Sunday, May 31, 2009

Wanted: a Toehold

We are here; the last day of May 2009.

How many months need to come to a close and a new month begin before I can get a "toehold" on anything?

Buddhist teaching would remind me that all this "toehold" business is about "grasping" and as long as one enjoys that particular frame of mind, being stuck will be a matter of course, predictable and self repeating.

I read Pema Chodron's When Things Fall Apart last week; read it in a day hoping to absorb the words and impact my thinking. The following day when life threw me yet another curve ball and I couldn't deal, I flung the book across the room. It hit the closet door and dropped to the floor, unharmed. How can I be this far along in life and be regressing into a lightless cave? Has life peaked and I'm on the down slope? How does one change the chemistry of the mind, the tight hold that our thoughts have on our experience?

May did not bring me a toehold. June won't either.

Impermanence. Change. The. Fleeting. Nature. Of. Everything.


Saturday, May 30, 2009

The End of May: Treasured Rhodie

May 2009

I hate to bid goodbye to this 31 days of May. Letting it go is like surrendering Spring and stepping into Summer. The days of May lengthened progressively, on a timetable bringing morning light earlier and the last rays of sunshine transitioning to darkness later. The rhododendrons and azaleas have been in full bloom, coming after the brief flash of yellow daffodils and myriad colored tulips of April but before the heady purple blaze of lavender in June. May in Seattle this year, despite the unseasonably cool and wet start, comes to a close in glory.

Each May we're treated to a burst of color from a rhododendron in our back yard that never fails to "wow" us with its bold spread of fuchsia and sprinkle of lilac purple. This Rhodie sinks its roots in the soil of the neighbor to our east but I believe we have the more gorgeous view as the blooms soak up the western, sunny exposure. This old, mature bush is more like a tree, standing twenty feet tall at least. Shady and green most of the year, May is her month to blast forth with color. This month of May, D and I have taken the time to study this gorgeous gem by setting our lawn chairs in front of her gorgeous show in the early evening. A glass of crisp white wine and conversation in the company of "her majesty" has been a wonderful diversion multiple times over these last few weeks.

I think of all the pictures we've taken in the month of May with loved ones standing in front of this beauty. She is the perfect backdrop for a spring photograph, especially as the afternoon light hits those flowers. This year I noticed that a light purple bloom infuses the lower branches of fuchsia; what's this? Has the tree been grafted with a variant species? Or, is this a mutation? Or is this a separate Rhodie bush pushing out beneath its taller friend, entwining branches leaning to the sun? Whatever. Lovely she is, transient in her beauty, begging quietly for our attention.

The peak has passed but the glory blazes on for another week or so until the petals involute and drop to the grass. Every morning I look out to appreciate what remains of her grandness. Letting her go to her next phase is the sign that June is coming on, replete with more gifts. Moving forward is bittersweet. I crave just a bit more time to enjoy the boldness of nature singing in my backyard.

Friday, May 29, 2009

Becoming a Mother-in-Law

In a few months, November to be exact, when Chris and Heather tie the knot, I'll become a Mother-in-Law. Gasp. Here's another role for me, this one replete with its own colorful history. Everyone, it seems, has mother-in-law jokes or horror stories to tell regarding this member of the extended family. (I ask, how come there aren't father-in-law jokes? Hmmmmm.) The new hat I'll wear has been on my mind frequently. Don't we all want to be the best we can be? Who do we look to for guidance? My last two blog posts about the importance of mentors in my life segues nicely into the question of how I might prepare for this important transition.

I'm so fortunate to have such a wonderful role model in Virginia, my own Mother-in-Law. Virginia taught me much about "being there" without being in my face, about support and love, about weathering the good times and the no-so-good times, about strength and courage, about loving my family, and about forgiveness. A year ago I blogged about Virginia on the occasion of her Birthday. Yesterday was that special day again; another chance to reflect on and to celebrate her life. She would have been 95 if she were alive. I miss her, perhaps even more so now that I'm about to step into that uncharted role of Mother-in-Law. I remember how our relationship grew over time, how she supported and invited me into her life, and the many times we laughed (and cried) over those 26 years.

Yesterday we remembered Virginia (and her birthday) with our tradition of eating a meal at one of her favorite restaurants. Denny used to take Virginia to lunch at Spiros rather frequently; she loved the salad and specialty pizza, the casual atmosphere, and probably more than anything, the chance to sit with her son over a nice meal. Since her death, we've gone to Spiros on her birthday every year and I hope we can continue this tradition long into the future.

This year D and I were thrilled to introduce our daughter-in-law to be to this mini-celebration of Virginia's life. The restaurant was hopping when we arrived last evening. Familiar as always, the menu never changing, the service and food up to the quality we've grown to expect, the five of us (see picture above minus me) had a great time. D remarked that had Virginia been with us she would have "picked up the tab". Exactly right. She was always generous in addition to her other qualities.

All this brings me back to the anticipation of becoming a Mother-in-Law. Thankfully I've a good role model and hope that I can live up to all she taught me. God Bless You, Virginia!

Tuesday, May 26, 2009

More Thoughts about Mentors

I wrote my last post about the loss of a mentor. If we're lucky, we have many mentors on life's journey. Professional mentors. Life mentors. Spiritual mentors.

I am fortunate to have had two professional mentors. One is now gone; gone before I could write him the letter that I've been composing in my head since the last time I saw him at his retirement party in Little Rock over five years ago. Lesson learned: write those letters, say those words of thanks now, when you can. Our next day is never guaranteed. Opportunities evaporate into mist.

My goal is to get a letter of thanks out in the mail to mentor #2 before another week passes. Lesson taken.

Friday, May 22, 2009

The Death of My Mentor

I'm flooded with feelings tonight....

What does it mean to learn that my mentor, that great facilitator of my professional development, the one who had faith in my potential, the one who pushed me to my limit but not beyond, the one who trusted and believed that I could be all that I wanted to be.....has died?

I learned today that my mentor, Thomas Andreoli, M.D. died April 14, 2009. A letter crossed my desk today from the University of Arkansas College of Medicine inviting me to an event to "celebrate" his life. The invitation stopped me in my tracks; a celebration of life means someone has died. I hadn't known about his death and went on line immediately to find his obituary in the April 19th issue of the N.Y. Times. He was 74. I never expected this. Not now. He died too young, taken from this world with accomplishments, recognitions, and honors only the very best in the field can expect. I'm privileged to be among the many trainees he mentored over his many decades in academic medicine. He is the hero of my professional life. Forever.

In this time when I question my role as a physician and the value of my work, wondering if this is work worth doing, I am pulled back into the reality of what was, what made me choose this specific trajectory, and how his influence steered me towards his passion, making the field of Nephrology my passion as well. I owe everything to this man. He nurtured the immature and developing wings of young physicians, and while demanding excellence in science and service to patients, he touched hundreds, maybe thousands of young lives as we "became" who we were meant to be as physicians and scientists, whether in clinical service or basic research. His mind, ever brilliant, demanded the best we could give and serve it up we did. If he said jump, we asked, "how high?" I've never met another person like him and no one person has ever affected my life as he did.

I'll never forget as a medical student interviewing with him for an internship position at U.T. Houston. I was nervous. He was not. I was in awe. He was a giant in the field and held all the cards. I covered up all those nerves with sheer will and made it through the interview only to have him tell me as we finished up, "Kate, I want you in this entering class of interns. Welcome aboard." And later as a medical resident he steered me towards the sub specialty of Nephrology and away from my second love, Cardiology. "Kate; you will be a Nephrologist.", he would say. I listened because I trusted him, was in awe of his brilliant mind, and his ability to mesmerize me with his knowledge.

After 25 years as a practicing Nephrologist, I look back tonight at the man, the mentor who believed in me, who knew I could do this work and do it well. Thank you Dr. Andreoli. Thank you and God Bless. You will be missed.

Thursday, May 21, 2009

More on "Work Worth Doing"

I'm obsessed with the the question: What is Work Worth Doing? In an earlier post I'd written about what former Justice Sandra Day O'Connor had to say about happiness and its direct link to "work worth doing". An attractive hypothesis, these three words still have me flummoxed personally.

I'm seeking the proper mental approach to the work I've done for over 25 years. Somewhere in the soup sits the key to unlocking the door in my mental block that says what I do has little or no meaning to me. I know that what I do often has meaning for patients and our interactions are "worth doing". Why am I left with the emptiness that comes from struggle and a sense that little that I say or do results (I'm a results sort of person) in meaningful change for the better? I'm not talking about prescribing antibiotics to cure a pneumonia. I'm talking about the weight of age, and problem lists with a minimum of 6 major diseases, the total body decline that is inexorable. What do I have to offer but an organized ear, a mirror that talks back in a language understandable to to my patient, a trained mind? It's just not enough I say to myself over and over; it's just not enough.

And so, I'm destined to wrestle with this question after decades of plodding along. My colleagues who love what they do tell me the worth (and the joy) come in the moments, however brief, when there is human connection on a deeper level, a trust, a link of understanding; call it what you will. For me it still translates to exhausting work that gives back little in nourishment.

I'm too scared to quit however.

I cannot imagine that there is anything else out there for me. I need to juggle my mind, mix it up, re-boot the neurons so that this becomes (again) work worth doing.

Tuesday, May 19, 2009

On my Mother's Heart....

I don't typically share details of my life that may invoke anxiety in my parents, particularly for Mom. But a couple of days ago, figuring that she needed a bit of distraction from thinking and worrying about my sister and her travels in far off Istanbul, I started in on my shoulder woes. I thought that maybe if she had a minor, local issue to consider, MM's trip to Turkey might slip out of the spotlight if even for a moment or two.

Dad's reaction to the shoulder business was thoughtful and concerned. "Won't this keep you from the Triathlon this year with a bad shoulder? You can't swim with a bad shoulder." Yes, indeed Dad. But, I can look ahead to next year. Dad was spot on.

Mom, who never really connected with my athletic adventures two years ago when I actually made it through the training and completed the Danskin Triathlon, figures events like these are pure work (and not work worth doing) much like camping or cleaning up messes. She's always wondered why someone would voluntarily subject themselves to things uncomfortable. I predicted Mom would be relieved that the shoulder would keep me from training in water and on roads riding a bike/running for the next few months. The shoulder problem, in her view, would be a good excuse to bag the whole thing. Her response though was out in left field but at least she was laughing and that made me laugh too.

"Well," she said, "you'll just have to move to Alaska!".

Huh? Come again? Alaska? I didn't really get that one but I've learned to go with the flow. We were on to other topics before too long and the shoulder and a move to Alaska were long forgotten.

Yesterday, I was lamenting about my fast approaching appointment for the shoulder injection and describing to her (she's still my Mom) how nervy I was feeling about the needles and all, the haze lifted and she connected.

"Do you want me to go with you? I will, you know. I'll just go right down there and sit with you."

I was touched. No matter that she's almost 92, can't walk well and needs so much help to just make it through a regular day; she offered to hold my hand and comfort me on an anxiety provoking journey. I told her thanks, that I'd be "just fine" and indeed it was all that; just fine.

Her offer touched me deeply. The times are few and far between when she breaks free of the hazy interior world that holds her tightly, the place where the needs of another typically have no relevance, and where life is jumbled and confusing. The call of motherhood is stronger, enduring. When it comes to her 3 children she has always quoted her own Mother who used to say, "Doris, when they're young they're on your hands and when they're grown, they're on your heart." Clearly I was on my Mother's heart yesterday and for that I'm grateful. I still have the chance to be on her heart.

Monday, May 18, 2009


Check this out.

Last fall I gathered up all the pots, some full of soil and some empty and dragged them to the south side of our house, a shady spot, semi protected from wind and just a good place to store this stuff before time comes for re planting in the spring/summer. I usually up-end the pots as you can see here.

This is what I saw a couple of weeks ago when tulips were blooming elsewhere in the garden.

Obviously, there were a couple of tulip bulbs embedded in that up-ended potting soil all winter. And, like the rest of the tulips in the garden, the mystery unlocked in early spring and the bulbs unfolded their green sprouts, hungry for the light. How hard was it for these two stalks to find the hole in pot, the path to glory? I'll never know but successful they were and the blooms are proof. There's not much light on the south side of our house but somehow.... this orange beauty is basking in a ray.

Sunday, May 17, 2009

What is "Work Worth Doing"?

According to a blog I read regularly entitled The Happiness Project, former U.S. Justice Sandra Day O'Connor is quoted as saying that the secret to a happy life comes from "work worth doing". I'm intrigued. Intrigued because I agree but yet don't know what "work worth doing" means to me personally. I flat out want to know. Now. Please.

I strive for the mental state of happiness like everyone else I know, plodding along with an idea here, an idea there, some good days, some bad days, and lots and lots of just plain in-between days. Is the key really "work worth doing"? I have to wonder. I have to stop and really consider this.

I believe the former Justice is right. Her response is so concise, a 3 word answer, sufficiently non-specific, open to interpretation and absolutely gorgeous in its simplicity. Work. Worth. Doing.

I went to work today. Was it work worth doing? The work was obviously helpful to some, I offered expertise, oversight, review, commentary, and the all important written documentation to prove that I was there, working. Much of this work was rather boring and tedious today (that is the exception rather than the rule) and most of the patients would have incited a deep sadness in me had I let those emotions bubble up. Feeling that what I do is so small in comparison with the real need often overwhelms me. "It" is broken and I can't "fix it". Imperfect and incomplete; the nature of what we do in Medicine makes me question on a personal level if this is really the right fit for me; "work worth doing".

I remind myself that our work is way more than our paid or unpaid jobs and responsibilities. When what we're paid to do or what we must do to keep life flowing doesn't quite satisfy the "worth doing" qualification, we must look deeper into life and find the nuggets of joy that make our hearts soar with creativity. Perhaps it is what we love, those inner passions and gifts that we throw out there with abandon, hope, and innocence that constitute the "work worth doing". When you happen to make a living at what you love to do, that's all the better. But, it's not a requirement.

I'm still searching. But at least I'm sensing movement and opening my mind to the possibilities.

Saturday, May 16, 2009

Gets me Thinking

This poem snared me this morning as I lay in bed preparing for my weekend workday.

No Deal

And when I died, the devil came and said,
"Now here's the deal: I'll give you your old life
all over once again, no strings attached.
Like an actor in a play, of course, you'll have
to follow the same script that you rehearsed
the first time through—you cannot change a glance,
a word, a gesture; but think of taking your first
steps again, and having your first romance

repeat itself, your love back from the dead,
beautiful and new and seventeen.
What matter if you see the future coming—
The cloven hoof of sorrow, loss's horn—
her dreamy eye, her nodding head?"
Get thee behind me, Satan, I should have said.

by Ronald Wallace

What if you were promised the life you have now all over again but only if you had to play the cards exactly the same way and have that sharp view into your future? I wouldn't bite, much as I love life.

I prefer to wonder, as a dear friend of mine already knows, if ......."each of us has chosen his or her path before coming to live out this incarnation, and that [we] are learning lessons [we] came here to learn, as hard and painful as they may be. You may never know during life what the lessons are, or even if you are facing problems as you originally set out to do, but some day you will know what happened this time around. And then all the people around you (me included) will get to come back here again and do it another time, another way."

I love this friend. As this poem makes me think, so also does she.

Friday, May 15, 2009

Shoulder Woes

I must say, the accumulation of birthdays is a humbling proposition. Body parts I never thought about suddenly come to life (in a not-so-good way) and start talking, talking the language of pain. Arghhhhhh.

This time it's the shoulder....both shoulders really, but the left way more troublesome than the right. It started a couple of months ago with ever so mild, but annoying aching pain with movement. But this discomfort just kept getting worse, ever so slowly over weeks. I blamed it on muscle strain from moving furniture, packing and unpacking boxes, helping my Mom move in and out of the car, up from a chair and such. Finally when sleeping on my left side, or putting on a jacket, or reaching back to grab the seat belt from the driver's seat of the car predictably led to a zinging pain like a spear stuck through my upper arm, I knew something was way wrong with this shoulder of mine.

Now I know....all the doc had to do was listen to the story, do a brief exam and confirm a normal looking Xray to make the diagnosis: FROZEN SHOULDER, otherwise known as adhesive capsulitis, a most painful inflammatory condition of the aging shoulder. No trauma necessary apparently. This can be bilateral (oh no, the right shoulder is starting to act up too), will eventually get better in a year or so but in the meantime, healing can be sped up by a steroid injection into the joint, physical therapy and heat.

Apparently this a common condition seen by orthopedic docs. I wouldn't know; the shoulder joint is rarely on my radar screen when I see patients and if so, I usually refer them for better advice than I can give. So, long and painful story short: I'm following his good advice and getting an injection next week, physical therapy to follow and will take my aspirin and ibuprofen meantime. As he reminded me, "things could be worse...." OK. OK.

Looks like my plans for training for the Triathlon (which, to be honest, were fading steadily due to lack of discipline, bad weather, and very low energy) are out again this year. Last year it was the meniscus tear in the right knee, this year it's a frozen shoulder syndrome. Yikes! What's next? I never had any of these ailments before I tried to be the least bit athletic. Is there a message here?

So, all of you readers, if you can put your arm above your head to reach that object off the top shelf, pull on that sweater in the morning, and buckle your seat belt in the car without thinking of your shoulder, you're having a "good shoulder day". And that is very, very nice. I happen to know.

Thursday, May 14, 2009

Bloggy Ambivalence

I haven't posted a blog in 15 days.

Fifteen days is my longest interval of time without a post since the launch of Ahead of the Wave nearly 2 years ago. A deep ambivalence about writing, a kind of paralysis, and an inability to process all the big and little things going on in my life put a sudden halt to my creativity. I also started to question myself, my motivations for blogging and whether the risks were bigger than I was willing to take. Many questions. No answers.

I miss posting and have been touched by the gentle email queries from friends..."What's up?" and "Are you OK?" and "I'm thinking of you."

Life moves on. Some days are good, many not so good. But, I sense that the dust may be starting to settle and maybe, just maybe I can see myself anticipating the next blog post, feeling the creative spirit at work, basking in the wonder of words.