Gay rights

I have been thinking about what happened yesterday in Ireland, that same-sex marriage was made legal by a referendum with about 70% of the popular vote.  Finally, a safety of equality before the law, in at least one country,  for gay people!  For much of my life, I have loved gay men.  Several were the best friends I had, in my late teens through mid-30s.  Some tried desperately to not be gay.  One stopped short of a marriage to cover up being gay.  I have thought over and over about a friend of my mom's, who came home one day to find her husband in her bed with another man.  She had had 5 children with him, and thought it was a stable marriage, and it had lasted almost 20 years.  She was so devastated.  The church we grew up in was no help.  I have a friend who is a pastor in a Christian church, and we have discussed the issue of how human sexuality and gay rights have ripped the church's solidarity apart.  I still believe that the most important thing for pastoral care, in every Christian church, is to re-affirm consistently, and firmly, that God loves everyone.  God does not prefer straight to gay people.  God has a preference for the uniqueness and individual souls' relationship with the ineffable mystery, the divine,  which calls us forth.  God makes lilies of the field, and people, each perfect in our own ways, even though we see our flaws, our failings, often more clearly than we see our strengths.  I look forward to the day when all bad theology is thrown out, and we can be a safe-haven for everyone who needs to feel the love of God shining on them.
I wrote a poem this month, about this issue in my own life.  Although I am not gay, I have loved people who are.  And I want them to be safe.  I have also been thinking a lot about the issue of what safety in sexuality means, for women, for pregnancy, for relationships which lead to parenthood.  I want people to have relationships based on mutual respect and affection.  It frightens me to think that so many people have built relationships on being drunk and taking advantage of someone.  I am worried about date-rape, and variations of power over the partner, which have been talked about since Ibsen wrote "the Doll's House".   I think there are a lot of people who have never experienced the joy of consensual sex.  We need to work on teaching healthy sexuality, and healthy self-care, as the foundation for healthy relationships.
Here is my poem, thinking about a very dear friend I have had since I was very young.

"I WANT YOU TO LOVE ME LIKE YOU LOVED ME THEN"

I want you to love me like you loved me then; 

When we were 30,  at the opera, 

watching the last trio in Der Rosenkavalier;

you were holding my hand and we were caught in the passion,  

Our hearts in our throats, singing in silence with them, 

Breath for breath on rising notes of heartwrenching beauty, 

Joyful and overwhelmed, 

Aware that we really understood each other,

And even though you were gay, and I didn’t understand that,

You loved me in the way in which we loved the opera,

In the way we had brought ourselves through all that

growing up, together;  

Holding hands and knowing so many things we loved at the same time,

In our eagerness to love and understand all we could about the world,

All the art and music, and the tenderness and scent of silver roses,

waltzes in gilded rooms under glittering chandeliers,

and the past

We almost could touch with our fingertips; 

Sitting in the red plush velvet seats,

Watching the Marschallin give up to Sophie

The very love of love;  in the most graceful

And powerful flourish of generosity.

Quin-quin  singing the words of not understanding why

The fine gift she is giving makes her seem even greater, 

Even grander, as he turns from her to go to Sophie

And happily ever after—

While we are sitting there, holding hands tightly and not breathing,

and moving apart in the same way,

and almost for the same reason.  

mn 2015

Eulogy (just my part) for Dr. Joan Barber

Joan graduated from medical school with honors in 1971.  The following year Patsy Mink, who was a congress woman in Hawaii, got Title IX passed in Congress, which gave women equal access to higher education.  Patsy’s dad was a doctor, and she wanted to become a doctor, but they wouldn’t let her into medical school, so she became a lawyer and then a very well-respected congresswoman.  JoAnn did not get any help from Title IX, but many later women doctors did.

I graduated with a degree in philosophy with honors in 1972, and was in the Peace Corps for 2 years.  When I came back wanting to become a doctor, the dean of admissions at UCDavis laughed me out of his office. So we had that in common!

I consider JoAnn to be the perfect role model,  from that vanguard of women in medicine— when there were only a few brilliant women in each class.

It is amazing that she wanted to be a doctor all her life, and was still sure at 18!   She was such a perfectly-built woman— compact and energetic, smart and cute.  She reminded me of a bright bird— I always remember her in good-looking, well-fitting clothes, which weren’t fussy, but showed off the physical fitness she built into her life.  It can hardly be emphasized enough that she was a role-model of how to be healthy, how to set oneself good goals and daily attempts to maintain fitness.  Her patients had chronic pain, chronic limitations and difficulty with movement.  But she always emphasized and modeled  what was possible and reasonable to do, to keep oneself as healthy as possible.

Also, I remember thinking that she and Milton seemed so “normal" and fun-loving a couple.   I once asked Milton about it, and he laughed and admitted he thought he had married a teacher!

But it says a lot about them both, that it was a great marriage, and that they both worked to raise good children who really are outstanding;  and that the work/life balance which is the Scylla and Charybdis of medical women’s lives, was something JoAnn mastered and carried out very gracefully.

Being a workaholic is not a good role model, although most of our early teachers were that.  (here I meant to add about time off— that women in medicine fought for maternity leave, and when Dr. Allari stood his ground with the Sutter administration and got his paternity leave, I knew we had fought for all doctors’ families, to be able to help the men doctors TOO, to have healthier lives)

One story from the early years of practice was from Becky— the office book-keeper— there was never any other item in the balancing of the checkbook except groceries— every few days on the way home JoAnn would stop to get groceries!  She hardly had time for any other shopping.

Another story from Becky is about the children— when they were young, if they got sick, she brought them to work in her van— kept them in the parking lot, doing their homework or sleeping.  NO secondary gain, no tv or distractions, and back-to-school as soon as they were healthy again!  To me this is very important;  about discipline and good boundary-setting, in raising children without self-indulgence.

Another thing is that JoAnn rose to that level of excellence as a clinician which made all of us doctors want to refer patients to her— especially if we weren’t sure of the diagnosis, because we knew she would do a thorough Physical Exam, and Differential Diagnosis, and in a very helpful and efficient way come up with the right treatment plan.  Our patients would rapidly improve, and also be eternally grateful! 

We both believed that estrogen helped decrease and smooth-out symptoms of arthritis in women, so we harmonized in our efforts to treat women for menopause and joint pain.

JoAnn was truly brilliant and insightful.  She cut through reams of articles and data and studies, to help us decide on what the Osteoporosis Committee recommendations should be, as to screening with bone densities, before standards were yet agreed upon.  Her sensible protocol has largely been upheld by the medical community.  The World Health Organization FRAX online tool has since made it easier for clinicians.  JoAnn was aware that rheumatoid arthritis does increase the risk of fracture, and she was vigorously pro-active in trying to reduce the risk for her patients.  

She was good at encouraging patients to increase weight-bearing exercise;  and because of her, I got interested and read the book by Miriam Nelson, the exercise physiologist from Tufts, called “Strong women stay slim”.  I started pushing my patients more to try to increase the walking; and to try to get to the goal of 10,000 steps per day.  

I always appreciated that she tailored theoretical and analytic knowledge to her patients, and her patients got copies of her notes long before I was willing to use the computer.  What was important was that her notes helped them understand their diagnosis and comply with her treatment plan.

On a personal note, my husband and sons got to go pick grapes in the Barber’s vineyard once or twice, but of course I was on-call and didn’t get to go.  They had a really fun time, and it was a community event, with good food and great wine! 

The last big event I got to attend at their home was for the medical society, especially to honor the earliest women doctors in Santa Cruz.  I remember Dr. Shorenstein, Dr. Korakas, and Dr. Meister there, and I think also Dr. Santora  and Dr. Baskerville came.  It was a lovely spring day, and we had a great time.  Milton took everyone on a walking tour through the redwoods, explaining details and interesting things about our special ecosystem, and it was a great educational event, which I still remember. ( The redwoods take up 16 times their weight in fog/water…)

I also saw JoAnn as her patient, and I echo what the other patients have said.  She emphatically encouraged exercise, and in easy-to-understand language, gave me some tips.  I was very encouraged when I saw her 10 years later, and she said I had actually improved my range of motion, so her notes were helpful, and one could assess progress and continuity from them! 

She took her own x rays, and read them— which was practical and there was no delay— she could get extra films if she needed them.  This is almost impossible for doctors now.

In every way she was an admirable physician, and her patients knew she was doing work she loved;  that she was not just trying to get paid; and that often she under-charged.  

Her staff said there were many times when she did not make money— and she always paid her staff first, before herself.  So again, it was lucky that Milton was there to back her up;

because he too believed in practicing in the most excellent and ethical manner. 

Finally— last lessons— Being Loved to Death.

Going to see JoAnn at their beautiful home that last time, a few weeks before she died, helped me know I should retire and try to find a better balance with my family.  

Watching Milton and Adelia care for JoAnn in that puddle of morning sunlight, when she was no longer speaking, and no longer walking, but still able to lean toward Milton’s voice, and his touch on her shoulder, made me think about how great it would be to be loved to death— to have such sweet and patient care.  Hospice was helping them;  but Adelia, who was nursing her baby, was watching and present, and helpful, as a person who was raised by a good doctor CAN be helpful.

And the reassurance of the loving touch and patience from Milton spoke worlds about what every physician hopes for, for our patients;  but may hardly dare to hope for, for ourselves.  

We live in a difficult age, and emotional support to help someone do a difficult and sustained job like being a practicing physician is hard to come by;  but this family, and especially Milton, have been a rock-solid base for JoAnn to be able to practice medicine in a beautiful and graceful way, and to meet the real needs of so many patients!  

Goodbye letter to patients

At the end of December, I was sending this letter to my patients, telling them I am retiring.  In an effort to try to give a bit of closure, and to thank my patients, and to wish them well, I felt impelled to get this into the mail.  It surprises me how few doctors actually "take leave" of the patients in a personal goodbye.  I believe when we have developed a doctor-patient relationship, I owe them this.  So here it is, and maybe someone reading it will comment, build a better one, or use it for their own patients.  

To my dear patients:

I would never find a good time for retiring, for saying goodbye.  As you probably have heard me say,  I have been having a very hard time keeping up with the computer, with the details which are needing attention, with having enough patience with all the things we need to do, so that your care is as good as it can be.  I will miss you all, but I know that it is time for me to let younger and more energetic doctors do this job.  I have been tired, and I don’t think I am as quick-witted as I used to be!  I am grateful that I do not have a life-threatening illness, or a big huge new stressor.  I feel glad that I can try to give more of my attention to my own family now, and to enjoy some time being healthy!   My retirement will begin January 31, 2015.

I want to believe that you are taking good care of yourself, doing your daily exercise, eating right, and not letting yourself be bullied.  I want your children to grow up smart and strong, and for your life and your relationships to be healthy and happy!   I am hoping that the next doctor you see really does engage you as a caring provider!   I think the younger doctors will have an easier time with the computer than I do, and that will make it easier to keep up the charting.

I believe the next big frontier in medicine is the mind;  and it is coming to pass, that more attention will be given to how to help people stay more mentally healthy as we age.  I envy the younger doctors who will have better tools for helping people to stay strong and healthy, and also probably have less guess-work.

The kind of private practice which we have here at Harbor Medical Group has had some very hard stresses;  as the majority of doctors move into bigger corporate practices.  We have tried to be flexible and to be accessible to our patients;  but the costs of delivery of care are rising, and it has been a big stress for us to try to juggle this problem, too.

If you need your records to be sent to another doctor, please send a signed record release form.  If you have received routine Obstetric or Gynecologic care, unless you have had an ongoing problem or need your pathology report from a previous surgery, your next doctor may not need these records.

 I do not think it is easy to form a healthy doctor-patient relationship, and so I hope you will have patience with your next doctor, to try to teach them how to do it! Because I know it is a relationship which is precious and worth having, and it DOES make a difference in getting the best care.

I thank you for your love and support, and kindness, and loyalty to me.  As I said, it would never be easy, or the right time to say goodbye.

With love and hope for all of our futures,

Martina Nicholson MD, FACOG

P.S. I will stop by and check once in awhile, so if you have a photo of your baby, or want to drop me a note about how you are doing, please do.

Retirement, and the Goodbye Party

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

"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.

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".

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.