Thursday

Thursday, the last day of January 2008, ticks away. This month has passed quickly but then they all seem to zip by at record pace. I am "off" today but thinking ahead to my next 4 1/2 days of work with some dread, unable to just let it all go and enjoy the present moment. It is cold but bright outside; I should be out there walking briskly instead of sitting here eating cookies and drinking water infused with vitamin C and glucosamine/chondroitin. But, it's cozy here by the fireplace with the "fake logs" fueled by natural gas glowing and creating some warmth in this drafty house of mine. The cat sleeps by my side and music plays in the background. I've swept the hardwood floors, made the bed, and vacuumed the downstairs carpets/rugs. Lunch was a hardboiled egg and dessert, of course....cookies from Costco that have me hooked. Deceptively light they make me feel that eating a half dozen is nothing at all. Ahhhhhh.

I got the word from my sports med doc yesterday that the best fix for the torn cartilage in my right knee is arthroscopic surgery. I don't have to do it; it's just that my knee will continue to hurt me in certain positions if I don't take this step. If I wasn't so invested in being a mid-life athlete, I'd say "what's the point?" but as I'm trying to stay fit and know this knee thing will interfere, I guess I'll go ahead. But when? When is the best time for this sort of aggravation? Recovery is quick, not like a ligament injury they say. I'll have to pull out the calendar and work around spring break, work schedules and Mom and Dad's needs.

I'm reading today; hoping to finish up a really weird book I picked up last month called The Brief History of the Dead by Kevin Brockmeier. It isn't my typical pick but this futuristic bit of fiction caught my eye in the bookstore. It's pretty good and based on the premise that when we die we go to a place where we keep living (sort of) until the last of those who knew us on earth also die. Then, we pass on into another "beyond".

Browsing around Magnolia's Bookstore today I also picked up What is the What by Dave Eggers. The book is a fictionalized account of a Sudanese youth (one of the Lost Boys) who braved all odds to find freedom (?) in the United States. This one received excellent reviews and is a bookclub selection (joined a new bookclub recently) for later this year. I also bought Eckhart Tolle's, A New Earth: Awakening to Your Life's Purpose. Sure, it's an Oprah pick but I've read his other book, The Power of Now which was enlightening even if the message evaporated quickly. I have read so many of these inspiring books, hoping that one will stick on me like super glue. I figure it will take more than just reading to actually incorporate these states of being into my everyday life. A little here, a little there; would that it would add up to something bigger. I will try again.

I also passed the clothing store in Magnolia Village this morning and stood mesmerized by a red dress (just in time for Valentine's Day?) in the window. Although the color and the fabric are the same as my red dress, this one has a covered back but a charming criss cross front. A more sedate style, certainly much more appropriate for my stage in life. This makes me sad. I don't think this red dress of mine will every make another showing unless it's to dust the house or run in the Valentine's Day Dash (I made that up but my red dress could certainly double as a great sports top coupled with a pair of red or black tights. Ha! Guess my back can only be out there legitimately if I'm at the pool, at the beach, or running a race.

And so, I'm done with my musing for this sunny but cold and windy late January day. Things are a rumblin'. There's work to be done both inside and out. Life's a mystery. Open up those sleepy eyes and witness.

A Pain in the Knee

Registration for the 2008 Danskin Triathlon is just ahead; sometime in early February. I'm going to sign up but am concerned that I may not be able to participate as I did last year, much less push the boundaries of my time last year. It all started in the weeks after the August 2007 Tri; my right knee started to talk to me and say, "Hey, I hurt, something isn't right". My response was to lay off the exercise but I still noted that certain positions like a squat or sitting cross legged or in balasana pose during yoga would "zing" my knee. Surely this is a tendinitis, I rationalized. It will get better with time. Not.

The MRI shows a torn medial meniscus in my right knee. I don't know when it happened; there was no particular moment when I was aware of a sudden pain. Mind you, everyday activities are pretty cool. My knees love doing stairs and walking on even surfaces. Yesterday I went out to run and did a mile and although I've got sore muscles, the knee isn't too bad. Today I see my sports medicine doc for advice on what to do about this pesky issue in my knee. I know very little about this ailment; it is far removed from the world of kidneys and truly, the last time I gave the knee much thought was during an orthopedics rotation in medical school. I do know that arthroscopy has revolutionized the management of certain knee problems over the last decades and that removing torn cartilage is one of the "bread and butter" procedures of the orthopedic profession. We shall see.

I want very much to swim, bike and run on August 17, 2008 in the Danskin Triathlon. Prepping (aka training) for this event and participating did amazing things for my body and mind. I don't recall a high quite like the one I experienced in the hours and days post Tri. I want that back again. There is some resistance to getting in the water however; I know I'll have to start from scratch with my swim stroke and re-gain stamina. The swim is the hardest part of this journey and the most humbling. I watch the effortless strokes of good swimmers and marvel. This is beauty, captured in an endless rhythmic slice through water. Biking and running? Well, they are just that.

And so, I will wait to see what unfolds in the journey towards this year's Danskin Tri.

Critical Care Medicine

Today, rounding in the intensive care unit, I was able to spend more time watching the activities of the young in training and was struck by the changes (good ones) that have evolved since I was a resident rounding on the critically ill with my senior attending physicians. The tradition then and into the majority of my years as a practicing physician was to make the official bedside rounds "closed"; that is only for the doctors, medical students, and the nurse taking care of the patient. Nowadays, a flock of people hover around the door to the patient's room. In addition to the doctors, there is a respiratory therapist, a pharmacist, possibly a social worker and to my great surprise, significant others of the patients (spouse, partner, parents, or grown children).

At first I bristled at the idea of these all inclusive bedside rounds particularly in the intensive care unit. I told myself that families had no business listening to the hum drum reality world of hospital rounds which are nothing like what goes on in "E.R." or "Grey's Anatomy". Besides, wouldn't the rounds take forever with each medical term, abbreviation, or inside communication needing to be translated for family? And then, what happens when we simply "don't know what to do" about whatever situation exists; how do we brainstorm options without looking like we are total idiots and poorly qualified to be making major decisions in the care of loved ones? Wouldn't we have to be "on guard" and pay attention to every word, innuendo, and stray comment so as not to cause confusion, misunderstanding, or at worst anger and pain in family or patient (who in some cases is able to listen in, depending on the severity of illness)?

But today, as I watched and participated in a group discussion of a complex patient with both of her parents present, I witnessed a very professional, thorough, and important gathering of key players (family included). Medical terminology flourished, give and take discussion (teaching points) occurred and it left me quite impressed. The work flow and decision making occurred and I was left with the sense that including family in the process was more helpful than a hindrance. Times change, styles change, and we move forward, hopefully for the better.

I know that these doctors must convene at a later time to share their thoughts about the care of critically ill patients and allow the unknowns of medicine the opportunity to flourish. There is so much about the critically ill that we can impact but also much that we are forced to accept as just "what is". To accept that we cannot be healers at all times, that we may chose a path that ultimately was likely not the best one for our patient, and to teach and be taught behind "closed doors" is also very important. This, in my opinion, is work that must be done outside the patient's room and away from family.

'Tis a balance. But, I must say that I liked the way family was included into these very thorough bedside rounds. I believe this is happening more commonly, especially in the intensive care unit where such inclusiveness on the critically ill was never felt appropriate, until now. Progress indeed.

A Day with Mom and Dad

It is Sunday morning; I am still at Merrill Gardens. Ineke, one of Mom's favorite caregivers, will arrive shortly to "relieve me" after my time spent with Mom and Dad all day Saturday and through the night. I wanted to see with my own eyes the needs of my parents as they look ahead to another move, this time to an assisted living facility in Seattle's north end. I worry about Mom because for the last two months plus she has had round the clock care in the apartment with one-on-one response to her every need. This intensity of service won't be available in assisted living and I'm trying to get an idea of how safely (or un-safely) she navigates her days. I tried to get her to do as much on her own as possible and only provided assistance when she asked for it (other than fetching water and snacks from the kitchen which I didn't insist she do for herself...) It was a worthwhile investment of my time if for no other reason than simply being with my parents, a privilege and a rarity at their ages.

I had brought several books with me to read knowing there would be lots of "quiet time". But, I filled those hours knitting furiously; made two tightly woven cotton scrubbing cloths ("rags") and a scarf. My right forearm is a bit sore today and my fingertips dried out from maneuvering the needles and yarn as I completed hundreds of stitches. I found that I could observe, listen, and talk while knitting and the repetitive activity kept my mind from wandering to places it ought not have gone.

We ate lunch downstairs and then Mom had a hair appointment at the salon around 12:30. She's always there for over an hour; Mary, the stylist, takes her time which is nice. Mary always serves Mom a granola bar and yesterday a special treat, some Japanese crackers wrapped in a dried seaweed. We both choked those (crackers) down, smiling nicely but hating the taste. Have I inherited this trait from my Mother? Mom looked great and she made it all the way to and from the salon on her own steam with the walker.

Shortly after the hair appointment, Ineke came by with her dog for a visit. A perfect lap dog, sweet and longing for affection, he sat in Mom's lap for fifteen minutes and delighted her. Pets are such wonderful companions for those who are lonely, isolated, and in need of connection. There are even services out there that regularly bring pets into nursing homes and even to private fee for service customers. I wonder if Boo would ever take to this sort of visiting; I can see putting him in his cat crate and toting him up to visit Mom every week or so.

The rest of the day was rather routine; assisting Mom in and out of the chair to the bathroom or the kitchen, administering medications, opening the mail, watching TV, talking when there was something that inspired us to do so, undressing and dressing. And then at 6 PM we were treated to the Lawrence Welk show which Dad favors but Mom watches grudgingly. Me too; it bites. I had to bust out the Heineken at that point and Dad and I sat with beers in hand and a bowl of cashews. The treats made the show tolerable. I had to laugh outloud; Dad couldn't figure out why but Mom sure did.

The night was easy although sleeping on the couch isn't that comfortable. Mom, all bundled in flannel P.J.s, fleece socks and a white lace hairnet, fell asleep in her chair around 10 PM and never stirred until 7:15 AM. I heard her dreaming at one point but for the most part, quiet indeed. I wonder if this is typical or atypical; the log notes from night time caregivers usually indicate a busier night. Was it my presence? Was it just a really good night? I suppose we'll never know.

What will I do with this information from my 24 hours of observation? I guess it may be helpful to the nurse who does the intake interview at the assisted living this week. Once we pass that hurdle, we will be making plans in earnest for the big move. Everyone dreads the process but we shall persevere. I have to trust that this is the right decision; it certainly seems so at this time.

The Next Wave of Doctors

This is the season for recruitment of the new wave of residents into postgraduate training programs at medical centers around the country. Young men and women, seniors in medical school, interview for positions in residency programs which provide them the practical training in their chosen fields. The time spent touring various programs offers each the opportunity to see firsthand what the hospital and teaching faculty offers to their individual educational goals. They dress in dark suits and their hair is combed, their faces fresh, enthusiastic, and young. They arrive in groups, often on a Friday and spend the day seeing and being seen (for our program directors are carefully sizing them up as well).

Today I saw a group of half a dozen of these young "doctors to be" escorted through our hospital, walking through the intensive care unit and the corridors outside the emergency room, led by a senior resident of our program who fielded questions and cast our program in the best possible light. Historically, our training programs fills easily; these are highly sought positions at a well respected hospital offering residency training in Internal Medicine, Surgery, Radiology, and Anesthesiology.

I must say, these applicants look younger all the time. I remember when I was in their shoes, dressed in my suit, stockings and low heeled pumps back in 1979. I interviewed for positions in Internal Medicine at programs throughout Texas and a few out-of-state locations. Denny and I were in our second year of marriage, 25 years old, and we applied as a couple which meant that either we both were accepted at the same institution or not at all. Our top choice was to stay put at U.T. Health Science Center at Houston and fortunately, that all worked out.

Now almost 30 years later, when I see these youthful faces, excited about their future in medicine, propelled forward by a genuine passion for their chosen fields, energetic, and eager to learn from mentors and colleagues, I'm reminded how much my life in the field has changed over this period of time. Obviously, I've lost some of the "hey wow" attitude and have gained an uncanny ability to predict (or at least not be surprised) by outcomes. I have matured and allowed experience, one day at a time to flourish. I have grown into the white coat and go about my daily tasks with a familiarity that is such second nature that I am barely conscious of how I move through my day. I am struck by the countless decisions that I make on behalf of those entrusted to my care. But I never forget how humbled I am by the many unpredictable twists and turns that mark each day, the fact that medicine never sleeps, and the uniqueness of each patient encounter. I am always grateful for the trust my patients place in my abilities and experience as I participate in the walk through the storm, be it minor or major.

For all my years in the profession, I am most in awe of our abilities as human beings; as caretakers, caregivers, and listeners, as people privileged to touch the raw edged souls of those in greatest need. Seemingly small gestures, choice of words, extra moments, a lighthearted comment, or even a tear at the right moment become hugely relevant to the connection. Today I sat with the parents of a patient who is critically ill. I chose to preface some disturbing news with the hopeful statement that their daughter's "youth and healthy body" were in her favor and that in my experience (the accumulating years offer me rich examples on which to base my comments) individuals in this particular predicament generally have a favorable outcome. The journey may be long, frustrating, and complex but hope, not in the form of a promise of success but a probability of a win, is the gift I can give to those most terrified. To see their tears, whether outwardly or inwardly expressed, to feel my own in the same way, to acknowledge the connection between us and to savor the powerful reminder that we are all indelibly linked one to another is the meaning. THIS is what we are called to do in tandem with the exercise of diagnosis and treatment.

So, to these youthful new recruits; go forth, learn, grow and experience just what it means to carry the terrifying, yet powerful and important burden of your chosen field. And step up to the plate quickly so that I can continue to step away. I have been there, I have seen, I have wept and I have laughed. There are wins and there are losses. But there is always a time when comfort, the only thing left to give, is the most important gift of all.

In fact, in 1979 when Denny and I graduated from medical school, we received a gift from his sister Maureen; a framed print of the quote..."To cure sometimes, to assuage often, to comfort always". We connected with these thoughts then in a simplistic way but as the years passed, with more understanding, depth, and recognition. This, young doctors, is "it".

Willingness

WILLINGNESS In the willingness to feel, there is healing. In the choice not to closet, cast aside or deny experience, energy is freed, and I dive deeper into life. There may be maturity in choosing not to act, but there are no rewards for suppression and denial. To be fully alive is saying yes to the wide array of human feelings. When I soften, release and breathe, I discover I am more than what I think, feel, reason, or believe. Poems from the Heart of Yoga By Danna Faulds

Crystalline Insight

Today is one of those crystalline winter days where the blue of the sky is so boldly beautiful that it seems unnatural. The air, crisp and jolting, screams out for attention and recognition. That it is so cold makes the blue that much richer. The Olympic Mountains stand out like jagged ice cliffs, the white caps alternatively in full sun and shade as the sun passes overhead. Gorgeous.





Today I've gained a bit of positive ground thanks to powerful wisdom that escorts the garbled mess of my mind to a calmer place. Sharing the angst with a trusted receiver has once again given me permission to consider myself and what I want from this "one wild and precious life". ***

I've been to this most precious place where living one's dreams is possible so I know I can go back again; it's a place of peace, acceptance, self-love and surrender. Had I never been there, I would boldly deny the existence of this possibility. But, having lived genuinely for snippets of time varying from minutes to days and weeks, I know that it is there for the taking. I own the key but need to put it in the lock. The key will appear in my hand when I lose the sense that I can control the outcome of these brisk currents, the snow on these tall mountains. or the cyclic changes that come to barren branches. I am close, breathing close to the possibility.

*** From poet Mary Oliver

Ruminations

Insomnia keeps a tight grip on me. Last night every time I closed my eyes to settle down and relax with the comforter pulled up around my shoulders and my head on the pillow, the dreaded thoughts would begin their relentless attack on my peace. This, even after having taken something to help me rest tells me these thoughts are quite powerful just now and unwilling to surrender to chemicals that would like to lure me into a quiet place of restoration. Eventually I drifted away only to awaken at the dreaded 2:30 AM hour to thrash about twisting this way and that in the bed, trying not to look at the clock and trying not to dwell on the fact that a full day at work was my next responsibility. The thoughts were right there to greet me again, glad to see me back, and engaging me in endless rumination. Finally in the hour before dawn, trying anything to make sleep happen, I fell into dreams echoing the internal sound of "Om" said over and over again. The alarm went off at 6:30 and jostled awake, it was time for strong coffee and sheer grit.

Now it is nearly 8 PM. I'm sleepy, having navigated my day with relative ease. I'm wondering if I can turn off the thoughts when I turn out the light. We shall see. I don't like these thoughts for they come from a place that simply cannot nor will not surrender and accept "that which is". I yearn for such surrender but am fighting against it with a tenacious will. I don't lack for insight; I lack for a plan of action that will work.

Good Night.

"Wiggy-Jiggy"

"Wiggy-Jiggy"; that's what I am today and have been for the last few days. What this means to me is restless and agitated, other descriptives that fit my state of mind perfectly. I've got so many different things pressing on my brain and they are all conjoining to bug the hell out of me. Work, elderly parents, my children, my house, what to do with my "free time" (e.g. creative opportunities), money, my parent's expenses, long term and short term goals, and even bigger things like politics and the environment. There is just too much going on right now even though the days themselves peel away in an orderly fashion without major upset or drama. It's all below the surface.

I can't sleep. My insomnia which has been going on in one fashion or another for years, is boldly in my face again. Wide awake at 2:30 AM every morning, I find myself either reading or just lying there thinking. I spend way too much time in the bed not sleeping. My doctor tells me that the bed is for two things only: sleep and sex. This, she says, is proper "sleep hygiene". Apparently if you use your bed for surfing the net, writing blogs, daydreaming, writing checks, watching TV, reading, or staring out the deck window into the pine tree whilst imagining faces in the branches, this all takes its toll on your ability to then sleep in the bed when you need to do so. I'm in bad shape if that's the case. I'll have to create a sanctuary elsewhere to do all these other things that I currently do while in my bed.

Everyday I get up and out of bed with the goal of getting back in the bed. What happens in between is done with full-on intensity (usually) and is done well (usually) but the goal is always to get it done so that I can crawl back in between the sheets. I've been this way most of my adult life but I think it needs to change. I will work on finding another place to associate with retreat and peace from the day's responsibilities.

Meditation is good for the "wiggy jiggy" of life. Several years ago I took a 6 week class in "Insight Meditation". Perhaps I need to go back to that again. Exercise is good too. Yoga is good and I try to go once a week. But still, even after a great yoga class in the evening, here comes 2:30 AM and I'm wide awake thinking and wishing I could just turn off the brain for a moment.

Disturbing

This photograph is a view of the exterior wall at the parking garage I use at work. Someone painted these four birds (crows?) in flight on the white crumbly cement wall months ago. But then, someone came along more recently and painted red on two of the birds. Was it the same person who painted the original four? Or was it someone else who added to this scene? The result is eerie and disturbing to me; two of the four birds seem to be bleeding and dripping at that. What is the message here?

I wonder if anyone else is looking at these birds. I wonder what they think but there's no one to ask. People stand near here during the work week waiting for buses but they all seem lost in thought. I doubt that they give this any consideration at all. Eventually someone official will come along with a roller brush laden with white paint and obliterate this unusual artwork. Weird.

Important Birthdays

Two loved ones in my extended family turn 40 years young during this month of January. To Caroline and Steve: Happy Birthday to You! I hope you celebrate mightily!

Of all the decade markers I've lived through to date, 40 was most symbolic for me and it was also the birthday that I chose to celebrate out of town with good friends. The other major birthdays (those ending in a 5 or a 0) were certainly celebrated but closer to home and on a smaller scale.

For my 40th Birthday, I chose to stand on "Hospital Hill" amidst the ruins of the Lago Hospital in Aruba and salute the magnificent view of Colorado Point, the cactus fields, and the raging blue of the north coast pounding the rock ledges between the point and B.A. Beach. This place, after all, was where I made my entrance into the world and it will always hold a special place in my heart. In some ways, I love that the place now exists in its natural form, the hospital has long since been broken down but the hill remains intact and the view is unspeakably gorgeous. Mom always reminds me that for the several hours before I was born at 2:10 PM on an August afternoon, the sun was blazing through the glass windows of the so-called "labor room" and she wore sunglasses as she lived through those moments. Once she was wheeled into the delivery room the anesthetist removed the sunglasses, saying "I don't think you'll need these anymore, Mrs. Thompson."

On the day of my 40th birthday I was with my family, Laura, Chris, and Denny and with good friends Brenda, Ed, and their two boys Tristan and Jonathan Bradshaw. As I recall, we adults opened up cold Amstel Beer on that windy, warm and sunny afternoon and toasted the day, August 27, 1994. It was exactly what I had envisioned doing on my 40th birthday and the moments unfolded sweetly from there. Later that day we hiked around Colorado Point (another of my favorite places on earth) and enjoyed a dinner out and later a cake from De Dissel, an authentic Dutch bakery in Oranjestad. The photographs from that day are happy, smiles all around. It was one of the loveliest days of my life.

Turning 40 was good. Turning any age is good. All I know is that we keep getting wiser and stronger. Experience is a golden gift and the hope is that we unwrap this gift with enthusiastic joy and keep moving forward for the better.

Again, to Steve and Caroline: Happy Birthday and Much Love!

Starting to Tri

The Seattle Danskin Triathlon takes place on August 17, 2008, seven months from now. I have been resting on my laurels long enough. The relative physical inactivity of the last few months is daily picking away at the level of fitness and stamina that propelled me over the finish line last August. I need to commit to a plan to not only get back in the shape I was in but to push beyond if possible.

My goal is to finish the race 10 minutes faster than I did in 2007. Lofty? Unrealistic? No, I don't think so. I learned so much as a novice in training and the weeks post-triathlon gave me an opportunity to make observations about how things might be better. These are the tenderest of observations since overall, I was so proud to have finished the Triathlon; there was nothing to criticize, only good things to learn for next year. I know that I can shave off time from all three events: the swim, the bike and the run. And, I can shave off time from the transition times, T1 and T2. Ten minutes sounds like a reasonable goal at this stage. We'll see.

But, I've just got to get out there and start a routine to re-gain that which was lost by several months of inactivity. Swimming will be the most difficult; it took me months to catch my stride (it's all technique) in training and coupled with some physical stamina, it all gelled for me late in the game last year, just a few weeks before jumping in the cold of Lake Washington. This time, I will take more lessons and commit to more pool and open water time. The swim is my weakest link as it is for many.

Today I'm seeing a sports medicine physician about my pesky right knee pain, a misery that I first noticed within a week of the August 2007 Triathlon and which waxes/wanes in intensity. I hope it is a tendinitis that some specific stretching and other focused exercise will cure. I hope it doesn't limit or bother me through my training this spring and summer.

I'm feeling pumped up and ready to launch. It's going to be a good train.

Caregivers Three

For Katie, Ineke, and Josie, three most wonderful women, I am eternally grateful.

When Mom was released from the rehab unit in mid November after her hip fracture, she went back to Merrill Gardens to be with Dad. It was clear that she would need full time care for awhile to navigate safely the so-called "activities of daily living". What we thought might be a 2-3 week proposition has now turned into an ongoing 24/7 coverage by caregivers. At this juncture, Mom really doesn't need this level of care but it is so reassuring to know that there is always someone there to help her if/when she needs anything. Even Dad is getting benefits from their watchful eyes.

There have been many who have come and gone; we've learned that it takes awhile to bond with caregivers and sometimes the personal chemistry just doesn't work. But, by this point there are at least half a dozen wonderful women who rotate shifts and provide excellent care to Mom and Dad. Three in particular carry the bulk of the hours. Katie and Ineke, younger women, are like grand-daughters and Josie like a daughter to my parents. These women are courteous, insightful, thorough, caring, kind, and professional. They make Mom and Dad laugh and are always at the ready to serve in whatever capacity is needed in that moment. We collectively love and appreciate them. Each is unique and brings their own personal touch to the party that is going on in that apartment.

It's tough to know how to scale back on these expensive but helpful services. Mom could suffer another fall at any time; certainly having someone present and beside her 24/7 reduces the risk significantly. Just today there was an "almost fall" that Katie was able to prevent at the last moment. That this should be happening three months after the hip fracture shouldn't surprise me at all. The issue is knowing what risks are acceptable to take and which ones are not. What's the right decision?

But, for now, these three women make my life easier and the lives of my parents easier and safer. I am thankful and feel they've become part of the extended family. It really does takes a village to care for our elders; I'm convinced of this.

Wisdom by Text

Laura left her tip jar at Tully's on Friday afternoon after her shift was over. She realized it when were in the car and I asked if she wanted to go inside to get it. She declined allowing that she'd pick it up on Sunday. Hmmmmm, I thought to myself after she told me that the stash would be safe because "they are all my friends".

Texting back and forth with her today as she works and I lie in bed drinking coffee on this Sunday in January......

"Someone stole my tips I left the other day!"

"Told you!" (probably too harsh of me but I couldn't resist)

"I can't believe it!"

"Money is a huge temptation for people."

"I just can't imagine any of my co-workers taking it."

"How much did u lose?"

"Like ten..."

"Chalk it up to experience. Live and learn. Not everyone is as honest as they seem and hopefully this person needed the cash more than u. Philosophy 101."

"Yea, I was thinking that but it makes me mad."

"Just take some wisdom away from it and figure it was meant to be. Far better to learn off of ten bucks instead of a hundred."

No response and then a few minutes later...

"Do you want to get lunch or high tea today?"

Obviously wisdom imparting is over and we are on to something else.

There's a wonderful place call The Queen Mary that serves high tea and we had talked about going sometime while she was here. As it's her last day full day in Seattle before heading back to school, we just may do that.

And so it goes....
Texting is just another opportunity to impart some wisdom. Who would have thought?

To leave or not to leave

By this time of year, most deciduous trees are bare of leaves, waiting for the beginning of the next phase when youthful, lacy green unfolds on dormant branches. But there are some trees whose brown and withered leaves persist, tightly attached to stems that ordinarily are blown free by the winter winds. How or why these tenacious leaves don't drop is a mystery and I wonder whether it will take the push of young buds to knock these elders to the ground once and for all.

There is a tree I've seen on Viewmont that exemplifies this curiosity. The top part of the tree is bare of leaves, the bottom portion laden with what appear to be dead leaves that hang on with persistence. I wonder if somehow these leaves are still providing some service to the tree; perhaps they are nourishing in ways that are not evident. Otherwise, why would their grip on to the mother ship be so enduring?

Remembering E.J.

E.J. Maher was born on January 11, 1913. If he were alive today to celebrate his birthday he would be 95 years old. We would certainly be partying today if he were here with us; instead I'll remember him and honor the memories. E.J. died December 4, 1998 at the age of 85 of complications from leukemia, a diagnosis made just several weeks before his death.

I miss E.J. (Edmund John), Denny's father and my father-in-law; the passing years bring all the wonderful memories into clearer focus for me. How lucky for me to have a father-in-law at once so supportive and loving who offered endless advice but never had the "I told you so" attitude if his words were tucked away instead of heeded. His laugh, sense of humor, and "bigger than life" personal style were all his own.

After his death, the family gathered together to celebrate his life. We started a list of famous "E.J. sayings". I have this list by me as I write and will include a few of them here for they tell a bit about who he was and what he meant to those who loved him.

"'Tis a dark and gloomy day...."
"Money isn't everything but it sure beats what's in second place."
"What's the sco'?" (He watched every game that ever was on TV saying...."someone's got to watch it, might as well be me."
"Out-a-sight" (usually in regard to a great meal that one of us prepared)
"I'm going to shed a tear for Ireland."
"Neither a borrower nor a lender be."
"I'm not always right but I'm never wrong." (Denny has inherited this one)
"I've never felt better nor had less."
"Holy Hawkeye!"
"Your kindness is only exceeded by your extreme good looks."
"What did you do for the cause today?"
and "It's time to hit the golden stairs."

I remember E.J.'s memorial service in Sequim on that blustery December day. Chris, as a young 7th grader, adored his Grandfather (the "Good Guy") and summoned great courage to speak a few words at the service. I found Chris's notes from that day and his last paragraph reads..."Goodguy was the greatest man I knew and still know. He is in heaven right now and he's looking down at us now and is smiling. He is playing golf up there and having a great time. As he always said, "I'll see you down the road". "

And so it is. I miss you E.J. I'll see you down the road.

Green Dress

It had been about the red dress (post from December '07) but now it's about the green dress.

Last night Laura and I saw the movie Atonement. I had read the book years back but the details of the plot were long since forgotten. I am not one of those readers who can call up names of characters, plot lines and the like; I just remember the rough idea and whether or not the book swept me in and held me close. Seeing the movie was mostly all new for me and it was wonderful. This a very sad movie but rendered beautifully. The messages that one's reality is all perception, fraught with the innocence of youth, betrayal, lies and secrets added power to this visually moving film.

Messages aside however, the "green dress" worn by Keira Knightly in her role as Cecilia Talis was the movie to me. Figuring it wasn't just me who was swept away by the symbolism and the beauty of this gown, I confirmed with Laura that she too found this dress riveting. I've since learned that this green dress is a hot topic having been cited on a recent poll from those who follow this sort of movie trivia as a top winner on the list of iconic dresses worn in film (along with the little black dress worn by Audrey Hepburn in "Breakfast at Tiffany's" and the short white dress worn by Marilyn Monroe in "Seven Year Itch").

This unspeakably gorgeous dress stands alone as a separate character in the movie. Its powerful ability to capture passion, seductiveness, wonder, and self confidence laced with a darker side of anger, hurt and the pain of loss is obvious. That Keira wears it so well only adds to the magic of the dress.

This is a backless gown, my absolute favorite. Something about exposing one's back speaks boldly to me about the odd combination of strength and vulnerability. It is a part of our body we cannot see but we know deeply of its fundamental beauty and power.

Wiped Out

My new work schedule for 2008 is well underway. I was on-call for the hospital over the weekend which is nothing new, but now I'm also carrying the on-call duties over into Mondays. Today was insanely busy and brings it all back; the escalating stress of simultaneously multi-tasking issues that are urgent, semi-urgent and routine. I feel like I'm managing half a dozen different "pots on the stove", each cooking at a different temperature but all needing to be watched constantly. I'm absolutely beat and am still at work at 6:30 PM. I'm taking a brief break to write down my thoughts as my last patient for the day is just now checking into the Emergency Room and I can't do anything right now but just sit tight and wait.

My pager has gone off at least 20 times today.

My cell phone has been equally busy.

My children have both called me at work today; Laura about half a dozen times as we've tried to coordinate her visit to the dermatologist's office today. There were new prescriptions to be filled on her behalf (ok, add that to my list). Then, she was locked out of the house and did I have any idea how she could get in? I had her call her Dad on that one.

Mom called because the caregiver couldn't find her calcitonin nasal spray inhaler in the refrigerator; turns out she's all out and I've turned in a refill for her today.

The CPA called me in the middle of clinic and I had to let that one go to voice mail; although his message sounded urgent, I honestly didn't have the time to think about that one. Money can wait.

I saw 4 new patients in clinic today and 6 followup patients. I saw 4 hospital patients and one new hospital consult. And now the ER just called to let me know they are ready for me for the final bit of work before I can leave for the day.

My mouth is bone dry. Although I gobbled down some soup and a yogurt around 12:30 and have been trying to keep up with fluids, I feel like I've said more words today than I do in several days combined. Too much talking always dries out my mouth. When I go home I will become mute to try to recover from all the noise in my head.

I'm sore; I have "computer back" from sitting and typing all my notes today and reviewing records on line. We don't use paper charts anymore; it's all on a screen.

This feeling reminds me of 18 months ago when I did this every day, day after day, sometimes for up to 10-12 days straight without a break. I realize that this is a bone crushing pace and one that even a highly organized and experienced practitioner cannot keep going for very long. Perhaps a sprint but not a marathon, I often say.

If too many of my days are like this, I'm going to need to re-think my work (again). But for now, I will focus on getting the distractions down to a minimum; I don't think I will allow cell phone calls from my children while at work unless they have amputated a leg or worse (God forbid). And, Mom does not need to call about a missing prescription; it can wait. As for the CPA, he can wait too. Less volume, less input, less information and confusion will ease the unfolding moments. Something's gotta give.

Complain, complain, complain.

Un-Decorating

In December we decorate our home for the holidays like millions of other families with lights, ornaments, wreaths, poinsettias, a Christmas tree and more. For those few weeks the house comes alive with color, light and the sweet scent of evergreen and cookies. And then when January arrives, we take down all the decorations, pack everything away in boxes, dispose of the tree that adorned our living room so beautifully and transition into the start of a New Year. Today I "un-decorated" the house. It's a job I dread but when it's over, I like having my house back again. There is always a sense of relief for me when the vacuum cleaner sucks up the last of the pine needles from the living room rug, I move the furniture back into position, and replace the usual pieces that adorn the mantel all year long. Everything looks familiar and warmly inviting after the rush of December holidays.

This is definitely January; breezy, cold, grey and wet; at least so far. And, I'd just like to sink my teeth into the days and enjoy this mid-winter month. One of the ways I intend to do this is to boycott what I perceive as the assault of the "next big event", in this case Valentine's Day. I shudder to see the pink and red displays of candy, cards and knick-knacks all over the stores; they've been there for over a week now. Ugh! Why can't we just enjoy where we are without looking so far ahead?

As for Easter bunnies and chocolate eggs, I feel similar disdain. Ten seconds after midnight on February 14, the Easter candy will hit the shelves. I'm not into any of it. After all, I just finished "un-decorating" from Christmas and need a really decent, and long lasting breath of winter. Just winter.

Untangled

Yesterday I was sick and atypically just "gave in" to the symptoms and stayed home all day, lay in bed, ate and drank tea. I can never nap and couldn't read because the headache was so bad until afternoon. This is all just a viral type thing; it's been making the rounds in the family and few are left unscathed. I'm on the mend today.

What I did do yesterday because I obviously had the time and because I needed pure diversion was untangle the mess I had made of my beautiful skein of hand dyed yarn from Uruguay. I now appreciate that there are clever ways to avoid having the yarn end up in a convoluted, near impossible-to-undo mess (comments on 1/3/08 post) and will definitively heed this advice in the future. However, working on this yarn for hours (at least 3-4) was a form of therapy for me. In between curses, I was able to forget about most everything else and concentrate on the present moment with the endless length of yarn, painstakingly teasing out inch after inch into freedom. By late afternoon and several breaks from the task, I was almost to the point of surrender and contemplated cutting off the free ends of yarn and ridding myself of the last hour or two of work. But then, Denny came home and I knew there would be a willing participant. If there is one thing that draws him to challenge it is stuff that is "all knotted up". He is most persistent and took on the last twenty percent of this job. By mid-evening he proudly presented me with a single ball of yarn, tamed and ready for use. I could tell he was as lost in the process as I had been all day. Diversion.

Although I should have probably let this ball of yarn sit and breathe for awhile, I decided to knit. Despite the interval of several years since my last go at knitting, my fingers and hands moved in the right direction and the first inch of my simple, plain scarf is underway. That Uruguayan skein has been tamed and will gradually become a warm and wonderful piece that I'll wear around my neck. And, when I do, I'll aways remember how much work it took to even get to the first stitch.

All Tangled Up

Yesterday MM and I went to a yarn shop in the U District. She goes there frequently to select unique and beautiful yarns for her crochet pieces and sometimes looks upon the outing as a pleasant reward or escape after a particularly grueling day.

Yesterday was all of that as we shepherded Mom and Dad with all their accouterments and frailties to tour an assisted living facility in Shoreline. That's another story for another time. After we returned from that outing and they settled into their routine at Merrill Gardens (Mom in her chair and Dad in bed to sleep it off), MM and I stoked the fires with a double shot Americano each and headed out in the rain and gathering darkness of late afternoon to The Weaving Works, a little diversion after a long and sober day.

I was impressed. The yarns are gorgeous and there was so much selection that one barely knows how to begin. I've done some knitting in the past after my high school friend Ellen taught me a simple stitch with large needles. Since then I've knit perhaps half a dozen long, straight winter scarves with inexpensive yarn. Inspired by the thousands of skeins in all colors and styles, I found this yarn from Uruguay, hand dyed and "marblelized" blending all the fall browns and golds. I plan to knit (another) scarf and get my skills up so that perhaps I can advance to a more challenging project later.

Last night, as a just-before-bed project, I decided to roll the yarn into a ball from the loose skein. Mistake. I obviously don't know how to do this and spent over an hour with the biggest mess of tangled yarn in my lap. Working from both ends of the skein towards the middle has got to be all wrong but seemed the only way to make any progress. I finally gave up and so it sits, waiting to be worked on again today. The mass of yarn is so tight that it feels like I'm running a comb through dreadlocks. When my frustration gets impossible at one end of the skein, I try the other for awhile. Back and forth and back and forth I go while the matted mess in between gets tighter and tighter. I'd throw it all out and start fresh had I not spent a lot of money on this gorgeous yarn.

Meantime, I'm sick with a cold and have a migraine. But, I did do myself a good deed today and gave the only available car to Laura for the day. I am therefore house-bound on this rainy, cold winter day and that's probably the best thing for me. That and the ball of tangled yarn.

Would that the mindful process of untangling this yarn help to shine light on how to untangle other things that may be more subtle but more challenging in my life.

Happy 2008

I'm thinking about how we mark the passing years chronologically. Here we are in 2008 and I would bet that all reading this have "said" in their heads "two thousand eight". That would be one way of referring to our new year. But, in 1998 or 1988 or when we refer to a time we haven't lived like 1888, we say "eighteen eighty eight" and not "eighteen hundred eighty eight" or "nineteen hundred eighty eight". We lose the hundred or in the case of the new millennium, the thousand. But probably not during the first decade of the new century when to do otherwise would create some ambiguity. What does "twenty eight" sound like? Not quite like 2008. Hmmmmm.

The bigger issue is: who cares? But, this is the musing of my insomniac mind as we roll over into another year. When in this new millennium (and century) will we dispense with the "Two thousand" and just use "Twenty"? Probably in 2010.

To one and all; Happy New Year in this "Twenty Eight"!