Losses and Gains: The Calculus of Change

Spending time in my former office today as a consultant (something I now do on a weekly basis), I was struck by how sincerely I miss a handful of patients, and how much I truly don't miss a small group of my most needy former patients.

After three months of not working full-time following a seven year sojourn of intensive case management, I'm feeling the loss involved in saying goodbye and walking away from a number of close long-term connections. Periodically I think of calling one or another of my former patients, and one of these days I'll probably pick up the phone and do so. Those goodbyes can be hard, and the hellos can now seem equally challenging.

The intimate connections nurtured over those years came to be part and parcel of my life, and while that closeness eventually did indeed contribute to my experience of burnout and compassion fatigue, it also was a part of the fabric of my life, and now it seems like certain threads are sorely missing.

For now, I can sit with the uncertainty and emptiness that those losses have engendered, and I can also sit with the notion that calling and saying hello may be a new way of connecting (if, of course, I choose to do so at all). Providing such intimate and long-term care over time creates dependencies on both sides of the equation, and I am beginning to feel that some of those emotional equations are as yet unresolved. Will I attempt to balance them? Only time will tell.

Return!

We have returned from a wonderful journey to Boulder, Colorado and Santa Fe, New Mexico (as well as a number of points in between, including Ghost Ranch, an old haunt of American painter Georgia O'Keefe).

Traveling with chronic pain and Multiple Chemical Sensitivity certainly makes such ventures more challenging. One of the most difficult things for me was feeling quite limited in the amount of hiking and outdoor activities in which I could indulge without significant suffering in its aftermath. Still, I managed to enjoy the outdoors, take less vigorous hikes, and use medication to assuage my pain.

Now, returning to New England, I face important decisions as to how to earn enough money while not working full time. Pain is a limiting factor, yet bringing income to the table is crucial while still maintaining my health.

Another issue with which I am grappling is how to keep this blog alive and well without the frequent patient interactions which previously provided such excellent grist for my writing mill. I want to remain true to the spirit of this blog by providing commentary on nursing, health and healthcare, while still blogging about my own personal journey.

Suggestions are welcome, and feedback is treasured.

Off to the Southwest!

My beloved and I are taking our son and his beloved for a short one-week journey to Boulder and Santa Fe. I may or may not be blogging on the road, so please stay tuned and come back soon!

Happy Spring!

Please Vote Before April 22nd!

I am announcing for the second time that a proposal submitted by my dear friend Imre Kepes in Massachusetts was selected as a top 20 finalist among nearly 5,000 entries nationwide by the Case Foundation for its Make It Your Own Awards, a grant program that "challenges people from all walks of life to discuss what matters most to them, decide what kind of community they want, and take action together". If you peruse the proposals of the 20 finalists, you will see an amazing array of projects which have the potential to change the world by empowering people within their own communities.

I am asking for your support to help Imre Kepes' project be selected by on-line voting to be one of the Final Four to be awarded an additional $25,000. The Case Foundation will also give $2,500 to the favorite charity of the first 10 people who vote for the four projects that actually become the Make It Your Own Awards Final Four.

Imre's project---The Community Vision Project of Holyoke, MA (a struggling post-industrial city which has seen better days)---will develop a team of youth leaders to inspire others and gather input from a cross-section of residents to develop ideas to make their community a better place. Together they will create a Community Vision Map that will graphically express these ideas and help to inform and mobilize the community. Action teams will work to turn these ideas into action. The Community Vision Project is a collaboration between the Holyoke Youth Task Force Youth Commission, Hampshire College and other youth programs and adults in the community.

To vote for the Community Vision Project to be one of the Final Four, please log onto http://miyo.casefoundation.org/node/6736/promote and simply click on the vote button. Voting ends April 22. Please note that after you have selected your "final four", you will receive an email to which you must respond in order to confirm your vote!

Thank you so much!

The Future of Elder Care, Part I

As my parents, friends and I myself age, I've been doing a great deal of thinking about the state of elder care in this country. The nursing home industry has indeed changed over the last few years, with the lion's share of changes having to do with offering specialized Alzheimer's and dementia care, assisted living, and palliative care for those in need. More and more long-term care facilities appear to be offering services which allow residents to move along a continuum from independent living to complete care, based upon an individual's changing needs. This is a welcome change, but there is so much more that can be done.

With the Baby Boom generation beginning to retire, I predict that the care of the elderly will be an enormous field with unlimited growth and employment potential over the next thirty years. Savvy and relatively wealthy, Boomers will alter the landscape of long-term care by demanding services that the marketplace will naturally bend over backwards to fulfill. For those in a position to finance and create specialized facilities for the care of the elderly, the adage of "build it and they will come" is incredibly apropos at this point in time when it comes to this burgeoning field of healthcare.

When this generation of elders begins to need care beyond what can be provided at home, facilities will indeed need to change in order to satisfy the needs of this new long-term care demographic. Gone will be the days of singing "Melancholy Baby" by the piano. Gone will be many of the entertainment and leisure activities enjoyed by the previous generations who came of age in the first half of the 20th century.

Boomers, having cut their teeth in the 1950's and 1960's, will have a whole new set of cultural sign-posts and icons under their collective belts, and their sensibilities and predilections will need to be honored and integrated as these individuals begin to enter long-term care. With James Dean, The Beats, Jack Kerouac, Woodstock, Richard Nixon, the Civil Rights Movement, The Beatles, the Women's Liberation Movement, and the sexual revolution as major cultural milestones as part of their collective consciousness, Boomers will need a new cultural environment within the long-term care setting which acknowledges their generational history.

As we can observe in many industries, the marketplace will follow consumer demand if a cohort of consumers has enough collective buying power to drive changes. I submit that the Baby Boom generation will do just that, and those of us savvy and caring enough to ride that wave will have the opportunity to provide specialized care to an enormous audience of consumers willing and able to pay for our compassionate services.

(I will be exploring this issue over time and welcome your comments and suggestions along the way. Stay tuned, and there will certainly be more to come.)

Mindfulness Journal #6: Mindfulness Conference

Today I attended an all-day conference on mindfulness and meditation with Terry Fralich, a former student of H.H. The Dalia Lama and Jon Kabat-Zinn. The conference focused equally on cultivating mindfulness, the neurobiology of mindfulness, and how to impart mindfulness practices and philosophies to patients and clients when appropriate.

Here are some nuggets:

---Two parents and their teenage son are walking across a barren desert landscape. The father turns to the son and says, "Stop asking when we're going to get there already. We're nomads, for crying out loud."

---If you have time to worry, why don't you have time to meditate?

---In Tibetan, the word meditation means "to become familiar with"

---We live in an age of "data smog" and "techno-stress"

---Mindfulness is full-hearted presence, which translates into presence/intention and kindness towards the self

---The reality of the moment multiplied by my reactions = suffering

---If my thoughts were a movie, I'd get up, walk out, and probably ask for my money back.

Shortages: Not Just for Nurses Anymore

Doctors are leaving primary care in droves. That's the word on the street. Even my own doctor is leaving our local health center to become a hospitalist. As malpractice insurance goes through the roof, paperwork requirements become more stringent, and reimbursement rates plummet (even for Medicare and Medicaid claims), it seems that more and more doctors are choosing to specialize, leaving the pedestrian boredom of primary care for the sexy remunerative opportunities of various medical specialties.

Now, I'm sure that the reasons for a primary physician shortage are far more nuanced than I have so flippantly elucidated here, but the sad reality is that millions of Baby Boomers will begin to retire any day now, and they will all be in need of long-term primary care and preventive medicine in order to keep them healthy and out of the hospital.

In this market-based system, it seems that generalist doctors are being forced to specialize as a way of coping with increasing costs and decreasing revenues. In medical schools, interns and residents apparently are also learning how financially unrewarding primary care can be, and when one considers the cost of attending medical school in the first place, it is no wonder that newly-minted doctors want to maximize their earning potential right out of the gate.

Some reports indicate that advance practice nurses (such as nurse practitioners) will begin to fulfill more and more primary care duties as the shortage of primary care doctors grows, and talk of a new Doctor of Nursing Practice doctoral degree may lead to even more nurses assuming a roles historically held by doctors. These moves may help to assuage the crisis, and all options should be on the table as the crisis deepens.

As for me, I will return to the care of a Nurse Practitioner who left our little health center a few years ago for another position and has now returned. I love the care I receive from a nurse practitioner, and see no reason why I should see a doctor when my NP is capable, competent, and clinically skilled. Sure, my doctor is leaving and I wish him well, but for me there's no crisis, just an opportunity for change.

For the country as a whole, a physician shortage is most certainly problematic, and a shortage of primary care physicians could be devastating. Couple this with an ongoing nursing shortage, and you have one big healthcare mess on the plate of the next president who takes office in nine months.

So, the docs fly the coop and we're left holding the primary care bag. Just how to resolve such a crisis remains to be seen, and it is all of us who will pay the price when the proverbial healthcare feces hits the fan.

The Case Foundation's Make it Your Own Award

I am announcing that a proposal submitted by my dear friend Imre Kepes in Massachusetts was selected as a top 20 finalist among nearly 5,000 entries nationwide by the Case Foundation for its Make It Your Own Awards, a grant program that "challenges people from all walks of life to discuss what matters most to them, decide what kind of community they want, and take action together". If you peruse the proposals of the 20 finalists, you will see an amazing array of projects which have the potential to change the world by empowering people within their own communities.

I am asking for your support to help Imre Kepes' project be selected by on-line voting to be one of the Final Four to be awarded an additional $25,000. The Case Foundation will also give $2,500 to the favorite charity of the first 10 people who vote for the four projects that actually become the Make It Your Own Awards Final Four.

Imre's project---The Community Vision Project of Holyoke, MA (a struggling post-industrial city which has seen better days)---will develop a team of youth leaders to inspire others and gather input from a cross-section of residents to develop ideas to make their community a better place. Together they will create a Community Vision Map that will graphically express these ideas and help to inform and mobilize the community. Action teams will work to turn these ideas into action. The Community Vision Project is a collaboration between the Holyoke Youth Task Force Youth Commission, Hampshire College and other youth programs and adults in the community.

To vote for the Community Vision Project to be one of the Final Four, please log onto http://miyo.casefoundation.org/node/6736/promote and simply click on the vote button. Voting ends April 22. Please note that after you have selected your "final four", you will receive an email to which you must respond in order to confirm your vote!

Thank you so much!

Martin Luther King, Forty Years and Counting

It was 40 years ago today that Martin Luther King, Jr. was assassinated on the balcony of a Memphis, Tennessee motel. Like so many others---known or unknown---King worked tirelessly for the rights of others, and he was one more who fell unnecessarily to the unforgiving hand of violence.

Race still matters in this country, and it touches every person on Earth, and although King's dream is still not fully realized, we all carry the collective responsibility to see it through. From astronomical rates of incarceration for young men of color to predatory lending targeted at communities of color, there is indeed still a long way to go.

In memory of Dr. King, may we all still stand for justice.

Of Order and Chaos

I enter the apartment building and stop at the security desk.

“Who are you here to see?” asks the surprisingly pleasant security guard. She is a large African American woman, and she regards me with a friendly and curious expression.

“I’m here to see Mr. A,” I reply, fingering the ID badge that's clipped to my jacket. “Visiting nurses.”

“Oh, God bless you,” she says. “Good luck. Tenth floor, turn right out of the elevator."

I travel the ten floors in the briefest of upward journeys, and make my way down the hall, looking at the numbers on the apartment doors. His door at the end of the hall is wide open. I stand on the threshold and peer in. I knock and a voice responds, welcoming me in.

“Mr. A? I’m from the visiting nurses. May I come in?”

“Sure, sure, come in, come in,” says a disembodied voice from inside.

I step inside the studio apartment. To my left is the kitchen, or what once was a kitchen and is now more of a storage closet which only pretends to be a kitchen. Every surface is covered with papers, pens, and trash. Even the counters are covered, and the sink is full of dishes as well as a sheaf of papers and a telephone book.

Mr. A pokes his head around the wall that separates the kitchen from the living room.

“Come in here, please, please,” he says invitingly.

The fax that I received on this patient said that he could be combative, distant, or uncooperative. This gentleman seems so much the opposite, at least at first glance, anyway.

“How are you this morning?” I ask, as I attempt with some difficulty to clear a place on the table to put my bag.

“Oh, not so good, not so bad, but I’m going to visit my sister later today.”

His accent could be Indian, or maybe Pakistani, but I don’t want to ask. His diagnosis is paranoid schizophrenia, after all, and as a nurse who is visiting him for the first time, I don’t want to potentially alienate him from the start.

I take in the rest of his living space. The twin bed in the corner is covered with papers, envelopes, and a few plates of partially eaten food. A rowing machine takes up most of the center of the small apartment, and I marvel at the flotsam and jetsam that covers every surface.

“Did you take your meds last night, Mr. A?” I ask.

“Oh yes, here you are,” he says as he hands me the pill container which yesterday’s nurse prefilled for him yesterday morning. It’s empty.

“How did you sleep last night?”

“Very well, thanks,” he replies. His eye contact is good, although he seems to be uncomfortable sitting still at the table with me.

“Oh, before I forget, could you sign this for me?” I hand him my visit note, which has a place for patients to sign as proof that the nurse was actually there for the visit.

“That’s for them to know you were here, right?”

“Yes sir, you have that right, “ I reply.

He is so conversant, so positive and forthright. He is like the opposite of what I was told to expect.

I survey the remainder of his living space and see piles of papers everywhere. There is trash on the floor, chicken bones, milk cartons, a few cardboard boxes. I wonder what trauma or experience caused him to live like this. Although his eye contact is good, there is a wariness that I am now picking up on, a sense that he is uncomfortable in his own skin. Still, I feel completely comfortable with him, and we smile at one another.

I busy myself filling his med box with his morning and evening pills, reading the list carefully and putting my initials in each little box after I place that particular pill in its rightful place. He watches me closely. Once I‘m finished with the meds, I double-check the list and feel satisfied that I did it correctly. I hand him his morning meds.

“Thanks,” he says as he pops them all in his mouth and raises a large mug of water to his lips.
I check his blood pressure and pulse, listen to his lungs, and questions him briefly about his bowels, his urinary status, his appetite, his sleep quality, all the while looking in his eyes, assessing his skin and getting a general intuitive “read” on his overall health.

“Thanks for coming,” he says, as he walks me to the door.

The floor, covered with trash and papers, is like the elephant in the room that I dare not mention. Were he my patient, I would slowly address these issues over time. But in my position as just one more nurse passing through, I leave the elephant for someone else.

We shake hands and I leave his apartment. Even though I have been to so many homes like this in the past, I am stunned by how this man lives, and by the quiet desperation that I saw in his eyes.

“And how was our friend today?” asks the security guard who blessed me just thirty minutes prior.

“Just fine today, just fine,” I reply. “Thanks for your help.”

“God bless you” is her reply, delivered with a wave and a smile.

The outside air is fresh and cold, and I welcome my reentry into the clean orderliness of the wider world.

Immeasurable Abundance

A dear friend who I've known since I was 13 years old sent me the following text message this afternoon:

"The essential nature of the Universe is immeasurable abundance."

This simple phrase was like a sword of clarity cutting through my day, and I felt quite uplifted by it. I've been worrying about money, work, taxes, my health, our house, chores, the endless list of to-do's.

This simple message told me to just take a breath and realize that there is enough time and energy to go around, that it will all get done in good time (and if not, see Monday's post.....)

Even more food for thought for a busy mind in the Information Age.

Connection and Wonder

The house was filled with screaming and playing children and I could barely think straight. Trying to fill med boxes and query my patient about her health, I was having trouble concentrating.

All of a sudden, I looked up from my work at the kitchen table to see four earnest young faces staring at me. Sensing an opportunity, I decided to set the meds aside for a moment and check my patient's blood pressure instead. The children watched with rapt attention as I wrapped the cuff around their grandmother's arm, their fascination growing as I began to pump up the cuff and place the bell of my stethoscope on the crook of her elbow.

Finishing with the blood pressure, I knelt down and offered the oldest girl my stethoscope. I guided the ear-pieces into her small ears and then placed the bell of the stethoscope on her sister's chest. She smiled and giggled as she listened to her sister's heart, lub-dub, lub-dub, lub-dub. Each child in succession took turns listening to another child's heart, and by the time we were done, they were calm as can be and simply beaming.

After I left the house, I wondered to myself just how common it might be for a simple experience---like using a stethoscope for the first time---to end up being a crystallizing moment in a child's life, perhaps laying the groundwork for their adult life. Whatever the outcome, I had a great moment with those children today, and whether they remember it or not, we all had that brief time of connection and wonder, and that was worth more than words can say.

Apparitions and Laughter

Since everything is but an apparition,
Perfect in being what it is,
Having nothing to do with good or bad,
Acceptance or rejection

You might as well burst out laughing!

LONGCHENPA

Here With the Lord Beside Me

She sits on the double bed in her studio apartment with great dignity, the early morning light streaming in the window. Gospel music plays on a small CD player on a table by the kitchen door. This is our first meeting since I'm just covering for her usual nurse.

"How are you this morning, _________?"

"Oh, I'm OK. I'm here with the Lord beside me," she says with a nod of her head towards the CD player. The music plays on.

"Did you sleep well last night?" I ask.

"Well, I only slept a few hours. I can't sleep much since the doctors killed my daughter last year."

I look her in the eye, and she stares back. Her gaze makes me slightly uneasy, but I hold it.

"I am so sorry for the loss of your daughter. That must be so hard."

"Yes, but He sees me through."

We listen to the gospel music for a moment.

"The music is really beautiful," I say sincerely.

"Can I give you your meds now?"

"Sure, honey," she replies.

I put her morning meds together, prefill her evening meds to take with dinner, and ask if she needs anything else.

"No, I'll be alright. My PCA will be here in a few hours."

"OK. I hope to see you again some time, my dear."

"God bless you, and thanks for coming."

She stares at me with that unsettling gaze again. Sometimes the chronically mentally ill can be socially awkward or unaware of how they look at people or how they speak. But in this case, I just feel like she's looking at me very deeply, and I simply try to meet her gaze.

"God bless you, too, and I'm very sorry about your daughter."

"Thanks you. Bye bye, dear," she says as I close the door.

Walking to my car, the ubiquitousness of loss and grief hits me, and I take a deep breath as I open the car door.

Just another day on earth.

A Neighbor, A Death, and Thoughts Thereof

This morning, I was walking our dog and noticed a line of cars in front of a neighbor's house. All of the people walking up to the house were dressed in dark colors and the mood seemed very somber. Arriving home, I told Mary that I had the feeling that someone had died. We checked the local obituary and discovered right away that our neighbor---a man of 57 in the prime of his life---had indeed died twelve days ago of cardiac complications. Luckily, the memorial service was today, and we were able to attend and join the community of mourners.

The service was held in a local church, the altar still brimming with Easter flowers. The music of Van Morrison played in the background as people filed in and found their seats amongst the pews, and the service itself was a lovely event, replete with moving readings, poignant music and poetry, funny stories, and shared remembrances. The wife of the deceased spoke of their thirty years of marriage, and his adult children each took a turn to honor their beloved father whose absence will be all too keen as they themselves move toward their own parenthood.

Over the course of the service, I remarked to myself how this particular event was just what it should be. For those familiar with the person who had died, it was a reminder of cherished stories and of his particular idiosyncrasies which made him unique. With friends coming from near and far, I'm sure some new stories came to light and provided even more elucidation of his very singular mark upon the world.

For those of us less familiar with our neighbor, the service provided a very intimate snapshot of a life well lived, and the varied sharings left one with a very strong impression of a man, a family, a life, and a brilliant personal legacy.

Mary and I did not know this gentleman well, but we would cross paths with him and his wife while we walked our dogs over the years, and I recall that she even came to our house for a party once upon a time. Luckily for us, the last time we saw him was in the autumn. We were sitting by the pond near our house, and he sauntered over with his dog and sat himself down next to us, something quite uncharacteristic for a man who was generally much more socially reserved. I recall that we were at first feeling rather private, but he was very good company that day and we enjoyed our conversation with him very much, and never saw him again throughout the subsequent long and cold winter. What a blessing that we had that opportunity to be with him, and how glad I am that we have that memory of our last interaction.

Now, a new widow is in our midst, and within the privacy of her home, she will continue this process of grieving that is only weeks old. She and her children will go to the university to clean out his office, go through his papers, and will perhaps be at once perplexed and overjoyed by the things that they discover. How little thought most of us must give to the fact that, upon our untimely death, our loved ones will need to rifle through our things and settle the dust of our lives. There will be much to settle in that household after such a creative and productive life, and I do not envy that family the difficult task at hand.

With two dear friends so recently in surgery and now the death of our neighbor, I'm reminded quite starkly of the fleeting nature of life. As I struggle with chronic pain and some recently significant depression, I hold my own life up for close examination and wonder what conclusions would be drawn about me at my own funeral. I know I need to smile and laugh more. I also know I need to have more fun and take time to relax. While I struggle to earn enough money, I can say with certainty that no one at my funeral would begrudge my earning power or lack thereof. Still, life proffers many challenges, and we strive to honor our earthly responsibilities while also taking time to smell the roses.

Life is tenuous at best, and this week's experiences in my own life demonstrate that it can be saved or snuffed out at any moment. I am aware of this tenuousness, and I only wish to make that awareness something that informs my every breath.

Friends at Risk

As I write this missive, two friends are undergoing surgery, placing their lives in the hands of doctors and nurses and anesthetists on this very morning.

One friend is having a total hysterectomy in order to control Dysfunctional Uterine Bleeding (DUB) which has been unresponsive to hormones and other non-invasive treatments.

The other friend has been suffering from severe headaches and back pain which could not be controlled with any medications. An MRI of the brain revealed a 2-centimeter tumor in the frontal lobe. There are many risks to the surgery, including nerve damage which could result in paralysis or other consequences.

I will also mention that the husband of an old friend has multi-organ cancer which has not responded to conventional chemotherapy and he will now undergo a clinical trial at a major East Coast cancer treatment center in an attempt to slow or reverse the disease process.

May the surgeons and nurses and other surgical staff be guided to perform at the height of their skill. May my friends recover from surgery fully healed, without negative side effects or complications. May the cancers be contained and eradicated. We prayed for them last night here in our house, and we will hold them in our thoughts this morning and throughout the day.

What are my problems in the face of such suffering and life-altering disease? May we all find perspective and some modicum of peace when we examine and consider the suffering of others.

Back in the Saddle

Dear Readers,

I have been out of town for the long holiday weekend, visiting family along the Eastern Seaboard. If you and yours celebrate Easter, I hope it was joyous. And if you celebrated Purim, joy and merriment to you as well!

Traveling by Amtrak had its ups and downs, but overall it was worthwhile not having to drive all of those arduous miles. (I am also aware that train travel is a good choice vis-a-vis environmental impact). Still, getting around by train in the U.S. is nothing like it is in other countries, and I found myself pining for the timely, clean, and comfortable trains of Europe.

Now, here I am back at home, happy to be in my own space, and ready to get back to work once again. Stay tuned for the usual frequent blog posts, and please keep those comments, cards, and letters coming!

Blessings!

Change of Shift, Vol. 2, No. 19

The newest edition of Change of Shift is now available for your reading pleasure. Change of Shift, the brain-child of Kim McAllister at Emergiblog, brings you some of the best blogging by nurses anywhere in the blogosphere. I highly recommend a perusal, and many thanks to Kim for keeping Change of Shift active and dynamic.

The Ides of March

"Beware the Ides of March" was the soothsayer's warning to Julius Caesar prior to his assassination in 44 B.C., and the saying was apparently ingrained in the English language by William Shakespeare in his play Julius Caesar as a warning of impending doom.

According to Wikipedia, "the term ides was used for the 15th day of the months of March, May, July, and October, and the 13th day of the other 8 months" (in the Roman calendar).

In my life, the Ides of March signifies one of the most difficult times of the year. Living in New England, mid-March generally manifests as a blustery and damp time of fickle weather, fluctuating temperatures, chilly winds, and a deep longing for a Spring that is painfully slow to arrive. In the latter portions of March and early April, "mud season" arrives as the ground thaws and fills with the moisture from melting snow and ice. In March, our warmth- and sun-starved faces turn towards the sun whose appearances are still frustratingly brief. Still, with extended Daylight Savings Time and the natural course of solar events, sunset comes later and later, and the return of the light is upon us.

As I so recently opined, March also brings several death anniversaries, as well as the birthdays of a number of deceased loved ones, a potentially unfortunate synchronicity. But perhaps this inward and historically melancholy time is naturally and simply perfect for reflection and grief. One must remember that, on the heels of this most interminable winter, Spring is just around the corner, bringing with it longer days, brighter sun, blooming trees and grasses, and rising temperatures.

I wait with baited breath for those heady days when we can lay on soft earth and grass, soak in the sun, and turn our faces towards that beloved golden orb with relish and joy. Until then, we allow the Ides of March to come and go, looking forward towards the dawning of April and the coming of Spring.

Pain: The Unwanted Hitchhiker

Chronic pain is so very inconvenient. It is so limiting and restricting, like a belt worn unnecessarily tight.

Pain effects one's sleep, one's ability to exercise. It can curtail the enjoyment of sex, and even the most burgeoning appetite. It restricts one's activities, precludes some activities altogether, and can be a demoralizing agent whose influence cannot always be ignored.

Pain is like a hitchhiker who has worn out his welcome but cannot be extricated from the passenger seat. Perhaps his first appearance was not overly worrisome, and he exited peacefully when requested to do so. Maybe he was even helpful that time you had an emotional flat tire and needed an excuse to rest. But months later, thoroughly ensconced in the back seat, wearing an iPod, drinking a Coke and ignoring your every plea, this aberrant guest now refuses to let you be. The welcome mat---if it had ever been in place---was long ago jettisoned, but this vagabond ignores the rules and clings to you like a needy child.

When did this pain become such a burden? At what point did I realize that my life was being taken over? When was it that I picked up a passenger whose very presence makes me scream with impatience?

And so, with no other bright ideas, I embrace pain as a teacher. I follow his lead, peering into dark alleys which have long been ignored. He leads me to painful emotional places riddled with doubt and self-loathing. His mere presence is yet another vehicle for cultivating a mindful response to life, acceptance of what is, however difficult or ugly.

I am mindful of my pain, but also mindful of my innate ability to rise above its undo influence on my life. He is an unwanted hitchhiker, it's true. But even the most unwanted guest may hold in his hand a gift of great beauty, and since he is slow to reveal his secrets, I will continue to pursue them, even as I wish him gone.

So, dear Pain, my most aberrant passenger: reveal your gift and be done with it. I am ready for the message now, and ready for you to move on. The damage has been done, and I am poised to reclaim my life from your messy grasp. Relinquish me now, and leave your gift by the door. And please, don't look back. You will not be missed in the least.

A Brief and Pleasant Exchange

She's waiting for me in front of the tired clapboard house on a busy city street. I'm doing a visit for a colleague (in my new consultant position), dropping off some meds and checking in on this very lively couple with whom I am totally unacquainted.

"Hey! Thanks for coming over with the meds!" her partner yells. He is jovial and talkative, slapping my back and shaking my hand.

The house is a boarding house: shared kitchen, office downstairs with staff during the day. Pretty clean inside, a little rough around the edges. Their room is one large bedroom with a bathroom and a closet. A little small and dark, I think.

"How long have you been here?"

"About a month," she says.

"It's great. You both seem really happy. Can I check your blood pressure while I'm here?" I hand him his prefilled medication box and give her the rest of the things I've brought over: medicated shampoo and cream, Lidoderm patches for his muscle pain.

"It's so much better than the shelter," he adds. "I've been clean two, maybe three years now. See my tracks?" He shoves his arm at me as he rolls up his sleeve. I examine his forearm and the crook of his elbow, which he obviously wants me to inspect closely. Sure enough, track marks galore, but quite old and healed.

I take his blood pressure as he sits on their only chair. When it's time for me to check hers, she sits on his knee.

"This woman," he says, motioning to his partner. "She's my life. Don't know what I'd do without her."

"You all obviously care about each other a lot," I say in response.

"Yeah, through thick and thin," he says. She laughs.

We talk briefly about their health. I question them, nurse-style, about their bowels, their urinary status, pain management, respiratory status, the usual line of questioning. They answer each question with kindness and patience.

"Hey, thanks for coming, man. We really appreciate it." He shakes my hand and slaps my back again, just like he did when I arrived.

She leads me down the stairs.

"You have yourself a man who loves you, don't you?" I ask.

"Oh, he's the best. We've been though a lot together."

"Well, you keep taking care of each other. I hear you're both doing a great job."

She smiles. "Yeah, I guess so. We're tryin'. That shelter was awful, but things are better now. Thanks for bringin' our stuff over. Sometimes it's so hard to get to the clinic."

"No problem. Glad to help out," I reply. "I hope to see y'all again."

"You're always welcome here." She smiles as she closes the door.

So polite. So welcoming. So amenable to my presence, despite never having met me before. A thoroughly pleasant interaction, made easier by the fact that I bear no responsibility for their care, just for this brief and satisfying exchange.

International Womens Day

Today is International Womens Day, and I want to take this moment to recognize this very important day for women worldwide, a day which saw its genesis in the Socialist movement of the early 20th century. The website of the World Health Organization points out that this year's theme is "investing in women and girls". Investment can mean many things to many people. In my view, we could best invest in women's health, girl's education, violence eradication, an end to war, and socioeconomic justice for women, to name a few places to begin.

As the son of a woman, the husband of a woman, the uncle of several women, the brother of a woman, and the brother-in-law and son-in-law of several women, I feel that I have many significant and powerful women in my family and in my life, and I am grateful for them, as I am for all of the women who touch my life, both personally and professionally.

Having always considered myself a feminist, and working in a profession which is 95% women, I am sensitive to the plight of women and aware of the struggle for power and recognition which women have waged for hundreds of years. Today, in many countries worldwide, women still fight against the threats of rape and violence, not to mention the constancy of war. With rape being used as a tool of war, and human trafficking---mostly of girls---still widely prevalent, girls around the world are still at a great disadvantage.

International Womens Day is but one day when the world's attention is drawn towards the struggles of women for justice and parity in a world which has yet to fully offer either unequivocally. I urge you, dear Reader, to pause and consider how you might contribute---financially or otherwise---to the advancement of women's causes today and beyond, and then perhaps make a plan to follow through. Whether it be a contribution of time to a single young girl, or a check to a women's organization of your choice, consider how you can invest one small piece of yourself in the struggle, and honor yourself for being a part of the solution.

Happy International Womens Day.

The Flu Still Fits....

The flu is infamous for making it seem like it's on the way out, and just when the unsuspecting victim begins to expend some extra energy----ZAP!----down he or she goes once again.

I am trying to avoid this pitfall by laying low, sticking to home, begging off all work, and basically treating myself like an invalid. Today's menu: a wonderful Israeli movie which I highly recommend (whether you're sick or not); a few ever-so-brief walks with Tina the dog; some emailing; some phone-calls; some computer-based work; a nap or two; another movie which I cried my way through; and an evening with Mary. All in all, not a challenging schedule by any stretch.

And tomorrow? I'm afraid to even plan........

If the Flu Fits.......

Woe to anyone who suffers the flu this season, and I can now count myself among the chosen who have been visited by this most hard-hitting of viral illnesses. Arriving home from a trip to see my parents, I began to feel unwell on the train as I traveled through New York State. By the time I arrived home to New England, a fever, chills, and unbelievable muscle aches had taken over, and I moaned my way through the night as my amazingly patient and solicitous wife tended to my every need. Now I'm lethargic, with a head that feels like it's filled with cotton-candy, and muscles that ache unceasingly (although a hot bath worked wonders this afternoon).

According to the Centers for Disease Control, the week of February 23rd---the 8th week in this year's flu season---saw widespread reporting of influenza by epidemiologists in every state but Florida. You can see the epidemiological map here. According to the data, the entire country seems to have become "lit up" with flu, so to speak, during the month of February.

It is often difficult for people to tell whether they have the flu or a common cold. There are many tools available to assist you in making that determination before you call your doctor, and I offer several useful links forthwith.

A handy quiz on About.com will guide you through a series of questions to determine the potential source of your illness.

C Health offers this table comparing various symptoms.

The good ol' CDC offers general advice on the difference between the flu and the common cold.

And the U.S. FDA also chimes in with a basic table of symptoms.

As far as treatment for the flu, there's really nothing more to do than rest, hydrate, take a non-steroidal anti-inflammatory for pain and headache, and then rest some more. And did I mention rest? If your fever becomes precipitously high---especially in children and adults with other underlying conditions---a trip or telephone call to the doctor is probably in order. However, the majority of flu sufferers can usually stay home and recover without unnecessary use of medical resources.

As for me, even more rest is now in order, and I hope to be back to my usual self in a few days. Luckily, transmission of real viruses is impossible over the Internet, thus blogging while suffering from the flu is still allowed by the CDC.

More soon from Influenza Central.

Thoughts and Happiness

We are what we think.

All that we are arises with our thoughts.

With our thoughts we make the world.

Speak or act with an impure mind
And sorrow will follow you As the wheel
follows the ox that draws the cart.

Speak or act with a pure mind
And happiness will follow you As your
shadow, unshakeable.

----THE BUDDHA