Monday, February 28, 2005

Here and Now

Here and now. Here we are. This is it. Monday draws to a close as snow begins to fall once again.

Today was just a pile of work: charts, home visits, telephone calls, collaborative conversations with some of the docs in the clinic, logistical arrangements. I erroneously printed 80 pages of lab results for one patient on our office printer, much to the chagrin of our office manager. Mea culpa. I committed an eco-sin of high order today. I must make amends. Then I had to reprimand a patient who left me three impatient and demanding messages on my voicemail. One of my co-workers said that the "authoritarian voice" that I used for the call to that patient was sexy. Sexy? Should try that more often.

A meeting tonight for one of my volunteer positions was taxing but tolerable. So nice to be home with Mary and the Canines. Nowhere else I'd rather be, in fact. Some people try to make plans in order to be away from home after work. I try to not make plans in order to be at home more. Why make plans with friends when my best friend is right here at home? We're occasionally an undifferentiated ego mass, but we're differentiated enough to have our own laptops.

Sunday, February 27, 2005

The Future is Monday

Despite my recent diatribe regarding staying in the present, tonight I am experiencing feelings of dread as Sunday comes to a close and Monday morning is mere hours away, when the alarm clock will awaken me from my slumber and signal the start of the working week. True to what I so recently wrote yesterday, my enjoyment of this Sunday evening is clouded by the preparations which I'm making for the week (ironing, laundry, reviewing my Palm Pilot calendar, packing a bag for the gym, finishing lecture notes for Tuesday night's lecture), and my mind wanders to the fact that in only 12 hours I will be at my desk, the beeper beginning to ring, the calls coming in, the pile of charts and to-do's waiting for me patiently to pay them some mind.

I bring myself back to the present: At this very moment, I am sitting next to Mary as she types into her laptop, candles burning on the coffee table, Tina the dog snoring lightly, Sparkey half-asleep on the floor. I can hear the hum of the heating system, the tap of Mary's fingers on the keyboard, my own fingers darting on this computer, the rustle of Mary's jacket as her arm shifts position. I remind myself that this lovely home is ours, it's furnished and has a new roof. We have two cars---used but functioning---in the driveway. We went to dinner and a concert with good friends last night, and have yet another concert to attend on Friday night. Our checking account is in the red today, but paychecks are poised to be deposited this week. Our son is healthy, happy, and in love, and although I have a few minor health problems, we are both lucky and relatively healthy. The fact that I have a job (three, actually) to even go to is something for which I should be grateful.

Taking stock, I review my blessings, my fortunate status, my relative priviledge, and I can release my dread in this moment. I may not be flying to Puerto Rico today like one couple we know, or another couple who leave for a 5 week trip to Mexico on Tuesday, but my life is blessed and my cup runneth over whether I am conscious of it or not.

To feel sorry for oneself is perhaps the greatest conceit, one of which I am prone to be guilty. I must be honest with myself about my inner process, face these truths that cause me to lose so many moments of clarity and fulfillment, and try again to face each day as if it were the gift that it is.

Saturday, February 26, 2005

Fear and the Future

I was inspired this morning by a brief email that Mary sent to a friend of ours. It was simply a quote by Rudolf Steiner:

"We must root out of the soul all fear and dread regarding what approaches us from the future. We must acquire serenity with regard to all feelings about it. We must look with absolute calmness upon all that comes to us. Whatever happens, we must think only that it comes to us through the wisest guidance."

How much of our time do we spend worrying about the future? I know that I spend a fair amount of my time in such senseless pursuits, and it's a constant battle to wean myself of this utterly unproductive activity. What does it prove? Where does it bring me? It brings me to fear, to worry, to purposeless perseveration about things over which I have little or no control.

Part of the meaning for me of entering my forties last year is that my life is ostensibly half over--- more than half over, based on actuarial tables, in fact. How do I wish to spend these precious years? The half-time show is over, the confetti is cleared away, and now what's left is the business of living. Do I spend it in worry, or do I spend it in living, loving, and learning to live and love even more?

When our friend Woody was murdered by the police (see previous posts or http://www.justiceforwoody.org), I realized that honesty with those we love is the only thing we have. I am so happy that the last time I saw Woody, I told him that I loved him, as did Mary and Rene. We always told one another that in parting. I understand now on a visceral level that each goodbye could be the last, each encounter the final encounter with any individual. If we spend our time in fear, we miss such golden opportunities to express and receive love. This doesn't mean that we shirk our responsibilities and allow our bills to pile up unpaid as we "live in the moment". No---we work and pay our bills, savoring that we have the gift of breath which allows us that chance to work and pay bills. How many people around the world would give anything for that freedom and opportunity?

I continue to attempt to tame my mind's poor habits of careening into the past or future with either regret or worry. The past is beyond my reach now, the future no closer. This reptilian mind---or "monkey mind" in some Buddhist teachings---can so easily lead me astray. It's a daily task to keep its tentacles at bay. If I can release my fears, that which I fear will no longer be fearful. Any insight from you, dear readers, is more than welcome.

Thursday, February 24, 2005

A Welcome Visitor


Tonight's visitor was Sadie Richardson. If you look back at my January 27th post, you will see a beautiful black and white photo of Sadie as a newborn, entitled Beauty and Innocence. She was our angel tonight, bringing such joy to our home.......Posted by Hello

Wednesday, February 23, 2005

Scars

So often, my work is like looking at, dealing with, and addressing scars, both emotional and psychic. The physical scars are there too, of course, but it is the scars of trauma and life gone awry that make my work so challenging.

Today, once again, I had to actually tell someone that if they didn't start taking their health seriously and work with me closely, they would be dead within a few years. This scare tactic has worked before, and I see continued success in two people whom I have so directly challenged to "get on the bus" with me and do the serious work of recovery and healing.

In the course of this chilly but sunny day, I had to confront a certain individual who has never taken antiretrovirals---AIDS medications---and I had to tell her in no uncertain terms that the brain infection for which she was so recently hospitalized was a direct outcome of her ongoing refusal to concentrate and consider treating her underlying disease. She acknowledged that her inability to take her seizure medicines has landed her in the hospital several times with massive seizures, and I reminded her that if a major brain or lung infection takes hold at this point, she is most certainly going to die. She has so few T-cells (some of the cells that populate her immune system and give us a good indication of her immune health) that we sometimes joke in the privacy of our office that we could name each one since they're so few and far between. Poor gallows humor, I know, but so helpful when we're faced with such tragic realities.

Truly, it was not a "full-throttle" day, as it were, but I was more challenged than yesterday, and had many more plates in the air as I juggled my way through. Several times, I was struck with the awesome responsibility of assisting people through the healthcare system, of the underlying dysfunction of that system, and of many of my patients' natural or learned weakness in terms of self-care and self-direction. Many choices which seem like "no-brainers" (to borrow a very modern phrase) to me, are huge leaps for some of my patients to take.

For someone as priviledged as I, the obvious need to take medication to control a disease with which I am saddled is clearly obvious. Without a history of abuse, trauma, addiction, abandonment, deprivation, and disenfranchisement--not to mention second-class status in a world of white people who can't even see their own priviledge)---I can easily say "yes" to self-care, treatment, others' wish to assist me, the natural succor of love and compassion. But for so many people, the ability to say "yes", to rise above negative self concepts and self-loathing, is not so natural a skill. It is these individuals whom we try to reach as we send out the life-raft, offer a hand, extend ourselves a little more, offer a smile and a kind word on a consistent basis. Some take the bait, others try for a little while and eventually fall by the wayside. We will stop the bus and support them in their gradual or rapid demise, soothe their suffering and ease their pain, but there comes a point where there is no turning back and their death is only a matter of time.

I have watched these processes both as an objective witness and a committed player, attended the wakes and funerals, consoled the bereaved. It's not easy, I'll readily admit, and sometimes my frustration level is through the proverbial roof. That said, the show must go on, and whoever buys their ticket gets to play. For some, we force the ticket into their shirt pocket and drag them through the door. Others leave their ticket in the waiting room and return to the shooting gallery for their fix. There are always more tickets available but there are those who will never take the ride. My patient today is probably one of those who I will watch over as she fades into oblivion. I honor her scars, but can sometimes grieve her inability to take the proffered hand.

What do I do now? I offer consistent and caring advice for her to take. I meet her where she is and try to drag her further along if I can, either by logic or by coercion. If she doesn't take the bait, I do what I can and wait for her to crash and then pick up the pieces. If she dies, I tell myself I did my best and move on to the next person in need. It doesn't always feel like the best world in which to dwell, but I have my cozy abode, a woodstove, and a wife and dogs to curl up with when I get home. Priviledge has its benefits and its costs. I honor both, and begin anew each day.

Tuesday, February 22, 2005

An Ebb

Today was one of those days when having the energy to do anything more than the minimum required was beyond consideration. Aside from making it to the gym in the basement of the hospital for a 30-minute sweating session on the elliptical cross-trainer before work, it was energetically a time of taking care of that which was right in front of me, without any proactive movement on my part in terms of seeking out additional tasks.

While for some this might be a modus operandi---doing what's minimally expected and nothing more---for me this type of day is a rarity, one in which I feel I cannot possibly tackle or accomplish anything beyond the absolutely necessary. Whether it is the effect of the long weekend, a night off from teaching at the community college tonight, or what seems to be a never-ending winter, impetus for extra action was at an ebb today. While I didn't ignore or neglect any patient in need, I also didn't make those extra calls that I might be moved to make on a more energetic day. I didn't write those letters that needed to be written or review those charts that are waiting in a pile on my desk. Those will have to wait.

That said, if a crisis or dire situation had arisen in the course of the day, I'm certain that I would have equally risen to the challenge, boosted by adrenaline and the sympathetic nervous system. Fortunately, the phone was mercifully quiet with only a modicum of calls, the beeper was mostly silent, and overhead pages from the waiting room announcing the arrival of unexpected patients seeking my assistance were never heard from 9 to 5 today. My few home visits were uneventful--one to a patient with a new colostomy who is doing well after being discharged from the hospital, the other to a patient to simply deliver a prefilled med box and insulin syringes, a ten-minute chat not resulting in any acute needs.

It was a day when my nervous system needed rest and a respite from the often break-neck speed of my office landscape. I cannot keep up my usual pace without an occasional day like today. I don't dare dream that tomorrow might also be so tranquil, but I give thanks for day that was a gift to my tired brain and body.

Monday, February 21, 2005

Why Not Politics?

On this "holiday" of "Presidents' Day" (why don't we have a Citizens' Day?), I pause to contemplate why politics is so far being eschewed on this blog. While I follow politics relatively closely and have strong opinions about many contemporary subjects like the war in Iraq and American Imperialism, there is so much incredibly good writing on those subjects widely available in so many formats, it seems counterproductive---or at least redundant---for me to chime in here on Digital Doorway. My list of links can point interested parties towards commondreams.org, truthout.org, indymediacenter.org, onthecommons.org, and there is just a plethora of opinion out there for anyone to find.

That said, you would not be remiss in possibly expecting diatribes about healthcare and other issues that might come up for bantering about. Although these issues have a political aspect, I look at them through a wider lens than might be called "political".

In future, if I decide to opine on politics itself, I may make some entries here on Digital Doorway, or I might create a companion blog for such ruminations. Until then, I think this blog will remain a more personal venue for exploring my thoughts and daily musings. A stray political thought or issue may creep in here and there, but I feel fairly strongly that this here blog will remain a rather personal journal format, at least for now, that is.

Stay tuned for my next entry later this week. And thanks for stopping by.

Sunday, February 20, 2005

Bikram Reprise and Indian Food

Another weekend rolls along. Bikram yoga class this morning: sweat, aching muscles, and an enervating relaxation from taking one's body further than one would in another venue. The cold weather continues, but dog walks keep me out there, no matter the urge to hibernate.

Tonight I cooked an Indian meal for friends: orange lentil dal, yogurt and cucumber raita, masala paratha bread, coconut-cilantro chutney, brown rice, potato and caulifower shak (spicy veggie dish). Our friends leave for a two-month trip to Central America next week and we discussed our mutual visions of a creative life of service, living in a sweet Spanish-speaking culture. So many of us are making reconnaissance trips---the reports keep coming in....

Now to finish writing a fifty question exam, fulfilling my role as professor. A nurse's work is never done, apparently.

Bon nuit.

Saturday, February 19, 2005

Radio En Absentia

Three months ago, my car was broken into in front of the clinic where I work and the removable face-plate of my car stereo was stolen. The would-be thieves, aside from spraying broken glass all over my car's interior, tried unsuccessfully to pry the stereo itself out of the dashboard, leaving me with a non-functioning car stereo. As perturbed as I was when this first occurred, it has been many months and I still have not made any move toward replacing said stereo or at least buying a new face-plate to determine if the slightly damaged equipment still functions. I occasionally wish that I could slip in a tape (the CD player's been broken since I transferred the stereo from my son's defunct car to mine) or listen to NPR or Democracy Now! on the way to work, but I have grown used to the silence,or rather, the absence of noise.

Driving to work, I sing, talk to myself, or watch the road and think random thoughts. Sometimes I'll try to focus my attention on one issue or problem facing me at that moment, but my mind will eventually digress into random thought and fleeting images. (I sometimes think about the movie "Wings of Desire" by Wim Wenders, wherein the angels listen in on people's thoughts and try to intercede, and I'm embarrassed by what they might hear in my head.) I also have a small shaker between the seats (it's a large clam shell filled with beads), and I shake it while singing or just thinking aloud. It's strangely comforting in an obsessive-compulsive kind of way.

All of this said, what I find is that I actually cannot listen to the radio anymore. NPR seems like a whole lot of noise and banter---"All Things Dithering"---and Amy Goodman's Democracy Now! seems like Left-Wing Major Depressive Disorder Without Prozac (I think Amy has lost her ability to smile). While I sometimes wish I could tune in to Car Talk or other shows of cultural significance, I've come to relish my silent car time and am hesitant to repair the radio and once again be tempted to fill the car with distracting noise. I truly don't miss the pattern of local news/corporate sponsors/weather/human interest stories/political malfeasance/depressing war stories/station identification that can fill one's commuting time. I get my news from commondreams.org, Google News and The Nation and leave it at that. Do I truly need those other voices in my head?

In order to make this radio-free car time more productive, I am tempted, however, to purchase a small digital voice recorder, which would allow me the freedom to record random thoughts and ideas for this blog, make mental notes about patients and things that I need to take care of, and otherwise make my time in the car more entertaining and interesting.

Any ideas or feedback on the subject would be most welcome, and although I don't recommend having one's car broken into in order to achieve it, car-radiolessness is a state worth exploring. If one cannot have silence in some aspect of one's life, the noise will eventually blend together into one vast hum of distraction. Silence anyone?

Thursday, February 17, 2005

There But For The Grace of God.....

As I went about my day today, visiting patients in the hospital, talking on the phone with a crying client, sitting in a patient's home as we discussed her recent hospitalization and current treatment for complications related to advanced AIDS, I was struck by the relative blessing of my own physical health. With comparatively minor problems of low back pain, depression, high cholesterol, a hiatal hernia and acid reflux disease, I am healthy and in no way compromised in my ability to live life and pursue my dreams. Having spent no more than seven days of my life in a hospital over the last forty years, I'm blessed with relative health, intelligence, priviledge, and assets of many kinds. I may feel sorry for myself from time to time, cry into my beer and pray for a change of lifestyle and scenery, but I can count myself among the many who are not enslaved to the care of a chronically diseased and debilitated body which seems to betray one at every turn.

There are many times in my day when I can say, "There but for the grace of God go I", and today was yet another of those times when that phrase can save me from further morose and self-indulgent rumination. Once again, I am reminded of the blessings I hold in the palm of my hand, the ways in which I self-indulgently revel in my sorrows, and how I can choose to see my half-full glass as actually overflowing with abundance. It is a daily choice---in fact, it is a moment by moment choice---to embrace what one is given and see it as truly enough. "There but for the grace of God go I" is a reminder that life can turn on a dime, and one must seize what one has in the present, since the most fleeting of blessings can be lost in a flash, without warning. Self-indulgence is a choice, and one is well-served to allow its visits to be short and few and far between.

Wednesday, February 16, 2005

Work as Identity

In this culture, we all seem to define ourselves by our work. We meet someone at a party, and the ubiquitous first question is inevitably, "What do you do?" In response to said question, the vast majority of us reply by describing or defining what it is we do "for a living".

First of all, that expression---"for a living"---tells alot about us as a culture, does it not? This expression significantly defines our work as our "living", as much a part of who we are (or more so) than any other aspect of our lives. Isn't this cruel reductionism, minimizing our sense of self and its projection out into the world?

It would certainly be a radical departure to respond differently to this common question posed during small talk. When asked what we do, why do we hesitate to say that we take time to read to our children; play with our dogs; love our spouse; cook for pleasure; listen to birds as we drink our morning tea?

At our couple's retreat last weekend, many people asked me "what I do" during meals and other non-workshop times. I always responded by describing my work as a nurse in a poor Latino neighborhood in the inner city. I realized over the course of the weekend that my identity within the group---other than being "Mary's husband"---also included being "the male nurse". I also realize that within the context of this blog, my identity greatly centers on my professional persona. This "nurse-ness", as it were, to a large extent delineates my self-identity, and I must venture to guess also defines a large extent of my self-worth.

The rhetorical questions to ask here are many: Is this healthy? Is this productive? Is this normal? If so, should it be? What are we missing when we limit our self-definition?

I cried tonight after dinner---the tears flowed as the feeling of being overwhelmed with responsibilities crashed down upon me......Does my over-identification with my work place such demands on my psyche that its burdens carry through into my home-life? The answer is obviously yes; this identification with work can often preclude the ability to leave such preoccupations at the office door. I shed my work clothes, place my bag by the door, set the Palm Pilot, beeper, cell-phone, pens, keys, and other detritus in their resting places. But the psychic shadows remain, and as I attempt to integrate into home and its welcoming warmth, the galloping neurons engaged during the day are hesitant to silence themselves.

It is a practice to disengage, a meditation and a skill. Now, as I prepare for sleep, midnight approaching, I try to shed those tangles of thought, and allow my tired brain some reflective time in the dream-world, where some of that psychic static can be recycled and refined. I will emerge on the other side in the morning, and I hold out the hope that this seven hours of respite can assuage my troubled mind.

Tuesday, February 15, 2005

Mexican Time/Gringo Time

Amidst the busy-ness of daily life, we received an inspiring and impressive email from our friend Dagen, who is currently in Mexico, having successfully created a life in which he is living three to six months of the year here in New England and the remainder in Central Mexico. As the house which he purchased is repaired, the land reinforced, terraced, and walled with stone, Dagen has realized that the pace of the culture is seeping into his bones. He writes:

"The most obvious change that has occurred in my perception of reality here has been my conception of time. I noticed it when I was in the colorful public market standing in line for some roast chicken. By the time I got to the head of the line, an hour had passed by and I hadn't even noticed it fly by. And all I was doing was standing and watching. This is new for me. And since that day I have been far away from the demands of the clock. It is a new practice for me to allow whole pieces of a day to breeze by with nothing to account for other than a readiness for the next adventure. When I have no appointments I live by the time of the sun - morning, mid-day, evening, night. I am finally learning to 'allow' my day to unfold instead of measuring it by my output of productivity. I still get things done but now they seem to get done on their own, in their own time. Instead of doing, I am letting doing be done."

For me, this epistle sums up what I feel is missing in my lifestyle. It isn't just time, it's the notion that one can choose to lessen one's awareness of time. I spend so much of my day intently tuned into the clock and roped into the vicissitudes of following its dictates. I long for a lifestyle in which the clock doesn't rule my every action and thought. Everything I do from Monday until Friday is ruled by the clock's domineering hands. It may seem idealistic to overcome this most modern of afflictions, but I know that it's possible, however it seems wholly impossible in the current chapter of my life. Dagen continues:

"I give thanks daily for being in a world where I admire the people and am captivated by the culture. But I have forsaken something in this transition and I feel afloat in a universe of new and unknown possibilities. I no longer have that sense of building a life or a career. I no longer look forward for more than a day or two. I no longer make my goals my taskmaster. Something new is happening to me here and I can't quite pin it down. I miss my compulsive, frantic quest for career success that has been my ally for so much of my life; but on second thought, thanks for the memories! I'm ready for all of this, I know good things are coming, I believe in my dreams, it's just hard being between two realities, on my own. Writing this dispatch is a way for me to connect with 200+ friends and acquaintances, giving me a semblance of connection."

I wrote Dagen that I'm so pleased for him, and can truly see what he's doing as a model for others wishing to do the same. I also feel concern for how it will be for him when he continues to return to the US to earn some money, and the inevitable culture shock returning to the States can surely bring. In response to my concerns, he added:

"I am very curious myself about my return trip this time. Either things will work for me or I am ready this time to move down here full time......I might need to use you as a compassionate ear to help me figure this one out."

My ear is ready to listen to the tribulations of our friend as he engages fully in being a person living in two cultures, two distinct realities. For someone as creative and open-hearted as Dagen, I imagine he'll find the right balance.

Carlos Fuentes wrote in A New Time for Mexico (1996): "The Mexican manana does not mean putting things off till the morrow. It means not letting the future intrude on the sacred completeness of today. There is nothing more distant, I agree, from the Anglo-Saxon sense of expediency---and nothing more attractive, either, to the Anglo-Saxon rebel."

Can this Anglo-Saxon rebel---and others like him---find the path to such a way of being? Mired in the trappings of North American life and all it demands, this is highly unlikely, lest one rid oneself of desire for material comforts to which we are all more or less addicted.

For myself, as Mary just reminded me as she drifts off to sleep beside me, each day is a gift, for better or for worse. It's your life---you choose, blessing or curse. The modern curse is the slicing of the day's pie into 24 segments to which we're tethered. How we use those hours is the measure of our ability to confront time and its limitations with joy and wonder.

Monday, February 14, 2005

That Monday Feeling

That Monday feeling has returned, despite the sweetness of arriving home and celebrating Valentine's Day. We are both unfortunately "back at it", each buried in our laptops, wishing there was a way to forgo these tasks and bask in the afterglow of the weekend retreat. Nonetheless, the connection and intimacy of the weekend pervades, and it is a blessing that we are both occupied. There's nothing worse than one partner feeling abandoned when the other is preoccupied with responsibilities and tasks which preclude connection and thoughtful interaction.

Where is the time to sit under the stars and drink tea, ruminating with one's lover over the direction of the evening breeze and the sounds of birds? Why is it so hard to find the hours for quiet contemplation and repose? Why do we create lives in which leisure is at a premium and work becomes our focus, our raison d'etre?

These lives are of our making, and it is our choice to unmake what we have wrought. Change is always a choice---so is stagnation. We must always remember that "this is it". There is no other now, no other time. This moment is all we have. That longed-for future never comes. This really is it.

I choose in this moment to embrace the fulness, the busy-ness, the richness. Without that act of embracing, the moment is lost. How can I choose to lose out on the only moment I truly have?

Sunday, February 13, 2005

Valentine Eve

We have just returned from a refreshing couple's weekend retreat at Rowe Conference Center in Rowe, MA. Fourteen couples varying in age from late 20's to late 70's, and two leaders who have been married for 35 years, helping hundreds of couples in their work as therapists. Despite the hectic nature of our full lives, replete with responsibilities, deadlines, and countless errands and chores, this time of retreat and reflection was most needed.

We spent a blessed 48 hours without computers, cars, money, stores, dogs, household chores, bills, or telephones, and concentrated on the most basic unit of inquiry---ourselves in relation to one another. We come home with new tools of reflection and communication, and a renewed sense of who we are as a couple and where we would like to go, figuratively speaking.

On this eve of a holiday ostensibly and allegedly created by corporations, we honor the underlying spirit of love and commitment that binds us together now for more than 15 years. Marriage as a spiritual practice could sum up the notion that I come away with most clearly this evening as I hesitantly integrate back into daily life.

Tuesday, February 08, 2005

Monday, February 07, 2005

Sketches of a Monday

I hit the ground sprinting this morning. Everyone seemed to be racing today. Skid-marks on the carpet. Chaos is a frequent visitor to our over-crowded office and today was no exception. Let me illustrate:

Patient #1: Advanced AIDS, now on meds and doing OK. Almost died from liver failure last time she tried antiretrovirals (AIDS meds) due to her poor liver status from Hepatitis C infection. She has new-onset mental status changes and may be failing the prophylactic regimen we have been treating her with to prevent toxoplasmosis (a brain infection), a full bout of which she had last year before she started her new AIDS regimen. The visiting nurse calls to tell me that she seems worse today and I plan to pay her a home visit in the afternoon. I worried about her all weekend.

Patient #2: severe depression with psychotic features, anxiety disorder, hypothyroidism, osteoporosis, asthma. Originally from South America. I've worked intensely with her over the last 12 months to help her apply for citizenship. I successfully found someone to take her to Boston two weeks ago for her interview with the Feds and we had the citizenship exam waived due to her psychiatric disability---not a small feat. She passed her interview with flying colors and will be ceremoniously made a US citizen at the Hynes Convention Center in Boston on Wednesday. I take time today to search the web for bus schedules and call a few taxi companies in Boston to get an idea what it will cost her to take a taxi to the convention center from South Station. She calls me: she isn't sleeping at all and wants sleeping pills. I have to speak with her primary doc who called out sick today. Hasta manana, OK?

Patient #3: Brittle diabetic with poor control of his disease, Hepatitis C. Lives in a motel with his 22-year-old son. They are both IV drug users but my patient has been clean for a few weeks and is trying to get it together. His son shoots up in front of him which is a big "trigger" for him. Patient never showed for our follow-up office visit last week, and while I'm at another patient's house, I receive a page that he's at the office waiting for me. I call the office and tell them to send him packing. He needs to make an appointment. No kid gloves for him.

Patient #4: forty-year-old male with AIDS (fully controlled with meds for four years), Hepatitis C (treatment for which he failed), narcolepsy, uncontrolled hypertension, depression, and a history of IV drug use (for which he's on methadone maintenance). He's been showing signs of mental deterioration over the last year. Neuropsychiatric testing shows major deficits. We treated him inpatient in 2004 for presumed neurosyphilis but now the symptoms are back. I visit him at home--he breaks down crying as we sit on his bed, his wife standing to my right, Planet of the Apes on the TV. He's having suicidal thoughts and thoughts of harming others. He doesn't feel at risk of doing anything but I give them the number for Psych Crisis, just in case. I make a note to discuss his case during our HIV Provider Meeting this afternoon at 4, if I can make it back in time to the clinic.

Patient #5: I spend 90 minutes in the depressing home of a new patient, meeting for the first time. Arthritis, severe osteoporosis with multiple fractures of various bones, bilateral cataracts, emphysema (and still smoking 1 pack per day!), coronary artery disease, angina,pernicious anemia, a metal plate screwed into his broken hip last fall. Not a happy camper. Where do I begin?

Patient #6: African-American female who has come and gone from our program several times. History of IV drug abuse, violence, incarceration for assault and battery, young son with sickle cell disease, lost one of two twins while pregnant last year, the surviving baby doing OK and sickle-cell free. Patient has severe COPD (emphysema), still smokes, suffers from crushing migraines, and has severe depression and a relatively chaotic life complicated by parole. Her head feels like it's going to explode. I manage to find her an appointment for tomorrow. Just hold on and go to the ER if you can't make it through the night......

Patient #7: dry alcoholic with anxiety disorder and recent deep vein thrombosis (DVT--a huge clot in his leg from his ankle to his thigh). Couldn't walk for three weeks and never called me. If a piece of the clot had broken off (common occurrence), it would've traveled to his lungs and killed him instantly. He's now on blood thinners but can't keep up with the instructions, blood draws, and dose changes. Hasn't taken any Coumadin for five days. Can I scream now?

There's so much more, but you get the picture. The constant headaches, no-shows to appointments (a HUGE problem!), complicated lives, dysfunctional families (they've taken the "fun" out of dysfunctional), drug abuse, poverty, Medicaid fraud, inability to understand and process instructions correctly, you name it.

Do I love my work? Yes. Do I feel that I change people's lives for the better? Yes, often. Do I sometimes feel like I can't take it anymore? Absolutely. This is a Monday where I question my resolve to continue but know that I will. My spirit still keeps me in the moment and I shoulder the responsibility and continue on. I sometimes pine to be a nurse in a small town doctor's office, swabbing throats and taking the blood pressure of arthritic Jewish matrons. Is that in my future? I doubt it. Thriving on Chaos is not just the name of a book.

Sunday, February 06, 2005

The Bikram Challenge

This morning I was invited to join two of my dear friends at a Bikram Yoga class in a nearby town about 15 minutes from my home. For anyone not familiar with Bikram Yoga, it is a fairly regimented form of Hatha Yoga practiced in a room heated to approximately 100 to 105 degrees Fahrenheit (about 37 to 40 degrees Celsius for my European and Canadian readers)! Bikram is supposed to be taught in the same way wherever anyone offers Bikram classes: hot temperatures; lights only turned down at the beginning and end, otherwise a fully lit room throughout the class; and a standard sequence of poses that does not change from class to class. Eyes remain softly open throughout the 90 minutes, even when in a resting state. Within that structure, it's said that a freedom develops to look deeper into oneself and one's practice as it continues along the continuum created by the highly structured and seemingly repetitive method of teaching and practicing.

I honestly felt very challenged by the class, both physically and mentally. The heat in the crowded room was intense; within fifteen minutes I was drenched with sweat, as was the towel covering my sticky yoga mat. Luckily, I had heeded my friends' advice and refrained from eating this morning, having only my Chinese herbs in hot water with honey and milk, and a tall glass of cool water after that. Having once been a Kripalu Yoga teacher (sometimes nicknamed "Cripple-You" Yoga by its detractors), I had an idea what to expect, but have not regularly practiced yoga or attended classes in many years. Yoga tends to be more something that I do in the name of stretching before exercise, rather than a mental/physical discipline in and of itself. That said, the experience was uplifting, exhausting, exhilirating, and challenging. Taking my leave of the studio, I felt light (not light-headed, though!), lubricated (both mentally and physically), and fully awake. While I generally like to sleep late on Sundays, I felt no qualms about having gotten out of bed today for this experience. I feel lucky that I've been getting alot of cardiovascular exercise on an ellipitical cross-trainer these last four weeks, that preparation making it easier for me to have the stamina to make it through the my first Bikram experience with only two or three poses where I opted to rest and catch my breath.

Although Bikram may not become a regular part of my weekly routine for several reasons (one being timing of classes and time itself), I am very grateful for my friend who offered me this very singular experience of my body. The heat was a welcome intensity, and the physical challenge opened not only my joints and connective tissue, but my mind and emotional body as well.

Now for an afternoon of taking in the near-50-degree (10 Celsius) sunny warmth which bathes the land today. Mary returns from a weekend conference in a few hours and I'll share my impressions of the morning with her as I listen to her account of her own interesting and thought-provoking weekend away at Rowe Conference Center in Rowe, Massachusetts (http://www.rowecenter.org).

The dogs await the moment when I put on my shoes and say the magic words. Their waiting is almost over......

Saturday, February 05, 2005

The Saga of Patient X (cont'd)

For those of you who've been following the story of "X", my patient with alcoholic hepatitis, this is an update, of sorts. For those new to this site, you may wish to refer to several earlier posts, namely "Exhaustion" and "Recovery".

Last Monday morning, I paid a visit to X, who was, as I surmised he would be, hanging out at the bar which is his ersatz home, as it were, apart from his apartment which I've yet had the opportunity to visit. That said, I must say that he actually works at said bar and hall---cleaning, organizing, washing dishes, and otherwise pitching in for a small wage. It keeps him busy, off the streets, and allows him to earn a little cash which Social Security (SSDI) doesn't need to know about.

X greeted me warmly and eagerly, almost like a sheepish dog. He actually looked relatively well, his psoriasis less angry, his eyes less jaundiced. X swore that he's drinking only non-alcoholic beer (a step in the right direction, at least), eating well (apparently a chef's salad the day before), and drinking plenty of water. A cursory physical exam did indeed bear out the fact that the swelling of his legs is decreased and his blood pressure improved. The most worrisome factor now is a growing paranoia and anxiety which, thankfully, he's able to reconize and verbalize, adding that he's now eager to re-enter psychotherapy. I recommended decreasing his coffee intake from 8 or 10 cups a day to a mere two or three in the morning, in an attempt to decrease his anxiety and improve the quality of his sleep. While actions speak louder than words and many an eager patient will "yes" the well-meaning clinician to death, perhaps a renewed therapeutic relationship might solidify his tenuous and newly-found recovery, and break the pattern of poor habits which only serve to exacerbate his poor health, both physically and mentally. I take these signs at face value, and remind myself that even seven days free of alcohol is a gift that X is giving to himself. Stay tuned.

Another patient of mine who we will call "Y" had been in complete recovery, with fully suppressed HIV disease, excellent adherence to his meds, and a graduation last summer from an 18-month residential stay in a facility for Latino men with substance abuse issues. Having failed Hepatitis C treatment due to falling blood counts, Y still had shown great promise and was a model patient, quitting smoking and really cleaning up his act. After living in a lovely sober house for HIV+ men in recovery, Y disappeared last fall, ostensibly returning to Puerto Rico to see his family. He resurfaced two weeks ago, calling me on our office's 888 number from Puerto Rico, alerting me that he'd be back in town within two days. During a brief visit in the office several days later, I ascertained that he had stopped all of his meds and didn't currently have a place to live. I actually drove him to the bus station after our visit (a general no-no in my office these days), and he was planning to catch the next bus to a town 40 minutes to the east to stay with a cousin. Promising to return in two days for a clinic visit with a doctor, we parted with a hearty handshake.

Several weeks passed after he missed that appointment, and just this past Friday I received a call from a residential substance abuse treatment center in a city two hours from here, informing me that he's now residing at their facility. I requested a signed consent be faxed to me so that our two agencies could openly discuss his case, and having received that paperwork, am expecting a return telephone call soon to advance the discussion and learn the details of Y's current state.

These bumps in the road are just that---bumps---with the added caveat that for a person living with untreated AIDS and chronic Hepatitis C, recidivism back to drug use and avoidance of medical care can be exponentially harmful and worrisome. Nonetheless, when and if Y returns to my care, I'll plan to meet him where he's at, begin afresh, and walk the road with him, if he's willing to do so. Meanwhile, dozens of other greasy wheels beg for attention, and there's no shortage of needy patients for this nurse. Monday will open that office door once again, and I will surely hit the ground running, my plate fuller than it should be even before I sit back down at that cluttered desk, already littered with the flotsam and jetsam of last week's unfinished tasks. Oh my.

Friday, February 04, 2005

Satisfaction

We are newly arrived home from the pleasurable experience of taking my son Rene to a concert. The California Guitar trio (http://www.cgtrio.com) performed a perfect set of progressive instrumental music, accompanied by Tony Levin (of Peter Gabriel and King Crimson) on bass, and Pat Mastelotto (of King Crimson) on drums. Their masterful chops, obvious enjoyment of their craft, and clear sense of humor all combined to create a feeling of watching a group of magnificantly talented musicians truly enjoy the art of making music for us. It was an intimate show, with a palpable mutual positive regard between performers and audience. To paraphrase Robert Fripp, recorded music is a love letter, but a live performance can truly be a hot date when the energy is right! The energy certainly was right last night, and we bathed in the music as heavy snow floated down on the fair city.

Warming up for the band was a slight, energetic young woman who played the theramin, an electronic instrument invented in the 1920's, I believe. It's the only instrument played without actually touching it, the hands actually waving gently in the air to alter the electrical current flowing between the antennae. The "wavy" sound on The Beach Boys' famous "Good Vibrations" was made by a theramin, as were many spooky sound effects on early television shows like Lost in Space. As I remarked to Rene during her set, it was as if she was playing an energy field, which in fact she was. (My extreme talent for stating the obvious shining through, as usual.)

The CGT plays in a vast array of styles without being obviously derivative, their chops giving them an ability to satirically perform exact note-for-note covers of songs like Queen's "Bohemian Rhapsody", the quality of playing highlighting the fact that, for a person not familiar with the original song, it would justifiably come across as a technically perfect and entertaining musical composition. While their original music conveys little in the way of detectable angst, it has a subtlety and controlled power that keeps it from ever seeming trite, although it's often lighthearted, but never without heart. I highly recommend checking them out live or on their recordings. They're truly talented and kind individuals who love what they do and seem to go out of their way to express their appreciation to their audiences.

Seeing Rene was a true pleasure, and Mary had the opportunity to spend time with her cousin while Rene and I had our father and son date. The city treated us well, and we arrive home at the end of a Friday taken off from work in pursuit of pleasure. We now enter the weekend with our individual loads of homework to tackle, Mary for her current entrepreneurial training, and me for my community college teaching post, a fifty question exam waiting to be created for my anxious students.

I have more to share in this venue, but will keep it close to my chest until the next inspiration for writing sparks my mind.

May this day bring you peace.

Tuesday, February 01, 2005

Midnight missive

It's going on midnight at the end of a long day. Every Tuesday finds me working my day-job, then commuting over to the community college to teach a class to LPN (Licensed Practical Nurse) students, away from home over 12 hours. Being only my second semester as a teacher, I'm still trying to find that correct balance between mind-numbing didactic lecture and somewhat-less-mind-numbing non-lecture activity. With reams of detailed information to cover, and a class of 25 tired adult students who also work and have personal lives and children to care for (several of my students work 11pm to 7pm after attending my 4pm to 10pm class!), I am hard pressed to keep it interesting and varied enough to hold their attention and make learning at least somewhat enjoyable, or at least not painful.

Tonight, I chose to spend 40 minutes reading aloud to the class from Sherwin Nuland's The Wisdom of the Body, the chosen chapter being a compelling story of a woman's brush with death from internal bleeding and a surgeon's heroic attempt to (successfully) save her life. The author writes so well--my students were on the edges of their collective seats and were the quietest and most attentive that they've ever been!

Overall, the class went well, and I end a long day in front of the fire with Mary and the dogs; Tina, the small grey canine snores at my feet, as she so often does. As the fire in the woodstove burns itself out, I prepare to retire to the warm bed and bid another day well-lived.

No regrets today. My work is done, it was done well, and I can sleep a tired but satisfied slumber. It's cold, the day was long, my brain is fried, but this is the current path of choice, and I embrace it today in its entirety. Life is for living, after all.