Friday, April 29, 2005

Hiatus Interruptus

A short work-week sure seemed to last an eternity, but here I am on Friday night, home from work and back on-line.

With my Jewish "fro" making a comeback, I just had my locks trimmed and must have lost an extra 1/4 pound which lay scattered about the stylist's chair. I love the luxury of having someone else wash my hair, although I don't find those hair-washing sinks with the little indentation for one's head terribly comfortable. I also hate staring at myself in the mirror as my hair is cut--as the scissors do their thing, my face always seems about three feet wide at the cheekbones. Nonetheless, the deed is done, I am sufficiently "cleaned up" as they say, and Mary will mourn the (temporary) loss of so many unruly curls for a day or so. Perhaps when we're living on a small plot of land with goats and dogs and a garden and I have eschewed the professional workaday world, I'll once again let my hair do its natural thing and wind up with natty dreads and a rabbi's beard. Til then, it's trim time every six or seven weeks like clockwork.

The week saw some substantially morose moods, a few good headaches, some lost sleep, some sweet moments with Mary, and thoughts turning towards some kind of change in my work situation. What I most greatly resent about working in this country is that one must often make choices about work based upon "benefits". Now I'm not talking about that new terminology of "friends with benefits". I refer to that ubiquitous and long-standing pursuit of healthcare coverage by a workplace which many of us so dearly covet. If it were not for the necessity of employer-sponsored health insurance, I would most certainly make a choice to pursue several per diem or part-time positions rather than my current 40-hour weekly slog. If we lived in a country intelligent enough to have universal single-payer healthcare, I could work per diem for my current employer, teach another class, and perhaps do some hours for a visiting nurse agency, commanding very high hourly pay, at that. But the health insurance trap currently keeps me where I am to a large degree. Why must one choose one's work situation based on a need for healthcare? It's categorically absurd and so very "Old World". At any rate, here we are, and I continue in the current mode for the moment, poised for a new adventure when the wheels turn.....

Last night, we made the choice to stay out late and see the new Nicole Kidman/Sean Penn film, "The Interpreter". Not bad Hollywood fare: moderate violence, United Nations intrigue, twisty plot turns which I failed to completely follow, and commendable performances from the two stars, although Sean Penn seems to just play the same character over and over again. Overall, a worthwhile venture, taking into consideration a lost hour of sleep on a work night.

Anyway, I digress. The week draws to a close and another dusk descends. Good night to all.

Monday, April 25, 2005

Mental Health Day

Today is a planned mental health day. With prompting from my ever-loving partner, I requested this day off a week ago, planning to rest and recreate as a novel way to start the work week. It is a welcome balm.

This morning I try not to think about my patients but I will take a few moments to exorcise a few from my mind.

First, there's Q, a white middle-aged man with AIDS and a penchant for heroin, alcohol, and cocaine. Just last week, he left the hospital AMA (against medical advice) after a bout of pancreatitis, not to mention a large stone which is still lodged in his ureter (the tube from the kidney to the bladder). He had left a straw and white powder in the bathroom the day before, leading us to suspect illicit cocaine abuse. I wonder where he is now, and will wait for him to find me when he needs to be rescued.

Next there's my 350+ lbs Latina woman with severe asthma. I did my best to have her transferred from the hospital to a rehab facility, something I hope and pray happened over the weekend.

I also think about my wonderful 70-year-old woman with AIDS, diabetes, COPD, asthma, and schizophrenia. I worry for her health which is somewhat compromised at the moment. You ask me how she could NOT be compromised? I answer that, over all, she is amazingly healthy, believe it or not. However, I think she may be entering a final phase, but how many years she has left is up to the goddess.

Finally, there's my sweet gentle giant of a patient with AIDS and a new-onset dementia that we cnanot understand, not to mention new-onset diabetes which just will not come under control. The visiting nurse who sees him calls me daily with updates and we pray for things to resolve themselves. Time will tell, but I sense his days may be numbered. Then again, mine are numbered too, but I hope to have a bunch more numbers to go.......

Now that I've cleared my nurse's brain of a few worries, I can move on to the rest of my day. Unfortunately, at least 2 hours of that day will involve study and note-taking for tomorrow night's lecture on the urinary and reproductive systems. I just can't seem to escape nursing, even on a day off from it.

The sun is out, the dogs wait (somewhat) patiently for a walk, and my stomach rumbles. Thanks for reading, for tolerating my self-indulgence, and may your day be filled with grace.

Sunday, April 24, 2005

Limitation versus Stimulation

This afternoon, after some yard-work and other household chores, we packed the dogs in the car and went to Amherst to join in the Earth Day festivities on the lovely "town green" where so many festivals and events occur from early spring until late fall. We heard live music, saw friends, the dogs sniffed and did dog-like things with other four-leggeds, and we signed petitions at the Amnesty International table.

An hour later, attempting to order a burrito at a local Mexican place, I was hit by that powerful feeling of overstimulation that I often experience, coupled with a lowering blood sugar that clouds my ability to think clearly. When this occurs, I become thoroughly unfocused and ungrounded, irritated by the slightest sounds, overwhelmed by most all sensory stimuli. Some of you may be familiar with such feelings, to others it may seem entirely foreign.

Such is my lot, wherein my circuits are easily overwhelmed, brain turns to mush, and I must retreat quickly to a relatively unstimulating environment. Whether this is related to endogenous depression or is a separate condition akin to anxiety, I cannot readily say. I just realize that I have several personal limitations which impact my enjoyment of life, as well as Mary's enjoyment of life at my side. These "disablities", while not visible, effect my daily life and function capacity in the world, and it is my yoke which I carry.

Thinking back on my life in Philadephia as a young adult, it becomes clearer why I so often felt overwhelmed and stultified. At the time, I must have been in a state of near-constant sensory overload----traffic, car horns, noises, vehicles, all of the noise pollution of modern city life. You may laugh, but I experience complete overload in our small town of 20,000, a bucolic and relatively quiet college town in Western Massachusetts. As much as I love New York City and have spent much time there, I find myself avoiding making plans to visit several friends there, mostly out of a feeling of dread related to facing the onslaught of sound and visual stimuli which awaits me. While I occasionally can thrive and flly enjoy myself in such environs, I am most determined to spend the majority of my time in the quiet retreat of nature, or at least my own home, my favorite retreat.

I now think of the nature of my work which involves a busy, windowless office with ten people constantly moving, phones ringing, pagers going off, cell phones playing irritating ditties, intercoms sounding announcements. I am frequently at my desk, a cell phone in one ear and my desk phone in the other. I interact with doctors, patients, co-workers, others. How do I cope? How do I get through the day? What toll is this taking on my psyche, vis-a-vis the limitations which I described above?

Post-modern life is a maelstrom of input, connectivity, interaction, stimulation, information. Where does it end? How does one escape? At what point does one say "Enough!"? When do one's limitations actually dictate one's lifestyle, or do we simply allow our limitations to be pushed to their breaking point? These are questions worth pondering.

Saturday, April 23, 2005

Off the Map

We just returned from seeing a very moving new film , "Off the Map". This is not a film review, so I won't try to summarize the plot, the characters, or even the tone of the film. What I am moved to say is that within the film lies a very rich and realistic portrayal of male depression---the pained silence, the unspoken torture, the disassociative mannerisms, the curtailed ability to verbalize feelings, and the almost unbearable suffering and helplessness of those standing by, unable to make a dent in the armor which keeps all suitors at bay.

While the character and his depression reminded me deeply of a close friend's current struggle, it also brought to mind my own torturous path, and the frustration I know that Mary has experienced during some of my more trying episodes. It is so easy to relate to that sense that there is no definitive answer to the question, "Why do you feel sad?" For many men, we have spent so much of our lives running from (or burying) our feelings, that actually verbalizing what's at the heart of our emotional state is a Herculean task. It is often difficult for the uninitiated to grasp that depression is a disease and not a character flaw, although it is easy to judge---even for me---others who seem unable or unwilling to help themselves.

That said, as someone who has struggled---"battled" might be a better word---with the ogre of depression for decades, I know that seeking treatment and doing the work at hand to overcome the overwhelming entropy which depression elicits is essentially a life's work. For some, a situational problem can resolve over time and the melancholia---or true depression---may pass and leave nary a trace. For others, myself included, it is a daily task to scan the self for signs, read the emotional landscape for hints, track one's moods, and continually self-monitor for those signals that things are not quite right. In my world, there are triggers, sure signs, and red flags which warn me that foul emotional weather is afoot. Perhaps I need to map these signals, track them and categorize them, in order to share them with other men (and women) who might find an ersatz roadmap helpful.

Tonight, the rain slaps against the side of the house. Tina the dog begins to snore in her endearing way. Sparkey is at the foot of the bed, apparently grateful that we have finally settled down, but will probably feel better when I've turned out the light and begun my own sleep-induced breathing pattern. Mary drifts off next to me, the rain persisting in its soaking dance. I suddenly remember a scene from M*A*S*H, where Alan Alda's character, Hawkeye Pierce, has gone temporarily blind and realizes for the first time that the sound of the rain against the roof can sound like bacon frying in the pan on a Sunday morning.

It is notions like these, and the appreciation of simple things like the warmth of the body next to you and the sound of rain, which can be blunted, perhaps even obliterated, by the grip of depression. For me, a fog---a fine film or haze---descends, and the world is seen through this filter which can powerfully block out the sun, subdue color, thwart the powers and pleasures of the senses, and dull the mind. Learning becomes painful, conversation is an enormous effort. Smiling becomes an affront to the muscles of your face which feel as if they are made from unmalleable materials incapable of expression. I honestly sometimes feel that it could take over if I allowed my vigilance to slack for more than a few days. I must be forever on guard.

Tom Waits once sang of "An Emotional Weather Report" some years ago. When I feel my barometric pressure rising and a storm on the horizon, I know the signs and the measures to take in order to guard the gates and ready the defenses. For those too caught up in the storm, rather than being a swipe of the serpent's tail, it can seem more like being in the belly of the beast when the gloaming descends.

Some people are blessed by unknown chemical or emotional underpinnings which preclude their ever having to know these struggles, and to them I say count your blessings each day. To those who share my curse, it's one which we must bear with compassion for ourselves and others, and the ability to speak even when the speaking is unbearably difficult. Our loved ones deserve to be included, and to them we owe our thanks for sticking by us as we delve into the darkness. "Off the Map" (bet you never thought I'd get back to the film, did you?) demonstrates clearly the systemic struggle wrought by depression, and the redemption that is born of fighting the battle with humility and compassionate strength, not to mention the loving and stalwart support of the family members who bear witness to the afflicted person's pain.

Mary has stood by me all these years, and for this I give thanks. To those who helplessly watch their loved ones flounder, I send strength as well as the realistic reminder that some people are not able to make that leap to recovery, and one must decide for oneself if you can continue to stick by the side of someone unable to grasp the hand which you continue to offer. If your loved one will not jump into the lifeboat, sometimes you must let go and allow them to find their own landing.

In the end, healing truly is an individual act, and we must remember to care for ourselves as well as others. This most post-modern of afflictions seems to affect more and more people as the world speeds up and its demands on the individual only grow. Depression is a monster, and so many wrestle each day. I count myself among those afflicted, but I also offer hope that it is controllable and can be overcome with concentrated effort and attention. There is so much to be grateful for, so much life to live. Each day is yet another opportunity to eschew the pain and embrace the challenge. Which map we use is up to us, or we can leave the maps behind and forge our own way. Whichever route we take, there we are.

Thursday, April 21, 2005


An energetic ebb has been reached, and I hope it goes no deeper. A profound fatigue has swept into my life this week, with an after-work nap each evening and a sense that there just are not enough hours available for sleep. Is it the change in season? Is it stress? Am I simply tired? A mild depression accompanies the lowered energy levels---a symptomatic comorbidity, as we might say in the business. The business of medicine, that is.

My mind is filled with thoughts of patients, things to do, and work for next week's lecture and exam that must be done. Mary and I escaped the house for an hour tonight to walk around town with the dogs and stop into a local cafe to hear some old-time Americana music played by an interesting ad-hoc group of local musicians, most seemingly in their 20's. Banjo, guitar, lots of fiddlers and vocals with a fake twang. We also enjoyed decaf and a cream-puff. Sugar cravings run deep these days.....

May your days be bright.

Wednesday, April 20, 2005

I'm Being Tested

Taking into consideration the post which I wrote last night, it seems that I was being tested today. Examples:

*My 70-year-old patient with AIDS, diabetes and a host of other chronic conditions was recently in the hospital for an asthma exacerbation. While there, it was discovered that she has a mass in her chest which is pressing on her trachea and a pericardial effusion (fluid collected in the sac around her heart). Against difficult odds, I landed her a follow-up visit with a doctor at the clinic this morning. Of course, twenty minutes after the appointment time, her granddaughter calls to say that they can't make it to the appointment, but A. was feeling worse this morning. Maybe next week, she asks? My reply: maybe next week at her funeral (I said this silently, of course). I'll get another appointment for Friday if I'm lucky...

*A patient with untreated Hepatitis C and chronic pain that we treat with huge doses of methadone had been unable to move her bowels for more than a week and I feared an obstruction. We prescribed magnesium citrate and Fleet's enemas. She didn't return my calls for more than a week, and today called me an hour after her scheduled appointment with her doctor to ask if I could reshedule as she wasn't feeling well. It seems she had taken a laxative and was afraid to get on the bus since she felt like she was about to explode. She says she "forgot" that she had an appointment. (This next part is not for the squeamish) I explain that the pain in her belly and the liquid stool that she experiences could just be the watery part of the stool squeezing past the obstruction in her colon. She was not impressed.

*I visit a morbidly obese patient of mine (>350lbs!) in the hospital. She is so deconditioned and depressed (and agoraphobic) that she spends 20-22 hours of each day at home in her urine-soaked bed, surrounded by dust and detritus that only triggers further asthma attacks. I can't get her to clean her room, so I am trying to convince the local pulmonary rehab facilities to take her in for a few months of rehabilitation and specific care. They all say she's "inappropriate for their facility". So, we'll probably send her home to wallow in misery while chronic steroids weaken her bones.

*My colleague's patient needs dental work (as do all our patients). Medicaid no longer covers dental, and the one dental clinic in the area who accepts patients for free has made their free care application so difficult that most patients simply give up out of frustration. This particular patient made it through the hoops but needs transportation to his appointment. Medicaid won't pay for the van-ride to the appointment because dental isn't covered! They think they're saving money by denying poor people dental care, but they're happy to pay for ER visits when our patients have abscessed teeth and need Percocet for the pain. They also pay for the hospitalization once that infected tooth causes sepsis--infection of the blood. There's savings for you!

So many scenarios, too little time to describe them all in painful detail. What am I to do? Today's remedy was a few good bangs of the head against my desk. And a beer after work.

Tuesday, April 19, 2005

Human Stories

A forlorn and needy patient of mine surfaced at the clinic today, after failing to show for bloodwork and an appointment with me last week. Based upon his unannounced arrival and my busy day, I directed him to be triaged as a "walk-in" in the clinic. Later on, the Physician's Assistant who saw and treated him called me into the clinical area for a chat. The patient's primary provider, a Nurse Practitioner with whom I share several other patients, was also present for the conversation.

As I bemoaned my patient's dysunctional patterns and innate ability to fall apart then come crashing into the clinic asking me to save him from himself, the NP looked at me and said, "Keith, every patient here has a story. Unfortunately for you, the ones with the toughest stories are referred to you. Without them, you wouldn't have a job." The PA added, "And that's why you have the hardest job of us all."

I realized that they were right. These stories all add up: AIDS, hepatitis, trauma, incest, abuse, neglect, generational cycles of poverty, diabetes, poor nutrition, class warfare, violence, disenfranshisement, racism, illness upon illness, learned helplessness, substance abuse, homelessness or risk thereof, splintered families, mental illness, lack of education----but how do we calculate their effects? How do we draw the line between individual responsibility and societal/cultural dysfunction? Of course, we wish to hold individuals responsible for their actions. Clearly, people can learn to be responsible, come to appointments, adhere to medical recommendations, choose to step up to the plate. As a white, middle-class American, these are basic expectations and assumptions that I can make of myself and impose on others. I can also judge others by their inability to adhere to my concepts of responsible action. Also, as a human being, I have the right to be annoyed with my patients who fail to plan and take appropriate action, only to look to me as a source of rescue in their time of need.

The secret here is balance. Can I recover from my annoyance, rise above my frustration, and deliver compassionate, high-quality care? Can I see my patients' dysfunction as what it is---symptomatic of so many other visible and invisible factors---and continue to educate, cajole, and empathize? Can I release my guilt over my own judgements and grievances, giving way to that heart-centered place of witnessing the pain of others and working to assuage it as best I can?

My work challenges my ability do just that, and more. Admittedly, some patients are individuals who I avoid at most every turn. I cringe when dialing their number, knowing that I could be opening a Pandora's Box by inviting myself into their painful and dysfunctional world. There are others for whom my tasks are a joy, their communicativeness and ability to be proactive in their own interest inviting me to gladly join them in a symbiotic partnership. For those who actively help themselves and meet me half way, joining them on that road is easy, intuitive, a pleasure to be of service.

This rumination is just that---a rumination. Each day is another opportunity, and my all-too- human failings can often shine through as I attempt to tackle the next challenge. I remind myself that my own judgements are not necessarily negative, as long as I can acknowledge them for what they are, and then move beyond them. Some days are easier than others, and empathy can wax and wane, as can any emotion. I do this work because I love it, because I have something to give, and the self-knowledge which is born of it is worth its weight in gold. Each day I offer what I can, and then move on, hoping that each day's learning will inform my subsequent life experiences. At the end of this challenging day, I close the proverbial book and welcome the forgiving embrace of sleep.

Monday, April 18, 2005

Monday Yet Again

Another Monday. A headache has plagued me today despite a wonderful acupuncture treatment with my friend Karen--no reflection on her, seguro. It's a headache born of stress, I think. After such a nice weekend, it's a shame to start the week on the wrong foot, but this too shall pass. What's a hard-working nurse to do?

Do my readers tire of my Monday laments? Do they relate to the dread, that feeling of "monday ad nauseum"? Do they wish I would somehow overcome this post-weekend melancholia which descends so frequently? Advice and support (and criticisms) are welcome, dear Readers.

I'm sure a dose of Jon Stewart at 11:00 and a good night's sleep will help, not to mention this steaming mug of Chinese herbs that Mary just handed to me.

Forgive me my failings and complaints, my Job-like despairings. Jewishness rears its lamenting head at times like these. Deserved or not, it's unbecoming, but I decided that this blog is not about self-editing in the final analysis.

May this missive find you healthy and whole.

A tout a l'heure.

Saturday, April 16, 2005

The Serpent

I usually don't remember my dreams nor do I write about them if I do. However, I do frequently have that odd sensation of remembering the feeling from a dream days or weeks after it actually occurred. I always enjoy that otherworldly deja-vous that is often best left unverbalized and simply experienced internally and silently.

That said, I woke in the middle of the night with what Mary describes as an escalating and gut-wrenching scream. I know that the scream was in reaction to an enormous snake which was winding its way through the ventilation system of a large house where I was hanging out. My fellow blogger at Swamp Things ( already knows about my innate fear and loathing of the serpent citizens of the world, and their surfacing in my dreams is always a provocation of utmost terror.

Mary says that I need to develop the skill of "lucid dreaming", wherein I consciously face my fear during an actual dream, remain asleep, and confront the demon which is often in the form of a snake. Perhaps I will some day be able to swallow the instant scream that rises in my throat when the serpent rears his head, and actually ask him what message it is that I consistently miss due to my ever-present fear.

It's said that snakes represent change, with their slithery selves shedding skins and transforming anew each year. I am not afraid of change, but from an early age, snakes have evoked within me a primal fear which I have never been able to shake, whether it's a photograph in a magazine or a show on National Geographic. Although I love to swim in ponds and lakes, I much prefer rivers with running water and less chances of my least favorite members of the animal kingdom swimming about. I'm sure if I was ever a participant on Fear Factor, I would be assuredly faced with my worst nightmare a la Raiders of the Lost Ark. At any rate, give me a bloody and infected wound any day of the week and I will gamely clean and dress it. A new amputation? No hay problema. Suction a tracheostomy? Pas de probleme. Gangrene? Lay it on me. A colorful and beautiful snake, with excellent (biblical) references and a long heritage through the millennia? Pass me a bucket or an Ativan.

I welcome change in my life. I have transformed myself several times and will do so again, no doubt. For now, keep the serpents at bay, and I'll continue along my merry way.

Thursday, April 14, 2005

The Teacher as Learner

Internet connectivity problems at home have precluded posting since Monday's entry, not to mention astounding busy-ness on my part. That said, the week flows on towards its natural end tomorrow. Ah, the built-in entropy of the work-week.

After teaching on Tuesday night, I was struck by the fact that there is so much I need to learn in order to teach well. One might assume that, as a nurse with almost ten years of professional experience, I could expound on various topics with little preparation. Au contraire! As a "generalist" nurse with little specialty knowledge, there are some subjects about which I can talk quite knowledgeably, but there are many others which I have scant thought about nor dealt with directly during my tenure as a nurse. Home study, note-taking, and lecture prep are simply de rigeur these days, and I'll be admittedly relieved when the semester is over and I can rest my neurons a bit. Still, teaching is enervating and fun, and in the final analysis, I generally leave school tired but uplifted by my interactions with my students who often challenge my thinking with provocative questions, bringing their own unique visions of the world to class.

As a first-time professor, I'm relying on my students for feedback, and I try to read the energy in the class to determine whether I am hitting the mark or not during the course of a lecture. I also try to elicit verbal and written feedback but few have taken the initiative to offer constructive criticism. Last week, I was humbled when the class announced that I had been unanimously chosen to be the speaker at their graduation ceremony, and they waited on the edge of their seats until I would confirm my acceptance of such an honor, which I quickly did, of course. They may even hire my son as the graduation photographer (he will be a newly-minted professional photographer after his graduation on June 2nd).

Learning abounds, and it is often as teacher/professional/caregiver that we receive our most humbling and instructive lessons. Today I witnessed first-hand the enormous love and mutual respect between a mother and her thirteen-year-old son. They are both my patients, and we were meeting with the amazingly astute and gifted PhD-level psychologist with whom I work. I was first blown away by my colleague's counseling skills (she makes it look so easy!), and I was further enthralled by the sincerity of the mother's verbalized dedication as a parent of a troubled but lovable child. Thirdly, I was incredibly and wondrously struck by the slow but inexorable emotional opening demonstrated during the session by her son who is the only teenager on my caseload at this time. Something shifted during that session, and it was humbling and satisfying to be present for its unfolding.

Today I also learned some lessons from a married couple with AIDS---I think I've mentioned them before---who are both my patients. Her disease is much more well-controlled than his, but he has made some progress, only to regress when he decides independently to stop his meds for a few weeks from time to time. We spoke intently for thirty minutes or so and they were quite sincere in their gratitude and recognition that I am simply trying to assist them in making positive choices for themselves and their two small children. On the verge of tears, I assured them that I was not lecturing them, rather, I was simply communicating to them the gravity of their decisions and the potential repercussions which I could not promise to assuage if they chose to not follow the best medical advice available at this time. Our eye contact was intense, and the feeling of being together in that room---truly together as a team---was palpable.

Thursday evening presents itself as a deep breath, four fifths of the week behind me, the final push tomorrow. The struggle is to be in the present, and to glean from those daily interactions as much learning as can be squeezed from each morsel. I'm more successful some days more than others, but it's truly the only game in town.

Monday, April 11, 2005

Monday Morass

Another week begins, ad nauseum. I began the day with great verve and high spirits, which lasted throughout the majority of my time away from home. Fatigue played a part in the slow denouement of my day's energies. Unfortunately, cardiac lecture details and other school preparation consume my evening. Luckily, Mary has some work to do on the other laptop and we sit at the dining room table side by side, together in a busy and distracted way, but nonetheless together.

I can see why teachers feel so undervalued and underpaid. I can't count the hours of prep I've done since September. I try to look at it as learning for my own nursing practice, the reconnecting of long-fatigued neurons which don't readily recall this voluminous amount of pathophysiological information. I also look forward to teaching the same course next year with all of the lecture notes, overheads and exams ready to use with only a cursory review each week.

Ah, the hard-working life. Must make time for pleasure or a dull boy I will be.

Sunday, April 10, 2005

Sunday Musings

Another one of those absolutely perfect April days---just a repeat of yesterday, if not a little warmer. Still making use of my outdoor office, now working on a lecture about cardiac pacemakers and arrhythmias. Sitting in the sun while I study and take notes decreases the burdensomeness of the task at hand. The dogs don't seem to mind my typing, as long as perambulations punctuate the day in between their naps and quiet reveries on the pine-needle-strewn front lawn. My neighbors rake leaves and clean up their yards. I note the general "forest-floor" look of our front yard and resume my work.

As I write, Mary is on a train between DC and Massachusetts, returning home from her nephew/godson's First Holy Communion. As a sacreligious and pagan-leaning Jew, I told her I hope he enjoyed his first cracker, and wondered if they'd offered something to go with it---jam, perhaps? My father-in-law thought that was pretty funny, damn Jewish Yankee son-in-law....

Anyway, back to pacemakers and cardiovascular disease. May your heart be filled with joy, dear Reader.

Friday, April 08, 2005


Friday evening arrives. Mary is out of town and I spent the evening with friends at a political talk by Michael Parenti (, then some time in front of the fire with cups of tea, chocolate, and sweet cantaloupe. Tomorrow night, a Tsunami benefit concert and silent art auction.

The peepers are here, singing their hearts out in the nearby swamps and wetlands. It's no longer painful to walk the dogs, no cold stinging the face or tensing the shoulders. I am through with having to scrape ice from the inside of my windshield. Our Dutch bulbs purchased in the markets of Amsterdam are sprouting in the moist earth. Summer's bliss is only a breath away.

My personal and life-long struggles with depression are in the forefront of my mind tonight. In the depths of depressions past, even the coming of Spring was not enough to wake my mind from its torturous maze of confabulation and perceived pain. Sunny days could sometimes not penetrate the fog. The fact that I control my depression with antidepressants does not diminish for me the wonder that I am able to feel with Spring's emergence. While I may sometimes still feel blunted in my perceptions by what I perceive to be endogenous melancholy, I am able to rise above the mental blocks and embrace life more fully. Some might say that the "me" they see may not be the real me, since the real "me" is Keith minus Prozac. I say the Prozac allows the real "me" to be actualized and come into being, not a carefree and always sunny me, but simply a real and complex person who can live in this insane post-industrial world and survive, perhaps even thrive.

Some of us cannot function fully in this world without the safety net of pharmaceutical support. I am unabashedly one of those people and I feel no shame about it. Whether it be nature or nurture---and I can see both sides---living in this crowded, complex, noisy, polluted, and dangerous world is potentially maddening, and there are those of us who simply cannot abide the mess of it all. Give me a life in rural Mexico, 10 months of sun a year, no need to work or commute, a big organic garden, and no financial struggles of any kind, and perhaps I could make it without the benefit of antidepressants. Short of a perfect life (and what exactly is perfect, anyway?) without undue stressors, I am fully here, fully present, contributing to society, working, giving, playing, producing, loving, and attempting to touch as many people in as positive a way as I can before I die.

This chosen lifestyle involves relationships, marriage, parenting, a mortgage, cars, commuting, jobs, taxes, shopping, appliances, home maintenance, finances, debts---it is what it is, and here I am in the thick of it. It's messy, it's hard, it's a challenge, sometimes it sucks, but what else is there to do but burn through life like there's no tomorrow? And there isn't, anyway, right? It's here and now. Just like that prayer, "if I die before I wake.....". Let this day be an example of my life in the moment. Here.

Thursday, April 07, 2005


Thursday at 12:45pm. At my desk at work, taking a breather. No guilt for blogging at work as I haven't taken a lunch break today. Come to think of it, the last time I took an actual lunch break was two weeks ago. (I'm afraid that's actually true.)

My plate seems so full today, the phone and beeper and cell-phone going off constantly since my arrival just after 9am. A patient with acute pancreatitis, long history of AIDS and new-onset dementia---now on his way to the ER for admission, his pancreatic enzymes are sky-high. Another patient with Hepatitis C and chronic pain hasn't moved her bowels in nine days---she's also on her way to the ER. The next call is from a patient with chronic asthma who calls me in distress--she's over 350 pounds and so deconditioned that her asthma just can't improve. I ran over to her house and we gave her a prescription for some prednisone. I have to work on getting her admitted to a rehabilitation facility for a few months of pulmonary rehab.

Then another patient calls---she was feeling suicidal, so her therapist told her to go the ER and tell them that she was an alcoholic and needed detox, why I can't imagine. So they sent her to detox for four days and she should've been in the psych unit. I must have a word with that very irresponsible therapist of hers.

The fun just continues non-stop. Must gallop off to put out the next brush fire. As Bugs Bunny would say, "it's a living, doc."

Tuesday, April 05, 2005

Signs of Spring

Walking the dogs this morning, I heard some sure sounds that tell me Spring is here: the clattering of carpenter's hammers as roofs are refurbished and windows replaced, and the staccato of newly-arrived woodpeckers, searching for their arboreal breakfast. Crossing through our local swamp with the dogs, I also spied one of Mary's and my favorite early Spring sights: baby skunk cabbage, curling up from its winter repose through the murky water and new undergrowth. Soon it will be flourishing and lush, a land of mosquitos and moist heat.

Other signs abound: Daylight Savings Time begins and I leave work with sunshine to spare. The beavers are back in our local pond, out of hibernation and looking for snacks and flowing water to dam. Robins flutter through the trees. The Canadian Geese have landed in that same pond, returning from their southern sojourn. Today, I was able to eat my dinner outside during a break from the class I was teaching. I was in the shade of the building and had to wear a jacket, but it was a meal outdoors---the first of many.

I've written recently of rebirth and Easter, changes and death. Spring adds more flavor to the mix as we all come alive with the Earth. Let the glory begin!

Monday, April 04, 2005

Death and Renewal

With the death of the Pope, I'm reminded of the many world leaders who have died during my lifetime. As community leaders fade away, one can only hope that new leaders---perhaps wiser leaders---will follow in their wake. As much as I personally felt that the Pope was disappointing on many levels (ie: the role of women, reproductive rights, homosexuality), he certainly staked his name on being adamantly anti-war----now that's a pro-life stance if I ever heard one.

Anyway, the renewal of Spring brings to mind the renewal of all things: politics, religion, humanity, compassion, kindness, humility.

May all beings be free from suffering.

Saturday, April 02, 2005

April's Renewal

As April eases its way into our midst, renewal is in the air. Flowers push through the melting snow, the winds of early spring jostle the trees, and those sure signs of winter's weakening grip take hold.

Another renewal is also taking place. An old friend from my art-school days in Philadelphia has located me in what I assume to be ubiquitous 21st century fashion--Googling. The gift of this revisiting of the past is recovered friendship and connection, the extension of life's lines back into the past, reconnecting with those who knew me as a younger version of my current self, yet to be shaped by the life experiences which thereafter ensued. At least three individuals connected with my friend who made the initial connection are now reaching out to me via email, and this is a gift beyond measure. Some five months ago, my brother was contacted by our closest high-school friend, and that reconnection following a 20 year hiatus has also delivered a new sense of wholeness and personal history coming full circle.

While the present indeed informs the future, it is the past that takes responsibility for our manifestation in the present. I welcome these old friends into my current reality, and look forward to the renewed blooming of those still vibrant seeds of friendship and connection.