In the Waiting Room

A favorite poem.  This is Elizabeth Bishop's recollection of the moment when, at age seven, she became aware that she was a Self in a world of Others, different from and yet still connected to everyone else.

In the Waiting Room

by Elizabeth Bishop 

In Worcester, Massachusetts,
I went with Aunt Consuelo
to keep her dentist's appointment
and sat and waited for her
in the dentist's waiting room.
It was winter.  It got dark
early. The waiting room
was full of grown-up people,
arctics and overcoats,
lamps and magazines.
My aunt was inside
what seemed like a long time
and while I waited and read
the National Geographic

(I could read) and carefully 
studied the photographs:
the inside of a volcano,
black, and full of ashes;
then it was spilling over
in rivulets of fire.
Osa and Martin Johnson 
dressed in riding breeches,
laced boots, and pith helmets.
A dead man slung on a pole
 "Long Pig," the caption said.
Babies with pointed heads
wound round and round with string;
black, naked women with necks
wound round and round with wire
like the necks of light bulbs.
Their breasts were horrifying.
I read it right straight through.
I was too shy to stop.
And then I looked at the cover:
the yellow margins, the date.
Suddenly, from inside,
came an  oh! of pain
--Aunt Consuelo's voice--
not very loud or long.
I wasn't at all surprised;
even then I knew she was 
a foolish, timid woman.
I might have been embarrassed,
but wasn't.  What took me
completely by surprise
was that it was me:
my voice, in my mouth.
Without thinking at all
I was my foolish aunt,
I--we--were falling, falling,
our eyes glued to the cover
of the National Geographic,
February, 1918.

I said to myself: three days
and you'll be seven years old.
I was saying it to stop
the sensation of falling off
the round, turning world.
into cold, blue-black space.
But I felt: you are an I,
you are an Elizabeth,
you are one of them.
Why should you be one, too?
I scarcely dared to look
to see what it was I was.
I gave a sidelong glance
--I couldn't look any higher--
at shadowy gray knees,
trousers and skirts and boots
and different pairs of hands
lying under the lamps.
I knew that nothing stranger
had ever happened, that nothing
stranger could ever happen.

Why should I be my aunt,
or me, or anyone?
What similarities 
boots, hands, the family voice
I felt in my throat, or even
the National Geographic
and those awful hanging breasts 
held us all together
or made us all just one?
How I didn't know any
word for it how "unlikely". . .
How had I come to be here,
like them, and overhear
a cry of pain that could have
got loud and worse but hadn't?

The waiting room was bright
and too hot.  It was sliding
beneath a big black wave,
another, and another.

Then I was back in it.
The War was on.  Outside,
in Worcester, Massachusetts,
were night and slush and cold,
and it was still the fifth 
of February, 1918.

Gotta Love Steinbeck . . .

From East of Eden:

"And this I believe: that the free, exploring mind of the individual human is the most valuable thing in the world.  And this I would fight for: the freedom of the mind to take any direction it wishes, undirected. And this I must fight against: any idea, religion, or government which limits or destroys the individual.  This is what I am and what I am about.  I understand why a system built on a pattern must try to destroy the free mind, for that is one thing which can by inspection destroy such a system.  Surely I can understand this, and I hate it and I will fight against it to preserve the one thing that separates us from the uncreative beasts.  If the glory can be killed, we are lost."

Sudden Solitude

I went for a hike up Massey Draw yesterday afternoon.  It was sunny and breezy, blue sky streaked with wispy white clouds.  I was alone.

I parked my truck and started up the trails through the prairie, mostly brown grass with green shoots poking through, and entered the mouth of the steep, piny valley.  Unexpectedly, the creek was completely dry at the bottom.  This far into the spring, I had thought the creek would be engorged with run-off, but I was wrong.

The climb was steep, and I took it fast, quickly breaking into a sweat.  After ascending a rocky staircase, the valley narrowed, thick pine forest on one side of the creek and sheer rock wall on the other side.  I stopped to grab my water bottle from my backpack, and listened to the breeze whistling through the pines.  I was only ten minutes and less than a mile from the parking lot, but already the valley had folded in on itself, obscuring any sign of the suburban sprawl below.  I looked up at the afternoon sunlight diffusing into the shadows of the pines, at the streaky blue sky above.  The tree tops swayed in the breeze, and I closed my eyes and swayed with them, the scent of ponderosa suspended in the shadows.  The sudden solitude was exquisite.

Then I was off again, more rocky steps, more pine.  Towards the top, the valley narrowed considerably, and heavy sheets of ice covered the creek bed, the tinkling sound of water running beneath melting snow pack.  Somehow, this scant stream of melt-water vanished before it descended to the prairie below.  It must go subterranean through some crack in the granite, I thought.  A fallen tree crossed the trail, a casualty of winter winds and age.  I scrambled over it and came out near a boulder pile, where a rush of movement caught the corner of my eye.

Out of a deep recess in the boulders, something large, black, and furry came lunging at me.  I jumped backwards into the rock behind me, and then breathed a sigh of relief.  Not a bear.  A large, friendly dog came sniffing from the cave.  I caught my breath and reached down to scratch his head.  "Hey, big fella," I said, "You up here alone?"

Then I heard voices tumbling down the creek from above, and four teens, two boys and two girls, emerged into view.  The boy with moppy hair and the profane t-shirt called out, "Here, Zeke!  Here, boy!"  And Zeke bounded up to him.  I continued up the trail, and as I passed the teens, I offered a friendly greeting, chuckling as I told them I thought Zeke had been a bear.  They avoided eye contact, offered uncertain laughs or silence, and kept descending without a word.

I made it into the aspen forests on top of the valley, all bare white trunks, no green yet, and then ascended into the scrub oak.  At a trail crossing, I veered towards Gothic Overlook, my intended destination.  Rounding a corner, I came over onto the crest of the foothills, the path meandering away from the sheer cliffs of the valley below.  In jerky movements, the vast horizon of Colorado's Front Range came into view.  Downtown Denver, Castle Rock, Chatfield Reservoir--hey, wasn't that the park where my kid's played soccer?--and then plains stretching forever eastward into Kansas.  It was always a breathtaking view.  Below, I could see my truck in the parking lot, and I could see the teens just emerging from the valley floor, Zeke still out in front.

The wind was chillier up top, but the sun was strong and warm.  I wound through the scrubs oaks and reached the end of the trail, a small clearing set atop the knob of the foothill.  Downward, towards the cliffs, there was an outcropping of rocks, a prime spot for a little reading, writing, and meditation.  Just a hundred yards off the trail, which was prohibited, but who was going to stop me?

I went off-road, stepped over the fledgling scrub oaks, greening grass, and scattered boulders and negotiated my way to the outcropping.  But once there, I saw that the terrain still continued to slope down towards the cliffs, where another granite crag jutted into the valley, punctuated by an ancient weathered juniper.  I kept descending.

The juniper was dead, polished smooth by wind and snow, a brown spiny skeleton perched on a shelf of granite.  Even here, the mountain sloped down further towards the cliffs, toward more jagged rocks and then the canyon beneath.  From the top, I hadn't guessed at the extent of this hidden pitch.  But I chose to stop now.  A flat indentation in the present rock looked comfortable enough, so I slipped off my pack and had a seat.

I grabbed a granola bar and had a sip of water, then fished my Robert Frost book out of my pack, pages rippling in the gusty breeze.  I opened to a new poem, "Build Soil: A Political Pastoral."  Long, and poignant, a hidden gem, Frost at his whimsical and melancholy best.  Then another one that was new to me:  "There Are Roughly Zones."  Brilliant.  Then I went for the familiar:  "Mending Wall," "To Earthward," and "The Road Not Taken."  The cadences of these poems are like listening to my favorite songs on my iPod:  I know them by heart, yet they (and all their connotations and reminiscences) carry me someplace private and transcendent.  Then I turned to "Desert Places," which concludes with these lines:

They cannot scare me with their empty spaces 
Between stars--on stars where no human race is. 
I have it in me so much nearer home 
To scare myself with my own desert places.

With that Frostian prelude, I reached for my trusty yellow spiral notebook.  Spiral notebooks for me are like a security blanket.  My pen acts like a conduit between the ephemeral thoughts of my mind, filtering, amplifying, translating to the concrete paper beneath me.  This is why I have a box of a couple dozen old notebooks in my basement.  I can't bear to part with them, even if they are filled with random doodles and poem fragments.

But today, my muse failed me.  Nothing would come.  The wind was rippling pages and my thoughts weren't coalescing.  After some blank moments, I thought I would make a list of all the things I need to do.  It quickly became depressing, so I stopped.  Looking down into the valley where I had been an hour before, I saw the pines waving, and I thought, let me just connect here.  I have time.  I have nothing pressing to attend to.  I'm alone.  Let me just relax and exist in the moment.  Meditation.  Out of time, out of mind.

The granite rock had a nice flat space, so I lay back and closed my eyes, tried to empty my thoughts and cast them into the wind.  Time to be a human being . . . just being.

The sun was warm on my face, the wind settled down and was gentle, and for a moment--who knows how long?--I found my Zen Point.  Laying on my back in the sun and the wind, a child of the universe, existing on this rolling sphere, a speck in the cosmos, and I felt harmony, tranquility, surrender.

Then sudden sharp voices fluttered through the wind.  An F-bomb.  Teens.  More profanity, cackling laughter.

Bummer, I thought.  I sat up, and there, emerging over the cliff's edge fifty yards away, came three teen boys.  Different teens.  They must have climbed straight up the cliffs, I thought.  They didn't have any equipment.  Maybe those cliffs aren't as steep as I thought they were.

They looked up the slope and saw me perched on the rock, and I waved.  They were startled, silenced for a moment, and one of them waved back tentatively.  Then they huddled together, another burst of laughter.  They clustered over the cliff's edge for a while, one of them clearly more boisterous and the leader, all clutching cans that I hoped were cokes and not beers.  They were quite vulgar, from the fragments of speech that the wind carried to me.  The discussion seemed to be centered on Viagra and female anatomy.  I lay back down and hoped they would move on soon.  Thankfully, having conquered the cliff and discussed life's great mysteries, they had soon had enough of the experience, and they descended back down from whence they came, disappearing over the cliff's edge and towards more conquests.

I was alone again.  I tried to get back to my Zen Point, but my mind was now cluttered with other thoughts.  The afternoon sun was sinking low in the sky.  Reluctantly, I reached for my cell phone, checked the time, and in so doing my email chimed.  Six new messages.  I scanned through them.  Three junk, three important.  I considered whether to deal with them now or later.  Later, I decided.

I gazed out over the Front Range again, the sprawling city, a half million houses, two and a half million souls.  Rich ones comfortably in the mansions just below me, less affluent ones painting the distant nooks and crannies of the city.  Within my field of vision, someone was dying at this very moment.  Someone was being born.  Crimes were being committed, loves consummated, agonies endured, triumphs attained.  And here I was, invisible to them all, an ignorant eye in the sky, a part of their world and yet completely separate, connecting ever so tangentially and transiently with awkward words, fleeting gestures, scattered emails.  Sharing so much, sharing so little.

The sun was angling obtusely behind me.  The wind had settled down again.  A sip of water, a few hardened gummy bears that had remained in my pack after a recent airplane trip.  Time to go.  Time to reconnect with the civilization that lurked below.

How to descend?  I realized I was not interested in returning to the trail and going back the way I came.  Should I follow the teens down over the cliff's edge?  No, that might mean engaging with them in some manner.  Not a good idea to climb down solo, anyway.  I scanned the eastern contour of the foothills with my eyes.  If I headed north and down through the scrub oak, and climbed over a rocky rim, then the brush turned to a long, steep grassy slope that descended until it spilled into the trail that would lead me back to the parking lot.  Easy enough.  It was off trail, sure.  But again, who was going to stop me?

Heading east off the foothills, I dropped into shadow while the suburbs before me remained splashed in golden sunlight.  The wind died down to a murmur.  A few bikers crisscrossed the prairie trails below.  I was feeling mellow, rejuvenated.  I let out a subdued yawp that disturbed no one.  I picked my way through the brush and rocks and made it to the final steep slope.  I lightly traced my own mini-switchbacks to slow the descent, to take the pressure off my toes.  I was getting a blister.

I kicked a rock loose on accident.  It wobbled, paused, and then gravity pulled it over a threshold.  It tumbled a few feet, then paused, creaked over the threshold again, and rolled downward.  It bumped and zagged and kept tumbling bit by teetering bit, a slow motion landslide of one.  I was almost keeping pace with it.  It slowed, but nothing was going to make it stop.

My new rock companion and I continued to travel downward together, and it was with some sadness that I saw it finally come to rest in a clump of grass just as the slope flattened out at the bottom.  The pressure came off my toes.  This rock's journey was over, and so was mine, nearly.  It had been sitting on the side of that mountain for maybe a million years, heaved there by unfathomable seismic forces rumbling from the earth's molten core.  There it had sat as an inanimate object of potential energy until my misguided step unleashed its inner rolling stone.  Now it lay fifty yards off the trail, buried in a grass clump in a depression at the bottom of the slope, likely to never be disturbed again for a thousand years, maybe a million, its energy released, its potential energy depleted, one entropic step closer to its destiny as a nondescript component of a homogeneous, cold, and flattened world.

My phone chimed again.  Voicemail.  I ignored it.  Then my email chirped.  I had to look.  What was I doing here staring at this rock?  I better head back to my truck.  I had things to do.

New Beginnings

It has been a tumultuous and exciting few months.

I am no longer working for Chatfield Family Medicine.  Please check out this new blog for the details.  http://www.markfosterdo.blogspot.com/

I'm working on some very exciting projects, including starting my own practice or joining an existing practice, various writing and speaking opportunities, and some exciting family situations.

I'm juggling a lot of things write now, but I hope to get back to my musings on life, spirituality, medicine and family on this blog in the near future, so stay tuned.

Here's quote from They Might Be Giants that always gets me pumped up:

"They don't need me here and I know you're there
Where the world goes by like the humid air
And it sticks like a broken record
Everything sticks like a broken record
Everything sticks until it goes away
And the truth is we don't know anything . . ."

Don't read too much into that, except for the last sentence.  We humans have learned so much, and yet we know so little.  Which means there is so much to learn, so much to stand in awe of.

It's good to have fellow travelers on this journey of life.  Thank you, friends.

The Beatles' Genius

I recently have been reading through a special edition of Rolling Stone, "The Beatles 100 Greatest Songs."  It has been a exhilarating trip down the penny lanes of nostalgia and creative genius.

I think the enjoyment comes from recognizing and relishing their genius, which was so unique, so fresh and challenging, so overpowering that, in the span of eight short years, they revolutionized the world of music, and the world generally.  How did they do it?  How did they go from Liverpool to the Ed Sullivan Theatre to Strawberry Fields to Abbey Road, from Yesterday to Tomorrow Never Comes to A Day In The Life to The End in the short span of eight years?  Seeing in pictures the physical transformation of the group is fascinating, from the close cropped hair of the early years, to the mop tops of their American invasion, to the John-Lennon-is-Jesus hippie look of the later years.  What would it have been like to have witness that evolution--no, revolution--in real time.  I remember my dad relating to me the sheer excitement he felt when taking the newest Beatles LP out of its sleeve for the first time.

The creative collaboration between John and Paul was propulsive, ecstatic with energy, and yet some of their very best songs were written by George.  Ringo seemed to be the perfect complimentary personality for the group, congenial and comedic.  What would have happened if they hadn't been pushing each other?  It's interesting that early in their careers, they didn't really even consider themselves talented song writers.

The external rivalries and collaborations with their contemporaries are also fascinating.  Bob Dylan and John Lennon had a decades-long rivalry going.  Paul and Brian Wilson of the Beach Boys were constantly trying to one-up each other:  Rubber Soul begat Pet Sounds which begat Sgt. Peppers which eventually begat Good Vibrations.  Chuck Berry, Elvis, Eric Clapton, the Rolling Stones, and most other contemporary rock and rollers and folk rockers figure prominently in the Beatles' development, yet they also seemed ahead of the curve, pushing and exploding the envelopes, dragging the rest of the musical and cultural universe along with them.  The songs are all forty-plus years old, and yet they sound as energetic and pertinent as ever.  Timeless.

It all happened so fast.  Eight years ago I was just graduating from medical school, which still in some ways seems like yesterday.  But in eight years, John, Paul, George and Ringo changed the world.  They weren't even thirty when they broke up.

There are such interesting parallels in their music that matched their trajectory as a group, from the explosive energy of the early chords that heralded their arrival, to the psychedelia of the middle drug-infused years, to the mature, contemplative ballads of the later years.  And yet the music was sublime every step of the way.  It's as if they simultaneously created and mastered this new form of musical expression.  They couldn't have known that Let It Be would be the title track for their last released album, or that the final song from their final recording session, which would become Abbey Road, would be entitled "The End" and finish with lyrics "And in the end, the love you take is equal to the love you make."  The long and winding road came to a presaged ending.
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But I guess the simplest reason that reading about the Beatles songs is enjoyable is because the music is just so good, and so familiar.  I think we all have imprinted in our brains, in a literal way, the massive original creative output of these four boys from Liverpool.  Hearing these songs, or even just reading about them, instantly trips multiple pleasure switches in the brain.  It's almost like some of these songs exist independent of their creators, like they were melodies and harmonies and lyrics that the Beatles didn't so much write as discover, digging them out of the ether of the cosmos, polishing them, and then leaving their indelible fingerprints all over them.  In some cases, like Yesterday and Blackbird, that is true:  Paul woke up and fell out of bed with the fully formed song buzzing through his brain.  Sometimes, genius is a work of persistence, and sometimes a product of inspiration.  In the Beatles case, it was seemed almost like an organic, synergistic and semi-spontaneous phenomenon.

Here are the top fifty songs from Rolling Stone's list.  I don't quite agree with all of their placements, but how can you argue, when their perfection was so prolific?

1. A Day In The Life
2. I Want To Hold Your Hand
3. Strawberry Fields Forever
4. Yesterday
5. In My Life
6. Something
7. Hey Jude
8. Let It Be
9. Come Together
10. While My Guitar Gently Weeps
11. A Hard Day's Night
12. Norwegian Wood
13. Revolution
14. She Loves You
15. Help!
16. I Saw Her Standing There
17. Ticket to Ride
18. Tomorrow Never Knows
19. Lucy In The Sky With Diamonds
20. Please Please Me
21. All You Need Is Love
22. Eleanor Rigby
23. Abbey Road Medley
24. Happiness Is A Warm Gun
25. Here, There, And Everywhere
26. If I Fell
27. You're Going To Lose That Girl
28. Here Comes The Sun
29. Can't Buy Me Love
30. We Can Work It Out
31. You've Got To Hide Your Love Away
32. Penny Lane
33. I Am The Walrus
34. Eight Days A Week
35. Paperback Writer
36. I Should Have Known Better
37. She Said She Said
38. Blackbird
39. Day Tripper
40. For No One
41. Get Back
42. I Feel Fine
43. Drive My Car
44. All My Loving
45. No Reply
46. Don't Let Me Down
47. Things We Said Today
48. The Ballad of John and Yoko
49. The Night Before
50. Got to Get You Into My Life

Anatomy of an Epidemic

Could it be that our drug-based paradigm of psychiatric care is fundamentally flawed, that the magic bullet medicines purported to correct chemical imbalances are actually worsening mental illness in America?

That is the conclusion of Robert Whitaker's new book, "Anatomy of an Epidemic:  Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America."

It is an evidence-based, highly persuasive critique of psychiatry's devastating failure as a medical specialty.  Disability from mental illness has multiplied ten-fold since the the introduction of psychotropic medications in the 1950s. Pharmaceutical giants make billions off patients from whom they have willfully withheld evidence of their addictive drugs' deleterious long-term effects.  And one in eight children in America is started, in childhood, on a pathway towards a lifetime of medication-induced mental disability, some before they are even potty-trained.  Two year-olds are being placed on antipsychotic medications for "bipolar disorder."  Read that last sentence again.

This is not to say that mental illness is not real, or not that psychiatric medications are not sometimes appropriate.  But how did we get from that point--limited use of psychotropic drugs to stabilize rare, severe episodes of mental illness--to this point:  some psychiatrists now suggest that over half of Americans suffer from a pathological, biochemical mental illness, and virtually all psychiatrists utilize, as their only treatment modality, cocktails of two or five or even seven mind-altering medications.

Mr. Whitaker's book rips away the curtain from psychiatry's hall of mirrors and gives its distortion of drug studies no place to hide. With even one step backwards to look at the big picture, it is all so ludicrous, so pervasive, and if it continues unchecked, so very calamitous for our children and future of our society . . . yet so very profitable for the drug companies.

Every physician, every patient struggling with anxiety or depression, every parent with a rambunctious child, should read this book carefully.  I know that in my own practice, I am foregoing the habit of mindlessly refilling my patient's psychotropic medications and initiating the discussion of the mind's capacity to heal, of our need to constantly reevaluate (every six months at a minimum) the use of psychiatric medications.  I've been surprised at how receptive my patients have been.

Read the book.  It's engrossing, and so important for all of us to try and reverse this destructive paradigm of mental health.

Children: the Antidote to Existential Crises

First post in several months.  Writing has come with difficulty recently, and I'm not entirely sure why.  The most obvious reason is that life has become busy:  busy at clinic, busy at church, busy at home.  Busy is good, but sometimes it seems hard to, well, catch your breath.

I believe the more subterranean reason is because I have been battling through what I would term a prolonged existential crisis.  This is nothing new.  These crises have occurred to me periodically throughout my life, but this one seems different, more profound, more enveloping.

What's different this time?

In the past, I've always had some focal point, some future goal, a graduation, engineering an escape from Wyoming, writing a novel that, with the perspective of time, now seems in essence to be a scream into the void, a quest for validation.  Point is, there has always been some distraction or project into which I could project my existential frustrations and anxieties.  I don't seem to have that "next big thing" any more.

By all external measures, my life is great:  great job, relative financial security, lovely wife, cute kids, a good church, a home we love in a state we love.  And yet . . .  and yet . . . I find myself unsatisfied, frustrated, yearning for more.  I don't find myself questioning the existence of God, but I find myself wondering, in spite of that faith, about ultimate meaning, my place in the vast emptiness and benign indifference of the universe.

Bono said it well:
 
I have climbed highest mountains
I have run through the fields
Only to be with you
I have run
I have crawled
I have scaled these city walls
These city walls
Only to be with you
But I still haven't found what I'm looking for

I believe in the Kingdom Come
Then all the colors will bleed into one
Bleed into one
But yes I'm still running
You broke the bonds
And you loosed the chains
Carried the cross
Of my shame
You know I believe it

But I still haven't found what I'm looking for
But I still haven't found what I'm looking for

(That's from a man who has worldwide fame and colossal fortune.  And now a surgically repaired back.  Coming to Denver May 21st.)

All of this could fairly be called a midlife crisis.  I am, after all, turning thirty six next month, and I've noticed a few gray whiskers recently.  Cue "Dust in the Wind."  Prescribe me a bottle of prozac.

But the truth is that I am, perhaps foolishly, still hopeful that good will come of these melancholy ruminations, that there is something powerful, overwhelming, intimate and beautiful to be found on the other side of this abyss, not just echoes reverberating into the chaos of entropy. 

For those that know me well, this is why the LOST finale struck such a powerful cord.  It conveyed, beyond words or summarization, what I've been feeling:  that this Island of Isolation and Mystery, this life, on which we are all scratching out a sorrow-laden existence, ultimately means something, means everything, in fact, and we are not alone on the journey.  We see through a glass darkly, but the best we can do is to help each other stumble towards grace and redemption, believing that someday we will cross that great divide together and find that something brilliant has been awaiting us all along.

I could, and maybe should, be writing volumes about this inner weather, as a means of processing and understanding myself.  Perhaps I should spare the blogosphere and my minuscule audience that agony.  Maybe this post is a start.

But what I want to say today is that I have found a readily available antidote for these crises:  my children.  Especially my three year old.  He lives entirely in the now, in the throes or ecstasy of whatever current emotion or appetite is coursing through his mind and body.  This can lead to tantrums and meltdowns, and also the most hilarious things that he says.

Brief example:  Justin loves loves loves swords.  Everything--sticks, brooms, pencils, rackets--is a sword.  I made the mistake of getting him a Nerf sword for his birthday, and then had to confiscate it a few days later when the rest of us got sick of being pummeled with it.  We were at a park recently when Justin saw an old man hobbling along with the use of a cane.  Justin, in his adorably uninhibited way, ran up to this elderly man, and with a tone of awe and admiration, pointed to his cane and asked, "Huh?  You got a sword, too?"

The point is, Justin is real.  Undeniably, flesh and blood, you-can't-ignore-me real.  And the fatherly love that flows from me towards him as I place a bandaid or wrestle with him or carry him from his car seat to his bed, is real.  And that realness becomes an anchor point in this  "liquid fray of consciousness."

I've been reflecting upon that, how my children, by their very being, can rescue me from this pit of existential despair.  I don't believe that it makes the pit any less valid or real, but the kids provide a counterbalance:  physical mass vs. dark matter, and I'm kept hovering between their gravitational pulls, and maybe that place is not a bad place to be.

I keep thinking of Darth Vader and Luke Skywalker, and how Anakin's child he sired by the woman he loved became the ultimate force in pulling him back to his innate goodness, fulfilling his destiny and saving the galaxy.  When Justin is old enough, he's going to love Star Wars.

Especially those cool light sword things.

Annie Dillard Is A Genius

(Here is some of the greatest prose ever written, the first paragraphs

of Annie Dillard's Pulitzer Prize winning essay, "Heaven and Earth In Jest".)

"I used to have a cat, an old fighting tom, who would jump through the open window by my bed in the middle of the night and land on my chest. I’d half-awaken. He’d stick his skull under my nose and purr, stinking of urine and blood. Some nights he kneaded my bare chest with his front paws, powerfully, arching his back, as if sharpening his claws, or pummeling a mother for milk. And some mornings I’d wake in daylight to find my body covered with paw prints in blood; I looked as though I’d been painted with roses.

It was hot, so hot the mirror felt warm.  I washed before the mirror in a daze, my twisted summer sleep still hung about me like sea kelp.  What blood was this, and what roses?  It could have been the rose of union, the blood of murder, or the rose of beauty bare and the blood of some unspeakable sacrifice or birth.  The sign on my body could have been an emblem or a stain, the keys to the kingdom or the mark of Cain.  I never knew.  I never knew as I washed, and the blood streaked, faded, and finally disappeared, whether I'd purified myself or ruined the blood sign of the passover.  We wake, if we ever wake at all, to mystery, rumors of death, beauty, violence . . .   "Seem like we're just set down here," a woman said to me recently, "and don't nobody know why."

These are morning matters, pictures you dream as the final wave heaves you up on the sand to the bright light and drying air.  You remember pressure, and a curved sleep you rested against, soft, like a scallop in its shell.  But the air hardens your skin; you stand; you leave the lighted shore to explore some dim headland, and soon you're lost in the leafy interior, intent, remembering nothing.

I still think of that old tomcat, mornings, when I wake.  Things are tamer now; I sleep with the window shut.  The cat and our rites are gone and my life is changed, but the memory remains of something powerful playing over me.  I wake expectant, hoping to see a new thing.  If I'm lucky I might be jogged awake by a strange birdcall.  I dress in a hurry, imagining the yard flapping with auks or flamingos.  This morning it was a wood duck, down at the creek.  It flew away.

I live by a creek, Tinker Creek, in a valley in Virginia's Blue Ridge . . . It's a good place to live; there's a lot to think about.  The creeks--Tinker and Carvin's--are an active mystery, fresh every minute.  Theirs is the mystery of the continuous creation and all that providence implies:  the uncertainty of vision, the horror of the fixed, the dissolution of the present, the intricacy of beauty, the pressure of fecundity, the elusiveness of the free, and the flawed nature of perfection.  The mountains . . . are a passive mystery, the oldest of all.  Theirs is one simple mystery of creation from nothing, of matter itself, anything at all, the given.  Mountains are giant, restful, absorbent.  You can heave your spirit into a mountain and the mountain will keep it, folded, and not throw it back as some creeks will.  The creeks are the world with all its stimulus and beauty; I live there.  But the mountains are home."


--excerpted from "Heaven And Earth In Jest" by Annie Dillard, 1974

Parenting Gems

I know why you came to this blog today.  You came here because, as a parent, you are seeking wisdom from a man who's got it all together.  You want a "How To" list that will help you master the exact science of parenting, boxes that you can check off as you bask in the satisfaction of quantifiable achievement.  You came here because you want to know the secrets of becoming a Super Dad.

Sorry to disappoint you.  I'm blessed with fantastic children, but as a parent, I'll admit it:  I don't know what the heck I'm doing.  But few things bug me more than hearing by-the-book advice of how to deal with kids, because whoever wrote that book doesn't know my children.  I'll always have these advantages over the book:  I love my kids, I know them personally, and even if its unorthodox, I trust my instincts to guide me in how to deal with them.

So, sit back and relax as I share with you some of my instinctual, experiential principles that represent the survival concept  we often call "winging it."  It may not be pretty, but it's the best I can do.  (By the way, after you read this list, please disregard it.  Just trust your instincts.)

1)  Non-interventionalism:  This is my hallmark principle.  It might also be termed laissez-faire:  let them do as they will.  This is not to suggest that you allow your kids to run wild and tear around the house unsupervised, at least not if Mom is home.  This means simply that your should avoid the temptation to solve their problems and micromanage their lives.  (This is especially true when you're doing something important, like reading the paper or watching the Rockies for the fifth night in a row.)  But seriously, let your kids fight sometimes, let them make mistakes and let them navigate their own way to a resolution.  Kids are resourceful, and truthfully, Daddy ain't always gonna be there to help them, so they might as well develop some independence.

2)  Be Consistent:  If you're like me, you sometimes will succumb to the temptation to make a threat or a promise to get you out of a bind, such as when you're in the store with your two-year old and you've only got three more things to get but you sense the unmistakable warning signs of a thermonuclear meltdown about to occur as clearly as a blaring siren and so you tell your son that if he's good for five more minutes you'll let him ride the penny horse by the check-out line or perhaps you tell him that if he screams one more time then he won't get to have any dessert tonight.  The point is, if you said you were going to do it, then do it. It takes a lot fewer times then you would think for kids to realize that you're going to do what you say you will.  Then they can learn to make rational decisions about the risks and benefits of their own behavior.  The more inconsistent you are with threats and promises, the more erratic their behavior will be.

3)  Mess With Their Minds:  This may be just my own quirkiness, but I joke with my kids all the time, often in bizarre ways.  In our house, the most important day of the year is always the next upcoming minor holiday, like Groundhog's Day or St. Patrick's Day.  There's always a squirrel-bear in the backyard or the cats are plotting to escape or some other nuttiness.  At nearly every breakfast, there is a shared epiphany that today is the first day of the rest of our lives, and that it's only minus one days until yesterday.  Is there any value in that weirdness?  Probably not, but I'd like to think my kids are growing up with the ability to find humor and excitement in their own imaginations, and also a healthy sense of skepticism about the information they receive, a discernment that they will need to intellectually survive in our age of infinite information.  If nothing else, it sharpens their wit, and I think (hope) they'll develop into interesting adults.  Or they might go insane, which I guess is interesting in its own way.

4)  Wrestle With Your Boys:  I remember going to the zoo and watching the daddy lions wrestle with their cubs and thinking, "Yeah, that's what I like to do with my boys." Seriously, I think there is an inborn need for Dad's to toughen up their boys, teach them how to fight and be tough and protect themselves and their families.  And the boys love it.  So do I.  If we had our way, we'd pound and pummel each other all night, every night.


5)  Don't Raise a Girly Girl:  I'm sure this is my bias because I grew up in a home of all boys, but my feeling is that our daughters will get enough messages about their innate girliness from society that they need some potent counter-messages from their Dads to keep them healthily balanced.  Teach them to camp, play sports, wrestle, do math, fix bikes, ski, mow the lawn, etc.  That way, when they have their first boy crisis or feel devalued because someone said they were fat, they will have a deep well of other, less image-centric experiences from which to draw their sense of self-esteem.  It seems to me too much of Barbie dolls and ballerinas could make a girl subliminally feel objectified, and that might transform into a poor self-image once she becomes a teenager.  (Plus, if she learns karate, she can K.O. any fool that tries any funny business with her.)  I don't know.  My daughter is only eight.  I let you know in eight more years how this strategy turns out.

6)  Do Stuff That's Fun For Both of You:  I remember when my daughter was a toddler, perhaps from some sense of guilt about the above Principal 5, I tried and tried to engage myself in her play with dolls.  I just couldn't get into it.  In fact, I hated it, so our play, of necessity, evolved.  We developed games called Flying Frog (that involved trying to catch Beanie Babies) and Smackdown (that involved lots of tackling and wrestling) and both became big successes.  Because we both looked forward to play time, it was a much more powerful bonding experience.  This translates to boys, too.  I've found that if we're building with blocks, it's much better to invent a game that engages all of us rather than just watching someone else build.  This usually involves building something and then destroying it together.  What fun.

7)  Forgive Easily and Give Lots of Hugs:  Kids will make mistakes and will need to be disciplined, sometimes sternly, but they should never doubt they are loved.  I've never been a fan of exaggerated punishments, like "You're grounded for a month!".  Make punishments immediate, logical, and brief, and then let everybody move on with life.  A good hug and hair tossle can communicate a lot of love, so do it often.

8)  Cast a Wide Net With Activities:  Who knows if my kids have the capacity to be the next Mozart or Lindsey Vonn or John Lennon or Madame Curie?  We'll never know unless we expose them to the possibilities.  However, I also believe we should resist strongly over-extending our kids, and that the majority of their childhood should be spent in unstructured play, like we had in Missouri, playing in the creek and woods behind our house every night after school until dinner.  I think there is a balance there.   What we've settled on is having them play one sport at a time or season, and then have them try one other activity like karate or piano or horseback riding.  If they show an interest or special talent, then we stick with it.  If not, then we may decide to move on to the next thing.  Sometimes, for activities like skiing, or supremely important activities like basketball, kids may need some extended motivation.  But don't be afraid to spread the experiences around and see what sticks.

9)  Know When to Get the Heck Out of Dodge:  as in the above-mentioned two-year old in the grocery store experience, one of the true secrets of parenting is knowing when to hit the eject button.  The meltdown is coming, everyone knows it, so head for the parking lot and deal with the aftermath in the relative private of your own vehicle or home.  Don't try to display good parenting techniques in a public place when you're dealing with the mother-of-all-tantrums.  There is no good solution there, so pack it in--quickly--and minimize the humiliation.

10)  Don't Spank:  I've done this once or twice, and there may be times when its necessary, but don't do it regularly.  You'll feel horrible, your kid gets some very mixed signals, and everybody loses.  There's got to be a better way to handle the situation than violence.

There you have it, my ten Parenting Gems.  Spend about ten more seconds reading this, and then forget about it.  Nobody loves your kids like you do, so don't trust anybody else--especially me--to tell you how to raise them.  Trust your instincts.  Find your own style.  Now, go give them a big hug, and find some Legos to play with.  Childhood is magical, and they'll never be this young again.

Chagas Disease and the Exploding Heart

When I lived in Brazil, long before I knew anything about medicine, I met a man who told me the most ridiculous story.  He said his father had recently died of an exploding heart.  I asked how such a violent thing could happen.  It seems, he said, that years ago his father had reached behind a wood pile and had been bitten by a poisonous bug, the bicho barbeiro, or barber bug.  The bite had healed and the bug had been long forgotten . . . until seven years later, when the poor man's heart suddenly exploded, and he died. 

Yeah, right, I thought.  Another Brazilian medical myth, like their old wives' tale that if you eat hot cake and then walk in the cold rain, you will drop over dead--BOOM--like that.

But then I went to medical school and learned a thing or two.  I learned about Chagas disease, an illness endemic to Central and South America which infects over ten million individuals.  This disease is caused by a parasite, Trypanosoma cruzi, that is passed to humans after they are bitten by the Reduvid Bug.  This dreaded bug, also known as the blood sucking assassin bug--or in Brazil, the bicho barbeiro-- lives in woodpiles, and after it bites its victims and sucks their blood, it defecates on the host's body.  The feces contaminate the open wound, and thus the parasite is directly transmitted into the blood stream.  A slow, insidious infection of human tissue ensues, most specifically of the heart.  After a quiescent period that can last seven or more years, the infected heart muscle shows signs of weakening, typically leading to congestive heart failure, with symptoms such as fatigue, swelling, shortness of breath and chest pain.  But in some cases, the heart develops an aneurysm--a ballooning weakness of a heart chamber--which can spontaneously rupture in previously asymptomatic individuals.

Or in other words, an exploding heart.

Have you ever been to South or Central America?  Mexico, perhaps?  Were you bitten by an insect while there?

If so, you could have Chagas disease, and you might not even know it until the day you are taking the trash out and your heart pops like an overfilled water balloon.  The take home lesson here is that life is short and unpredictable, and yours could be in imminent danger. 

It's enough to make you want to forget it all and eat some cake. 

Just be sure to stay out of the rain.

Come check out this and other medical calamities that could be putting your life in danger at www.hypochondriacdream.blogspot.com

Grey Matters

Grey Matters is in print.  You can purchase it through Amazon, Barnes and Noble, or through this link:  www.createspace.com/3416990

I'd love to have you read it.  Thanks for the support.

In Sickness and In Health

I was hit by a truck this week.  I could barely make out the license plate as it sped away: H1N1.

I had spent the last six weeks dodging germ traffic in my clinic, having diagnosed several dozen patients with the much hyped Swine Flu.  But my luck could only hold out so long.

My symptoms were mild at first, causing me to believe I may have contracted some lesser virus.  But, being a much better doctor than patient, I pushed it too hard through the weekend, and then crashed on Sunday night.  Still in denial on Monday morning, I loaded myself up with ibuprofen and tried to make it into work, only to have my nurse make an executive decision and send me right back home. 

And then I truly crashed.  Through the floor.  Plummetting towards the dark ugly bowels of the earth.

Being several days into the illness at that point--too late for tamiflu--I decided that as long as I was home, I wasn't going to mask my symptoms with ibuprofen.  If this illness was telling me to lay prostrate in bed, then that's what I was going to do.

My lungs were on fire.  My sputum was the color of pond scum.  My sinuses were turgid with pressure; I thought if I could stick a needle in them, they would pop.  My head throbbed.  My skin bristled at the slightest pressure of even my clothes.  I had no appetite. But mostly, my entire body was overpowered by a profound malaise, the likes of which I have never before known.   I lacked the strength to read, to even hold up my head.  I lay in bed and moaned for hours and hours, like a cow crazy with disease who stumbles in a winter pasture, thrashes, and then lies still, the only sound the mournful, wheezing bellows of its lungs as snow begins to slowly cover it like a white sheet in the morgue, like the blizzard that dropped two feet of snow in Denver that night.

I thought, so this must be what it is like to die.  This is what happens when an insult utterly saps my body of vitality, and I succumb finally to the malignant entropy of the universe, wave upon wave of disease and pain crashing over me as I flounder, thrash, and then relent.

Forty eight hours passed in unmitigated misery.  My lovely wife was an angel, Florence Nightingale bringing me soup, covering me up with blankets, and holding down the rest of the fort.

Just past the point where I thought my body had lost the fight, I began to heal.  My sinuses cleared.  My cough lessened.  My brain fog lifted.  But mostly, I felt energy returning to my bones.  I felt a rush of exhilaration.  "I have taken your worst shot, you dreadful Pig Flu, but I'm still standing."

Today, I went and played basketball, wary of whether or not my convalescing body could handle vigorous exercise yet--if ever.  As I drained three pointer after glorious three pointer, I knew that I was back.  Me.  My body.  My soul.  My deadly long range jump shot.

I deal with suffering people everyday of my life.  I sympathize with them as I try and coax them back to health.  Lucky for me, I don't often personally experience pain or physical suffering.

But I have renewed empathy now.  An illness such as this is a reminder of how miserable it is to lose our precious health, how our physical suffering threatens our emotional strength, and of how amazingly frail, yet marvelously resilient, our bodies are.

The sky is blue today. The snow is melting.  Life is beautiful again.  Hallelujah.

The Power in Sean's Palm: A Short Story

     Evening breeze, indigo sky pierced by early stars, sharp and shimmering. This is August in Colorado, just past dusk: cool, dry, and violet. I make my way up the trail from the culvert, across the field and towards the car, with Sean at my heels. No flashlights. He pants and shuffles along, struggling to keep up. He's a foot shorter than me, and as is his custom, he keeps on talking. 

     ". . . and then the ghost waved his arms and because the Indian was afraid of ghosts he jumped on his horse. . . "

     Sean talks, but we rarely converse. These excursions of ours across the expansive meadows at the edge of suburbia are exercises of his legs, tongue, and imagination--and my ears. I take him on these hikes by choice, but not for the conversation. I feel some sense of obligation towards Sean, though I’m not sure why. Maybe it's my inner nice guy. Or maybe it’s just fatigue that makes me relent to his constant requests, because I have a hard time saying no. But something tells me the real reason has little to do with Sean. These trips are for me, too. An imperfect antidote for loneliness. On a otherwise perfect Friday summer night, it’s either Sean, or no one.

     Sean has a syndromic appearance: short stature, misshapen face, mild developmental delay. But either through denial or bravado, his parents don’t acknowledge that he is different, determined that he be treated as absolutely normal. Since they moved onto our cul-de-sac two years ago, they've never made mention of him being different—playing catch in the front yard, inviting me over to watch movies, going to football games. Or encouraging him to ask me to go on these evening hikes. Sean is eighteen years old, a year older than me, on track to graduate from high school next year in the special ed program. He is nearly "normal" enough that at times I've wondered if he has any true handicap other than being slow. He is nice, harmless, not unpleasant in any way. But his small size, compact facial features, and thick gaze mark him physically. I took the cue from his parent's and became his friend, treating him as normally as possible. He sits with me at lunch. But what does normal mean to Sean? He’s still talking,  

     “. . . then the chief shot the arrow straight through the heart and then the Indian . . .”

     I’m ready to change the narrative. “Hey, Sean,” I interrupt, and we stop walking. I point upward. “Look at the stars tonight.” Sean continues to blithely tell his story for a few more steps until he collides with my leg and his narration trails off.

     “What?” he asks, stumbling backwards through the weeds. He sees that I'm pointing and looks up. “What?”

     “See that really faint cloud up there?” I feel like a museum guide. My elaboration of random facts is another standard feature of these treks. I continue, “That's really a billion stars or more that are so far away that to us they look like a cloud of light. It's called--”

     “--that's the Milky Way,” he finishes for me, matter-of-factly, staring at me now rather than at the stars he’s just named. I cross my arms and look back at the sky.

     “Yeah,” I say, “you're right.” Sometimes he knows more than I expect. I breathe deep and feel the cooling, dusty air in my nostrils, and for a moment I feel like I'm breathing in stars. So vivid, so far away. The breeze glides open and vast across my face.

     “Mark,” Sean calls, “do you know what stars are?” He has yet to lift his eyes off of me, continuing with that thick gaze. I look down at him, waiting for his answer, preparing a gentle correction. He concludes emphatically, “They’re burning planets.”

     A thin smile escapes my lips. After a second, I respond smoothly, “Well, kind of, Sean. They're actually huge balls of gas that burn super hot. They're like the sun, just farther away.” 

    "What makes them burn?" he asks. 

  

    "Well, let's see, when gravity pulls the gas into the star, it starts to heat up, I think. And then . . ." Now it's my voice trailing off as I realize I don't have any depth of knowledge about what's next or why, and I'm also highly doubtful that Sean cares about anything more specific anyway. I could say whatever I want, but instead I just stop talking. His gaze remains unbroken. In the starlight, I can't tell what he's focusing on—my nose, my cheeks—but it’s not my eyes. Silence. I wonder if he is thinking or if his brain is just on pause. We're only few feet apart, but suddenly it seems there is a great distance between us. I glance towards my car a hundred yards away and start to walk towards it.

     “Mark . . ." I turn my head back around and see Sean holding up his palm. He whispers, “Wait.”

     I stop walking and turn to face him, wondering what he's going to do. He is breathing deeply and closes his eyes, bending dramatically forward. He squats and brings his palm down among the weeds, passing his stubby hand back and forth a few inches off the ground. He whispers, “I can feel them.” I say nothing. A moment passes, and he tries again. “I can feel them,” he repeats, adding, “They were here.” He grabs a handful of dust and pebbles and lets them sift slowly out of his thick fingers. He soulfully turns his gaze back to me and begins to speak.

     But I beat him to it.  “Who?” I ask. The line between reality and imagination is thin for Sean. Apparently I have run out of patience for tonight. “Who was here?”

     Sean theatrically sweeps his gaze across the fields, to the mountains and back, fingering the dust. With his eyes on me again, he intones, “The Indians.” Tension mounts in his voice. I wonder what movie gave him this idea. “Six of them. They died on this ground, because of. . .” Once again, his eyes sweep to the ground, back to me. "Because of . . . the white man."

     He says "the white man" with an affected, introspective guilt, as emotionally raw as an 90’s TV Western. When he pauses again, I blink and turn away, walking briskly towards the car. Sean churns his legs and stumbles through the weeds, struggling to keep up. The drama intensifies in his voice. “Mark, I can FEEL them.” He waits for me to say something, but I don't. He grabs my arm, but I'm not stopping. “You don't believe me, do you?” I have little desire to respond and can’t think of anything to say. We have reached the car. I walk over to the driver's side door. Sean follows me around, watches as I slip into the driver's seat, and then walks back around to the other side. I turn the ignition as he opens the door and plops down. The radio comes on loudly, and I turn it down to a murmur. Sean stares forward and asks again, “You don't believe me, do you?” 

     I roll down the window and put the car into drive. I glance at Sean, then back to the road. What should I say? “Sure,” I shrug, “there used to be lots of Indians around here. Utes, Arapahoe, some Cheyenne, I think . . .” Then I stop, realizing I don’t really know any more beyond that. What do I really know anyway, except for things that other people tell me? How do I know what Sean knows, or doesn't know?

    The lights from the suburbs shine across the fields. In the daylight, I can pick out my house from the crowd, but at night they all meld into a wash of sodium lights and empty spaces. The cool Colorado air flutters through the open window, drowning out the radio.  I reach over to turn up the volume. I look at Sean. His head is bent over like he might be asleep, but I catch a wet glint of the distant lights reflecting off of his dull eyes. He's awake, staring at his open palm like a Bible.

After Apple Picking

We're up to our ears in apples.

We have two apple trees, and our neighbor has three, and he said that if we picked his apples, we could have them. Well, I'm a sucker for anything free, so I have--rather recklessly-- risked life and limb in climbing to the flimsy upper boughs of the trees to pluck from them the last tantalizing, crimson-blushed green apples. (Where's Waldo in the above photo?)

The kids have been great helpers. Joy is a skinny little tree monkey who can slither onto branches I can't reach, and Grant is my right hand man on the ground. We've all come away scratched and scarred, but we're now enjoying the fruits of our labors. The apples are small and tart, but perfect for baking, and Elizabeth has made apples pies, apple sauce, even apple pizza.

It all reminds me of a favorite Robert Frost poem, After Apple Picking. Like all of his best work, it's full of rustic imagery, subtle symbolism, and whimsical melancholy. It evokes thoughts of hot apple cider, autumn frost, and the irrepressible encroachments of time that fatigue our best intentions.

Enjoy!

After Apple Picking
by Robert Frost

My long two-pointed ladder's sticking through a tree
Toward heaven still,
And there's a barrel that I didn't fill
Beside it, and there may be two or three
Apples I didn't pick upon some bough.
But I am done with apple-picking now.
Essence of winter sleep is on the night,
The scent of apples: I am drowsing off.
I cannot rub the strangeness from my sight
I got from looking through a pane of glass
I skimmed this morning from the drinking trough
And held against the world of hoary grass.
It melted, and I let it fall and break.
But I was well
Upon my way to sleep before it fell,
And I could tell
What form my dreaming was about to take.
Magnified apples appear and disappear,
Stem end and blossom end,
And every fleck of russet showing clear.
My instep arch not only keeps the ache,
It keeps the pressure of a ladder-round.
I feel the ladder sway as the boughs bend.
And I keep hearing from the cellar bin
The rumbling sound
Of load on load of apples coming in.
For I have had too much
Of apple-picking: I am overtired
Of the great harvest I myself desired.
There were ten thousand thousand fruit to touch,
Cherish in hand, lift down, and not let fall.
For all
That struck the earth,
No matter if not bruised or spiked with stubble,
Went surely to the cider-apple heap
As of no worth.
One can see what will trouble
This sleep of mine, whatever sleep it is.
Were he not gone,
The woodchuck could say whether it's like his
Long sleep, as I describe its coming on,
Or just some human sleep.

The Best They Can

I work with a great nurse, an RN with years of ER and OR experience on her resume. She maintains a healthily humorous view of needy patients, exhibiting some of the hardened exterior that most of us health care workers eventually develop out of experience and necessity. But beneath the tough veneer, she has a gigantic heart and displays gentle acceptance of even our most difficult patients, and face to face she always gives them the best of her compassion and kindness.

On the very first day we worked together, she came out of a room with a patient who was, to put it mildly, a train wreck: a damaged body with a defeated soul, at the end of their rope, whose health and social situation was as depressing as it was desperate  She came into my office, put the chart in front of me, and said with a sigh, "Dr. Foster, they're a mess. But you know what? They're doing the best they can."

I looked at her for an explanation. She continued, "You know, they didn't wake up this morning and say, 'I want to fail at life today, so I'm going to ruin my health and my relationships and do bad things that hurt other people.' We're all doing the best we can. I guess this is what that looks like for her."

The best they can. Over the succeeding months, she and I have repeated this phrase like a mantra when dealing with our challenging patients. (However, we have decided that there are exceptions, and that some of our patients are indeed not doing the best they can, and in fact are intentionally failing out of the school of life. But these are rare exceptions.)

By and large, it holds true. At the least, this mantra forces me to perceive needy patients in a more compassionate light. Isn't it true, I tell myself? Don't most people, within their capacity and experience, try to succeed at life? The narcotic addicts, the hypochondriacs, the borderline personalities, the depressed and defeated: isn't the fact that they're breathing, sitting in the doctor's office and seeking help--doesn't that mean they're trying to get better, to do better, to be better, taking the debris of their lives and attempting to refashion something usable, even beautiful?

We all have survival instincts, and many of us are stuck permanently in survival mode. The frantic, abrasive mother who slaps at her children as she begs for pain meds may be tough to deal with, but after all, she's a single mom, abused herself as a child, and she is trying in some dysfunctional way to carve something better out of her life for her and her children. She's seeking love, safety, acceptance, and peace on very basic levels, and when these appear too elusive she turns desperately to unhealthy avenues to fulfill her needs, like stoning herself with oxycodone and sedatives every day and living with an abusive man who at least pays her some attention. This probably represents the best way that she can figure out how to cope. She's doing the best she can. And sadly, so is he.

The best they can. I keep repeating it to myself as she slaps at her two year old again and becomes more insistent of her absolute necessity for narcotics. She needs them like she needs air. She might die without them. On a scale of one to ten, her pain is, like, a bazillion.

I'm not sure I believe it, but luckily I've got a nurse who reminds me to look at her with compassion, even if I refuse to enable her addictions. Maybe with time I'll learn to be more naturally accepting and kind.

Forgive me if I'm not there yet. I'm doing the best I can.

Lincoln

Greatness takes many forms. It is typically easy to recognize and quantify, and we celebrate those who achieve such heights. Roger Federer's fifteen grand slam titles, for instance. Neal Armstrong walking on the moon. Warren Buffett's wealth and sagacity. Dealin' Doug's hairpiece.

But rarely do we find greatness in a place that matters most, embodied in a person whose values, vitality, and vision become intertwined indistinguishably with our own identity, our own survival. These most rare people represent a near perfect incarnation of our highest ideals. There are probably only a handful of them in the history of the world--great men and women who perform their greatest acts on the grandest, most critical stages--and unfortunately, they tend to be assassinated. But their greatness doesn't fade with time, but rather grows, and we justly carve their faces onto mountains, build monuments to them in the nation's Capital, or write them into scripture.

At the very top of my list of great ones, behind only Jesus Christ and the Buddha, is Abraham Lincoln. I just finished Team of Rivals by Doris Kearns Goodwin, and my mind is overflowing with gratitude and admiration for the backwoods prairie lawyer who freed the slaves and saved the Union.

The book is tirelessly researched, referenced, and comprehensive in its scope, nearly eight hundred pages long, and honestly I have so many thoughts floating in my mind about Lincoln that I don't even know where to begin. I think I'll just start by naming, in no particular order, attributes that Lincoln evinced and why they are so resonant with me.

• Magnanimity: this is, to me, his overarching and most remarkable character trait. He had such a generosity of spirit about him that he was able, nearly always, to set aside petty, selfish concerns and do what was best for the greater good. Time and time again, he promoted talented men who had personally insulted, slandered, betrayed, and undermined him to positions of responsibility and trust. In kind, these men proved their worth, and eventually became trusted, diligent advisors, indispensible to the Union's war effort. This is most evident in Lincoln's relationship with Henry Seward, the man he defeated for the Republican nomination in 1860. Initially embittered and aghast that he had been defeated by a non-deserving hick, Seward went on to become Lincoln's most trusted advisor, most able stateseman, and his closest friend. Likewise was Lincoln's relationship with Edwin Stanton, the lawyer who humiliated Lincoln at a trial in 1858 but went on to become his irascible, indefatigable, and ingenious Secretary of War, his second closest advisor and friend. There are dozens of other examples, not least of which was Lincoln's liberal and forgiving attitude towards the South and Reconstruction, which he was never able to implement due to his assassination.

• Strength of purpose / Confidence tempered with humility: Lincoln's magnaninity sprung from his rock-solid, healthy self-confidence, a powerful ego tempered to perfection with humility. Where his confidence sprung from is anybody's guess. His mother died when he was young, and he had virtually no formal education. He was tall and physically powerful , but awkward and not good-looking. He endeared people to himself with humor and meekness, but was not in any way socially dynamic. No person had any reason to believe that someone of his background and education could become President, rid the nation of its original sin of slaverly, or save the Union. But somewhere inside Lincoln's mind and heart, he was aware of his own powerful mental and moral faculties, and came to believe in his own essential goodness and importance. That accurate self-awareness and internal fortitude propelled him into election after election, through defeat after defeat, and eventually self-actualized during his presidency and within the crucible of the Civil War, when he put all his skills to the maximum test and maximum utility.

• Courage: doing the right thing for the right reasons in the face of tremendous adversity and personal (or political) danger was Lincoln's hallmark.

• Wisdom: he possessed a folksy wisdom. Similar to Jesus and his parables, he had an intrinsic gift to relate anecdotes--usually humorous--that would lucidly define a principle or succinctly illustrate a complicated argument. It's probably hard for us to completely understand the social and political environment in which his reasoning was required. How do you reason with a society that has been attempting to justify enslavement of other human beings for hundreds of years, and that is correctly wary of the extinction of their way of life should slavery be abolished? Lincoln did it--if not successfully--then at least convincingly.

• Humor: he was a funny man, consistently conjuring humor to rouse the spirits of those around him, and even more so to lighten the impossible sorrows that burdened his own shoulders. He was always self-deprecating, in great contrast to most of the preening politicians of his time. Here's a favorite Lincoln anecdote that he once relayed:
  
  A man encountered Lincoln in the woods. Lincoln saw that the man was carrying a rifle, and tried to charm him. "How do you, sir" he asked.
  The man gave a half smile but said, "Friend, I have no quarrel with you, but you must now prepare to die, for I must shoot you, for I have vowed if I ever encountered a man who is uglier than myself, I would kill him."
  Lincoln ripped open his shirt and exclaimed, "Sir then fire away directly for my heart, for if I am uglier than you, I do not want to live!"
• Eloquence: derided by the self-important bloviators of his time as too plainspoken and simple-minded, he nevertheless wrote and uttered some of the most articulate, logical, poetic, and essential words in national and world history. At Gettysburg in November of 1863, following a three hour speech by the preceding verbose speaker, Lincoln arose and gave an address that was shocking in its brevity--less than three minutes. The gathered crowd could scarcely believe it as he folded his paper and sat down. Some didn't even know he had started yet, much less finished. Pundits of the time ridiculed him or professed offense at the breach of proper etiquette. But as we all know, the words he spoke are among the most important, concise, and resonant words of all time. He would go on to top that speech (in my opinion) with his second inaugural address 18 months later as the war drew to a close.

And if I didn't have anything better to do with my time, I could go on and on: Determination, Ambition, Resilience, Honesty, Social Intelligence. Lincoln possessed all of these qualities in more abundance than most any other human ever has.
Weeks before his assassination, he had a portentous dream foreshadowing his own death. But he was at peace with that. He had said many times that should he die but the Union be saved, he would die a happy man. Around that same time, he was on a ship sailing toward Virginia when a terrible squall rattled the rest of the passengers and crew. Lincoln emerged hours later from the hull of the ship, stretching his arms after having slept peacefully through the storm. Just five days after Robert E. Lee's surrender at Appomatox, John Wilkes Booth put a bullet in Lincoln's head. It was the night of April 14th, 1865, Good Friday.
The parallels to Christ are eery and unmistakable. Forgive me if my praise of Lincoln borders on being reverential. Certainly, he was only a man, in full possession of human flaws. But it is not hard to see the hand of divinity working in his life. raising him up from obscurity, placing him in position to be savior of our fledgling republic.
Not everyone we call great deserves the honor. But Abraham Lincoln does, a reminder of the greatness of our nation, the greatness of the human spirit, and the greatness we each harbor within ourselves.

The Back Nine

"Golf is a good walk spoiled." --Mark Twain

I think I'd have to disagree with Mr. Twain on this one.

Maybe that's because I usually play golf with my Dad, and we always get carts. Can't spoil a walk when you're riding.

But even when we do walk, and in spite of the fact that I'm a pretty lousy golfer, in spite of the fact that I routinely lose, and in spite of the fact that it costs a lot of money and takes an exorbitant amount of time, I've learned to love golf.

Especially on a day like today, when we had the back nine at Foothills pretty much to ourselves, and the morning sky was flawless blue and the green grass was still dewy wet. Even the fact that I collapsed on the final hole and lost to both my brother and my Dad barely even phased me. I still came home relaxed and smiling.

I owe my love of golf primarily to two men. First, Dr. Dave Smith, a mentor and golfer from my residency in Greeley. "Dr. Foster," he persuasively told me, "Part of becoming a doctor is learning how to play golf, and I'm going to teach you how." Thus, he dragged me to Greeley's handful of courses on many occasions, and under his tutelage, I finally overcame the threshhold of total humiliation that had always precluded me from improving my skills. I've learned that once you get past the point where you can hit at least half of your shots decently and a few shots well, golf starts to get fun.

The other man is my aforementioned Dad. We never golfed until I was done with medical school, but we've golfed a ton over the past six years. I'll admit, he's paid more than his fair share of green fees on my behalf, and my old excuses of "I'm a poor starving resident with young and hungry children," or "I forgot my wallet. Again," no longer apply. (My latest in the age of cell phones is, "I'm running late. Would you pay for me and I'll meet you at the teebox?" This still works pretty well on occasion.) We're both at points in our careers where we can take Friday mornings off, and it doesn't take much persuasion for either of us to meet up at the links. Dad's better than me, but not by too much, and so we always have pretty competitive rounds, with neither of us having a clear advantage.

But as I mellow with age, the competition is no longer the thing for me, at least on the golf course. I enjoy the scenery, the air, the quiet. I enjoy the momentary concentration prior to each shot, the precision required of all my muscles, limbs and breathing acting in unison, and the glory of striking the ball perfectly--as smoothly as slicing soft butter--and watching it sail through the shadows and sky and land within feet of exactly where you were aiming.

Okay, so that doesn't happen very often for me, but when it does, I'm telling you, it's sweet.

The momentary glories of golf don't always obscure its myriad frustrations. Sometimes I still feel like pulverizing some bystanding goose when I skull a chip shot into the lake, or twisting my putter into a knot and chucking it into the bushes when I rim out a five foot gimmee.

But for the most part, I refrain from demonstrative frustrations now. I take a deep breath, look at the surrounding lush foliage, and remind myself that "Hey, this is a game, and it's better than working."

It's a great game, and one I hope to grow old with. I've put my kids in golf lessons early with the semi-selfish hopes that, for at least the next forty years, even when I'm an old, crooked man, we'll be able to play golf together.

I see myself chuckling softly as I sink a putt to ice the round against my middle-aged son, and not minding a bit that he unaccountably forgot his wallet. Again.