December 20, 2013

health insurance


     I got this from my health insurance company.  Not to worry, it says, my plan will become ACA compliant.  What worries me is they don't say what will happen to my premium.  Something tells me I won't be paying less.  I'll have to start writing my own prescriptions since I won't be able to afford seeing a doctor.

December 16, 2013

we have a pill for that

            “We’re still hurting a lot right now from when we failed a few days ago.  You’re not really going to do this, are you?” the three extra vertebrae in my back asked in disbelief.  They were clearly not happy with the notion of being jostled up and down repeatedly for two miles.
           
            “Yes.  I am going to go for a run,” as I started to slide my socks on.
           
            Look at yourself, man.  You’re falling apart.  Have you noticed that your toenails on BOTH big toes are probably going to fall off?  Are we going to end up like that?  We can't grow back like toenails can.  Surely you haven't forgotten that much of the first two years of med school.”
           
             I wiggled the toenails and sure enough, both started to lift up like the pop top on a can of beer.  Both were the result of separate bike wrecks while riding at night.  On both evenings, I had already worked out for the day but by evening, the anger and stress had come back in full force.  So I went riding on the trails at night.  I had toe pain but the anger was less.
           
             “Oh, well.  Wouldn’t be the first time.  If it means anything, I'll jog slower.  I already quit running sprints for y'all.”
           
            “We do appreciate the no sprinting thing.  But today's run.....having us get all inflamed and pissed so you can’t walk wouldn’t be a first time, either.  Do you want us to go back to the way we felt two days ago?  Is that what you want?  You couldn't even stand up straight, for Pete's sake!”

            “Not really, but what are my options?  I can suffer more emotional pain or more physical pain.  It’s that simple.  It’s nothing personal against y’all, even though y'all are congenital defects.  You’re just going to have to hurt so that I can burn off some anger.  Deal with it.”

            “Good God, man, what are you going to do to us when you start rotations again in a couple of weeks?  That's going to lead to less stress?!?!  Who the hell ever heard of med school adding less stress to a person's life?  Seriously?  What are you on?  And don’t be surprised when the nerves that live with us start flashing some serious pain signals upstairs.  We can see that they're already charging their little battery like thingies in anticipation.  You may be walking funny tonight.  Again.”

            “Yeah, I know.  And as I like to say to my patients, ‘we have a pill for that’.  I’ll make whatever deal I have to make in order to keep enduring."

December 13, 2013

surgery rotation

Fortunately, my surgery rotation was not as horrendous as the videos below.  Both my attendings and residents were pretty understanding and helpful for the most part.  But I did hear some horror stories from a few of my colleagues that wouldn't be too far off from these sad but true video.  I can, however, attest to waking up at 3:40 am and grabbing AWS (already worn scrubs) and not caring because it seemed like you just left the hospital and now you're headed back.  I can also attest to holding a retractor for nearly two hours when an inanimate object could've done a better job.  And yes, they do have inanimate retractors that do a better job than med students.

Part I

December 6, 2013

medicine


     The difference in his mood, his personality, everything was in stark contrast to what it was before.  It became apparent only 2-3 days after his second hospitalization and became more and more noticeable with each passing day.  His constant anger began to lessen.  His emotional resilience, which was completely absent before, grew stronger with each passing day.  His constant tendency to fly off the handle at the smallest thing grew strangely absent.  His ability to feel and receive love returned.  And he had reversed his decision in answer to Hamlet's dilemma.  He no longer wished to sleep that endless sleep.  As my wife said, it was like getting the personality of our son back before the many years of worsening darkness.
     The difference?  Medications.  Or I should say the combination of meds as it is likely that he would not being doing as well if one of them were absent or substituted.  Stumbling onto the right permutation of meds for psychiatric illnesses is one of persistence, luck, persistence, the art of medicine, and even more persistence.  I am grateful for him finally finding the right combo to keep him alive, at least for now.  Experience tells me that this is not the end, though.  This is no cure, only a respite of unknown length.  It will be a constant battle for the rest of his life, let alone ours.

November 29, 2013

guilt

I remember when my wife was pregnant with him, people would ask us, "do you want a boy or girl?"  Both of our response was the same.  It never changed.  It never wavered.  "We just want him or her to be born healthy."
     But you don't think of the diseases that lie in wait.  Those that are not apparent from birth.  Those that are part genetic, part environmental.  A ticking time bomb waiting to go off when the wrong set of circumstances start an abnormal chain of events in the brain resulting in catastrophic and horrendous consequences.  Suicidal thoughts that are as strong as the urge to eat, if not stronger.  And as a parent, you beat yourself up over and over and over again for missing the signs.  How could I, of all people miss the signs?  But when it's your own child.......you fail to see the signposts.  At the time, they are subtle.  In retrospect, those signposts are harsh and glaring, mocking me for my failure.  You think it's teenage angst.  Or just a phase.  By the time you've got it identified, the irreparable damage has been done. 

November 25, 2013

old wounds

The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.


Help, lofty genius! Muses, manifest
  Goodwill to me! Recording what befell,
  Do thou, O mind, now show thee at thy best
- Canto II from Dante's Inferno

     Without even looking at the chart, this poor young woman was college age at the oldest.  And there by her side was her younger brother.  We were consulted for essentially existential anxiety.  The patient had exhausted every option at their own hospital and were now at MD Anderson to see if they could pull a miracle.  As I sat talking, but mostly listening to her story, she began to have pain spikes.  I knew what those were all too well.  Already on a dilaudid drip and clicker on demand, she was on the best pain control possible short of putting her into a medically induced coma.  But still the pain spikes hit and during the spike her whole body would grimace and contort.  She or her brother would click the button to administer the extra medicine and wait for it to subside.  There was little medically I could do as she was receiving the best care possible.  So I held her hand and told her to squeeze it until the pain passed.  Sometimes the best thing a doctor can do is just be present and witness and honor their story and suffering. 
     The pain would pass and then she would continue telling her story with tears beginning to well up in her eyes.  She was also concerned about her mother which would cause her mother to cry.  And behind it all stood her brother unwavering.  It was all I could do to not start crying myself.  The only thing that kept me from crying was I didn't not want to intrude on their pain.  This was not about me, despite all the similarities.  It was about them and their experience.  She eventually finished her story and I reassured them that we were available to them for any help we could provide.  I walked out and waited for my resident to present to.  While waiting, the brother came out of the room to look for a coke machine.  While it was not about me, I felt that I did have something to offer the brother.  I interrupted his search and spoke to him briefly.  I told him to make sure he takes care of himself and especially his mother as they were both going through hell.  And I also gave the well used line, "and besides, how can you care for your sister if you're too broken and worn down?"
     My resident showed up shortly after and I presented to her without breaking down into tears, though my eyes did get a bit watery.  It was ok, my resident already knew my experiences with cancer (she had asked me why I seemed so comfortable around the dying patients).  There was very little we could do medically for this patient except listen.  The mother was religious so we put in a request for a chaplain.  Of course the chaplain was a familiar face from my experiences with my own brother.  Doing rounds the next day, I bumped into the chaplain and asked for his thoughts on the case.  I then bared my own experiences with him and his face went ashen.  He pulled out his card and gave it to me insisting that I contact him at some point.  I never did.  I was too busy.  Too much to do.  I wish I had taken my own advice and taken care of myself first.

November 22, 2013

relationship to pain

     Chronic pain is a difficult entity to treat.  Even if one has a purely organic cause of the pain, there are still emotions about the pain that can factor in and complicate the issue.  Pain is the relationship of your nerves, your neurology, your psyche, and your physical source of pain.  No wonder we're not good at treating it.  We simply do not understand the individual pieces of that puzzle, much less how they fit together.  I understand that stress cannot possibly not play a role in my pain.  But I am also able to predict weather fronts or a northerly breeze with a high degree of accuracy which would put a goodly portion of my pain into the organic realm and not emotional.  Whatever that relationship, it is not one I understand well.  Neither have any of the numerous doctors or physical therapists given me a sufficient explanation, much less a successful treatment.  The pain management doc went so far as to accuse me of being a drug seeker despite my not requesting any medication from them.  Being who I am, trying to understand it is important so being accused did not sit well with me.
     About the only branch with an explanation, albeit non-verifiable, is eastern medicine.  And the concept of chi is pretty ludicrous to me.  But hell, we've used medications numerous times without having a clue how they worked, or we had presumed an incorrect explanation.  Perhaps the Chinese stumbled on something millennia ago that simply works.  Their explanation doesn't have to make sense.  For me, it just has to work.  And I do get some relief from acupuncture, albeit temporary like everything else.


     Each one of these needles represents where I have, for lack of a better term, a trigger point (they continue down my right arm though you cannot see them).  These are points in the muscle that are hard, and when pressed deeply, elicit pain that extends beyond the point.  I asked the acupuncturist for the picture just for my curiosity of what the needles looked like.  When I looked at the picture, two thoughts jumped into my head, and they had nothing to do with the needles.  That part of my lower back with the four needles looks swollen.  And the upper part of my back that has 5 or 6 needles in it also looks angry.  I showed the picture to my wife, almost indignantly stating, "look at this!" feeling a need to prove that I'm not making up my pain.  It's not just stress.  Something is physically wrong with my muscles.
      "That?  Oh, your back always looks like that," she replies nonchalantly.
      "What?!?!?  Seriously???  So I'm not crazy.  I am not making this pain up."
      "Yeah, that's your back at 'normal'.  I figured you already knew that."
      In some sense, I do feel better that I'm not making this up.  It's important at this point in my life to have something make sense.  Even if only a little bit.  I shattered my right collar bone which alters the anatomy of my shoulder and my spine at that level has an extra vertebra which causes it to curve a bit to the left.  Both of these add up to a shoulder and back that have "issues", if not a proper diagnosis.  After all, my left back doesn't hurt at all.  So this simple picture helps change my relationship with the pain.  The relationship has evolved into one that is moving more towards acceptance and thinking about it less, which can only be a good thing.  I worry less about the role that stress may be playing into it and accept that it is what it is.  I accept the limitation of what my shoulder is.  Whether this acceptance alters the physicality or intensity of the pain remains to be seen (maybe, maybe not) but it is nice to know I'm not losing my mind.

November 18, 2013

existential anxiety

     As an inpatient psychiatry service at MD Anderson, we filled a role that is probably a bit different from other inpatient psyche services at other hospitals.  Our consults dealt with two main problems.  The first was altered mental state, usually after surgery.  Take someone at least 60 years old, stick them in the hospital, operate on them and a large portion will have an acute onset of dementia, especially at night.  They're affectionately named 'sundowners' because as the sun sets, the weird behavior begins.  While it is debilitating to the patient and exasperating to the night team, especially the nurses, it's temporary and treatable but that's not what this post is about. 
     The second reason for a consult from our service was what was brilliantly named by the head attending - existential anxiety.  This is not anxiety from someone with an anxiety disorder.  This is not anxiety from someone who is terrified of hospitals.  This is anxiety about dying.  It's not the least bit pathological in my mind.  In fact, it is a completely inherent part of the human condition when one is faced with knowing that death is likely imminent.  How else is one supposed to feel, especially in the younger patients?  What is the "normal" reaction that is expected in a 20 something or a 30 something when faced with such circumstances?  Existential anxiety seems the most appropriate reaction possible.

November 15, 2013

repetition

     For better of for worse, I find myself resorting to the same coping mechanisms I used during my brother's illness as well as after his death.  Perhaps they work, perhaps the familiarity of them comforts me, perhaps I'm grasping blindly at straws.  I stumbled across a blog post I wrote only 5 days after my brother died with the salient part being an excerpt from Steinbeck's East of Eden.  Out of repetition and familiarity, I will quote it again:

     Samuel sat down quietly, and he didn't trouble Adam by looking him too much, and he didn't trouble him by not looking at him.  The wind freshened in the treetops and a fringe of it ruffled Samuel's hair.  "I thought I'd better get back to the wells," Samuel said softly
     Adam's voice had gone rusty from lack of use.  "No," he said, "I don't want any wells.  I'll pay for the work you did."
     Samuel leaned over the basket and put his finger against the small palm of one of the twins and the fingers closed and held on.  "I guess the last bad habit a man will give up is advising."
     "I don't want advice."
     "Nobody does.  It's a giver's present.  Go through the motions, Adam."
     "What motions?"
     "Act out being alive, like a play.  And after a while, a long while, it will be true."
     "Why should I?" Adam asked.
     Samuel was looking at the twins.  "You're going to pass something down no matter what you do or if you do nothing.  Even if you let yourself go fallow, the weeds will grow and the brambles.  Something will grow."
     Adam did not answer, and Samuel stood up.  "I'll be back," he said.  "I'll be back again and again.  Go through the motions, Adam."
     I am Adam as well as Samuel.  The Samuel in me already knows loss and hurt.  It tells me to go through the motions.  But the Adam in me knows a new pain, a different hurt, a different loss, in nearly every way, a more soul wrenching loss, and says, "why should I?"

November 12, 2013

counting up my demons


     Though it was a year ago, I never blogged about my experiences during my psychiatry rotation at MD Anderson.  It certainly was not due to lack of material.  Perhaps it's taken me that long to feel comfortable writing about them.  Without a doubt, it was the most emotionally demanding rotation I went through so far, though I have yet to complete pediatrics successfully (I stopped after encountering a patient resembling my son while on call).  Or, perhaps I had no idea how to even give it words?  How do I properly do these patient's story justice?  It hit all to close to home as their are some universalities to human suffering, at least as it relates to cancer.  Time to confront those demons before I go back to my rotations full time.  I start with pediatrics so I will have all new demons to confront then.  Best exorcise these while I can.

November 10, 2013

down

     Despite being asleep, my hiking partner's pulse cruised in the 120s.  Eight hours prior, four of us had made the final ascent during the dark of night up Mt Kenya so that we would be standing at 16,355 feet watching the sun rise over the clouds far below us.  Our original intent was to hike down a longer but more scenic route.  But one of us was hurting badly, ironically the one in the best shape.  Vomiting came not once but twice on the ascent.  Even though this time period vastly preceded my medical days, I knew this was the onset of Acute Mountain Sickness (AMS).  The only cure is to go down.  So I volunteered to take the sick partner back down the way we ascended as it represented the quickest way down.
     We descended roughly 2,000 feet in a short amount of time.  My partner looked like shit despite the descent.  "Take a nap," I said, "and we'll go from there."  It was about noon now and I cooked some lunch.  After an hour's rest, the pulse was still in the 120s.  Not good.  We can't camp here.  Untreated, AMS can proceed to pulmonary and/or cerebral edema.  Given we were in a third world country far, far from  medical attention, much less first world medicine, any edema would be lethal.  So I emptied their backpack and loaded mine up to essentially double the weight.  I woke them up and said, "we need to get you down.  This isn't looking good." 
     So down, down, down further we went.  By then, we were no longer above the clouds.  We were in the clouds which limited visibility to about 20-30 yards.  This was my first time climbing Mt Kenya so I was not exactly well familiarized with the route.  I had relied on our other partner who had climbed it before but was now descending the other side.  Not much help now.  Even a map and compass didn't help much when you can't see any landmarks to triangulate, at least to my limited skills.  And then to make matters worse, we hit the Vertical Bog.  The name pretty much describes it perfectly.  You muck and suck your feet out of knee deep bog-like conditions for about a mile.  I'm starting to get nervous that I'm losing the trail.  I can't see shit.  I don't even want to guess what my pack weighs but I know it's way over the 1/3 body weight guide.  I've been up and hiking since 10 pm last night.  And I've got a sick partner who's pounding headache and nausea are not improving despite the descent.
     Thoughts of Dante begin to arise.  There are no beacons, no signposts, no cairns, no trail in a bog.  Each step down is another step down into uncertainty.  Into the unknown.  Into hell.  It seems like a good as any time to panic but I can't show that to my sick partner who is depending on me.  And that is my situation now.  I have people depending on me, I can't see shit for the future.  My back is faltering under the load having already been worn down from the last three years of my life.  And I have little to no idea in which direction the next step leads except downwards.  Unlike the Mt Kenya adventure which eventually ended well after 18 hours of hiking, I have no such assurances here.  Each step down is another step down into the depths of hell.

November 1, 2013

on the edge of the night

It's the terror of knowing
What this world is about
Watching some good friends
Screaming 'Let me out'

Turned away from it all like a blind man
Sat on a fence but it don't work
Keep coming up with love
but it's so slashed and torn
Why - why - why ?

 'Cause love's such an old fashioned word
And love dares you to care for
The people on the edge of the Night
And love dares you to change our way of
Caring about ourselves
 - Freddie Mercury & David Bowie

     For the sake of my back and shoulder, I headed straight for the comfortable chair of the waiting room.  As I filled out hospital forms relating to my son's stay, in my peripheral vision was a man who was pacing and fidgeting.  Not unusual in the waiting room of a psych hospital.  But something about him seemed to want to get my attention.  As soon as I raised my eyes from the form, he approached me.  The me of five years ago would've been chastising myself for making eye contact with him and looking for a way to avoid any further interaction with someone who clearly was mentally sick. But now, I looked at him as just a human being, albeit one who is suffering from a deadly disease.  
     "C-c-can I borrow your ph-ph-phone?  Mine is d-d-dead," he asked haltingly.  Without hesitation, I unlocked my phone and handed it to him and then went back to filling out my forms.  I could tell his first call didn't pan out.  His second call apparently struck success.  He handed the phone back and was quite thankful.
     "Did you get your ride settled?" I asked him.
     "Yup.  I j-j-just have to walk over t-t-to the Taco B-b-bell."
     "Come on.  I'll give you a ride."  He at first resisted but I pointed out it was starting to rain and I was going that way anyways.  He accepted and we began to talk.
     "Why were you there?"  I guess he knew I wasn't ill so he wasn't sure what I was doing there.  Perhaps he was a bit paranoid.
     "My son."
     "How old is he?"
     "17."
     "M-m-man, I wish somebody had d-d-done something for m-m-me when I was 17.  I got off my meds.  That's why I-m-m-m like this now.  Did he do drugs?
     "Yup.  He was self-medicating before we found out he was sick."
     "Yeah......we do that," his voice trailed off, filled with sadness.
     When I dropped him off, he told me to keep fighting for my son (he has no idea).  I, in turn, shook his hand and told him he needs to stay on his meds.  In some ways, we weren't speaking to each other.  He was wishing someone had helped him more when he was young.  And I was wishing that I will not have to bury my son due to this illness.

October 25, 2013

who shows up


     His moods are so volatile, that there is a dark anticipation amongst my wife and I that we're never quite sure which son we're going to get when we visit him.  Wait.  Let me take a step back as all of you may not have visited a mental hospital.  It is not like a normal hospital where you can come and go as you please.  Visiting hours are very limited and very strict as it's a highly controlled environment.  Only two people at a time, only for an hour, and only on certain days.  So there's a tension to make the most of the limited visits knowing that the time is limited and precious.

     This particular visit, he is in a good mood.  While acceptance of an illness, especially one of the mind dictates accepting the entire mental illness, we are only human and are grateful that he is in a good mood as those are far fewer and further in between.  Is it the 100th medication alteration that is making a difference?  Or, is it just one of his cycles?  There's no way of knowing for sure.  But we are still grateful knowing full well that the next time will likely not be as pleasant.  Regardless, he is animated, engaged and even laughing.  Laughter!  What sweet music! When is the last time I've heard his laugh?  It is as a song that is deep in my memory and have not heard in an eternity.

     "I'm the craziest one here this time," he says jovially.
     "Yeah?  How's that?"
     "Med time.  When they pour my pills out of the cup for me to take, it sounds like they're pouring a box of cereal there's so many for me to take."
     And he laughs making the hand motions of pouring cereal along with sound effects for full measure.  We've never seen him laugh at his illness before.  It's the first time.  We hardly see him laugh at all. Period. But we struggle to appreciate these moments and take them for what they are, though they be far and few in between.

October 22, 2013

the straw that broke Atlas

     I've wrestled with this before.  Don't play doctor.  Be the brother, the son, the dad, the whatever but don't be the doctor.  In a more perfect world, I could gladly cast off that role.  But when faced with these notions of "if things went better..." I like to quote from Grumpy Old Men, "you can wish in one hand and shit in the other.  Let me know which one fills up first."
     And so I keep justifying it to myself, keep trying to make it right, keep damning that I am put into this role, time and time again.

Brother...

Dad...

Son...

     I could not save my brother but he did die in far, far less pain because I was not just a brother.  Given my dad's situation, he may have very well died (it's a long story) if I had just been just a son.  And my son?  The story is still being written but my wife recognizes that he likely would have completed suicide if I had been just a dad. It's a foregone conclusion in her mind.  Despite all this, a fresh passage in the pages of my son's story are troubling me.
     My son needed a blood draw.  At least I thought he needed a blood draw and the doctor agreed but wanted a fasted one.  As we entered the LabCorp office, I double checked the orders.  A few tests were missing.  But the doctor did want these tests run.  I tried calling the doctor.  No luck.  My son starts to notice my hesitation.  My conflict.  He asks me, "what's wrong," sounding nervous as his paranoia is never far from the surface.
     "There are some tests left off that need to be run," I reply.
     "Just check them off then.  You're a doctor," he replies laconically.  Issue settled in his mind.  But not mine.
      I've been told, "don't be his doctor. Be his dad."  And besides, it's not my signature at the bottom of these orders.  But if I don't "play doctor" as I have done hundreds of times in the past, my son will get inferior care.  So I check off the boxes.  The correct ones as I do not guess.  I know.  I relay a message to the doctor letting them know what I did.  "No problem" was the reply.
     In all honesty, compared to all the other doctor things I've done with my family, this is really was "no problem".  A clerical error, really.  But I've been told so many, many, many times to create a chasm between being the loved one and the doctor.  And this small episode proved to be the straw that broke the camel's back.  On some level, I am angry at the people who tell me to just be the loved one.  But on a deeper level, I am furious at the universe, at God, at the situations that keep putting me in this role and forcing a choice.  Once, it happens.  Twice, and at the same time, well that's getting to be a bit much.  But three times?  In three years?  Is there any mercy or grace in this world at all?  Or, am I being punished as I wait for the fourth, or even fifth shoe to drop?  Am I cursed to play Atlas the rest of my life?

October 18, 2013

sleepwalking through a dark night of the soul

     I stumble lamely out of bed.  The only light is the soft glow provided by the alarm clock.  3:30 am.  Didn't F. Scott Fitzgerald write:
Now the standard cure for one who is sunk is to consider those in actual destitution or physical suffering -- this is an all-weather beatitude for gloom in general and fairly salutary daytime advice for everyone. But at three o’clock in the morning, a forgotten package has the same tragic importance as a death sentence, and the cure doesn’t work -- and in a real dark night of the soul it is always three o’clock in the morning, day after day. At that hour the tendency is to refuse to face things as long as possible by retiring into an infantile dream.
As I stumble to the bathroom, I notice a throbbing pain in the great toe of my right foot.  I don't remember that pain being there when I went to bed.  Half asleep and half dreaming, I turn on the bathroom light and plop down onto the floor as standing requires to much effort in this condition.  I pull my sock off and through the crust of sleep and squinted eyes against the light, I observe that my toe is red and swollen, at least I think I do.  At the time, I probably couldn't have registered the correct number of fingers held up 3 inches from my face.  My mind quickly, well slowly actually, raced to conditions which cause the great toe to hurt.  Ah shit, I have gout?  Seriously? What else can go wrong?  My brain asks my brain, "how do you treat an acute flare of gout?"
     "Well, that's easy.  NSAIDs" my brain replied to my brain.
     "But didn't you already take some naproxen for your back and shoulder?"
     "Right you are, Brain.  What's the second thing you can add?  That drug you can add to the NSAID?" my brain puzzled over.
     "Colchicine or something like that.....we don't have any of that, do we?"
     "Now why in the hell would we have colchicine???  Please try to keep up," my brain said exasperated to my brain.
     "Wait...we have pred.  Prednisone can work, too!  When in doubt, give steroids!  That's what I learned from pharmacology."
      As I rustle through my cabinet under the sink looking for some prednisone, some part of me either shuts down this train of thought or another part wakes up a bit and says, "WARNING, DO NOT DIAGNOSE YOURSELF WHILE IN A HALF DREAM STATE!"
     "Ok," my brain replied already shutting back down, and I returned to a sleep state.
      I went back to bed.  In the morning, through the haziness of sleep, I began to remember what happened last night.  Holy Crap!  Did I try to treat myself for gout???  I look at my toe and see the big bruise on the toenail.  I had smashed it on a log during a bike mishap the day before.  That was the source of pain.  Not gout.  It reinforced to me that I absolutely need to go back and finish school before I hurt myself.  I have a deep need to finish that's not even explainable anymore.  At this point, it's my Mount Everest to climb because it's there.  That climb should start again January 1.  I qualify the "should" because at this point of my life, I have no control over what other hells can befall me.  My response is if not this January, then next June.  Come hell or high water, wait, those are already here.  Come hell, high water or zombies, I will finish.

(Of note, I've done even stranger things while sleepwalking.  Ask my wife.)

October 11, 2013

my son

     His right leg bounced up and down, quickly and repeatedly.  There was no rhythm or song in it.  It was more a muscular twitch that was far, far beyond his control.  While eating his Cheetos, his fingers had a fine tremor to them.  Not the large tremor of someone with Parkinson's, but one with a very small frequency.  Again, involuntary.  It did not seem to prevent him from devouring the Cheetos, though.  His eyes....his beautiful eyes that he inherited from his mom, often stared blankly with dilated pupils across the room focusing on nothing in particular, even while talking.  Because the hospital was quite cold, he wore a sweatshirt, one purchased from his parents at REI to be used when hiking with his dad.  He had the sleeves pushed up, exposing the 54 individual self-inflicted cuts marring the inside of his entire left forearm.  Though being right-handed, even his right arm was not spared the cutting.  Life was unbearable, filled with nothing but suffering.  He wished it to end.  Now.  Maybe it was not even a desire, but instead a need, an itch that simply must be scratched.  To him it was an inclination as natural as breathing.  He had pondered Hamlet's predicament and found no dilemma at all.  In his broken and suffering mind, it would be better to end "The heart-ache, and the thousand natural shocks that flesh is heir to".

   This is what mental illness looks like.  This is my son.

October 8, 2013

stop playing doctor


With my brother, I was told repeatedly, "just be his brother." 
With my son, I've been told, "just be his dad."
With myself, I've been told, "stop trying to diagnose yourself."

     I clearly have a problem with this advice, not because I'm arrogant or untrusting.  It's because if I don't....well, let me tell my story.  My shoulder pain I wrote about is still pretty damned painful.  So my family doctor (he's one of the good guys, albeit relatively few in my experience sadly) suggests I get another opinion.  Completely appropriate given the circumstances. I'd already seen a sports medicine doctor and failed two rounds of physical therapy.  Acupuncture helps some but only for a few days.  So I went to go see a pain management doctor.  Again, chronic intractable pain = pain management.  Not rocket science, is it?  I told the specialist my story and he wanted an MRI of my neck before proceeding.  Seemed reasonable to me.  It was possible I had a disk pinching a nerve and rather then presenting as nerve pain, it was irritating my muscles.  Ok, I can see that being different but in the realm of possibility. 

     So I dish out nearly $900 for the MRI and lo and behold, I do indeed have a bulging disk in between the vertebrae C6 and C7.  It's not huge or anything but it is there.  The arrow is pointing to the bulge. 


     So I go back to the doctor to "get the results" even though I've already looked at the images myself.  But I follow the advice and don't diagnose myself.  Personally, I don't think a bulge that size is causing all the problems, but hey, that's me.  Leave it to the professionals, right?  The pain doctor tells me, "it's possible the disk is causing it, it's possible it's not."  If it is, a steroid shot is in order but because it's in the spine, it involves the OR.  Whoa, that sounds expensive.  Let me find out how expensive this is first, because my insurance sucks.  I wait a day and discover that it's going to cost me close to $2,000 for something that might help.  Well, when you're in pain all the time, you're willing to try damned near anything so I was sorely tempted.  But the frugalness in me won out.  I declined.
     So I wallowed in pity wondering was I doomed to be in pain, both physically as well as emotionally, the rest of my life.  But something bugged me.  I threw off the "trust the professional" mantra and instead cast on, "physician, heal thyself", aka "I'm right, damnit."  My bulging disk, if affecting nerves, would be hitting C7 nerves because the nerves in the neck exit above the vertebral disk, ie C7.  Problem is, the biggest and baddest bulging knots were in my trapezius, rhomboids and levator scapulae.  Um, Houston, we have a problem.  The nerves that feed the rhomboids and levator scapulae exit at C5 higher up.  And the nerves that feed the trapezius exist even higher up from the skull.  That's like going out to the breaker box on your house and tripping the switch for your garage but having the lights upstairs go out instead.  Unless you're wired wrong, it doesn't make anatomical sense.
     So I almost spent $2,000 of money I really don't have in desperation because somebody forget their spinal anatomy as it relates to muscles.  Damned doctors.  So I'm left without an accurate explanation of why the muscles on the right side of my back are so angry that they are visibly swollen.  While stress may play a role, I seriously doubt it's causing my shoulder this many problems for the simple reason that I threw out my lower back simultaneously and it got back to "normal" in exactly the same amount of time as usual.  I don't think stress is so selective.
     I'm going back to my family doc to brainstorm.  At least I know I'll likely have a C7 problem down the road.  That's something fun to look forward to.

October 3, 2013

2br02b

I've had three posts titled using similar letters - 2s and Bs.  I'm not trying to bore readers or prove I'm losing it (well, that may be debatable).  They all relate in an emotional progression, I can assure you.  It might help if the numbers and letters where actually translated into some meaningful English.

The first one BU2B = Brought up to believe.
The second one BU2B2 = Brought up to believe part 2
The last one 2BR02B = To Be, or naught To Be

The first two are song lyrics by Neil Peart.  Being a voracious reader, I knew his song title was used not as text-ese but must instead relate to a piece of good literature.  I finally figured it out that it tied back to an old short story 2BR02B by one of my favorite authors, Kurt Vonnegut.  His title obviously ties further back to Hamlet's famous dilemma of which I wrote earlier.

From Hamlet to these three more modern writings, they all relate to a progression of my worldview as well as my inner view. 

The first song BU2B, relates very much to the attitude we were raised with from my dad.  My brother and I both even talked about as he neared death.  My dad has (or had, maybe it's changed) an unshakeable belief that things will always work out for the best.  To my brother and I growing up, we both envied his belief as well as thought it bordering on irrational.  But in the mind of my father it was unshakeable.  It was one of his major guiding principles in life.  As my brother got closer and closer to death, that notion began to unravel for both myself and my brother.  Things were not working out for the best, or at least in the sense that we desired.  One of the core beliefs that was modeled to us from an early age was shaken to its core and blew away in the wind from our perspective.

The second song BU2B2, was one of my mantras as I grieved my brother's loss yet discovered deeper ways of being compassionate with patients as they struggled with their own health and problems.  It allowed me a sense of feeling utterly and completely lost, while still feeling some purpose, if that makes sense.

And if you read Vonnegut's short story (which of course I highly recommend), you'll get a sense of what extreme lengths a father will go to for his children.  I don't always have the words or strength to write about things openly so I'm left with allusions to others who are better writers.

As it's an open domain story, you can read it here at the Gutenberg Project 2BR02B.
Or, you can also listen to it as an audiobook for free on YouTube below.

September 30, 2013

bu2b2

I was brought up to believe
Belief has failed me now
The bright glow of optimism
Abandoned me somehow


Belief has failed me now
Life goes from bad to worse
No philosophy consoles me
In a clockwork universe

Life goes from bad to worse
I still choose to live
Find a measure of love and laughter
And another measure to give

I still choose to live
And give even while I grieve
Though the balance tilts against me
I was brought up to believe

 - BU2B2 by n. peart

September 26, 2013

bu2b

I was brought up to believe
The universe has a plan
We are only human
It's not ours to understand

The universe has a plan
All is for the best
Some will be rewarded
And the devil will take the rest

All is for the best
Believe in what we're told
Blind man in the market
Buying what we're sold
Believe in what we're told
Until our final breath
While our loving Watchmaker
Loves us all to death

In a world of cut and thrust
I was always taught to trust
In a world where all must fail
Heaven's justice will prevail

The joy and pain that we receive
Each comes with its own cost
The price of what we're winning
Is the same as what we've lost

Until our final breath
The joy and pain that we receive
Must be what we deserve
I was brought up to believe

- BU2B by n. peart

September 15, 2013

confusion

     As the temperature in my garage flirted with triple digits, I was sufficiently sweating even without lifting weights.  Not that I'm good at lifting weights, especially with my extra vertebraed spine.  But the daily anger gets burned off, at least a good part that allows me to get through yet one more day.  I was in between sets standing still and catching my breath as the sweat dribbled steadily off my nose as my head hung low.  My head does that a lot of late, hang low.  The music was blaring out a song that once meant nothing to me.  But after my brother died, parts of it touched raw spots in my heart.  But now with my son, it takes on an even different meaning.

Gone Away by Dexter Holland
Maybe in another life
I could find you there
Pulled away before your time
I can't deal it's so unfair

And it feels like
Heaven is so far away
Yeah it feels like
The world has grown cold
Now that you've gone away

Leaving flowers on your grave
Show that I still care
But black roses and Hail Marys
Can't bring back what's taken from me

I reach to the sky
And call out your name
And if I could trade
I would

And it feels like
Heaven is so far away
Yeah it stings now
The world is so cold
Now that you've gone away

Gone away
Gone away

I reach to the sky
And call out your name
Oh, please let me trade
I would

And it feels like
Heaven is so far away
And it feels
Yeah it feels like
The world has grown cold
Now that you've gone away

     "Oh, please let me trade, I would." I crumpled to the ground with the saltiness of sweat mixing with tears from deep soul wrenching sobs.  My brother "pulled away before your time".  Wanting to trade places with my son.  "I can't deal it's so unfair."
     I now longer know for whom I'm wailing anymore.  And does it even matter?  The pain over the last few years is all so intertwined now that to try to unravel it would be to unravel myself and find nothing left.  There is no understanding the pain, only feeling it, and more importantly, making friends with it.  So I stood up, took a deep breath, and performed my next set of squats with tears still mixing with sweat, as the physical pain traded places with the emotional pain.

September 8, 2013

it's all in your head

     The physical pain in my shoulder spiked recently for no apparent reason.  It's an old injury that I've learned to live with, for the most part.  Given that it functions as a built in barometer, it guarantees that I will never move to colder climes.  Every winter, my shoulder aches in advance of even a moderate cold front, such as they are down here in Houston.  There is a muscle knot along my right shoulder blade that never goes away and grows and shrinks in direct relation to the pain.  And when it gets good and pissed off, it acts as an epicenter spreading knots up and down my spine, and even down my arm into my forearm when it's furiously angry.  On this event, the knot had grown substantially.  Clearly it was pissed off big time.  Now no longer a know to felt under the skin, it was visible to the naked eye when my shirt was off due to the angry swelling.  And to touch it meant to touch concrete.  And never mind the at least ten other tender knots that had arisen elsewhere.
     With lifting weights, I'm able to lessen the frequency of these flares.  But when they do occur (typically in the winter), I'm able to ride them out after a few days of icing it, some extra stretching and a lot of bitching and moaning.  But not this time.  It's the middle of summer which is usually when it does the best so weather clearly isn't the reason.  No physical trigger like after driving 800 miles in a car with poor posture.  I didn't do anything different from an exercise perspective.  I asked my doctor for advice.  His response was, "you already failed two rounds of physical therapy with this thing," and referred me to an orthopedist.  Ah yes, PT.  I remember the PT on the first day took one quick look at the knot and said, "there's NO way, I'm going to be able to massage that out.  I'm just letting you know."  Hence the two rounds of PT.  The second fared no better than the first. 
     I try different things out of desperation and then nightly ask my wife to assess the swelling and hardness while I cuss and moan about why it's doing what it's doing.  Exasperated, she tolerates the checks but finally tells me flat out, "you ARE under a lot of stress.  You think it might all be in your head?"  Um, yeah.  I remember this sucker hurting horribly before I took the MCAT.  The day after?  The pain was completely gone.  Slight problem then with this one.  Stress ain't going away anytime soon.  And it takes time to get into a specialist.  What am I supposed to do in the meantime?  How about a chiropractor?  I was always skeptical of them but a desperate man grasps at anything.  Turns out I was right to be skeptical as I would've been better off throwing my money into a sewer.  I know, a good masseuse.  That ought to do it.  She looked at the knot and touched it like it was something to be afraid of.  After she felt the rock, also known as my rhomboid muscles, she simply stated, "fffuuudddgggeee......you do realize this is going to hurt and it's not coming out in just one sessions, right?"  She was right on both accounts as she wailed on the know like a jack hammer.  It did provide some mild temporary relief.
     Still desperately in pain, I turned east to acupuncture.  Her reaction wasn't too different than the masseuse.  "It is very angry.  It must hurt, no?" Um, yeah.  It hurts so bad I'm about to stick you with needles.  She had difficulty even getting the needle into the knot due to it's tight density.  But amazingly, altering my chi or whatever bullshit reason has given me some temporary relief.  Don't ask me how to explain it.  It just does and I'm going back because I'm desperate.  But it gives me pause to think what stress can do to the mind and body.  Good stress, such as exercise or even good mental challenges can push us to our limits thereby achieving things we thought not possible.  But bad stress.....It'll do a number on you.  I'm not imagining the knot.  I'm not consciously making it up.  It's physically there for anyone to feel and touch.  And despite all the things I can do to handle the current circumstances (exercise, meditate, therapy, etc), it's still not enough.  The knot returns just as angry as before.  The power of deep emotional pain can exact even enormous physical pain.

September 1, 2013

honor thy pain

The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.


     I strode down to the ER, trying not to get lost in the catacombs of hallways, despite having been in this hospital for months.  Lack of spatial skills ruled out radiology as a specialty for me pretty damned quickly.  Being the middle of the night, the patient had the sheet pulled over her head trying to shut out all the noise and intrusions of a busy ER.  Gently as I could, I awoke the patient and was greeted by the equivalent of this lady in the video below, only instead of an African Americam lady, mine was a rural Caucasian lady. In all honesty, when people are sick, I tend to find the commonalities of what it means to be human be far more important than cultural differences.


     Her raw honesty and spunky character perked me up from lack of sleep right away.  Small and bent over with skin the texture of leather, she had a toughness that bespoke a very, very hard life.  I began with the simple questions of a full history.  It got interesting about time for the social history.
     "You married, single, divorced?"
     "Heh-heh, there be a good story if I wasn't in such bad pain."
     "So let me guess, divorced then?"
     "Yup," she said still chuckling.
     "How much alcohol do you drink?"
     "Oh just one now and then."
     "Come on Miss Smith, do I look like a young and na├»ve doc to you?  Now how about the real amount?"
     She laughed despite her abdominal pain and answered, "You funny.  About a six pack a day.  And that's the truth."  I noted it and she interjected, "don't be writing that down, honey!  Lord, Jesus, you gonna be thinking me an al-key-holic."
     "Now come on ma'am.  Does it look like I'm gonna judge you?  I'm here to help you."
     "Well, doc, then you gotta do sumpthin' about this pain.  Lord, Jesus, I'm about to go down to the gift store and get me some Tylenol!  Sweet baby Jesus, I got the flu and it hurts"  Nevermind it was 3 am and the gift shop had long been closed, but I believed her.  She really would climb out of that bed and start wandering around looking for the gift store to get some Tylenol.  I did not doubt her for a minute.  She had a gritty determination that I could not help but admire.
     "Well, ma'am, your flu test came back negative and according to the CT, the reason you're in such bad pain is you have a pretty bad case of divertilitis."
     "What?  Nah, you're test be wrong.  I ain't got no whatchamacallit, that whatever-itis.  Baby, let me tell you, it's the flu.  I've had the flu before and it's the flu."
     Round and round we went, with me trying to explain diverticulitis and her trying to convince me it was the flu.  So rather than argue, I asked her to trust me, which she reluctantly but finally did.  I think that simply by listening to her, truly listening, I had earned her trust, which was not a quick thing for her to give out given her past incidences in life.  And I validated her trust by getting her some pain meds ASAP.  And after she got her pain meds, she was the sweetest, most appreciative patient in the world.
     As I write this, I think of my own pain.  Of when it hurts so bad, all you want to do is to make it stop.  You don't care what anyone else thinks.  You want it to stop and when determined, you'll do anything to make it stop.  She also reminds me that, when lost in your own pain, it's easy to forget that everyone has their demons.  Granted, some people may experience less than others, but to the individual, that doesn't matter.  Pain is pain.  And as a both a doctor and human being, it's best to honor that person's pain.

August 29, 2013

equanimity


It is easy to keep your equanimity in heaven; can you keep it in hell?

–Zen saying

August 25, 2013

search for meaning

     Victor Frankl, if you have not heard of him, is a rather famous author and physician, most notably for his book Man's Search for Meaning.  He developed a form of psychoanalysis dubbed logotherapy, which arises from the Greek word logos meaning an account or reason.  In his particular context it meant therapy to help find meaning in life.  Once one knows the meaning of their life, everything else becomes secondary, in his mind.  And this book is no dry tome laden heavy with medical terms.  It is his thoughts and conclusions from having survived WWII as a Jew in a concentration camp.  If anyone should know suffering, this man should.  It sounded perfect for my next round of bibliotherapy after Hamlet.
     While not a technically difficult read, it is emotionally difficult, at least for me.  My first impression was, "this man suffered far, far worse than I have and yet did better than me.  Crap, I'm weak."  It's a valid evaluation as this man went on to live a long and fruitful life without becoming horribly bitter or resentful.  He suffered his torments well but as to the how, he merely states:
If someone now asked of us the truth of Dostoevski's statement that flatly defines man as a being who can get used to anything, we would reply, "Yes, a man can get used to anything, but do not ask us how."
     I can relate.  When I've told others of my experiences in med school, they often ask how did I survive that?  I'd shrug my shoulders and say, "I have no idea but I never want to go through that again."  But the again part is here, yet again.  So do I trust that I will make it through yet one more time and at the end, shrug my shoulders and say, "I have no idea how I survived"?

August 22, 2013

dark night of the soul


"Letting go of our images of God can be terrifying. It is often the result of an experience of suffering in our lives, when our previous understanding is no longer adequate to give meaning to what has happened to us. When my mother died suddenly in my early thirties, I was thrust into the desert. All of my certainties about God and life were stripped away and I was left raw and frightened. Many people offered trite words and shallow comfort in my grief, they were not willing to sit with me in the darkness, but only hoped to rush me through to a place of light.

This is the mystical experience of the “dark night of the soul,” when old convictions and conformities dissolve into nothingness and we are called to stand naked to the terror of the unknown. We must let the process move through us—one which is much greater than we can comprehend. We can never force our way back to the light. It is only in this place of absolute surrender that the new possibility can emerge. We don’t just have one dark night in our lives, but again and again, as we are called to continue releasing the images we cling to so tightly."

-          Christine Valters Paintner

August 18, 2013

what DOES come out the other side?

I've been away from writing for too long.  It's a cathartic process for me, but remains quite difficult under the current circumstances.  Emotions come at me faster than I can process them.  Besides, I'm more than a bit slow emotionally.  Ask me for a diagnosis and I can that spit out quickly.  Ask me what I'm feeling and I take on the appearance of sloth.  You might as well ask a 6 year old to solve a derivative equation.  I may be slow, but I'm not stupid.  So I looked to the past as to what I felt when my brother was diagnosed, when my dad was diagnosed and all the events that followed.  Do any of those feelings still apply?  Some rules have changed when it's your own kid.  Others still apply.  Like this post.  It's hard to believe I wrote this over two years ago.  It was true then.  But today looking back, it's even more true now, if that makes any sense, especially the last couple of sentences.  My bearings are so lost, I have even less of an idea of what comes out the other side.  And at this point, is there even an other side to the tunnel?


January 15, 2011
what comes out the other side?
    I'm enrolled in an extracurricular class entitled "The Healer's Art".  It's a six-part seminar whereby they train a more human and humane physician.  The second seminar was dubbed "Honoring Loss".  We were instructed to close our eyes, center ourselves and in our mind's eye go to a time where we dealt with disappointment, loss, grief.  No trouble there.  After some exercises, we broke into smaller groups to explore the role that loss plays in healing.  Personal stories were told and after recounting a much abbrievated tale of dealing my with my brother's illness as both brother and physician, I was asked, "did you find things out about yourself that you didn't know?"
    My reply, "in situations such as this, you never really know what you'll do until you're confronted with the situation."  A week has passed from that session and now I'm yet again confronted with more slings and arrows.  My dad went in for a physical and came back with a descriptive condition by the name of pancytopenia.  In a nutshell, his red blood cells (and corresponding hemoglobin), platelets and neutrophils are all way too low.  Family doc thinks, "maybe it's a fluke or instrument problem."  Retest.  Same answer comes back except his hemoglobin drops from 10.0 to 8.6 in just 7-days (normal for a male is >14 depending on the lab, anything less than 8.0 becomes critical anemia).  Conversations between my dad and I flow back and forth.  He thinks that it's due to a bleeding ulcer as he has a history of that.  Nothing terribly serious, in his estimation.  I can tell that he wants to believe that.  If only.  My gut tells me differently.  This is something potentially very serious.  And I'm angry because once again I'm thrust into the position of convincing a loved one that something very dangerous is going on.  This takes priority over everything else, period.  Where the hell is the doctor in all this?  Why does this keep happening?  After reflection, I accept that nobody wants any of these cards but this is the hand we're dealt.  My brother didn't want cancer.  My dad didn't want something from a deep dark road I don't even want to think about, but can't help (leukemia, lymphoma, aplastic anemia, etc).  A sense of naivete still hopes for something less ominous.  We'll have to wait for more testing. 
    The anger is still there.  If anything, it's intensified with the reflection and dealing with my brother going through a rough patch.  I start to wonder if I am capable of doing this.  But no, I can at least now put one foot in front of the other and accompany yet another family member to an oncologist to start the path of naming the demon we're confronted with.  This week, it's my dad.  Next week, it's my brother for a clinical trial.  Somewhere after that I supposedly have some exams, too.  In the midst of all this, I can tell that family members are beginning to become concerned about me.  It's a valid concern, I guess.  In looking ahead, I can't see a damned thing.  I used to think about what kind of doctor or person would come out the other side of medical training with a sense of curiosity.  Now, I have no idea.  How can I?  What kind of life comes out the other side of this?

August 3, 2013

all the world's indeed a stage

Like most, I first read it in high school.  And probably like most other people, that was the only time I read it.  Too old.  Too many strange words.  Too many long, drawn out speeches.  Completely unable to relate to the modern world.  Lacking the life experience then, I never thought much of the highly acclaimed play Hamlet.  Until now.  I just reread it.  As my dad said, "interesting choice of leisure reading."  I am blown away by Ol' Will's ability to string words together.  Granted, I had to look a lot of them up as I'm no scholar in old English but as I moved towards to what is arguably in my mind some of the finest writing ever in the Western World, I had tears brought to my eyes as I read Hamlet's soliloquy debating whether life is worth living.  For most people, it's a no brainer.  But having been run through time after time after time......I. Grasp. Every. Single. Word. Of Hamlet's dilemma. Not on an intellectual level as something to be studied and dissected, but on an experiential level.  How many times must, or even can, a man endure "The slings and arrows of outrageous fortune" before we question whether or not "to end the heartache and the thousand natural shocks that flesh is heir to?" and answer it thusly, "Tis a consummation devoutly to be wished."  This man not only commands language like few in history are capable of, but he knows the depth and darkness of what it means to be wounded and the associated weariness of tolerating further wounds upon the very soul.  I could go on but I do it no justice.  Just watch Mel Gibson's performance below.  You may have to watch it more than once.  You may need to have the words if you're not familiar with it.  They can be found here.
 

July 31, 2013

grasping at straws

I've done myself an impossible crime
Had to paint myself a hole
And fall inside
If it's far enough in sight and rhyme
I get to wear another dress
And count in time

Oh, won't you do me the favor, man
Of a giving mind
A polymorphing opinion here
And your vague outline

I'll find myself another burning gate
A pretty face, a vague idea I can't relate
And this is get what you get for pulling pins
Out of the hole
Inside the hole you're in

It's like I'm pressed on the handle bars
Of a blind man's bike
No straws to grab, just the rushing wind
On the rolling mind
 - james mercer

July 25, 2013

anguish

You nights of anguish.  Why didn't I kneel more deeply to accept you? Inconsolable sisters, and, surrending, lose myself in your loosened hair.  How we squander our hours of pain.  How we gaze beyond them into the bitter duration to see if they have an end.  Though they are really seasons of us, our winter..... -  Rainer Rilke
     The dogs laid in the tall grass, munching on what are presumably old deer bones.  They thoroughly relish visits to these hay fields but of late, I have no desire to bring them. I have little desire for anything. But my wife's dog, AKA my new Hiking Partner demands it. The dog will growl at me until I take her. And their vehicle of transport across hay fields? Why a jeep, of course. My son's jeep. Mixed emotions every time I drive it. Very mixed.
     But here we are - me sitting in the jeep and the dogs crunching contentedly. The setting sun and breeze remind me that at this time of year, my son and I should be in Colorado backpacking. I am hit with a clenched stomach and sobs of pain. This is not crying. NO. Crying follows emotional pain, there is an order. This is soul destroying anguish where physical pain is caused from the wailing. I cannot catch my breath as my diaphragm contracts tremulously. I can no longer move air through my oral passages as I clench my jaw with fierce yet impotent anger. No more, please, I cannot bear it. I no longer know to whom or what I am pleading but there is no answer as the pain only intensifies. I cannot kneel anymore deeply than this.


July 19, 2013

the cure

The Cure
 
We think we get over things.
We don’t get over things.
Or say, we get over the measles
but not a broken heart.
We need to make that distinction.
The things that become part of our experience
Never become less a part of our experience.
How can I say it?
 
The way to get over a life is to die,
Short of that, you move with it,
let the pain be pain,
not in the hope that it will vanish
but in the faith that it will fit in,
find its place in the shape of things,
and be then not any less pain
but true to form.
Because anything natural has an
inherent shape and will flow towards it.
And a life is as natural as a leaf.
That’s what we’re looking for:
not the end of a thing
but the shape of it.
 
Wisdom is seeing the shape of your life without
obliterating, getting over a
single instant of it.
 
— Albert Huffstickler, from Walking Wounded

July 12, 2013

the centre cannot hold

     My advisor who has steered me through school in the midst of my brother and father, has strongly urged me to take a leave of absence to keep myself together through the next disaster.  Perhaps "strongly" isn't sufficient.  Adamant, compelling, resolutely.  But also sagaciously, compassionately, wisely.  After adding up all the things facing me, both personally and from school, it suddenly became clear to me that she was right.  To borrow a line from Yeats, my center cannot hold.  So I'm taking a leave of absence from school.  I view it as a necessary evil, rather than a path I wish to choose.  In fact, it pains me greatly to follow this course.  But the other options left me on a path towards burning out, or worse.  As my own words are not flowing adequately to encompass my emotional and psychic totality, I look to literary giants who are far better able at bringing to life such feelings with their gift of words.  If you've never read Rilke before, I highly recommend him.
It seems to me that almost all our sadnesses are moments of tension, which we feel as paralysis because we no longer hear our astonished emotions living. Because we are alone with the unfamiliar presence that has entered us; because everything we trust and are used to is for a moment taken away from us; because we stand in the midst of a transition where we cannot remain standing.
That is why the sadness passes: the new presence inside us, the presence that has been added, has entered our heart, has gone into its innermost chamber and is no longer even there, – is already in our bloodstream. And we don’t know what it was. We could easily be made to believe that nothing happened, and yet we have changed, as a house that a guest has entered changes.We can’t say who has come, perhaps we will never know, but many signs indicate that the future enters us in this way in order to be transformed in us, long before it happens.
And that is why it is so important to be solitary and attentive when one is sad: because the seemingly uneventful and motionless moment when our future steps into us is so much closer to life than that other loud and accidental point of time when it happens to us as if from outside. The quieter we are, the more patient and open we are in our sadnesses, the more deeply and serenely the new presence can enter us, and the more we can make it our own, the more it becomes our fate.
-Rainer Maria Rilke

June 20, 2013

sorrow

Give sorrow words;
the grief that does not speak;
whispers the o’er-fraught heart
and bids it break.
- William Shakespeare from MacBeth

Forget the future. I'd worship someone who could do that.
- Rumi

     Once again, I enter deep into the vale of tears, in fact further than I've ever tread before, as our son is suffering.  While I could blog about my brother's and father's illness, I will not do so of my son's.  His medical condition is that of someone who is not yet an adult and as such, deserves the privacy afforded to him.  All that I will say it is not cancer this time, but it is just as life threatening and is fundamentally life altering.  Much like with my brother and my dad, there is no going back to the way things were before.  So if my blog turns dark and gloomy without any details, you will know why.

June 17, 2013

a fine place to hesitate

There is a lake between sun and moon
Not too many know about
In the silence between whisper and shout
The space between wonder and doubt

This is a fine place
Shining face to face
Those bonfire lights in the mirror of sky
The space between wonder and why

Ahh, yes to
Why the sun?
Why the sun?

There is a fine line between love and illusion
A fine place to penetrate
The gap between actor and act
The lens between wishes and fact
 
 
THIS is a fine place
To hesitate
Those bonfire lights in the lake of sky
The time between wonder and why

Ahh, yes to
Why the sun?
Why the sun?

Some need to pray to the sun at high noon
Need to howl at the midwinter moon
Reborn and baptized in a moment of grace
We just need a break
From the headlong race

This is a fine place
Shining face to face
Those bonfire lights in the mirrored sky
The space between wonder and why

Ahh, yes to
Why the sun?
Why the sun?
- pye dubois & neil peart


June 14, 2013

solitude


I have lately got back to that glorious society called Solitude.
- henry david thoreau

June 10, 2013

first, to endure

     The extra vertebrae in my back along with their respective degenerative disks cried out in pain.  The terrain was a glorified walk of only 2 miles with no altitude gain.  And while my backpack was not light, I had carried far heavier far further far higher in my past.  I expected my back to hurt but even my legs were getting a bit wobbly by the second mile.  My dog paused obediently whenever I had to stop for a few seconds to catch my breath but she looked at me expectantly.  She had cardiac damage from heart worms and she was kicking my butt.  What the hell happened to me?  I used to be able to do far more physically.
     I recalled an email from another student who was also older than the average student.  In it he counseled me, "Man, stay in shape now while you still can or med school hours WILL damage your health."  It seems that it had indeed taken its toll on my physical health.  But sitting on a rock, petting my lone and faithful furry hiking companion, med school may have taken some toll, but I was stupid to think it was just that.  I laughed grimly at myself.  What had happened to me?  I really had to ask such a question of myself?  Life had kicked the ever living shit out of me.  Physically, mentally and emotionally.  That's what happened to my body.
     And while I reflexively resolved to get myself back into shape with some gung-ho enthusiasm, I immediately tempered that with realism.  Be a bit more forgiving towards myself.  That's great to get back into shape, but first, I must endure.  And enduring metaphysically is the ultimate goal for me right now and that's ok.  That philosophy of life has served me well.

June 7, 2013

answering the call of the wild



But especially he loved to run in the dim twilight of the summer midnights, listening to the subdued and sleepy murmurs of the forest, reading signs and sounds as a man may read a book, and seeking for the mysterious something that called -- called, waking or sleeping, at all times, for him to come.
- jack london

June 4, 2013

call of the wild


Sometimes he pursued the call into the forest, looking for it as though it were a tangible thing, barking softly or defiantly... Irresistible impulses seized him. he would be lying in camp, dozing lazily in the heat of the day, when suddenly his head would lift and his ears cock up, intent and listening, and he would spring on his feet and dash away, and on and on, for hours, though the forest aisles.
- jack london

May 22, 2013

ave atque vale

Two years later, I'm not sure these words are any easier to live:

Through many countries and over many seas
I have come, Brother, to these melancholy rites,
To show this final honour to the dead,
And speak (to what purpose?) to your silent ashes,
Since now fate takes you, even you, from me.
Oh, Brother, ripped away from me so cruelly,
Now at least take these last offerings, blessed
By the tradition of our parents, gifts to the dead.
Accept, by custom, what a brother’s tears drown,
And, for eternity, Brother, ave atque vale
‘Hail and Farewell.’

May 17, 2013

nearing two years

Make the most of your regrets; never smother your sorrow, but tend and cherish it till it come to have a separate and integral interest. To regret deeply is to live afresh. By doing so you will find yourself restored to all your emoluments. - Henry David Thoreau 

     It's been nearly two years since I watched my brother die.  No, that's not quite accurate.  I was an active participant in his process of dying.  I walked with him every step of the way and in doing so forever changed my notion of being a doctor.  As if the stress of medical school wasn't enough.  The first patient I ever took care of was my brother.  The first time I ever had to make those decisions at 3 in the morning without anybody to ask was with my brother.  No one was looking over my shoulder to ensure that I did not make a mistake.  I did not have the benefit of years of experience to aid me, either.  The first patient I ever lost was my brother.  The second patient was nearly my dad.  And I had both at the same time.  I was rushing my dad to the ER on the day of my brother's death AND the day of his funeral.  If that's not enough to turn a man to drink or drug, then what is?

     Through much grief work, much sadness, much therapy, and even medication I have come to accept the following paradox.  While a part of me wishes to be happy again, that part involved in loss will always grieve and dwell in the darkness.  I accept the notion that two mutually exclusive thoughts can be both equally true.  I continue to, and likely always will given my profession, grieve the loss of my brother, and the near loss of my father.  And I selfishly grieve the fact that my career will always be inextricably entwined with those losses.  I can never naively enjoy my training with this knowledge.  Every time I see a patient in horrible and chronic pain, every time I see a patient with a terminal disease, every time I see a patient with existential angst, I will grieve that loss again and again, all the while still hoping for happiness.

     I have been told by multiple people, including grief counselors, that I will be a better doctor for it, that it is a gift.  I can empathize and sympathize on a level that can only be experienced.  But that brutally misses the point, which is the pain still remains in order for that knowledge to exist.  One simply cannot exist without the other.  And in speaking with others who have experienced such traumatic loss, time does not necessarily heal all wounds.  As a soldier who saw all of his friends die in WWI, Tolkien aptly penned, "There are some things that time can not mend. Some hurts that go too deep, that have taken hold."  So after two years, is the pain healed?  No, it merely ebbs and flows, much like the seasons passing time.