There is no use in crying over spoiled milk!
I have been thinking a lot lately about focus. As a young physician my ability to multitask was breathtaking. I could answer an emergency phone call from the hospital, change a diaper, and mow the lawn while stopping at the store to buy my wife flowers. I was able to navigate the roadblocks of each day without losing stride. Sure I sometimes stumbled, but I was up and running again without cutting precious seconds off my daily wind sprints.
Age has changed me. Through the years my career has grown, and the number of pressing professional interruptions has exploded. But more importantly, my mental agility has slowed. My brain is no longer as nimble at managing multiple concurrent situations. So choices have to be made. When I am discussing end of life options with the family of an imminently dying patient, I tend to ignore the pulling on my sleeve as my son tries to convince me to buy the latest trinket in the department store.
Choosing becomes a mode of survival.
This weekend was no different. The holiday season ushers in a long slog of patient care crises that usually last well into March. Between phone calls, I tried my best to navigate family activities, errands, and nursing home rounds.
And of course, it was imperfect. I missed the end of my children's violin concert because I was being berated by another physician for the care of her family friend in one of my nursing homes. Later that night, as my kids frolicked in the newly fallen snow, I sulked at the edges of the park consumed by a patient care issue that didn't go exactly as planned.
My wife awoke to me sitting on the bed Sunday morning charting on a hospice patient instead of chatting affably and yawning away the last remnants of sleep. We eventually rounded up the kids for a full day of errands, capped off by a trip to the grocery store, before going to my parents for dinner. Katie had been looking for a special brand of milk that she explained, between phone call interruptions, would somehow be well suited for our children (I was too distracted to put it all together).
When we arrived at my parents, I dutifully put the milk in the refrigerator so as not to spoil. After dinner, I retrieved the carton and packed it away with the other groceries stuffed into a bag with a bunch of binders for my son to take to school.
That night, during more phone calls, we unpacked the groceries, got the kids settled, and relaxed a few minutes before going to bed.
I woke up this morning at 4am in a panic wondering if I had remembered to unpack the milk and put it in the refrigerator. After a quick shower, I got dressed and squeaked down the stairs to find that my fears had been realized. There the milk was, sitting in the doorway, next to the binders, stuffed in a bag, spoiled.
On the way to work, I looked around at the deserted streets as my car whisked through the snow. It was a little after five and the rest of the world had not yet wiped the sleep from their eyes. And I began to cry.
Because the wisdom I have gained from years of dealing with sickness and death has taught me that I can't go back and start the weekend over again.
And be a better dad, a better husband, a better doctor.
What's done is done.
The milk has already spoiled.
Monday, December 12, 2016
Saturday, December 10, 2016
I'm Sorry
Dear Mrs J,
I would like to express my deepest condolences in the passing of your mother. A magnificent woman, I had the pleasure of being her doctor for almost a decade. And it was a pleasure. During our short visits she regaled me with stories of childhood and often gently sprinkled in advice gleaned from years of experience. Even as she began to decline, we would sit together in the nursing home and she would reach out to hold my hand. She was a gift, your mother. A gift that I in no way deserved.
I'm sorry she got cancer. As a physician, there is no word worse than the word metastases. It not only creates fear in the hearts of our patients but cleaves a chunk out of our souls. We are never as hapless in our calling as when we admit that we are mere unarmed foot soldiers in the face of this raving beast. We are not helpless. We can comfort and palliate. Cure, however, becomes an ever increasing implausibility.
I'm sorry that your mom experienced pain at the end. Lying in bed in the nursing home, she somehow mustered a smile through the groans as the nurses and I passed through the room. She told me that she didn't see the point anymore. We discussed the risks and benefits of morphine, and I dutifully wrote all the orders.
And I'm sorry, most of all, that you stormed into the room that morning and ordered the nurse to stop. That you somehow convinced your mother, in the last hours of life, that she would get addicted to morphine. That you screamed at her for not participating in physical therapy the day before because she was far too exhausted. And that she saw you and I arguing in those last precious moments when you should have been sitting at her bedside, holding her hands, and sobbing.
Your mom is now at peace. She will suffer no longer.
I know that you meant well. I am all to aware that the next few years will be excruciatingly hard as you try to work through loss and maybe even come to terms with the fact that you willfully denied your mom a peaceful death. There was probably much sadness, denial, and guilt that led you to make such decisions.
I am no longer angry.
But I'm sorry that I will not be able to be by your side during this arduous journey. Because above being a doctor, I am an imperfect human being. And far from above it all, I am right there in the muck with you
I cannot help you at this time.
Frankly, I'm still too disgusted.
I would like to express my deepest condolences in the passing of your mother. A magnificent woman, I had the pleasure of being her doctor for almost a decade. And it was a pleasure. During our short visits she regaled me with stories of childhood and often gently sprinkled in advice gleaned from years of experience. Even as she began to decline, we would sit together in the nursing home and she would reach out to hold my hand. She was a gift, your mother. A gift that I in no way deserved.
I'm sorry she got cancer. As a physician, there is no word worse than the word metastases. It not only creates fear in the hearts of our patients but cleaves a chunk out of our souls. We are never as hapless in our calling as when we admit that we are mere unarmed foot soldiers in the face of this raving beast. We are not helpless. We can comfort and palliate. Cure, however, becomes an ever increasing implausibility.
I'm sorry that your mom experienced pain at the end. Lying in bed in the nursing home, she somehow mustered a smile through the groans as the nurses and I passed through the room. She told me that she didn't see the point anymore. We discussed the risks and benefits of morphine, and I dutifully wrote all the orders.
And I'm sorry, most of all, that you stormed into the room that morning and ordered the nurse to stop. That you somehow convinced your mother, in the last hours of life, that she would get addicted to morphine. That you screamed at her for not participating in physical therapy the day before because she was far too exhausted. And that she saw you and I arguing in those last precious moments when you should have been sitting at her bedside, holding her hands, and sobbing.
Your mom is now at peace. She will suffer no longer.
I know that you meant well. I am all to aware that the next few years will be excruciatingly hard as you try to work through loss and maybe even come to terms with the fact that you willfully denied your mom a peaceful death. There was probably much sadness, denial, and guilt that led you to make such decisions.
I am no longer angry.
But I'm sorry that I will not be able to be by your side during this arduous journey. Because above being a doctor, I am an imperfect human being. And far from above it all, I am right there in the muck with you
I cannot help you at this time.
Frankly, I'm still too disgusted.
Thursday, December 8, 2016
Writing and Imperfection
For the first decade of life, I had headaches. Daily. Every day. Occasionally they were mild, but often severe. I saw various doctors. Suffered through multiple scans. At the end of the workup, the answers were no more forthcoming than the day we began. There was never a clear antidote. Never a divine potion.
Then something magical happened. Exasperated, my parents took me to a biofeedback specialist who taught self meditation. And my life was transformed.
The last year, for many reasons, has been hard. I have found myself pulled in too many directions. And my centeredness has skewed. My balance faltered.
I have been thinking a lot about this balance. As a child, it was built on meditation and thoughtfulness. As an adult, I now realize what has been missing in the last year.
Writing.
My daily routine of putting thoughts into words had recently become too overwhelming. My days were so disjointed that I had neither the emotional energy nor the physical time to place fingers to keyboard.
Because writing, as life, is excruciating. Filled with psychic pitfalls, it is awkward at best and messy often. The words come out disjointed and backwards, and rarely reflect the intangible emotion that circulates amongst the fussy neurons in my brain.
I am rarely satisfied with a piece, even after all the edits have been made. Imperfection pervades my writing, my soul.
Yet somehow this imperfection provides that thing. That thing which is missing most.
Then something magical happened. Exasperated, my parents took me to a biofeedback specialist who taught self meditation. And my life was transformed.
I won't say that my headaches went away completely. They didn't. But practicing regular meditation instilled in me a confidence and a calm that revolutionized my life. At the age of ten, I learned to manage stress, physical discomfort, and visualize the place I wanted to inhabit in the world. It helped center me.
Although the habit of daily meditation has fallen off over the years, I still return from time to time. Whether physical illness or mental, there is a safe harbor in times of need. There are few practices that have been so impactful on my life.
Although the habit of daily meditation has fallen off over the years, I still return from time to time. Whether physical illness or mental, there is a safe harbor in times of need. There are few practices that have been so impactful on my life.
The last year, for many reasons, has been hard. I have found myself pulled in too many directions. And my centeredness has skewed. My balance faltered.
I have been thinking a lot about this balance. As a child, it was built on meditation and thoughtfulness. As an adult, I now realize what has been missing in the last year.
Writing.
My daily routine of putting thoughts into words had recently become too overwhelming. My days were so disjointed that I had neither the emotional energy nor the physical time to place fingers to keyboard.
Because writing, as life, is excruciating. Filled with psychic pitfalls, it is awkward at best and messy often. The words come out disjointed and backwards, and rarely reflect the intangible emotion that circulates amongst the fussy neurons in my brain.
I am rarely satisfied with a piece, even after all the edits have been made. Imperfection pervades my writing, my soul.
Yet somehow this imperfection provides that thing. That thing which is missing most.
Tuesday, December 6, 2016
The Shepherd
Mathew preferred using the more biblical term shepherd. After all, he labored his flock through pastoral pastures and meandering meadows. His parishioners, of course, were sheep and not people. But after years of leading them, he could discern subtle differences. The slope of a forehead, the stutter of a step, the variation in bleat. So much so that he had a distinct name for every animal in his flock of thousands.
Mathew preferred isolation. From humans that is. But he was far from alone. He spent his days in constant motion among the animals, and nights still, under the moonlight beside them. In this way he past many youthful decades. A quiet, tranquil life, but not one lacking turmoil.
For Mathew grew to love these animals. And in so doing, he was forced to master a much broader skill set than just moving to to fro. Sheep got sick, got stuck, or became prey. So he devoured books on parasitology, mastered the art of disentanglement, and learned to scan the horizon with the eyes of the hunter.
And death came. From time to time. Despite his best intentions. The fox was too wily or the dehydration too severe. Panic could also be an issue. Mathew knew profoundly that the axiom scared to death could take on a more literal meaning.
At first these deaths were of little concern. Natural. Mathew, however, found that as his love for the animals grew, the impact became more sobering. He worried incessantly about plausible dangers. He scanned the horizon for predators, he sniffed the air for hazard. His anxiety grew each time he passed the great cliffs at the Northern most border of the pasture lands.
The cliffs were steep, unforgiving, and unavoidable. There was no other way to advance through the Northern rim of the territory, and move such a large group of animals to the South. Mathew approached this part of the journey carefully. He talked to the sheep. Cooing quietly as if the steadiness of his voice could paralyze the musculature of thousands of legs.
He had seen it happen. Once. Twice. Ten times. A poor ram would take off in the wrong direction. If Mathew wasn't fast enough, he could lose a hundred head as they followed to their doom. He almost always lost one. If he was on his game, he could mitigate the death spiral by stopping the rest from their morbid march.
As the years passed, he felt these losses more profoundly. Mathew remembered the distinctive faces, the names. His fear would bubble to the surface days before reaching the horrid place. Although he couldn't identify it, what he dreaded most was the guilt.
Mathew had blood on his hands. If he had only been better. Faster. He might be able to prevent such catastrophe. He wandered many lonely evenings with feelings of regret dancing through his psyche and laying waste to his previously held joy.
It ended, one night, on the eve of his fiftieth birthday. Mathew dreamt that herd was running towards the cliffs. Since they were lambs. A straight, genetic, preordained path. He yelled and screamed but all he produced was bleating.
So he ran with them. Moving some out of the way. Stopping others in their tracks. Saving those that he could, and mourning those that were lost.
He woke up from his dream certain that he could no longer hold himself responsible for nature.
We are born and we die.
If we are lucky, we help others make the journey more smoothly. We turn them from the most imminent, and palliate the most severe.
This knowledge gave Mathew comfort.
He could once again love being the shepherd.
Mathew preferred isolation. From humans that is. But he was far from alone. He spent his days in constant motion among the animals, and nights still, under the moonlight beside them. In this way he past many youthful decades. A quiet, tranquil life, but not one lacking turmoil.
For Mathew grew to love these animals. And in so doing, he was forced to master a much broader skill set than just moving to to fro. Sheep got sick, got stuck, or became prey. So he devoured books on parasitology, mastered the art of disentanglement, and learned to scan the horizon with the eyes of the hunter.
And death came. From time to time. Despite his best intentions. The fox was too wily or the dehydration too severe. Panic could also be an issue. Mathew knew profoundly that the axiom scared to death could take on a more literal meaning.
At first these deaths were of little concern. Natural. Mathew, however, found that as his love for the animals grew, the impact became more sobering. He worried incessantly about plausible dangers. He scanned the horizon for predators, he sniffed the air for hazard. His anxiety grew each time he passed the great cliffs at the Northern most border of the pasture lands.
The cliffs were steep, unforgiving, and unavoidable. There was no other way to advance through the Northern rim of the territory, and move such a large group of animals to the South. Mathew approached this part of the journey carefully. He talked to the sheep. Cooing quietly as if the steadiness of his voice could paralyze the musculature of thousands of legs.
He had seen it happen. Once. Twice. Ten times. A poor ram would take off in the wrong direction. If Mathew wasn't fast enough, he could lose a hundred head as they followed to their doom. He almost always lost one. If he was on his game, he could mitigate the death spiral by stopping the rest from their morbid march.
As the years passed, he felt these losses more profoundly. Mathew remembered the distinctive faces, the names. His fear would bubble to the surface days before reaching the horrid place. Although he couldn't identify it, what he dreaded most was the guilt.
Mathew had blood on his hands. If he had only been better. Faster. He might be able to prevent such catastrophe. He wandered many lonely evenings with feelings of regret dancing through his psyche and laying waste to his previously held joy.
It ended, one night, on the eve of his fiftieth birthday. Mathew dreamt that herd was running towards the cliffs. Since they were lambs. A straight, genetic, preordained path. He yelled and screamed but all he produced was bleating.
So he ran with them. Moving some out of the way. Stopping others in their tracks. Saving those that he could, and mourning those that were lost.
He woke up from his dream certain that he could no longer hold himself responsible for nature.
We are born and we die.
If we are lucky, we help others make the journey more smoothly. We turn them from the most imminent, and palliate the most severe.
This knowledge gave Mathew comfort.
He could once again love being the shepherd.
Saturday, November 12, 2016
Weight Loss and Change
I lost quite a bit of weight in the last year. It was on purpose. I started by tracking my intake and monitoring food choices. Before I knew it, the pounds melted away. I dropped two pant sizes and had to completely flip my wardrobe. My body was transformed.
Strangely, it didn't always feel that way.
After losing twenty five pounds, I looked in the mirror one morning after getting out of the shower. I couldn't discern a bit of difference. I could see the same layers of skin and love handles as before. Although my outsides had changed drastically, my brain was stuck in its former state. My internal version of myself was so deeply ingrained that I couldn't recognize that which was so obvious to my family and friends.
Sometimes I think I resist external change not only out of fear, but also because I am a creature of habit. My brain often deceives me.
I now know cataclysmic change is upon us.
Unfortunately, it is exceedingly tempting to look into the mirror, as I have done many times, and convince myself that reality is as it was before.
I think this is dangerous. I also think it is dangerous to consider the fact that we elected a buffoon as president the main problem.
The problem is that half the electorate felt so disenfranchised and desperate that they would knowingly elect a buffoon because they thought they had no other tenable option.
And yet, as I look back at the last eight years, I am filled with such optimism and hope. I am so proud.
Or is that my brain again, tricking me into seeing a reality that no longer exists?
Maybe a reality, that for some, never existed.
Strangely, it didn't always feel that way.
After losing twenty five pounds, I looked in the mirror one morning after getting out of the shower. I couldn't discern a bit of difference. I could see the same layers of skin and love handles as before. Although my outsides had changed drastically, my brain was stuck in its former state. My internal version of myself was so deeply ingrained that I couldn't recognize that which was so obvious to my family and friends.
Sometimes I think I resist external change not only out of fear, but also because I am a creature of habit. My brain often deceives me.
I now know cataclysmic change is upon us.
Unfortunately, it is exceedingly tempting to look into the mirror, as I have done many times, and convince myself that reality is as it was before.
I think this is dangerous. I also think it is dangerous to consider the fact that we elected a buffoon as president the main problem.
The problem is that half the electorate felt so disenfranchised and desperate that they would knowingly elect a buffoon because they thought they had no other tenable option.
And yet, as I look back at the last eight years, I am filled with such optimism and hope. I am so proud.
Or is that my brain again, tricking me into seeing a reality that no longer exists?
Maybe a reality, that for some, never existed.
Thursday, October 27, 2016
Glue
Glue
As Leila giggles blissfully at something Katie said, I realize that I lost a moment. Maybe I was on the phone, maybe caught up in my own head about some patient conundrum or another.
Cameron is tugging at his mother's sleeve. He tries to wile her attention from dinner and across the table to his iPhone where he discovered a new glitch.
It's pasta a la vodka night and we are all ravenous. A natural chef, Katie one day glanced over a recipe and created a masterpiece. We long ago lost the actual vodka and other ingredient modifications have taken place. It's now one of our favorites.
I tuck my shirt in carefully, and try to avoid splatter as I shovel pasta into my mouth. A busy day at work, I haven't yet had a chance to change. I received many compliments on the shirt throughout the day, and I don't want to ruin it. Katie bought it for my birthday. I can't quite remember when I stopped picking out my own clothes, but it was probably shortly after we met. Thankfully, I now look reasonably well put together and current.
After dinner the kids have violin group practice. Katie thought it would be a good idea to get them started on instruments early. That was years ago, and now the screeches have turned into intricate melodies.
Looking across the table at my family, I can't help but feel a certain pride and cohesion. We all have our place. I, the workaholic spacey dad. Cameron, the techy, sensitive son. Leila, tough and smart.
As Leila giggles blissfully at something Katie said, I realize that I lost a moment. Maybe I was on the phone, maybe caught up in my own head about some patient conundrum or another.
Cameron is tugging at his mother's sleeve. He tries to wile her attention from dinner and across the table to his iPhone where he discovered a new glitch.
It's pasta a la vodka night and we are all ravenous. A natural chef, Katie one day glanced over a recipe and created a masterpiece. We long ago lost the actual vodka and other ingredient modifications have taken place. It's now one of our favorites.
I tuck my shirt in carefully, and try to avoid splatter as I shovel pasta into my mouth. A busy day at work, I haven't yet had a chance to change. I received many compliments on the shirt throughout the day, and I don't want to ruin it. Katie bought it for my birthday. I can't quite remember when I stopped picking out my own clothes, but it was probably shortly after we met. Thankfully, I now look reasonably well put together and current.
After dinner the kids have violin group practice. Katie thought it would be a good idea to get them started on instruments early. That was years ago, and now the screeches have turned into intricate melodies.
Looking across the table at my family, I can't help but feel a certain pride and cohesion. We all have our place. I, the workaholic spacey dad. Cameron, the techy, sensitive son. Leila, tough and smart.
Saturday, September 3, 2016
Evanston
If you walk north from my front door a half block, the sidewalk dead ends into a path juxtapositioned between the golf course and Leahy Park. Continue a few hundred feet and turn east on Lincoln Avenue, and eventually cross Sheridan. Go past the water reclamation building and around the athletic center, and you will come to my favorite place.
Wend your way through the ambling students and the outdoor athletic field, and eventually you will reach Lake Michigan. Almost as if by surprise, the incomprehensible body of water jets into view framed by green grass over landfill, a winding path along the waterfront, and an odd assortment of grafitti'd concrete haphazardly placed as an embankment.
This is my Evanston
This is particularly odd for a guy who has never owned a beach pass, hates sand, and rarely swims in anything but pools.
Certainly my youth was much more colored by the shops lining Central Street on the northwest side. Primordial memories of riding in the back seat of my mother's Buick station wagon while we dropped off laundry at the drive through dry cleaners. Or stealing my first candy at Deacon's Dime Store and then feeling remorse shortly thereafter. There were trips through the alley that started adjacent to the old house on Lawndale and ended at the White Hen Pantry.
The pantry eventually turned into a 7-11. Then it closed. The Deacon's is now a real estate office. Strangely, the dry cleaner still stands. The path leads from Central Street, through a tunnel where laundry is dropped off at a window, and then dead ends into the same alley that I use to traverse to get to White Hen.
Did I mention the Baskin Robbins?
Adulthood has changed my paths, although I still awake occasionally from childhood dreams with the taste of the Lawndale house on my lips. I drive past occasionally but the facade has changed.
It's not the same.
My kids and I now walk Sherman or Orrington to get downtown. We pass by the 201 bus stop I used to take home after going to my after-school tutor when I was diagnosed with a learning disability. The Betty's Of Winnetka has long been replaced by some store or another.
We cut through fountain square (much the same as my childhood) and end at the renovated Chandlers Building and eat at Edzo's or Potbellys.
And we always walk home along the lake. Down the same path but from the opposite direction. Passing the rumbling machinery as Northwestern builds new constructs of glass and steel facing the lake. The strange beauty of technological colossus adjacent to greenery and natural waterway.
Katie, the kids, and I.
I have changed since childhood. I walk different paths.
Yet my city still lives. Like me, filled with contradictions. The ugly concrete slabs slathered with multicolored paint somehow not detracting from the picturesque lakefront.
Familiar yet mysterious. Uncertain. My DNA entwined in a small imprint of soil. On a street full of houses. In a world full of cities.
The place I was born. Where I spent the only eight years with my father. Where I brought my children home from the hospital.
Evanston
Wend your way through the ambling students and the outdoor athletic field, and eventually you will reach Lake Michigan. Almost as if by surprise, the incomprehensible body of water jets into view framed by green grass over landfill, a winding path along the waterfront, and an odd assortment of grafitti'd concrete haphazardly placed as an embankment.
This is my Evanston
This is particularly odd for a guy who has never owned a beach pass, hates sand, and rarely swims in anything but pools.
Certainly my youth was much more colored by the shops lining Central Street on the northwest side. Primordial memories of riding in the back seat of my mother's Buick station wagon while we dropped off laundry at the drive through dry cleaners. Or stealing my first candy at Deacon's Dime Store and then feeling remorse shortly thereafter. There were trips through the alley that started adjacent to the old house on Lawndale and ended at the White Hen Pantry.
The pantry eventually turned into a 7-11. Then it closed. The Deacon's is now a real estate office. Strangely, the dry cleaner still stands. The path leads from Central Street, through a tunnel where laundry is dropped off at a window, and then dead ends into the same alley that I use to traverse to get to White Hen.
Did I mention the Baskin Robbins?
Adulthood has changed my paths, although I still awake occasionally from childhood dreams with the taste of the Lawndale house on my lips. I drive past occasionally but the facade has changed.
It's not the same.
My kids and I now walk Sherman or Orrington to get downtown. We pass by the 201 bus stop I used to take home after going to my after-school tutor when I was diagnosed with a learning disability. The Betty's Of Winnetka has long been replaced by some store or another.
We cut through fountain square (much the same as my childhood) and end at the renovated Chandlers Building and eat at Edzo's or Potbellys.
And we always walk home along the lake. Down the same path but from the opposite direction. Passing the rumbling machinery as Northwestern builds new constructs of glass and steel facing the lake. The strange beauty of technological colossus adjacent to greenery and natural waterway.
Katie, the kids, and I.
I have changed since childhood. I walk different paths.
Yet my city still lives. Like me, filled with contradictions. The ugly concrete slabs slathered with multicolored paint somehow not detracting from the picturesque lakefront.
Familiar yet mysterious. Uncertain. My DNA entwined in a small imprint of soil. On a street full of houses. In a world full of cities.
The place I was born. Where I spent the only eight years with my father. Where I brought my children home from the hospital.
Evanston
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