tag:blogger.com,1999:blog-8448780833103095422024-03-14T12:50:51.910-05:00The heart is a lonely huntertales from the training of a physicianIsaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.comBlogger685125tag:blogger.com,1999:blog-844878083310309542.post-32813718817129388632019-05-22T13:02:00.002-05:002019-05-22T13:02:18.654-05:00Ave, Atque, ValeCarried through many nations and over many seas,<div>
I arrive, brother, for these wretched funeral rites</div>
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so that I might present you with the last tribute of death</div>
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and speak in vain to silent ash,</div>
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since Fortune has carried you, yourself, away from me.</div>
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Alas, poor brother, unfairly taken away from me,</div>
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now in the meantime, nevertheless, these things which in the ancient custom of our ancestors</div>
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are handed over as a sad tribute to the rites,</div>
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receive, dripping with brotherly weeping.</div>
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And forever, brother,</div>
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Hail and farewell.</div>
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<br /></div>
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Time heals all wounds. We've all heard it. I've had so many people tell it to me myself. And I wonder, do they believe it to be true? Is it something they tell themselves to feel better? After all, it IS simply easier to forget those left behind and move on. But then I would not be true to myself. Which is one of the most important things The Bard could've written. To thine own self be true. But then, Polonius was a fool. So where lies the truth in these platitudes? In experience. I have holes and wounds that have scarred over. But the scar still remains. The absence of that limb still remains. Have I learned to live without it? Of course. But it still is missing. As so many things are missing...</div>
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Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com5tag:blogger.com,1999:blog-844878083310309542.post-25454322952196034072018-02-12T09:44:00.005-06:002018-02-12T09:47:02.522-06:00hemingway's whiskey<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">I know it's tough out there, </span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">a good muse is hard to find.</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">Living one word to the next,</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">living one line at a time.</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">Now there more to life then whiskey,</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">there's more to words than rhyme,</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">Sometime nothing works,</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">sometimes nothing shines.</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">Hemingway's whiskey</span><br style="background-color: white; box-sizing: border-box; color: #222222;" /><span style="background-color: white; color: #222222;"><br /></span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">Sail away, sail away,</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">as the day grows dim.</span><span style="background-color: white; color: #222222;">Live hard, die hard,</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">this ones for him.</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;"><br /></span><span style="background-color: white; color: #222222;">Hemingway's whiskey</span><br style="background-color: white; box-sizing: border-box; color: #222222;" /><span style="background-color: white; color: #222222;">warm and smooth and mean,</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">Even when it burns,</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">it will always finish clean.</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">He did not like it watered down, </span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">he took it straight up an neat.</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">If it's bad enough for him,</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">you know it's bad enough for me.</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">- guy clark</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;"><br /></span></span>
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">The world breaks everyone and afterward many are strong at the broken places. But those that will not break, it kills. It kills the very good and the very gentle and the very brave impartially.</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">- ernest hemingway</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;"><br /></span></span>
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">The sounds of the talking heads vaguely reach my ears from the TV. Yet another study came out touting the benefits of alcohol on longevity. Countering that was a physician saying that he wished patients could instead use yoga or meditation to relax after work instead of lifting the bottle. Having pronounced my fair share of patients dead from the liver failure that resulted from hitting the bottle for too hard, for too long, I could see his point. But the pious, self righteousness of his tone couldn't help but accompany his words. If only the patient would do what I tell them to do.....What would he tell Papa? Would he pretend to know what is best for that brilliant wordsmith, that tortured soul, that broken man, that icon of icons?</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;"><br /></span></span>
<span style="font-family: inherit;"><span style="background-color: white; color: #222222;">My yoga mat is rolled out in front of and I stare at it, as if by gazing at it long enough, the pain will subside enough for me to even do yoga in the first place. Which I do to reduce the pain. But the pain is keeping me from doing it. A catch-22, if ever there was one. Next to my mat is a glass of my type of whiskey, a bourbon flavored with that nectar I have cherished since even as a young child - honey. If it's bad enough for Papa, it's bad enough for me.</span></span>Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com3tag:blogger.com,1999:blog-844878083310309542.post-64978773530706443252018-02-09T13:32:00.000-06:002018-02-09T13:32:19.194-06:00down the roadAdvice to a future me (and future doctors)<br />
<br />
When in doubt,<br />
Talk to the Patient,<br />
Listen to the Patient,<br />
...<br />
...<br />
...<br />
...<br />
...<br />
...<br />
Clarity. Will. Return.<br />
<br />Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com0tag:blogger.com,1999:blog-844878083310309542.post-80773135034313443762018-01-30T13:21:00.003-06:002018-01-30T13:23:09.816-06:00begins with a broken heart<em style="background-color: white; color: #1c1c1c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14.85px;">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.</em><br />
<br />
"If we live long enough in this world, we will have our hearts broken. And do they heal? Well, maybe not fully, ever. But in the cracked and broken pieces, that's where the light shines through. We walk in the world forever after with more depth, more sensitivity, more compassion. Our love affair with the world begins with a broken heart."<br />
- Marilyn Sewell<br />
<br />
He faced an aggressive cancer. He was facing death. He certainly faced physical pain as evidenced by the multiple bone metastases. My experience tells me that bone mets are some of the most painful conditions imaginable. Experience also tells me that the existential anxiety is equally painful, though. And he was young. But not ONE doctor had sat down and asked he how he was doing. And I mean, how are you DOING. No one had sat down and gotten their hands dirty. Which is to say, gotten their emotions dirty. Expose themselves emotionally. Be open and listen. Hear the full extent of his pain. Things he could not tell his spouse. Things he could not tell his parents. Things he could not tell his children. Things he could not tell his best friends. Things he could not even tell himself. But things he could tell his doctor. If only, they would be willing to listen. So, I listened. I spent nearly two hours with him. And I by the time he left.........<br />
<br />
A wise man, mentor, and friend once advised me, you're going to have to figure out where to draw the line. It does no good to open up to every patient if you lose yourself in the end. You cannot save everyone. I am still figuring out where to draw that line.<br />
<br />
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<br />Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com1tag:blogger.com,1999:blog-844878083310309542.post-16374106604641668062018-01-08T14:36:00.002-06:002018-01-08T14:36:41.537-06:00miles to go<br />
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The woods are lovely, dark and deep,</div>
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But I have promises to keep,</div>
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And miles to go before I sleep,</div>
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And miles to go before I sleep.</div>
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Not exactly an even wear. On a riding heel, no less, so that's not a trivial amount of mileage. Not ridden atop a mighty steed, but ridden hard and long nonetheless. And whipped many a time with a riding crop. It's my left foot. I don't even need to check which foot it is. It is the foot that drags when my back starts hurting. And I don't mean hurting. I mean REALLY hurting. A pulsing numbness, yet combined yet with searing pain exists in a mutually exclusive duality going down my left leg. Numbness. And pain. There's no explaining how those two exist side by side unless you've felt it. And my wife looks for a new pair of boots to last this final sprint towards the finish line. An identical replacement, really. For they have served me well. After all, I have <i>earned</i> the name of Vaquero Doc. Why trade it in now?</div>
Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com1tag:blogger.com,1999:blog-844878083310309542.post-6894392530826251992017-11-26T13:16:00.000-06:002017-11-26T13:16:25.193-06:00the honest man<iframe allowfullscreen="" frameborder="0" height="344" src="https://www.youtube.com/embed/KizL_-YjxoI" width="459"></iframe><br />
<br />
Ever since I was a kid, I have attracted stray animals. Dogs, cats. Even turtles. It seems I attract the same types of patients. Among my colleagues, I have become notorious for being A Black Cloud. You see, we are a highly superstitious lot. Even more than athletes. As one off service resident told me, it was a pleasure working with you but I NEVER want to work with you again. One of my close friends dreads working with me again towards the end of our residency because they know what is in store. As I work nights in the hospital and admit new patients from the ER, I hear comments from my day team colleagues who then have to deal with the aftermath of my admits. Such comments as:<br />
<br />
Really? You had to pick THIS one?<br />
Seriously? Do you go looking for these?<br />
WTF???<br />
I hate you so much right now.<br />
<br />
Even multiple attendings in clinic have asked me, don't you have any normal patients? You know, like simple diabetes or high blood pressure. Regular stuff.<br />
<br />
It makes me laugh inside. Sometimes, one laughs to keep from crying. What else can one do? But I continue to accumulate my menagerie of strays. As time has passed, though, I do not simply inherently attract disasters, though I do seem to do that. Patients share their disasters with me. For whatever reason. They tell me things. They tell me things they have never told anyone else. Honesty, has tattooed itself all over my face and patients feel comfortable telling me things that they have not told anyone. I have accepted that role and embraced it.<br />
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<br /></div>
Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com3tag:blogger.com,1999:blog-844878083310309542.post-36305542565049097972017-11-10T13:47:00.001-06:002017-11-10T13:50:17.820-06:00i am the brute squad<div class="separator" style="clear: both; text-align: left;">
<em style="background-color: white; color: #1c1c1c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14.85px;">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.</em></div>
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<span style="background-color: white; color: #181818; font-family: "merriweather" , "georgia" , serif; font-size: 14px;"><br /></span>
<span style="background-color: white; color: #181818; font-family: "merriweather" , "georgia" , serif;"><br /></span>
<br />
<span style="font-family: inherit;"><span style="background-color: white; color: #181818;">Some people never go crazy. What truly horrible lives they must lead.</span><span style="background-color: white; color: #181818;"><br /></span></span><br />
<span style="background-color: white; color: #181818; font-family: inherit;">- Charles Bukowski</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">"Am I going to have a call a Code Green?" the charge nurse asked, referring to a psychiatric emergency.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">"Don't call a Code Green. Call me. <i>I am the Code Green.</i>" She smirked and agreed to put the patient on the floor against her better judgment as I gave her both my hospital phone number and cell phone. My bravado, my swagger, and my humor helped sway her.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">My junior resident asked me, "should I be talking to the charge nurse?" Huh? I was confused by the question. But then it became clear with one statement. "Well, I've just never seen one of my uppers talking to the charge nurse." Seriously? I then explain how 90% of being a good doc is simply giving a shit and getting stuff done, which means talking to all the people that get shit done. It's a lot of work but in the end, it matters. Remember your humanity, I tell them.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">This patient had been sitting in the ER for six days. SIX days. I was looking for admissions and the ER attending didn't sugar coat it. I had paid my dues in the ER and earned their respect so was treated as one of their own. The patient had broken their elbow, had surgery with pins placed which were extruding from the skin. One pin was missing, though. Oh, raising my eyebrow. The patient had removed one pin by their self. And then proceeded to attack what they thought were demons present. So now the patient sat in the ER pending transfer to a psychiatric hospital but no one would take the patient with one extra weapon in the elbow just waiting to be unscrewed. My junior resident looked at me as if to say, you're joking. No wait, you're crazy. Indeed. I smiled back and tell the ER that we will take the patient. Fast forward a few days of heavy duty psychiatric medications, including an episode of me, in fact, functioning as a Code Green. Today, orthopedics removed the remaining weapon, aka pin, and the patient is pending transfer to a psychiatric hospital, without a built in weapon. My Texas bourbon tastes extra good today.</span><br />
<span style="background-color: white; color: #181818; font-family: "merriweather" , "georgia" , serif; font-size: 14px;"><br /></span>Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com4tag:blogger.com,1999:blog-844878083310309542.post-1195735931713602162017-10-01T04:20:00.004-05:002017-10-01T16:21:45.466-05:00anatomy of a callSunday<br />
<br />
<u>4:17 am</u><br />
The tea kettle is singing and it's time to go camp out in the hospital.<br />
<br />
<u>6:46 am</u><br />
After making a pit stop for caffeine and nyquil at a 24-hour pharmacy (doctors get sick, too), I'm at the hospital. Got checkout from my colleague on all the patients and now it's time to start digging into their charts for there's always that possibility of a phone call. So even though I've never seen any of these patients before, it's expected to know everything about them. Hell, I expect myself to know them, regardless.<br />
<br />
<u>4:15 pm</u><br />
Sure enough. That call came. And it came before rounds even started at 8 am. "Is Mr Jones your patient?" And 8 hours later I am called again to pronounce the patient's death. While listening for silence, I close my eyes and I suddenly became aware of the absence of my mala beads. So many times I rolled those well worn beads between my fingers during times of death and emotional turmoil. The physicality of their sensation leaves a hole in my tactile senses. But they broke. Such is the way it goes. I am tired but somehow my feet find their way to the chapel. But it is not long before more calls come. I am tired. My body aches. My sinuses are on fire. And emotionally I feel an ache that is buried deep inside my bones. Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com1tag:blogger.com,1999:blog-844878083310309542.post-7485709126731972017-09-23T11:28:00.001-05:002017-09-23T11:28:27.054-05:00writing<span style="background-color: white; color: #322f31; font-family: inherit; font-size: 16px;">"In utter loneliness a writer tries to explain the inexplicable."</span><br />
<span style="background-color: white; color: #322f31; font-family: inherit; font-size: 16px;">- John Steinbeck</span><br />
<span style="background-color: white; color: #322f31; font-family: inherit; font-size: 16px;"><br /></span>
<span style="background-color: white; color: #322f31; font-family: inherit; font-size: 16px;">"If you want to be a write, you must do two things above all: read a lot and write a lot."</span><br />
<span style="background-color: white; color: #322f31; font-family: inherit; font-size: 16px;">- Stephen Kind</span><br />
<span style="background-color: white; color: #322f31; font-size: 16px;"><span style="font-family: inherit;"><br /></span></span>
<span style="background-color: white; color: #322f31; font-size: 16px;"><span style="font-family: inherit;"><br /></span></span>
<span style="background-color: white; color: #322f31; font-size: 16px;"><span style="font-family: inherit;">I am not sure if I want to be a writer. But I do know that not writing leaves me with an unease. This period of inactivity in retrospect seems a dark and useless experience. It sits in my stomach. Like a stone. Which cries out to be acknowledged. So over the next few hours, few days, few weeks, I will struggle with those inexplicable stories that I face on a near daily basis. And write.</span></span>Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com0tag:blogger.com,1999:blog-844878083310309542.post-39896425450800243002017-07-17T17:45:00.000-05:002017-07-17T17:45:36.952-05:00the power of a story<em>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.</em><br />
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The phone rang in that lull of the morning when phone calls usually do not come in. The only calls at 3 am never portend good tidings. This one proved no different. It was a nurse requesting to come evaluate a patient. There was to be no miracle for this patient, no last minute stay from the disease that had carried out its death sentence. The pronouncement of death is one of those duties I hold sacred. I consider it a sacrament to my profession and to my identity. It is the final chapter a doctor can add to the story that is a patient's life. Indeed, the final word, except for the memories that live on within the loved ones. Still, it is rough way to begin a day. I bow my head in reverence as I place my stethoscope upon the chest and listen for silence, bearing witness to the story that has ended.<br />
<br />
It is now the end of the day. Despite the fact that I am no longer in the hospital, my mood is somber, colored by the death earlier in the day. But the last patient of the day in clinic knows nothing of this. It is only my second time to see the patient but I remember the first visit well. I only need look at my previous note briefly to refresh my memory. She had come in, like all patients at some level, with a measure of suffering. She had been to several doctors before and still felt no improvement in her suffering. So I started at the beginning of her story. And I did what I always do when unsure how to proceed. I listened. The doctors before had not listened to her story. Instead, they ran up an enormous bill with a shotgun approach. Had they listened, her diagnosis became clear. Textbook, in fact, which is rarely the case for most diseases. I pulled out my pen and added to her story by making changes to her medications. She now sat in front of me with a smile and a thank you. The day began with death, the final word in a story. The day ended with a new chapter, a new sentence for a patient that reclaimed her life.Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com0tag:blogger.com,1999:blog-844878083310309542.post-65764861352131835812017-07-07T08:51:00.000-05:002017-07-07T08:51:06.756-05:00at the end<em style="background-color: white; color: #1c1c1c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14.85px;">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.</em><br />
<br />
Suddenly you were gone<br />
From all the lives<br />
You left your mark upon<br />
I will remember....<br />
<i>- N. Peart</i><br />
<br />
There is only now, and if now is only two days, then two days is your life and everything in it will be in proportion. This is how you live life in two days.<br />
<i>- E. Hemingway</i><br />
<i><br /></i>
<br />
Instinctively, I turned to walk to her room. But she was gone Like most patients, she was only in my life but a brief time. But in the span of a little over a week, a lifetime can be lived, or at least revisited. It makes for an intensity in those few days that makes everyday life pale in comparison. I had rounded on her every morning. Medically. And every afternoon I rounded on her. To listen. To say she had lived a hard life would trivialize it to a cliche. It would also be an attempt to define one solely by what has happened to us. As if our response was irrelevant. Because she also lived a fascinating life. Within her was a resilience I rarely encounter. And also envied. Now that she entered into this final phase, that determination to carry it through until the end became more fierce. Death became not something to cheat or avoid. Neither did it become something to accept and willingly embrace. It became something to conquer. It was as if all the slings and arrows of misfortune were culminating in one final challenge. One final obstacle to overcome. To prove to herself that she was indeed strong enough.<br />
<br />
And I saw the effects of that determination ripple through her relationships of those who came to visit. Her iron will, her pride, her self reliance. Contrasted with those who wished to provide comfort, compassion, care. In the face of her loved ones, I could see the hurt it caused those who would be left behind with her memories. <br />
<br />
Indeed, it triggered my own memories of my brother. He was not perfect. He didn't always get the choices right. Or, at least what I felt to be right. But I also remember remarking on his stoic response to what life had handed him. It allowed him to continue to fight. And it also was an impediment in his care, especially at the end. I imagined myself in his shoes, to the extent that one's imagination is capable of such feats. And who is to say how any of us would handle such adversity? Those that live in glass houses and all that. Certainly I am not without my own regrets when faced with life and death choices.<br />
<br />
It's not that I learned to not judge the patient's choices, though I did learn that. It's not even a question of whether to criticize how someone copes with such choices. Instead, it is recognizing how muddy the waters are. That it is possible to accept and hold paradoxes true, even if for the briefest of times. My patient was coping the best way she knew how with whatever tools that had served her in the past. But neither does that negate the pain experienced by the loved ones at being brushed aside. Perhaps, I wished to find fault in one party. That would make things more palatable. But there was none. Everyone simply was playing the cards dealt to them. It is a messy business, this life and loss.Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com0tag:blogger.com,1999:blog-844878083310309542.post-8024782629471340562017-07-02T09:11:00.000-05:002017-07-02T09:11:00.579-05:00final year<div>
Courageous convictions will drag the dream into existence.</div>
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Adventures suck when you're having them.<div>
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- N. Peart</div>
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I now stand as a senior resident. My final year of residency. I briefly look in the rearview mirror to take it all in. Where I started. What I experienced. What I have accomplished. What I have failed. And now standing so close to the finish line of this grand adventure that essentially started as a mid-life crisis......It truly does suck when you're in the middle of it. And yet, and yet, it is a dream dragged kicking and screaming into existence. Both dream and nightmare. I am not sure I would ever want to do it again. But I do not for a moment regret the choice I made.</div>
Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com2tag:blogger.com,1999:blog-844878083310309542.post-57799209896317861142017-06-08T11:49:00.001-05:002017-06-08T11:49:36.048-05:00gomer<div>
<em style="background-color: white; color: #1c1c1c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14.85px;">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.</em></div>
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"So what brings you into the ER tonight?"</div>
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"I've had a cough"</div>
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Did I mention it's 4 am?</div>
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"How long?"</div>
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"Oh......probably at least for at least 10 years now."</div>
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"Has it changed at all? Gotten any worse? Coughing up anything?"</div>
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"Nope. It's the same."</div>
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Did I mention that his vitals were stone cold normal?</div>
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"Any fevers, chills, weight loss, night sweats, etc, etc, etc"</div>
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"Nope. Just the cough."</div>
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Did I mention that the patient is comfortable, calm, completely relaxed? </div>
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"So what exactly made you come into the ER in the middle of the night?"</div>
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Did I mention this is the ER, stressing the EMERGENCY aspect of that term?</div>
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"Oh, I just thought I should get it checked out."</div>
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"And why didn't you go to a primary care doc?"</div>
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"Well, I don't like my doctor very much."</div>
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Did I mention that there are actually other SICK people in the ER?</div>
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"Do you smoke?"</div>
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"Yup"</div>
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"You, sir, likely have a smoker's cough. Follow up with your primary care doc."</div>
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Remember this the next time someone is blathering ignorantly on about why our medical system is becoming increasingly more expensive. Because both your and my dollars went to pay an ER triage nurse, an ER nurse, and a doc to evaluate smoker's cough at 4 am. Never mind the infrastructure of an ER.</div>
Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com2tag:blogger.com,1999:blog-844878083310309542.post-21745391395502178712017-06-05T11:54:00.000-05:002017-06-05T11:54:07.933-05:00first, to endure<em>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.</em><br />
<em></em><br />
My phone vibrated just as we sat down to eat. My first weekend off in 6 weekends but by noon, I was already getting called back in to the hospital. One of those, what I call 2-for-1 specials, came in. In other words, a pregnant woman. OB is one aspect of family medicine that just doesn't do it for me. I've seen too many instances where an "uncomplicated" birth can go to a stat C-section in 5-10 minutes. It's one of those instances where you just have to know your limitations because time means life. For two people.<br />
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But I dragged myself back to the hospital. Appropriately, it was raining heavily which just added to my frustrated and sleep deprived mood. But I've learned to put that all away when with the patient. Everything about the birth went fine. No surprises. No difficulties. Perfectly routine and uninteresting which is the best kind of delivery to me. The dad cut the cord and the parents were both joyful. But when we asked if they had a name already picked out, the response made me stop for moment. Josh. I don't think I've ever delivered anyone with the same name as my brother. No, I would remember that. I signed the birth certificate with a sense of pride. Probably more towards myself than anything. I was a witness on my brother's death certificate. And now I was the delivering doctor on this young child's birth certificate. The words with which Hemingway signed his letters rang back through my head, "first, to endure". I have endured.Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com1tag:blogger.com,1999:blog-844878083310309542.post-30822636972110516512017-05-21T12:21:00.001-05:002017-05-21T12:21:14.970-05:00ave atque vale<span style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;">Through many countries and over many seas</span><o:p style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;"></o:p><br style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;" /><span style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;">I have come, Brother, to these melancholy rites,</span><o:p style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;"></o:p><br style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;" /><span style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;">To show this final honour to the dead,</span><o:p style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;"></o:p><br style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;" /><span style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;">And speak (to what purpose?) to your silent ashes,</span><o:p style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;"></o:p><br style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;" /><span style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;">Since now fate takes you, even you, from me.</span><o:p style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;"></o:p><br style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;" /><span style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;">Oh, Brother, ripped away from me so cruelly,</span><o:p style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;"></o:p><br style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;" /><span style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;">Now at least take these last offerings, blessed</span><o:p style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;"></o:p><br style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;" /><span style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;">By the tradition of our parents, gifts to the dead.</span><o:p style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;"></o:p><br style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;" /><span style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;">Accept, by custom, what a brother’s tears drown,</span><o:p style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;"></o:p><br style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;" /><span style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;">And, for eternity, Brother, </span><i style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;">ave atque vale</i><o:p style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;"></o:p><br style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;" /><span style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;">‘Hail and Farewell.’</span><br />
<span style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;"><br /></span>
<span style="background-color: white; color: #1c1c1c; font-family: Times, "Times New Roman", serif; font-size: 14.85px; line-height: 20px; text-size-adjust: auto;">Nearly six years to the day now. And in that six years, I have lived and experienced six lifetimes. One thing I have learned, that experience, that life, that patients (and patience) have taught me is, I am especially in tune with the dying and suffering. Time and time again, I gravitate towards those patients, those experiences, those <i>opportunities </i>to bear witness to the dying and suffering.</span>Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com4tag:blogger.com,1999:blog-844878083310309542.post-90507285776121916602017-03-13T16:00:00.000-05:002017-03-13T16:32:44.811-05:00a good day to die<br />
Is there such a thing as a good death? Or, a bad death? Soldiers approach battle knowing full well that they may die that day. Lakota Sioux leader Crazy Horse would exhort his soldiers with the loosely translated phrase, "let us go! Today is a good day to die!" But what about those dying from a chronic illness? After bearing witness to so many dying, some had a day or two, some had months, I am convinced that there is absolutely such thing as a bad death, and if there is a bad death, there must be a good one. I am also further convinced that dying is <em>WORK, </em>at least from a chronic illness<em>.</em> Aside from the physical maladies, existential pain riles underneath. Soured relationships without making amends. What happens when I die. What will happen to my kids. Can you make the pain stop. Are you sure there is nothing left to try. What if......what if......what if......Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com1tag:blogger.com,1999:blog-844878083310309542.post-51315526048363516512016-12-14T20:00:00.000-06:002016-12-14T20:00:10.011-06:00Steinbeck's Texas<h1 class="quoteText" style="-webkit-text-size-adjust: auto; color: #181818; font-family: Merriweather, Georgia, serif; font-size: 14px; font-weight: normal; line-height: 21px; margin: 0px 0px 15px; padding: 0px;">
“I have said that Texas is a state of mind, but I think it is more than that. It is a mystique closely approximating a religion. And this is true to the extent that people either passionately love Texas or passionately hate it and, as in other religions, few people dare to inspect it for fear of losing their bearings in mystery or paradox. But I think there will be little quarrel with my feeling that Texas is one thing. For all its enormous range of space, climate, and physical appearance, and for all the internal squabbles, contentions, and strivings, Texas has a tight cohesiveness perhaps stronger than any other section of America. Rich, poor, Panhandle, Gulf, city, country, Texas is the obsession, the proper study, and the passionate possession of all Texans.”</h1>
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John Steinbeck</div>
Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com0tag:blogger.com,1999:blog-844878083310309542.post-20175289489493009352016-12-04T19:36:00.002-06:002016-12-04T19:36:26.087-06:00mentors #2<div class="separator" style="clear: both;">
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#drredduke</div>
Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com0tag:blogger.com,1999:blog-844878083310309542.post-28227365746723677592016-12-04T19:34:00.001-06:002016-12-04T19:34:46.910-06:00mentor #1<div class="separator" style="clear: both;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiu9qkiMmcW-gXXUsotX0a4w5ENCOYaav1_QKvDKsrZsOiPo_x0PT1agVracV4BUqVoZvaOe4jFTzk5WMcfRHG0R65Qk8VhW2d8316FNZaEl5-_SL8hjzuCKRLcIs7ktN3UUZp41aPdzpM/s640/blogger-image-907963831.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiu9qkiMmcW-gXXUsotX0a4w5ENCOYaav1_QKvDKsrZsOiPo_x0PT1agVracV4BUqVoZvaOe4jFTzk5WMcfRHG0R65Qk8VhW2d8316FNZaEl5-_SL8hjzuCKRLcIs7ktN3UUZp41aPdzpM/s640/blogger-image-907963831.jpg" /></a></div>
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Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com0tag:blogger.com,1999:blog-844878083310309542.post-3025422384578064982016-12-01T17:22:00.001-06:002016-12-01T17:22:35.560-06:00communion<div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmXUb1bvIa5COuqXYrGVOkdsFeb8w5YswnixEjZoJCzsIYCzBCK1BR2TdKcQNwVXp2eqXeWmE6RzzxOvDwCwrFRwFezYWCiGk2im6jzGV0qMVha_FZQa4tCAyOu35OP7RV6RL3o6v7lbo/s640/blogger-image-1730579150.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmXUb1bvIa5COuqXYrGVOkdsFeb8w5YswnixEjZoJCzsIYCzBCK1BR2TdKcQNwVXp2eqXeWmE6RzzxOvDwCwrFRwFezYWCiGk2im6jzGV0qMVha_FZQa4tCAyOu35OP7RV6RL3o6v7lbo/s640/blogger-image-1730579150.jpg"></a></div><div class="separator" style="clear: both;"><br></div><div class="separator" style="clear: both;">Time is a rarified commodity for me. Such is the nature of the beast of training to be a physician, both in the aspect of the hours demanded but also in the aspect of trying to stave off death for the patients. Caffeine and adrenaline are well known tools to any in the trade. Even relaxing involves an element of hurry. Hurry up and get home to furiously decompress. Always balanced against fatigue. Before it is time to go back and do it all over again. So even my beloved task of writing often takes a back seat to other more pressing matters, usually sleep. But one commitment I have kept is giving blood. I always make time for it. It has become a sacred ritual of remembering. It is a communion in the truest sense of the religious term. A communion with memories, motivations, unanswered questions, struggles, sufferings. Do this in remembrance.</div>Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com1tag:blogger.com,1999:blog-844878083310309542.post-67312284757169285952016-11-12T18:53:00.001-06:002016-11-12T18:53:34.455-06:00pagersThere are few devices that trigger a more negative Pavlovian response than a pager. At 3 am. When you've been asleep for 30 minutes. Because the last page was at 2:30 am. When you are already sleep deprived. And running on empty. Apparently, there is no training on what is deemed a good, or appropriate page, what can be resolved with common sense or what can wait until the morning. The hospital isn't Walmart. You can't just walk in and get whatever you want. At least it shouldn't be.<br />
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Good Page with Appropriate Response<br />
"Doctor, the patient's heart rate is in the 130s and they are having shortness of breath."<br />
"I'm on my way."<br />
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Bad Page with Forced Appropriate Response<br />
"Doctor, the patient is requesting mucinex."<br />
Silence..........."Mucinex? At 3 am? Ok" Click. The patient wasn't congested when I saw them at 9 pm and asked them if there was anything I could get them for the night. Again, not Walmart.<br />
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Worst Page with Restrained Response<br />
"Doctor, I see you put in a prescription for lowermybloodpressure. But I am looking at the patient's blood pressure and this is normal for them. Do you still want to give it?"<br />
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What I don't say, "no, a systolic of 180 is NOT normal NOR good. And let us not forget another nurse, perhaps someone you may know since you're both caring for the exact same patient, paged me not 45 minutes ago to tell me about the elevated blood pressure. Perhaps she can educate you about the dangers of elevated blood pressure since she seems to know more about it than you."<br />
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What I do say, "Yes. It's ok to give the medication."<br />
"Are you sure?"<br />
"Yes. I am sure that I want the medication I ordered to be given."<br />
"What is your name, doctor?"<br />
"It's the one on the order." Click.Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com3tag:blogger.com,1999:blog-844878083310309542.post-37684030105139544882016-11-09T19:36:00.001-06:002016-11-09T19:36:49.222-06:00best lineBest line in clinic from a patient all week, hell all month.<br />
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"I'm gonna be your black mama. Give me a hug."Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com2tag:blogger.com,1999:blog-844878083310309542.post-74259935104065700562016-11-05T19:56:00.003-05:002016-11-05T19:56:47.864-05:00what working nights is like<div class="separator" style="clear: both; text-align: center;">
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<br />Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com0tag:blogger.com,1999:blog-844878083310309542.post-27551696020871703872016-11-03T15:30:00.000-05:002016-11-03T15:47:58.677-05:00last resort<br />
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<span style="font-family: inherit;">I walk in. Walk being the operative word. As I glance furtively about the waiting room, wheelchairs with their occupants of varying degrees of physical humanness sit close by their care giver. I don't belong <i>here</i>, here being TIRR. The Institute for Rehabilitation and Research. Or, THE Institute, I should say. When the congresswoman Giffords from Arizona was shot in the head, she was flown <i>here </i>for rehab. A bit of a reality check sets in as an internal dialogue begins. </span></div>
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<span style="font-family: inherit;">"I can walk."</span></div>
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<span style="font-family: inherit;">"But some days, not so well."</span></div>
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<span style="font-family: inherit;">"Yeah, but I'm not this far gone."</span></div>
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<span style="font-family: inherit;">"Do you have a better idea?"</span></div>
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<span style="font-family: "helvetica neue light" , , "helvetica" , "arial" , sans-serif;"><span style="font-family: inherit;">The voice is silenced as I truly am out of ideas. As are my other physicians. This pain management physician came highly recommended by my colleagues and friends in the palliative specialty of all places. How's that for dark humor?</span> </span></div>
Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com0tag:blogger.com,1999:blog-844878083310309542.post-78514453178858368632016-10-04T19:40:00.002-05:002016-10-04T19:40:46.296-05:00prescribed burn<br />
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Pack up all those phantoms<br /> Shoulder that invisible load</div>
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Haunting that wilderness road<br /> Like a ghost rider</div>
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Show me beauty but there is no peace<br /> For the ghost rider</div>
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Shadows on the road behind<br /> Shadows on the road ahead<br /> Nothing can stop you now</div>
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It is my first weekend off in roughly four months. By this point in my journey, I am thoroughly lost. There is no cell phone service. There is no map. So I settle in and listen to the woods. Off in the distance I hear a woodpecker. The loneliness of the ratta-tat-tat echoes softly through the forest. While I'm sitting there, I am filled with nothing but frustration at getting lost on a dirt logging road. And drops of rain begin to fall. I am not in my jeep and my car is far from equipped to handle this road if rain begins to fall. And I notice the strangeness of this area. Where is the underbrush? At closer inspection, the trees have that characteristic black mark on the bottom, or at least the trees that have survived, of what follows a controlled burn. I am in the middle of nowhere, on a dirt road, lost, threatened with rain and I realize I need a prescribed burn. To clear out all the tinder that results in uncontrolled wildfires resulting in the destruction of the entire forest. The metaphor of putting out catastrophic fires the last years of my life is not lost on me. I take a few deep breaths of the pine scented air, climb back into my car, and methodically find my way back to civilization.</div>
<br />Isaachttp://www.blogger.com/profile/09608625023352376222noreply@blogger.com0