Tuesday, August 30, 2005

Mi Hijo

I spent a few minutes at the bedside of my patient in the hospital today. I sat in a chair to the right of her bed and rested the side of my face on the bedrail so that our faces were aligned, her head resting on her pillow. We spent several minutes smiling at one another and looking into each other's eyes. Of course, she asked me for news of my wife, son and dogs, and I told her a story of Mary calling me in a panic this morning when one of Sparkey's nails broke off and he was spurting blood all over the house. She laughed and said "bendito!" ("poor thing").

While I was sitting at her bedside, I noticed that the site of the needle biopsy on her upper chest was bleeding through the lame little bandaid that someone had pasted there, and I alerted the nurse that she needed a pressure dressing on the area. While holding a gauze sponge in place while the nurse searched for dressing supplies down the hall, I took the opportunity to not only hold the gauze in place, but also to perform a little Reiki on my patient's heart chakra. We stared into one another's eyes and breathed, chatting nonchalantly until the nurse returned and broke the spell. In a way, though, the nurse entered our little tete-a-tete with her own caring energy as the she dressed the area more securely and placed a nasal cannula on my patient's nose so that she could have receive some oxygen. I translated for the two of them and we all had a few sweet moments as a triumverate. After the nurse left the room, I said "Are you depressed, my love?" She nodded very sadly and we were silent for a few more moments.

At times my visits to see my hospitalized patients are more social than anything else, and at other times I am advocating, cajoling, fostering communication, or simply adding my two cents based on my intimate knowledge of the patient from outside the clinical austereness of the institutional setting. This visit was filled with meaning for me on many levels.

As I was leaving the room, my patient said, "Gracias por su visita, mi hijo" ("Thanks for your visit, my child"). The way many of our patients say "mi hijo" sounds like "me-hoe"---one word, really almost one syllable in the Puerto Rican vernacular. Coming from some of my younger patients, it feels somehow strange, but from this 69-year-old woman---old enough to be my mother---a grandmother with HIV and a myriad of illnesses but with a bright light in her eyes, it's like a benediction. I'll visit her again tomorrow, and I will hold her hand when we deliver the verdict on her biopsy.

There are many ways to be an "hijo", and this is one way that sinks deep into the heart and lodges there forever.

Monday, August 29, 2005

The C-Word

Another week begins, yet I approach it with renewed energy and no post-vacation malaise. What a relief.

For those of you who were following the story of my patient with metastatic stomach cancer earlier this month (see The Language of Illness and Stories Unfolding), he's back home from the hospital and we are aggressively managing his nausea and other symptoms. Whether or not we move ahead with chemotherapy remains to be seen. He's not long for this earth and my goal is to keep him comfortable and free of unnecessary pain and suffering. Intractable vomiting and dehydration is no fun, and we've managed to put out that brush-fire for now. I stand ready for the next one.

Sadly, one of my favorite patients---a 69-year-old Puerto Rican woman (whom I see as a "free care" patient since she's too old for our program) with HIV, hypothyroidism, asthma, emphysema, diabetes, anxiety, and depression with psychotic features, is in the hospital with what appears to be metastatic cancer to her lungs from a mass connected with her thyroid gland. Previous biopsies of this mass in what is called her "mediastinum" (the upper chest area) have been benign, and I feel so badly that perhaps now the time has come where the mass has taken on more sinister and lethal qualities. An avid smoker, she goes through one or two packs a day, and a great deal of my time has been spent trying to convince her to quit smoking over the last four years, all to no avail. With her HIV and diabetes under perfect control, I have focused on her respiratory health. It is a widely held opinion that one cigarette can be the one that activates cancer cells to begin their uncontrolled growth, and this is the turn of events which I have most feared.

My connection with this sweet woman is precious. Since she speaks no English other than being able to say "good weekend" or "I love you", our relationship is conducted entirely in Spanish. Every time we converse---whether it's on the phone or in person---she insists on asking me how my wife, son and dogs are doing, and smiles so beatifically as I recount for her my son's latest accomplishments, my wife's career changes, or the dogs' latest trip to the vet. I also ask about her family, and we always close our conversations with "Dios te bendiga" ("God bless you"), a salutation which I freely share with many of my Latino patients as a way to respect their cultural practices. She carries a bright light within her, even in moments of paranoia and fear when her face is mask-like and stiff. Over the years, she has fed me Puerto Rican food, brought me countless bags of plantains to bring home to my family, and will settle for nothing less than a kiss on the lips when saying goodbye. I always comply.

Today, sitting on her hospital bed and chatting, she seemed to have no idea that we are suspecting that cancer is growing within her. I hinted that we were going to run some tests and do a biopsy, but I hesitated to use the "C-word" just yet. Her mental health is tentative, and I didn't want her to lose sleep tonight unnecessarily. When the results are in, I'll make sure that I'm present for the conversation in which we inform her of the cancer and how it has spread. For now, I cling to the very dim hope that the shadows on the CT-scan were not metastasis, and that the mass is localized and operable.

She would be the third patient on my caseload with active cancer, and the burden which these individuals carry along with their families and loved ones is great. I do my best to walk alongside them on this difficult path, but it cannot be more true that one must always walk alone when faced with mortality and death. Courage and optimism go a long way, but misery and depression certainly play their hands as well.

It is these moments of profound humanity which most engender one's humility.

Saturday, August 27, 2005

Spam (Alot)

My dear Readers,

So sorry, but I had to enable "word verification" so that when you comment here on Digital Doorway you will need to go through an extra step in order to do so. Unfortunately, there are spammers who have begun sending millions of emails which infiltrate into blog comment areas, offering links to buy Viagra and stocks in McDonalds. Not that I really want to deny you access to such magnanimous offers of virility and wealth, but I'm sure you can find those offers most anywhere on the ol' Information Superhighway. FYI, I have also disabled anonymous comments to further ward off would-be spammers.

At any rate, technology must always stay one step ahead of those who take advantage of it for economic reasons. The dark side of Capitalism will always rear its ugly head. Get thee behind me, Spammer!

Friday, August 26, 2005

Know Justice? Know Peace?

Some of you Readers are aware that we recently were privy to a hearing at The Second Circuit Court of Appeals in New York City vis-a-vis the case of our friend Woody who was murdered by the Brattleboro Vermont Police in December of 2001.

It appears that the 2nd Circuit judges have made the unprecedented move of passing a judgment only 19 days after hearing the case. The three judges have basically thrown out the lower court's decision, sending the case back to the Vermont Federal District Court for further review. This article offers an excellent overview of the decision and its ramifications.

We are cautiously thrilled that the "Old Boy Network" judge---Gavin Murtha of Brattleboro Federal District Court---has been handed an embarrassing decision by the higher court. We only hope that this turn of events may eventually give the Woodward family their day in court.

None of this will bring Woody back. He will never again walk through that door and collapse under the weight of the excited dogs and humans welcoming him into our midst. He and I will never again share our love of electronic music and philosophizing about the state of post-modern culture. He will never again massage Mary's feet or counsel our boy in his inimitable way. But this is an important historical moment, separate from our memories and our love for his being.

We miss you, Woody, but the earthly fight for justice has not yet ended. From your vantage point, it all must seem like water under the bridge, but here in the third dimension we're still slogging away. As the saying goes: "Know justice, know peace."

Wednesday, August 24, 2005

A Hoop for the Lowly

Transitioning back to work has been challenging at best. Yesterday was the lowest moment, for sure.

But today after work I biked to town to do a few errands and watched the sky closely as the sun made its descent and the amazing clouds did their dance. I was caught in a sudden downpour, and by the time I stopped in a drive-in bank to escape the drenching rain, a full rainbow appeared from horizon to horizon, a second partial rainbow echoing the prismatic wonder.

By the time I arrived home to fetch my camera, the rainbows had begun to disintegrate, but I managed to snap a quick photo before it completely retired. Even as these challenging days of hard work tax the mind and body, I am reminded that wonder and beauty still rule the day.

As Jack Kerouac said so eloquently in The Dharma Bums, I believe: "What is a rainbow, Lord? A hoop for the lowly."Posted by Picasa

Monday, August 22, 2005

Rude Awakening

Well, Day One of Return to Work Week is over. I caught myself frowning in the rear-view mirror, dragging my feet (almost literally), and pining for a nap in the hammock. The pile of papers on my desk and in my mailbox overwhelmed me, not to mention the patient whose cancer has taken a turn for the worse, the dozen or more calls I received from patients in need, the beeper that would not quit, and the documentation of today's visits that seemed to be endless.

Leaving work at 5:30, I ruminated during the drive home, sleep tugging at my eyes. Not even music could soothe me during that 35-minute commute. It seems like the sleepiness I felt all day was a kind of defense mechanism, my brain fighting tooth and nail against the need to be sharp and clinical after nine days of relaxation. There are times when the memory of a vacation is literally swallowed whole by the onslaught of work, and I fear that this may be one of those times. I know, vacation is a luxury, and having a job to vacation from is an even greater luxury, but it was a monumental task to go through the motions today.

Eighty-three people and their medical needs began dancing in my brain again this morning after being shuffled off to some cerebral storage file, and though their renewed residence did not birth a headache, there was certainly some brainache, to be sure.

Please pardon my back-to-work blues. I am sure that this too shall pass and we will be back to our regularly scheduled nurse.

Sunday, August 21, 2005

It's the End of Vacation as I Know It....

and I feel fine......

Sunday morning. Breakfast with the visiting boy and his love after an evening of comedy and live performance by many of my son's talented friends. Also a quick visit from my brother and my ever-wonderful niece and nephew. Family, family....

Now that work begins again tomorrow, I must take account of this vacation and reflect upon my time here at home. I'm truly ecstatic that we chose to eschew travel this week and focus here at home. I am also quite content that I struck a good balance between relaxation, reading, writing, chores, biking, housework, taking care of business, and plain old summertime slacking. While we didn't make it to the beach, go camping, or visit museums, I feel thoroughly refreshed and well rested. My greatest accomplishment, personally, was having a hammock nap five or six days out of nine---an admirable track record, although 100% would have been a better statistic in the annals of napdom. Perhaps today I'll add another day to that list of successful naps.

With work less than 24 hours away, I feel my mind slowly making its transition towards that reality. Up until now, I've protected myself from thoughts of work and managed to maintain a buffer between me and that world. Today is the day that I will allow the face of responsibility and wage-earning to begin to insinuate itself ever so gently, so that tomorrow will not be such a shock. "Working for paper and for iron" (to quote Andy Partidge) is the modern equivalent of hunting and gathering. Today I gather my strength and resolve and prepare for re-entry.

Thursday, August 18, 2005

Growth and Complacency

A recent telephone conversation with a close friend yielded the notion of whether we can learn to grow from both the good times and the times of drama and duress. Among many people who are committed to self-growth and exploration, I think that there's an often unstated idea that times of happiness and stability are also prone to be times of complacency and stagnation. Many of us can become addicted to drama and feel the need to "create" it in order to challenge ourselves to evolve. Moreover, some people perpetuate their dramas indefinitely, living in perpetual crisis mode, leaving little room for moments of quiet reflection.

It seems clear to me that there is a balance, and that my friend was onto something. She felt clearly that she must learn to embrace the good times and see the growth and inner calm that is born of such moments. Being content and satisfied in the moment has its positive aspects, and while there is always room for improvement, there is also a valuable lesson in taking the good at face value, if only for an instant. Of course, there are points in life when one knows that it's time to confront a pattern, change an outmoded way of being, or challenge one's assumptions about the world and one's place in it. There are always relationships in need of mending, patterns of thought which are unhealthy and counter-productive, and, yes, there's also contentment which borders on complacency and stagnation.

How do we find this balance and grow while still allowing ourselves to be satisfied?

Wednesday, August 17, 2005

Zen Mind, Vacationer's Mind

Pardon the play on words, folks, but I couldn't help myself. I hope Mr. Suzuki doesn't sue me.

Anyway, life goes on here in vacationville. While others run off to "The Cape" (as in Cape Cod), the Jersey Shore, New Hampshire and such, I'm pleased with our decision to spend this week at home. That said, the challenge here is not allowing myself to be too busy, to not spend my hours either thinking of, or accomplishing, everything around the house that's been crying out for attention. That does not mean, of course, that Yours Truly is slacking up a storm. There's plenty to do, as long as hours of activity and sweat equity are balanced by hours on the bike, reading, watching movies, napping on the hammock, or at the ol' swimming hole with the pups and my love.

A measure of my level of relaxation is demonstrated by the fact that I just prank-called my workplace and had one of the administrative assistants on the run for a minute until I burst out laughing. I let her know that I didn't want any news about my patients, only to send my condolences to those worker-ants slogging away at their desks while I relax on my porch. I didn't actually say the latter part, but we had a good laugh and as I hung up the phone I realized how life at work goes on whether one is on vacation or not. Some things may not get done, some patients may be lost in the shuffle for a few days, but there's always 9-1-1 and the ER to take care of emergent needs. Meanwhile, I attend to my own emergent need---to take care of myself.

It's only Wednesday--the halfway point of my vacation, and I can feel my mind letting go, even as pieces of the future continue to insinuate themselves and draw me out of my residency in the present moment. My to-do list is there, for sure, but it's a guide, not a ball and chain, and many things on it may stay there for now. I remind myself to say, "Get thee behind me", and change the channel. Where's that mute button for the mind again?

Tuesday, August 16, 2005

Carnival Time!

For those of you not familiar with "blog carnivals", these are virtual gatherings of bloggers wherein a host blogger puts out a call for blog entries related to a given topic and interested/invited bloggers step up to the plate and submit either new or old writings. The host then posts links to all of the entries within a narrative on their own blog. Here is a link to an article which describes carnivals well.

I am pleased to announce that two of my recent Digital Doorway entries are included in the latest version of Grand Rounds, a medical carnival which "makes its rounds" every so often. I hope to host a future version of Grand Rounds in the coming year.

Thanks to all who sent birthday wishes by comment, email, or telepathy, and blessings to you all!

More soon!

Monday, August 15, 2005

Forty One

Well, today is my 41st birthday and I take another step into what is actually the fifth decade of my life, if I'm counting correctly (1-infancy to ten; 2-teens; 3-twenties; 4-thirties; 5-here we are, then!). Interesting.

Last year, turning forty was not a crisis for me. It was actually a relief, the self-searching thirties left behind and the more confident forties beginning to shine. And I hold to my feelings of last year that my forties are, for me, a time of fullness, ripeness, a time of feeling more "grown-up" in the sense of embracing being a full-fledged adult, but also more able to be my authentic self, and caring less about what others think. It is also a time for embracing the parts of me that eschew some of the psycho-emotional trappings of ageing, holding onto the aspects of youthfulness that serve me and those with whom I have contact.

Birthdays are meant to be self-indulgent, I believe, so today I'll indulge in self-examination, self-congratulation, as well as a deep desire to look ahead and think about the next few years to come. Thankfully for you, dear Reader, that process will not happen here to any great extent, and you'll be spared my financial planning, educational musings, and thoughts on career development. What I think is appropriate here is for me to muse about my own self-growth, the meaning that I find in the world, and how I view my place in it. Will you indulge me? If not, there's a little red X in the upper right corner of this window and I invite you to make use of it now. You've been warned.

Having chosen nursing as a career, and having spent many years before that in service of some kind, I still see my life's purpose as being one of service. I do not necessarily see service in the Mother Theresa-like view of selflessness and pure altruism. That said, Ayn Rand believed that true altruism could not exist because even the most "altruistic" action also benefits the self-esteem of the individual performing the act, hence that personal gain cancels out the veracity of the altruism. I don't subscribe to Rand's opinionated tunnel-vision (although her books were helpful to me as an adolescent, I will admit), but I can say that I do very much enjoy giving to others, and that my giving serves me as much as it serves the objects of my actions. I think that giving is what lends my life meaning, but one lesson for me at this time is to learn to give to myself as well, and to only give when I feel it in my heart, not when I feel the energy of a "should" behind that action. My Jewish guilt runs deep, and it can often spur a knee-jerk reaction of reaching outward when I am still in an inwardly focused state. Reaching out to others when one does so out of a feeling of obligation belittles the gift and throws into question the motives of the giver. Sacrifice is one thing when appropriate, but martyrdom can be the most selfish act of all.

So for my forties, I will relinquish martyrdom and the "shoulds" which continue to plague me. I will embrace my adultness and retain my youth. I will examine myself closely, change that which cries out for change, and develop that which calls for growth and expansion. I will be good to my body, rest well, and keep my mind active and engaged. I will seek to foster my own creativity, and use that creativity in a way which engenders further self-exploration. I will honor my own needs in relationships, nurture current relationships well, and develop new ones only when they feel right, not because I feel that I should. I will also begin to let go of those relationships which no longer serve, a process which can be painful and difficult. I will most of all be authentic in my primary relationship---my marriage---and learn even more deeply what it means to love and be loved.

I think that's enough homework for the next nine years. (The hell with grad school!) Now to dive into the day and await the arrival of my love who left for New York City on Wednesday morning. Her exit from that train this afternoon will, after a five-day absence, be the greatest birthday gift of all.....

Sunday, August 14, 2005

Pretty Vacated

Once again, dear Readers, a gold star to the first reader who can identify the musical reference for this entry's title.

I am now officially on vacation. Today is actually day two, although I recognized my vacation status at 5pm on Friday as I left work, whistling a happy tune.

Short on spendable cash, we have opted for a home-based vacation for the next week with a few day trips, maybe a night of camping---maybe not---and that leisurely feeling of nowhere to go each morning. That said, the trick for me during a home-based vacation is to somehow not get caught up in doing too much, allowing myself time for being. Granted, I plan to finish laying some stonework for our ersatz patio, clean the gutters, and maybe begin shuffling papers in preparation for the new semester of teaching, but I need to remind myself daily---nay, hourly---that this nurse needs a break from doing too much, and I should just revel in being paid a very good hourly wage for simply being home and resting on my laurels. (Just what are laurels, anyway?)

I'm sure that my patients will come to mind daily, and I'm equally certain that there will be moments when I'm just too focused on what's begging to be done. Still, vacation can also mean vacating one's mind, one's habitual ways of being, the ruts that are so well-worn that it seems one's wheels can never stop turning in them. My ruts are chasms, gorges, even canyons of habitual action and thought. Can I vacate those traps for seven days and redirect my wheels? Can I simply sit here "watchin' the wheels" (a la Mr. Lennon) and laugh at their absurdity?

Stay tuned as Our Hero attempts to overcome himself and yet be more of himself than ever.

Saturday, August 13, 2005

The Stuff of Life

I've been thinking today about on-line friendships, their meaning, and how this new form of relationship has grown to be an accepted mainstream form of bonding and communication. I now have friends whom I have encountered on-line---mostly through blog-related connections, apparently---and I'm wondering if there has been anything interesting or intriguing written about this new form of human relations.

Obviously, in this post-modern world where information has become a medium in and of itself, these relationships have taken on meaning and depth, wherein geographically disparate individuals can share personal and intimate information within the non-physical space of the Web. I was discussing this with a friend today and she noted that some people downplay the "reality" of relationships that occur only in the context of cyber-space, with the individuals never hearing one another's voice or speaking face-to-face. While I agree that a tete-a-tete is crucial for friendships in the concrete day-to-day sense, relationships developed and then nurtured in the digital world can still evoke emotion and feelings of loyalty, affection, concern, anguish, rejection, etc. Getting to know another human through the medium of the printed word (and perhaps augmented by photographs) wherein the individuals share intimately about their lives, dreams and daily observations, can be a very satisfying and growthful experience. When a beloved fellow blogger is having a particularly difficult day or shares a painful moment of their lives, there are often outpourings of emotion and support that are quite profound to behold. This may not be the intimacy of two friends sharing secrets over a cup of tea, but there is nothing "unreal" about the caring that occurs between electronically connected people. We have all heard stories of those who fall in love by email.

There are fellow bloggers whose sites I visit on a regular basis, and we thoughtfully post comments on one another's blogs regularly. A few of those individuals have also become email friends, increasing the contact and intimacy through private communicaton out of the public arena of the "comments" section of a blog. I was once warned that accepting comments on my blog might become a burden wherein I would feel obliged to respond to comments, but now I clearly see that the comments section is where the real heart of the site can live and breathe: hearing others' reactions to my writing---and the thought process that those comments can engender---is an intrinsic part of the blogging process for me.

If any of you have found interesting articles about on-line friendships and the whole notion of this relatively new paradigm of human relationships, please leave a comment. I would also be very happy to hear others' experiences of such relationships. My cyber-friends are now a part of my "social atom", and the richness which they add to my life cannot be measured based upon outmoded definitions of relationship. Friendship---in all its forms---is the stuff of life.

Friday, August 12, 2005

Stories Unfolding

As I anticipated, the meeting at the oncologist's office this morning was pretty heavy. In attendance were the patient in question, his son, his close friend, myself, and the oncologist, a very kindly woman whose chair-side manner was impeccable.

The news was as I expected, based upon my reading of the CT-scan report and biopsy results: advanced adenocarcinoma of the stomach with metastasis to the liver, adrenal glands, and very likely lymph node involvement throughout the abdominal cavity. In other words, it couldn't be worse.

I allowed the doctor to lead the conversation, chiming in as necessary, the son and friend and I all translating for the patient who speaks less than ten words of English. There were tears, a verbalized desire for aggressive treatment, and a thumbs up in defiance of the odds so squarely stacked against survival. The doctor was very clear that surgery was not an option, and that chemotherapy---if it didn't make the patient feel worse---might prolong his life by a few months. I was very cognizant of her choice of words: months. With a cancer so advanced, survival is short-lived, and we don't talk in terms of years. There are no years left. A harsh reality by any measure.

Our meeting was classic in many ways. The patient and family members listened quietly while the doctor spoke in soft tones. A few moments after she made the diagnosis and the prognosis unmistakably clear, my patient began to cry and reached out for his son, embracing him strongly, man to man. Then he reached the other way and hugged his dear friend who was sitting on his left. Then he embraced them both and the three of them wept together. At this point, he looked up and gestured for me to take his hand. We were all four of us physically connected, the doctor quietly observing, as this lovely and soft-spoken gentleman began to digest the fact that he had been handed a death-sentence, that his body had betrayed him and was, even as we sat there, producing non-functional cells at an alarming and unmitigated rate. He began to grasp that the chemotherapy might slow the growth of the cancer but could not arrest it completely, and that the side effects of the chemo could be gruesomely uncomfortable, perhaps even deadly. All of this cascaded down upon him and upon the minds and hearts of his loved ones as we sat in that air-conditioned and spartanly modern room.

Breathing in the scene in which I was an active participant and keen observer, I could feel the expanse of the city around us, the thousands of lives careening through the streets, the myriad other life stories unfolding in that instant. It was a poignant moment of existence for me: here we were, facing death and suffering in the face, the person facing the challenge being embraced by his loved ones, the compassionate professionals observing and noting the details of the moment, present, yes, but also somehow detached.

Throughout this time, I noticed the oncologist move her stool closer to the patient, leaning in when she needed to speak of the more difficult issues. Her body language was open, her eye contact steady, her voice level and professional but compassionate. She touched his knee at just the right time, and we all sat in silence when it was needed. When the doc left the room for a few minutes of consultation with her superior, I took a deep breath and reminded everyone to do the same. Towards the end of the appointment, the supervising physician came in and made his presence known in the most gentle way. It was as if he'd been there all along. His presence was reassuring but not domineering, masculinely strong yet not patriarchal. He knew what he was doing.

When witnessing scenes such as this, perspective is the word which mostly comes to mind. That could have been me, my wife, my mother, my brother; any one of us could be on the receiving end of such a conversation, such a life-altering moment. It is profoundly humbling when one is reminded so starkly of one's diminutive stature in the scheme of things, yet also the power and focused energy which the changing course of one life can command. We are all truly stories unfolding.

Thursday, August 11, 2005

The Language of Illness

I have a 64-year-old male patient with severe osteoporosis and a few other health issues like anemia of unknown origin. His main complaint has been pain which we eventually chose to treat short-term with Percocet, upping the ante to long-acting morphine when the Percocet couldn't touch it. A few weeks ago, he sat under a tree outside of his apartment building and said that he wouldn't take the morphine any more and he only wanted Percocet. This type of behavior often speaks of addiction (or at least dependence) but we gave in, at least for the meantime. Meanwhile, after grasping at straws regarding his anemia, we sent him to a gastroenterologist to see if perhaps he was bleeding internally, and also to treat his esophageal reflux disease.

Yesterday I received a call from the gastro provider that they needed to send him for an emergency abdominal CT-scan which later revealed the fact that his abdomen is riddled with cancer that has metastasized from his liver to his stomach, adrenal glands, and lymph nodes. Now his pain makes sense, although his symptoms were always vague (and we were worried about Percocet dependence!). My, how things turn on a dime.

Now the game-plan has changed and I will accompany him to an emergency visit with an oncologist tomorrow. I don't look forward to the look on my patient's face when we hear what I expect to hear: that the cancer is already profoundly spread throughout his abdomen, and the chance of curing him is almost nil at this juncture. I can see that we will be stepping gingerly onto a new path of palliative care as he begins what may be a very rapid decline. His stalwart friend and advocate will be there with us tomorrow morning, and it will be up to me to translate all of this new information---literally and figuratively---into something that my patient can grasp.

The language of illness and death can be harsh and forbidding. My job is to distill it into digestible syllables and be there to pick up the pieces of grief. All in a day's work, I guess.

Wednesday, August 10, 2005

Mixed Bag

As always, work is certainly a mixed bag these days. On the one hand, I had the wonderful experience the other day of reminding a patient that he has now achieved five years of having his HIV fully suppressed with no detectable virus in his blood (based on the most up-to-date assay that we have, anyway). His determination and desire to be healthy have kept him on the right road and now he is reaping the benefits. I explained to him how we can now view his HIV like his diabetes---a chronic illness controlled with medications and a positive lifestyle, with the goal of avoiding as many long-term complications as we can. As more and more people with HIV age, we will begin to see the data regarding how they fare as their bodies begin to go through the ageing process. We still don't know for certain how infected people of very advanced age will do in the long term, but it looks like we may have a chance to find out over the next few decades.

On the other hand, there are patients who never quite "get on the bus" and we track the slow and inexorable progress towards their eventual demise. There's not much to do in many of these cases except to be there when they crash. Then there are others who simply have lives too dysfunctional to fix, patterns of behavior and learned helplessness just too entreched. It is some of these individuals who can make a workday miserable.

Aside from the patients themselves, paperwork, organizational issues, the healthcare system itself, and other factors all combine to make the providing of quality care a challenge. Not everyone has the same work ethic, not everyone cares as much. And when money is the bottom line, everyone suffers.

Yesterday, we heard that an amazing doctor specializing in HIV in our community died of a heart attack while swimming from one island in Maine to another to raise money for an AIDS-related organization. Her loss is a shock to the community, especially since we lost another local HIV expert to suicide two years ago. When the healers die, those who rely upon them are stopped in their tracks. How many people see their doctors as something other than mortal and fallible?

Next week I have the entire week off to celebrate my birthday (41!) and soak in some of the final days of the summer before Labor Day heralds the beginning of school and that September feeling of renewal and change. In many ways I look forward to the autumn: the crisp air, wearing a jacket on the cool mornings, getting back to teaching on Thursday nights as the summer wanes and the leaves begin their transition. The end of August also heralds the beginning of the big harvest time when the abundance of autumn graces the land. As always, there is much to look forward to and cherish, and the mixed bag is just a fact of life on this awkward and lovely physical plane.

Monday, August 08, 2005

Internet Addiction

I just found this link on a very interesting blog called Shrinkette. The link is Dr. Grohol's Psych Central Internet Addiction Quiz. I was pleased with my own score but must re-test myself and make sure I was completely honest when answering the questions.

Could I live without email, Internet access, NetFlix (a new addition), on-line banking, ordering concert tickets on-line, searching favorite web-sites? When Mary and I discuss an eventual relocation to Central America, we often say that some of our no-brainer necessities would be: access to health-food, electricity, running water, and Internet access. Hmm. Food for thought.

Sunday, August 07, 2005

Gratitude for You

I am feeling very grateful just now for the comments---anonymous and otherwise---which so frequently appear on this blog. I comment on others' blogs almost daily, and I know how good it feels when one realizes that others actually care about what one writes and communicates to the world, taking the time to actually post their own thoughts in response.

That said, if you are a frequent reader but non-commenter, your presence is just as important and appreciated, and please feel free to continue to read without leaving a visible trace. I am surprised when I read the tracking data and see how many people are visiting on a daily, weekly, or monthly basis, and I thank you all for taking the time to do so.

May my output be worthy of your continued visits.....

Saturday, August 06, 2005

God's Interruption

Last night, after publishing my post about the hearing in New York City, I had a momentary panic in which it appeared that my entire blog had been erased from my Blogger "dashboard". A wave of adrenaline shot through my body, my adrenal glands pumping, and I shook in disbelief, screaming wretchedly into a pillow while Mary tried to comprehend exactly what had happened. After the initial shock, I took a breath and was able to determine the cause of the momentary lapse, discovering that the blog was still there, after all, that eight months of work was not lost.

What did I learn from this experience? First, I learned that technical issues with digital technology often have simple remedies if one can remain calm. Second, I learned that this blog means even more to me than I thought. Thirdly, it is painfully obvious that I am three months behind in saving my blog entries as Word documents, and saving them thus is the only way I could rebuild the site if it was indeed lost to the ethers. I also realized that, as attached to this blog as I am, it actually does not exist, except as a series of combinations of zeros and ones somewhere in cyberspace, whatever that is. Being a virtual entity, Digital Doorway really only exists in my mind and the minds of its readers. It has no physical presence and occupies no physical space. If someone wished to burn my writings (a great compliment in my mind) in order to remove them from public view, they would be hard pressed to actually locate anything combustible. That said, I will continue to save my entries into Word and also print them, perhaps even binding them in book form in order to give the project some feeling of corporeality. I would then be ready for the aforementioned book-burnings.

What were those screams and cries about? Of course, on the surface they were about the perceived "loss" of my blog, my web-site, my "digital doorway". But on a deeper level, it was about the loss which I relived on Thursday---the loss of Woody---and the reminder of his absence by the rather technical and dispassionate descriptions given in the courtroom. There was talk about the knife, the bullets, the number of wounds, his agitation, the congregation members' perceptions of him, the officers' fear, Woody lying face-down on a carpet in front of the podium in a growing pool of blood, handcuffs binding his hands. I know how he felt in those moments because he had placed a phone call to us on someone's cellphone moments before the police burst in, and while our outgoing message played, seven shots were fired, six striking his body. Our answering machine then recorded three minutes of his post-shooting agony as he yelled "I love you!" and"This is a political assassination!", interrupted by gutteral screams of pain from the bullets lodged in his thin body, hypovolemic shock taking hold as he struggled for life. The tape of that message still sits on our shelf. I have not listened to it for some time.

My screams were about so much more than the website, and I'm clear that---as Mary remarked---it was just one of God's (or the Goddess', or The Gods', or The Powers That Be) little interruptions which can quickly succeed in turning our awareness back towards the dark interior landscape which is ours alone. With Mary's intuitive guidance, I also realized that it was about my previous perceived losses of my creativity: the escape from art-school circa 1984; my abandonment of the visual arts for very complicated reasons; my feelings that I lacked the discipline, resolve, and talent to pursue a career as an artist.

There are many losses in life, and the apparent one in the forefront of consciousness will often stir the sleeping monsters who linger beneath in subterranean vaults of suppressed emotion and sadness. That said, I awaken refreshed this morning to the cool air brought to us by a break in the extended heat which has bathed us for the last few weeks. I'm recovering from the drama of the last two days, the exhaustion of being in the city, and the loss of sleep while away from home on uncomfortable beds.

The program was interrupted, now back to our regularly scheduled uncertainty.

Friday, August 05, 2005

Trials and Tribulations

Well, we're back from New York City and the long-anticipated hearing at the Second Circuit Court of Appeals. The building itself is an imposing structure, supported in front by massive columns (Ionic style, I believe), looking out on a large open area dominated by a large fountain, one block from City Hall Park and several blocks from the site of the World Trade Center---or "Ground Zero" as it is popularly known For us, the church where Woody was killed is our "ground zero", and this hearing was yet another event in the course of this long battle for some semblance of justice and recognition that he was wrongfully killed while begging for asylum. Anyway, on with the story.

Arriving, we discovered that Woody's case was fifth in a list of seven hearings scheduled with the three-judge panel sitting in our particular courtroom, namely Room 1505. Of the twelve judges on the 2nd Circuit Court of Appeals, we were facing Hon. Rosemary S. Pooler (a Clinton appointee), Hon. Sonia Sotomayor (another Clinton appointee who apparently has sided with police victims in the past), and Hon. Edward R. Korman (a Reagan appointee (!) who is apparently a temporary "sub" on the bench in New York).

We waited in an air-conditioned anteroom, with comfortable couches and chairs, windows with a view of Manhattan on two sides, free spring water, and a closed-circuit TV where we could keep an eye on the proceedings inside the courtroom. Our party numbered thirteen (including Woody's mother and sister and two family friends), plus a newspaper reporter who was brought to New York and kept hostage for the duration by several of Woody's Connecticut friends. (She wrote an accurate article about the hearing for The Day newspaper based in New Haven). Anxiety was certainly present in the room, not to mention guarded optimism tinged with hope.

When the case just prior to ours was beginning to wind down, the thirteen of us invaded the courtroom quietly, but our sudden presence certainly caught the eyes of the judges, who were sitting on a raised dais behind a mammoth wooden structure which was much too large to call a desk or a bench. It was more like a Great Wall of Justice (or Injustice, as you prefer). The room had thirty foot ceilings and was paneled in rich dark wood, the ceiling being recessed in small squares of varying colors (pardon my lack of architectural terminology here). I cannot recall the other decorative details, my attention being elsewhere, for obvious reasons.

The Woodward's lawyer, Joel Faxon, Esq., presented the case in a succint and compelling manner, and he was interrupted and peppered with questions by the three judges throughout, poking holes in his claims and bandying about varying "devil's advocate" questions which kept him on his toes. Overall, we felt that he did a very clean job and presented well.

The rebuttal and presentation by the lawyer for the town of Brattleboro was, as previously, slightly sloppy and poorly delivered, although to his credit he did indeed win the last round in Federal District Court (with an "Old Boy Network" judge presiding, I must add). Luckily, and thankfully, the defense did not assassinate Woody's character or paint him in the light of being "mentally ill", per se. I had honestly expected to hear some harsh words about my friend and was pleasantly surprised that the lawyer did not play such cheap cards. I must say, though, that the two female judges grilled this lawyer very satisfyingly, with Judge Sotomayor beginning her first interruption by saying, "What is wrong with your town, Counsel? Do people in your town have any capability for patience?", (referring pointedly to the fact that Woody was killed by six bullets fired by two officers within one minute of entering the church, with Woody threatening no one but himself.) Sufficiently raked over the judicial coals, the defense rested, along with his very tired diagram of the church which we have seen ad nauseum.

Faxon's rebuttal was sharp, concise, and to the point, again peppered with questions, but we all felt that his points were made quite clearly. Korman, the Reagan appointee, was the most derisive, and it seemed clear that he was not leaning towards overturning the lower court's ruling. Sotomayor and Pooler, however, both seemed quite dismissive of some of the claims by the defense, and many of us agreed that Pooler appeared to be our clear choice for a vote in our favor. Thus, Sotomayor may be the deciding vote in the matter.

When the case was dismissed (a decision is expected in three to four months), we all exited en masse, and it was again obvious that the judges noticed how many people had attended. While they could not necessarily determine that we were there for the sake of Woody, I think they also noticed many heads nodding in agreement when Faxon or the judges themselves made statements with which we all vehemently agreed, and many heads a-shakin' when Brattleboro's lawyer made spurious claims which the judges riddled with holes.

To wit, we all left the courthouse feeling more hope than when we entered, buoyed by the apparent support of at least one of the judges, but also understanding that it takes considerably compelling evidence for an appellate court to overturn the decision of a lower court. That said, all we can do is patiently wait for the outcome, knowing that a decision in our favor will invariably lead to a long and possibly painful trial by jury in which our friend's character will certainly be matter-of-factly and spuriously assassinated in an effort to relieve the town of Brattleboro of any financial or moral responsibility for his death. We are all willing to undergo that test of our mettle in order for the truth to be more widely known, but realize that a trial may be painstaking and emotionally costly.

We thank everyone who has publicly and privately supported us in the run-up to this hearing, as well as in the last three-and-a-half years of legal struggle and recovery from post-traumatic stress. We're glad to be home, relieved to have this event behind us, and anxious to receive the decision that will decide whether or not Woody's death will have a chance to be fully understood and perhaps publicly shown to be the result of corruption, poor police training, and overzealous officers making tragically flawed decisions.

Mary remarked that Woody is probably having a good cosmic chuckle over the absurdity of it all, and I hope that one day we'll chuckle with him, in this life or the next.

PS: Here are links to the three articles: Rutland Herald, The Day, and Newsday

Tuesday, August 02, 2005

Thursday at 10am

As I remarked in my missive on Saturday, tomorrow we head to New York City in preparation for a 10am hearing on Thursday morning at the United States 2nd Circuit Court of Appeals regarding the death/murder of our dear friend Woody. If you can, please think of us at 10am, sitting in that courtroom, listening to the lawyer for the Town of Brattleboro, VT, spewing forth lies and half-truths about the events of December 2nd, 2001, as well as doing his best to assassinate the character of our loving friend, adding insult to injury. Wasn't his physical assassination enough? It will be an emotionally trying morning, even though it's been said that the proceedings will last less than an hour. We're certain that it will be months before the court decides whether or not to allow the case to go to trial in civil court, but it will be good to finally have this day behind us.

So, dear friends and Readers, please think of us and I will post again on Friday night or Saturday.

Until then, blessings....