land, the resources in our care---- all of this is such helpful and true thinking! I highly recommend this book to everyone, like vitamins, it will help fortify your soul, and help focus your thinking about how to be both a good steward and a good friend. To me, the insight that becoming a deeper and better friend is a major and helpful tool for sorting through the issues of "first things first".
He speaks about the ways people engage in community life, and about valuing our interconnectedness. One of the things which was said about him in the introduction is that he winnowed down the lessons from Ivan Illyich (and also with a touchstone from the Gospels), to the formation and deepening of friendships. He was a very beloved and dear friend to many many people, and it seems to me an important insight which he has given us, to deepen our mastery of being friends. This also spilled over into what he says about politics, that we engage as voluntary participants, not as paid supporters of some cause which will actually bring profits to one side. The fact of wanting to do things impelled by our attention to the common good, and for the public weal, is a big part of what he attends to.
When we attend to being friends, there are some things we will see differently, and some things that we will learn from each other. But for many of us, it is a lesson of friendship that we do not have 100% agreement on things-- which stretches us, makes us want to understand the viewpoint of the other person, and teaches us to be "cultured" in the best sense. Wisdom grows when we learn to balance our self-interest by considering the good of our neighborhoods, and the needs of our friends. But also, Gene points out that it is wonderful to be known, and addressed by name, in our daily activities; whether going to a local farmer's market, participating in the life of our children's school, or any of the ways in which we voluntarily participate in local activities. Becoming friends to our neighbors, recognizing their needs as well as our own, and trying to work with our friends to accomplish mutually important goals, is a very healthy way to be human!
He gives a wonderful example of an inner city park which was blighted, and full of graffiti and drug-selling. Local people decided they wanted to have an annual Hispanic picnic, and that this park was the best location for it. And so, local people began pooling their attention and resources toward refurbishing, painting, and fixing up the park. It was not something imposed from the city ordinances, or the mayor's office. There was not an official budget. People all chipped in, with community volunteers doing the labor. The loving attention to the park paid off, and the celebration was a success. And it got better as the years went by. What he says about this is that instead of seeing the needs and the deficits, people were counting on the possibilities, and the talents and abilities in the people who live in the neighborhood. I love this, concentrating on the potential for good, and the abilities instead of the lacks. I also love that the community was able to reclaim this park from abusive people who had defaced it, and were making it uninhabitable and frightening. That local families were caring enough and able to do this together, is a great sign of health!
In a similar way, he talks about how economic power can be used to impoverish people, and aim more and more at corporate profits, which are often not reinvested in local communities; or to share, to attend to needs and limits, and find ways to make do with what we have. This fundamental economy, of recognizing that we cannot grow like cancer, and keep making more profits; we sometimes need to shrink, to conserve, to forego things in order to be good stewards of the land, the resources in our care---- all of this is such helpful and true thinking! I highly recommend this book to everyone, like vitamins, it will help fortify your soul, and help focus your thinking about how to be both a good steward and a good friend. To me, the insight that becoming a deeper and better friend is a major and helpful tool for sorting through the issues of "first things first".
Sunday, June 22, 2014
Dreams and Poetry
I got to go to a workshop on poetry with the best teacher I have ever had the privilege of working with--- Rodger Kamenetz. He came to town for a reading, and had a circle of local poets for this workshop-- and it was an unbelievable "mitzvah" or blessing, that I was off, and able to go, and be in that space!
He started out by saying "Let's set aside both pride and shame." The idea of doing so, as the preliminary to a workshop, was breathtaking. Then he spoke about the difference between a word and an image--- how much richer and more meaningful an image is, than a word. I had not read his book yet, called "The History of Last Night's Dream". He explained that the way he wanted to approach the subject of our poems was to speak about what is on the horizontal axis, the daily life stuff of the poem, and then the vertical axis--- the place in a poem where we get an image, a really rich soul-work piece of the puzzle, which is where the strength of the poem would be. As each person read their poem, he handled the commentary in that way--- avoiding tinkering with the horizontal or the structural issues, and just trying to discuss the importance of the image itself--- the "where's the beef?" of the poem. I read a poem from the set I have been working on, about the Camino. Since he had asked for dreams, I read a poem called "Dreaming the Journey". Rodger was intrigued by the line "I carry the tribes with me." I was writing about bringing the "new world tribes" back to Spain, in my own person. He inscribed the copy of his book about dreams to me, "to the one carrying the tribes". I was excited to think about this line more deeply, as an image, and also the one about the "gold on those altars" in Spain. After the workshop, I read Rodger's book "The Jew in the Lotus" about a group of rabbis going to meet the Dalai Lama in Dharamsala, and sharing issues about soul-work, across the two traditions. I was fascinated and interested in his command of the subject, of rabbinical thinking-- of Torah and the mishnah of reflections on the scriptures. And also, because he is a well-educated and sensitive Jew, his appreciation for the traditions, the mores of the Jewish people. I had grown more interested in Jewish faith and traditions when I was trained at Maimonides hospital in Brooklyn. Also, I have read a lot about the soul-journey, and so his way of looking at the question of "where's the beef?" in the tradition moved me and kept me very keenly interested, in his book. So when I got to the new book about dreams, I was overjoyed to see that question about yearning to see the face of God. I am still very interested in that question, and in anyone who asks it, from any tradition. I have pored over stories about the Baal Shem Tov, and the reflections in the 13-petalled Rose. I loved Rabbi David Cooper's book "God is a Verb" which I read about 20 years ago. I am also very much a fan of Martin Buber, and the "I/Thou" conversation. So each page was just getting more and more interesting, as I read about Rodger's soul work, and his going to Jerusalem to work with Colette, a dream-work person who was highly intuitive and aimed at healing through dreams, and the great-granddaughter of important rabbis in both of the lines of her genetics. In the book, Rodger finds a dream-work person in Vermont, named Bregman, who is very adept, and who sees the real soul image in a child, rather than the animus/anima of Jung. I was completely taken with and in agreement with this way of seeing things, because for me the deepest question is still that yearning to be in the "I/Thou" which is only possible if one acts as a little child. Jesus said "unless you are like a child, you shall not enter the kingdom of heaven". The other thing I really love about his work with this mentor, Bregman, is that there is an adversary or a predicament, and there is really important work to do, to get to that deep interaction with the divine. And that the way he characterizes that work is to say it requires the discipline of obedience. This fits with every spiritual tradition, and to me it is an ongoing invitation to what is really real, and really true. When one recognizes that one is being directed or guided, and that one must humbly do the work, we are at the depth of being on the journey. I am really excited to be thinking about this. It has been a long time since I have had a vivid dream. But like his teacher, I feel that I am being clearly directed in my work, and that my job is to humbly DO it. And that many times, I am working from instinct, and that voice, not from some intellectual grasp by my own capacity. I feel like I am working like a blind man, feeling carefully along the narrow path, using my white cane, and listening for that voice. There is a word I did not know before, "metonymy"--- which is when one is referring to an image, not using a comparison (like or as)--- which Rodger says is more true of modern poetry. I have stayed with that idea for a couple of weeks now, as I have read through this book. I feel like he gave me a whole new way of writing the poems for the book about the Camino. I am really grateful. I sent him a note and told him that I think he is the person for whom I wrote the poem "The Key to the House in Toledo". I was so excited when he mentioned that in Spain at around the time of Maimonides, there were Jews and Moslems, writing in Arabic, and sharing mystical understanding. It gives me tremendous hope that we could maybe recover that matrix of understanding, and interfaith sharing, and that somehow Spain is the crossroads, where it is possible. My feeling about being able to add this new sense to the understanding of the Camino is thrilling.
He started out by saying "Let's set aside both pride and shame." The idea of doing so, as the preliminary to a workshop, was breathtaking. Then he spoke about the difference between a word and an image--- how much richer and more meaningful an image is, than a word. I had not read his book yet, called "The History of Last Night's Dream". He explained that the way he wanted to approach the subject of our poems was to speak about what is on the horizontal axis, the daily life stuff of the poem, and then the vertical axis--- the place in a poem where we get an image, a really rich soul-work piece of the puzzle, which is where the strength of the poem would be. As each person read their poem, he handled the commentary in that way--- avoiding tinkering with the horizontal or the structural issues, and just trying to discuss the importance of the image itself--- the "where's the beef?" of the poem. I read a poem from the set I have been working on, about the Camino. Since he had asked for dreams, I read a poem called "Dreaming the Journey". Rodger was intrigued by the line "I carry the tribes with me." I was writing about bringing the "new world tribes" back to Spain, in my own person. He inscribed the copy of his book about dreams to me, "to the one carrying the tribes". I was excited to think about this line more deeply, as an image, and also the one about the "gold on those altars" in Spain. After the workshop, I read Rodger's book "The Jew in the Lotus" about a group of rabbis going to meet the Dalai Lama in Dharamsala, and sharing issues about soul-work, across the two traditions. I was fascinated and interested in his command of the subject, of rabbinical thinking-- of Torah and the mishnah of reflections on the scriptures. And also, because he is a well-educated and sensitive Jew, his appreciation for the traditions, the mores of the Jewish people. I had grown more interested in Jewish faith and traditions when I was trained at Maimonides hospital in Brooklyn. Also, I have read a lot about the soul-journey, and so his way of looking at the question of "where's the beef?" in the tradition moved me and kept me very keenly interested, in his book. So when I got to the new book about dreams, I was overjoyed to see that question about yearning to see the face of God. I am still very interested in that question, and in anyone who asks it, from any tradition. I have pored over stories about the Baal Shem Tov, and the reflections in the 13-petalled Rose. I loved Rabbi David Cooper's book "God is a Verb" which I read about 20 years ago. I am also very much a fan of Martin Buber, and the "I/Thou" conversation. So each page was just getting more and more interesting, as I read about Rodger's soul work, and his going to Jerusalem to work with Colette, a dream-work person who was highly intuitive and aimed at healing through dreams, and the great-granddaughter of important rabbis in both of the lines of her genetics. In the book, Rodger finds a dream-work person in Vermont, named Bregman, who is very adept, and who sees the real soul image in a child, rather than the animus/anima of Jung. I was completely taken with and in agreement with this way of seeing things, because for me the deepest question is still that yearning to be in the "I/Thou" which is only possible if one acts as a little child. Jesus said "unless you are like a child, you shall not enter the kingdom of heaven". The other thing I really love about his work with this mentor, Bregman, is that there is an adversary or a predicament, and there is really important work to do, to get to that deep interaction with the divine. And that the way he characterizes that work is to say it requires the discipline of obedience. This fits with every spiritual tradition, and to me it is an ongoing invitation to what is really real, and really true. When one recognizes that one is being directed or guided, and that one must humbly do the work, we are at the depth of being on the journey. I am really excited to be thinking about this. It has been a long time since I have had a vivid dream. But like his teacher, I feel that I am being clearly directed in my work, and that my job is to humbly DO it. And that many times, I am working from instinct, and that voice, not from some intellectual grasp by my own capacity. I feel like I am working like a blind man, feeling carefully along the narrow path, using my white cane, and listening for that voice. There is a word I did not know before, "metonymy"--- which is when one is referring to an image, not using a comparison (like or as)--- which Rodger says is more true of modern poetry. I have stayed with that idea for a couple of weeks now, as I have read through this book. I feel like he gave me a whole new way of writing the poems for the book about the Camino. I am really grateful. I sent him a note and told him that I think he is the person for whom I wrote the poem "The Key to the House in Toledo". I was so excited when he mentioned that in Spain at around the time of Maimonides, there were Jews and Moslems, writing in Arabic, and sharing mystical understanding. It gives me tremendous hope that we could maybe recover that matrix of understanding, and interfaith sharing, and that somehow Spain is the crossroads, where it is possible. My feeling about being able to add this new sense to the understanding of the Camino is thrilling.
Thursday, May 15, 2014
The Lightness of Being
Last night we had a discussion about "light" in medicine. Not just the feeling of enlightenment, or going toward the light, or light shining in a particular way on the subject at hand, but the way one is light on one's feet, the way Milan Kundera called "the unbearable lightness of being". Which to me is not unbearable, but actually the most desired way to move in the world; that is to be fitting in to the molecules of the situation in such a way that one is both coherent and graceful, and can do what is needed with the least friction, the "lightest" touch.
I haven't read the book by Milan Kundera in a long time, but I think I remember that the most important thing is that he cannot sleep unless he is holding her hand-- he begins to know love in that fact. He wants to stay connected, to touch, to be held by this particular woman. He who went through women like water before, suddenly finds a particular woman necessary-- and it is because he cannot sleep without holding her hand.
When we are going to surgery, I hold the patient's hand. I know that there is a primal fear, that the person is conscious of the reason the surgery is needed; but that they are frightened, as a child looking over the edge of an abyss is frightened. Holding the hand of someone trying to go to sleep without terror is a very important thing. Surgeons need to do it, sharing that moment with the patient in our care. It is a wordless reminder that we will be "attending" them through this experience, and that we have their life in our attention and care, and yes, love.
Another thing we talked about is the shared feeling of meaning. One of the great young women docs in our group, Neha, told us that she asks 5 questions when a person is in the hospital. The patient in the hospital always feels the terror of the child looking into the abyss. I call it "walking through the valley of the shadow of death". She feels that in between the daily rounds, there is a lot of time for the patient to find answers to these questions.
Her 5 questions:
"What is the meaning of the part of you that is ill? Why this part of your body?"
"What else needs to be healed?"
"Why now, in your life?"
"What else might you have missed?"
"What would you say if you could speak from your heart?"
I find this profound and helpful. It helps the patients find meaning and context for the illness, and for the way their life has been wending. It usually helps people come to terms with whatever other issues may need to be addressed, besides the illness. For most people, the logjam is in the relationships around them, and these questions help them to find the way to open up and deal with the dilemmas. The wonderful fact is that we are all having these dilemmas, and none of us is only a "patient". Our own "cloud of unknowning" is part of trying to work with our patients in helping to find coherence, in befriending their lives. We work toward our own coherence, as we confront these questions together, and find the answers.
One of our wonderful docs, Bruce, has become a chaplain. He spoke about the personal way we have been given some time. From the first breath to the last, we have a "complete" circle. He spoke of the way that each day, each breath, in whatever time we have-- another hour or another decade, is precious. We recognize the gift of it-- even when we are most profoundly affected by the loss of loved ones. This too, is a great gift. It lightens our suffering, to see "completeness"-- even when a life seems broken-off.
Energy is very like light. Vivekan Flint was a wonderful soul who helped Rachel Remen MD set up the program at Commonweal, and ISHI. He wrote poems. Abby read a poem of his, which speaks of a meteor. At the end, it turned into a streak of light. Light is a complex of mass and energy.
I wrote a poem called "Prayer for the Blue bird"-- it is in the first book of poems, called "My throat is full of Songbirds". It ends this way:
"Even death cannot stop
The true singing,
The real joy.
The air will fill with light,
The joy will be like light,
When light is speeding and blending with mass,
Becoming the bluebird singing."
I haven't read the book by Milan Kundera in a long time, but I think I remember that the most important thing is that he cannot sleep unless he is holding her hand-- he begins to know love in that fact. He wants to stay connected, to touch, to be held by this particular woman. He who went through women like water before, suddenly finds a particular woman necessary-- and it is because he cannot sleep without holding her hand.
When we are going to surgery, I hold the patient's hand. I know that there is a primal fear, that the person is conscious of the reason the surgery is needed; but that they are frightened, as a child looking over the edge of an abyss is frightened. Holding the hand of someone trying to go to sleep without terror is a very important thing. Surgeons need to do it, sharing that moment with the patient in our care. It is a wordless reminder that we will be "attending" them through this experience, and that we have their life in our attention and care, and yes, love.
Another thing we talked about is the shared feeling of meaning. One of the great young women docs in our group, Neha, told us that she asks 5 questions when a person is in the hospital. The patient in the hospital always feels the terror of the child looking into the abyss. I call it "walking through the valley of the shadow of death". She feels that in between the daily rounds, there is a lot of time for the patient to find answers to these questions.
Her 5 questions:
"What is the meaning of the part of you that is ill? Why this part of your body?"
"What else needs to be healed?"
"Why now, in your life?"
"What else might you have missed?"
"What would you say if you could speak from your heart?"
I find this profound and helpful. It helps the patients find meaning and context for the illness, and for the way their life has been wending. It usually helps people come to terms with whatever other issues may need to be addressed, besides the illness. For most people, the logjam is in the relationships around them, and these questions help them to find the way to open up and deal with the dilemmas. The wonderful fact is that we are all having these dilemmas, and none of us is only a "patient". Our own "cloud of unknowning" is part of trying to work with our patients in helping to find coherence, in befriending their lives. We work toward our own coherence, as we confront these questions together, and find the answers.
One of our wonderful docs, Bruce, has become a chaplain. He spoke about the personal way we have been given some time. From the first breath to the last, we have a "complete" circle. He spoke of the way that each day, each breath, in whatever time we have-- another hour or another decade, is precious. We recognize the gift of it-- even when we are most profoundly affected by the loss of loved ones. This too, is a great gift. It lightens our suffering, to see "completeness"-- even when a life seems broken-off.
Energy is very like light. Vivekan Flint was a wonderful soul who helped Rachel Remen MD set up the program at Commonweal, and ISHI. He wrote poems. Abby read a poem of his, which speaks of a meteor. At the end, it turned into a streak of light. Light is a complex of mass and energy.
I wrote a poem called "Prayer for the Blue bird"-- it is in the first book of poems, called "My throat is full of Songbirds". It ends this way:
"Even death cannot stop
The true singing,
The real joy.
The air will fill with light,
The joy will be like light,
When light is speeding and blending with mass,
Becoming the bluebird singing."
Saturday, March 29, 2014
Wednesday, March 26, 2014
Hope and Time; corollary to E=MC_2
Hope and Time
Hope is something all of us need, to be able to look forward to the future, in spite of our own inexorable path toward death. I have been so lucky to be able to hold babies, which is the deepest and most organic way I know to get hope for the future.
The equation of Einstein's, which teaches us that there is mass and energy, and that they become equal when mass is moving at the speed of light, actually inherently tells us that there is such a thing as time, and it is measurable, and because of it, the universe is moving onward, and as they say, expanding. So we do not just go over and over the same territory, and life is not static or circular. There is process, and there is evolution. Teilhard de Chardin spoke of God the creator as the alpha and the omega, both initiating the universe, and calling it home; and Christ as the central turning point in history. God grows green grass through the asphalt. No one steps in the same river twice, everything is actually new, and today is the first day of the rest of your life. SO time is the river of history, and each of us in it is unique, with our own particular past, and our own unique path into the future. The progress may be hard to see, from our vantage point, but it is there. This is a huge difference from 200 years ago, when some people thought life was just going over the same ground, over and over.
My life has been blessed, as I am in the vanguard of the women who got to train in and practice medicine. We have actually made great strides, in understanding both intelligence and healing love, not as a gender-limited thing. We can understand what it means to be a healer, and a professional person, independent of one's gender. I think a lot about the nuns, and the ordination of women. I think about what Jesus said and did, and how long it has taken to undo the problems of patriarchy. I am glad that when the Buddhist nuns told the Dalai Lama how hard it was for them to get the training, to become experts in their tradition, he cried. They were kept down-- treated as cleaning women, and refused admission to the sessions for the enlightenment of the male monks, just as women in the West have been. Everywhere on the earth, there has been a blossoming in this time; although in some places quite modest, there is a recognition that women are fully human, not just beasts of burden, or "hysterical" animals whose only task is to carry pregnancy and nurture the young.
We have been able to help hold the space, as more women come into medicine as the decades pass. We can see that bringing ourselves to work, as sisters, friends, daughters, wives, mothers, helps us to connect with our patients emotionally, and to be better at nurturing and compassion, without losing the ability to be good diagnosticians and surgeons. We can continue in our work as obstetricians and gynecologists, to help push for better and more maternal and infant care all over the globe, and we can try to push for better parenting, and better stewardship of the earth at the same time. We can help our patients to only have as many children as they think they can raise well. We can help them avoid having their children too close together, so they cannot recover physically from pregnancy. We can try to help them not get pregnant before they are ready to be mothers, both physically and emotionally. We can help get the children to grow up healthy, get more vaccines and better nutrition, partly through the working of public health care systems. It is unlikely that we will sink back into patriarchal societies where half the population could not get educated or be able to give their talents to the needs of the society. It is unlikely that women will continue to have to put up with abusive or alcoholic or violent spouses, just to be able to feed the children.
When I was a child, there were a lot of stories which had to do with being "odd"-- such as the Ugly Duckling, and Goldilocks and the 3 Bears. For those of us girls who got into medicine, and felt like Goldilocks, one might say that we are now able to sit in the right chair, and eat the porridge which is just the right temperature. We do not have to hide in Bear clothing, or pretend to be something we aren't. We are ok, being women in this place and time.
One of the things we can see as a benefit is that gay people are more safe, now that women are also in the field. Couples can choose to love each other, and are not routinely being stoned to death. Fathers are getting paternity leave, and men are able to give more love and attention to their children, as couples work cooperatively on family life, as well as economic security. Many couples who might have been unable to have children in the past are getting medical help to make that possible, so that they can have healthy families.
We are making headway against the laws which protected pedophiles from exposure, and we are making it more likely that the true bogey-men get caught, and prosecuted. The world is becoming safer for children-- less chance of incest and rape, less chance of under-age pregnancy, and less chance of abusive power over moms and children going unchecked. Although it is not true everywhere, as more brave women fight for respect and healthy behaviors, all over the world the laws will become better at supporting individual rights. We are working to reduce and end sex-trafficking, and prostitution. We are also working to increase job security, better worksite safety, and job protections, including healthcare and benefits for retirement and disability.
Although the trade agreements go against this human rights advocacy, we are building an informed citizenry, and it is not so easy to do things in the dark, to destroy human rights, as in the past. It is very likely that as we educate women, we will be able to help protect the environment, because women are raising children, and do not want toxic waste causing illness in our families.
I remember the song in "My Fair Lady" which is sung by Professor Higgins--- "why can't a woman be more like a man?"--- in which he says "… their brains are filled with cotton, hay and rags;" which was something I really wondered at, when I was young. I know now, that the problem was simply that women were not being educated. When they ARE educated, they still make mistakes as often as men, but the sheer necessity of raising children makes most women really work hard to get the best answers for themselves and their families that they can.
For this reason, I have tremendous hope, that we are moving into a much better future, where there will be even less abuse, less ignorance, less cruelty than now. I have great hope that family planning is going to be as great a force as war, famine and plague, at keeping humanity's numbers to a more bearable presence on the earth. I think we may actually become the good stewards we were intended to become!
Hope is something all of us need, to be able to look forward to the future, in spite of our own inexorable path toward death. I have been so lucky to be able to hold babies, which is the deepest and most organic way I know to get hope for the future.
The equation of Einstein's, which teaches us that there is mass and energy, and that they become equal when mass is moving at the speed of light, actually inherently tells us that there is such a thing as time, and it is measurable, and because of it, the universe is moving onward, and as they say, expanding. So we do not just go over and over the same territory, and life is not static or circular. There is process, and there is evolution. Teilhard de Chardin spoke of God the creator as the alpha and the omega, both initiating the universe, and calling it home; and Christ as the central turning point in history. God grows green grass through the asphalt. No one steps in the same river twice, everything is actually new, and today is the first day of the rest of your life. SO time is the river of history, and each of us in it is unique, with our own particular past, and our own unique path into the future. The progress may be hard to see, from our vantage point, but it is there. This is a huge difference from 200 years ago, when some people thought life was just going over the same ground, over and over.
My life has been blessed, as I am in the vanguard of the women who got to train in and practice medicine. We have actually made great strides, in understanding both intelligence and healing love, not as a gender-limited thing. We can understand what it means to be a healer, and a professional person, independent of one's gender. I think a lot about the nuns, and the ordination of women. I think about what Jesus said and did, and how long it has taken to undo the problems of patriarchy. I am glad that when the Buddhist nuns told the Dalai Lama how hard it was for them to get the training, to become experts in their tradition, he cried. They were kept down-- treated as cleaning women, and refused admission to the sessions for the enlightenment of the male monks, just as women in the West have been. Everywhere on the earth, there has been a blossoming in this time; although in some places quite modest, there is a recognition that women are fully human, not just beasts of burden, or "hysterical" animals whose only task is to carry pregnancy and nurture the young.
We have been able to help hold the space, as more women come into medicine as the decades pass. We can see that bringing ourselves to work, as sisters, friends, daughters, wives, mothers, helps us to connect with our patients emotionally, and to be better at nurturing and compassion, without losing the ability to be good diagnosticians and surgeons. We can continue in our work as obstetricians and gynecologists, to help push for better and more maternal and infant care all over the globe, and we can try to push for better parenting, and better stewardship of the earth at the same time. We can help our patients to only have as many children as they think they can raise well. We can help them avoid having their children too close together, so they cannot recover physically from pregnancy. We can try to help them not get pregnant before they are ready to be mothers, both physically and emotionally. We can help get the children to grow up healthy, get more vaccines and better nutrition, partly through the working of public health care systems. It is unlikely that we will sink back into patriarchal societies where half the population could not get educated or be able to give their talents to the needs of the society. It is unlikely that women will continue to have to put up with abusive or alcoholic or violent spouses, just to be able to feed the children.
When I was a child, there were a lot of stories which had to do with being "odd"-- such as the Ugly Duckling, and Goldilocks and the 3 Bears. For those of us girls who got into medicine, and felt like Goldilocks, one might say that we are now able to sit in the right chair, and eat the porridge which is just the right temperature. We do not have to hide in Bear clothing, or pretend to be something we aren't. We are ok, being women in this place and time.
One of the things we can see as a benefit is that gay people are more safe, now that women are also in the field. Couples can choose to love each other, and are not routinely being stoned to death. Fathers are getting paternity leave, and men are able to give more love and attention to their children, as couples work cooperatively on family life, as well as economic security. Many couples who might have been unable to have children in the past are getting medical help to make that possible, so that they can have healthy families.
We are making headway against the laws which protected pedophiles from exposure, and we are making it more likely that the true bogey-men get caught, and prosecuted. The world is becoming safer for children-- less chance of incest and rape, less chance of under-age pregnancy, and less chance of abusive power over moms and children going unchecked. Although it is not true everywhere, as more brave women fight for respect and healthy behaviors, all over the world the laws will become better at supporting individual rights. We are working to reduce and end sex-trafficking, and prostitution. We are also working to increase job security, better worksite safety, and job protections, including healthcare and benefits for retirement and disability.
Although the trade agreements go against this human rights advocacy, we are building an informed citizenry, and it is not so easy to do things in the dark, to destroy human rights, as in the past. It is very likely that as we educate women, we will be able to help protect the environment, because women are raising children, and do not want toxic waste causing illness in our families.
I remember the song in "My Fair Lady" which is sung by Professor Higgins--- "why can't a woman be more like a man?"--- in which he says "… their brains are filled with cotton, hay and rags;" which was something I really wondered at, when I was young. I know now, that the problem was simply that women were not being educated. When they ARE educated, they still make mistakes as often as men, but the sheer necessity of raising children makes most women really work hard to get the best answers for themselves and their families that they can.
For this reason, I have tremendous hope, that we are moving into a much better future, where there will be even less abuse, less ignorance, less cruelty than now. I have great hope that family planning is going to be as great a force as war, famine and plague, at keeping humanity's numbers to a more bearable presence on the earth. I think we may actually become the good stewards we were intended to become!
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