Poetry Tuesday: faith

Again, from one of my favorite poets, David Whyte.

Probably my favorite poem of his as well.

~~~~~~~

Self-Portrait

It doesn't interest me if there is one God 

or many gods.

I want to know if you belong or feel

abandoned.

If you can know despair or see it in others.

I want to know

if you are prepared to live in the world

with its harsh need

to change you.  If you can look back

with firm eyes

saying this is where I stand. I want to know

if you know

how to melt into that fierce heat of living

falling toward

the center of your longing.  I want to know

if you are willing

to live, day by day, with the consequence of love

and the bitter

unwanted passion of your sure defeat.

I have heard, in that fierce embrace, even

the gods speak of God.

Required Reading for Women 2012

HuffPo posted this article about the editorials of 2012 that should be required reading for women.

Check them all out for yourself! But some of my favorites - from that selection and the ones added in the comments - include:

At the Pinnacle of Hillary Clinton's Career
"Hating Hillary has jumped the shark"

The Mom Stays in the Picture
about how one mom realized that she had to be in pictures no matter how she felt about her body, and was rewarded by readers sending in tons of photos of them with their kids.

Why Millennial Women Do Not Want to Lead
by a 19 year old about why her (our?) generation is
"Ultimately, women equate leadership with perfection in a way that men don't.  Men are generally taught that perfection is not a necessary component of success, that, in fact, they can fail miserably - even commit felonies - and still bounce back to power."

Our Pregnant Week
a super well written story of finding out she is pregnant
"I zoomed home, called some feminists, cried more"

Opting Out of Parenthood
a NYT editorial about not wanting to have children - a follow-up to her blog about the cost of having a child

What else should we add to the list?

~~~~~~~~~

"life shrinks or expands in relation to one's courage"

- Ahais Nin

anyone who walks through the door

At the time I'm writing this (but not at the time I'm positing it - gotta keep to my confidentiality rules) I finished my second shift in a row in the Emergency Department.  My schedule just worked out so that I mostly work evenings, weekends, and sometimes two shifts in a row, which is an 18 hour day in one of the busiest places in the hospital.  But even though it's 1am after an 18 hour shift, I find myself feeling pretty okay.  I really like the idea of treating anything that anyone who walks through the door has (or thinks they have).

I sat for 45 minutes with a woman about my age accompanied by her corrections officers, with her legs and arms chained to the hospital bed trying to figure out if she had attempted to overdose on any medications.  She would only answer me in a strange and disorganized flight of ideas - often only with one number, or one color, or one place.  When I would ask, "When did you last feel like yourself?" She would answer, "Blue."  When I asked if she had taken any drugs intentionally or by accident, she answered, "North Carolina".  Occasionally she would to me, "I'm confusing her." And I wasn't sure if she meant that she was confusing me, or that she was confusing herself.

I talked with an older man who had suffered a subarachnoid brain bleed earlier that morning after having been basically healthy his entire life.  He told me that his wife was the greatest person in the whole wide world, and also advised me never to get old.  He was really fun with the neuro exam because A) it was totally normal, B) he wanted to prove to me that he was still strong (he was), and C) he didn't really like sticking his tongue out at me.  I think it felt rude to him.

I met a woman who was just a few months postpartum and had chest pain that was making her nervous.  She and her husband had come from the south and were just visiting in-laws.  When we imaged her heart, it looked like she did have some abnormalities.  So I helped these lovely young parents figure out some logistics about how they were going to care for their two babies if their mom had to be in the hospital.

I chatted with an older lady who had just had surgery a few days ago and was discharged from our hospital that morning feeling totally fine.  But then she had a few episodes of passing out at home, so her daughter convinced her - very much against her will - to come back to the hospital.  She told me over and over again that the best thing someone could do at her age was to stay as far away from doctors as possible.  I couldn't agree more.  Except that she turned out to have a pretty big bleed in her gastrointestinal tract that we helped her with.  She - and her daughter - were super grateful.  But I sat with them for a while just trading stories and cracking jokes.

Before I left, I said goodbye to all my patients and wished them luck.  There's something nice about feeling like I signed off with all of them before I head home.

On my way home, I passed the Dominos delivery car speeding by me in almost the exact same place it had been the night before at about the same time - again, the only other car on the road.  It made me hungry for pizza.

Poetry Tuesday: dive for dreams

a favorite by one of the most wonderful poets

dive for dreams 

by ee cummings

dive for dreams

or a slogan may topple you

(trees are their roots

and wind is wind)

trust your heart

if the seas catch fire

(and live by love

though the stars walk backward)

honour the past
but welcome the future
(and dance your death
away at this wedding)

never mind a world
with its villains or heroes
(for god likes girls
and tomorrow and the earth)

look for the helpers

This week's horrifying news of children dying in CT has definitely left me and those I love more shaken than I thought.  The two thoughts that came to me first were: (1) this shows how little we can predict about what will happen, no matter how safe we make sure we and the people we love are, and (2) this emphasizes how much we need to take care of each other on every level, whether that's getting to know your neighbors, to be there fore your family and friends, or to fund mental health services and outreach programs to help people who need even more help.

The best response I have heard was on NPR who quoted the wonderful Fred Rogers on how to cope with the fear and sadness happening around you:

"When I was a boy and I would see scary things in the news, my mother would say to me, "Look for the helpers. 

You will always find people who are helping." 

To this day, especially in times of "disaster," I remember my mother's words and I am always comforted by realizing that there are still so many helpers – so many caring people in this world."

I definitely look for the helpers - and more and more strive to be one myself.

Poetry Tuesday: Haikus

Today, a few of my favorite haikus from a book my mother gave me for christmas a few years ago.  The haiku is lovely because the poet must capture so much depth with so few words. Do you have any to share?

morning glories -- 

the well-bucket entangled

I ask for water

(Chiyo-Ni)

he says a word

I say a word:

autumn deepens

(Kyoshi Takahama)

a warm fall day,

learning from this rock

to do nothing

(Paul O. Williams)

shorter kisses

longer quarrels -

winter solstice

(Eric Amann)

birthcry!

the stars

are all in place

(Raymond Roseliep)

the inner tide

what moon does it follow?

I wait for a poem

(Diane Di Prima)

Poetry Tuesday: poetry

This week a poem by Neruda, translated by David Whyte - a double whammy of poetic greatness.

~~~~~



La Poesia

...And something ignited in my soul,

fever or unremembered wings,

and I went my own way,

deciphering

that burning fire

and I wrote the first bare line,

bare, without substance, pure

foolishness,

pure wisdom

of one who knows nothing,

and suddenly I saw

the heavens

unfastened

and open.

*this is a photograph (source unknown) of Horsetail Falls in Yosemite where every February,

the sun hits just so it looks like it's full of fire.

a different view

in case you are also in need of a quick smile, 

some new perspective:

this may be a commercial, but since you can't really tell what it's for, who cares?

better together

Love is the answer,

at least for most of the questions in my heart

Like why are we here? And where do we go?

And how come it's so hard?

It's not always easy and 

sometimes life can be deceiving

I'll tell you one thing

It's always better when we're together.

(-Jack Johnson, from Better Together)

Happy Birthday, Manfriend!

a web of connection

We covenant to affirm and promote

the inherent worth and dignity of every person,

justice, equity, and compassion in human relations,

acceptance of one another and encouragement to spiritual growth in our congregations,

a free and responsible search for truth and meaning,

the right of conscience and the use of the democratic process 

within our congregations and society at large,

the goal of world community with peace, liberty, and justice for all,

respect for the interdependent web of all existence of which we are a part.

- from the Unitarian Universalist Covenant

prints available from Lisa Congdon's incredible shop on etsy

Pelosi Rocks

Nancy Pelosi articulately fields a question from NBC reporter Luke Russet about whether or not she felt like not stepping down to make room for "young leadership" was bad for her party. Congresswoman Pelosi correctly points out 2 things: that men in Congress are never asked to step aside based on their age and that she came to Congress later than she might have if she were a man because she only ran for Congress after her fifth child was about to go off to college.

As one of the most successful Speakers of the House - and the person we really need to thank for promise and hope given by the Affordable Care Act, among many other things - it seems perfectly reasonable for her to continue her incredible career.

~~~~~~

"Let's for the moment honor it as a legitimate question, 

although it's quite offensive but you don't realize it, I guess"

- Nancy Pelosi (D-CA, Minority Leader)

Poetry Tuesday: One Boy Told Me

A poet I only recently discovered but am completely enthralled with.  Naomi Shihab Rye strings words together in a way that makes me think in different direction every time I re-read them.  Enjoy!


One Boy Told Me
by Naomi Shihab Rye

Music lives inside my legs.
It's coming out when I talk.

I'm going to send my valentines
to people you don't even know.

Oatmeal cookies make my throat gallop.

Grown-ups keep their feet on the ground 
when they swing. I hate that.

Look at those 2 o's with a smash in the middle --
that spells goodbye.

Don't ever say "purpose" again,
let's throw that word out.

Don't talk big to me.
I'm carrying my box of faces.
If I want to change faces I will.

Yesterday faced
but tomorrow's in BOLDFACE.

When I grow up my old names
will live in the house
where we live now.
I'll come and visit them.

Only one of my eyes is tired.
The other eye and my body aren't.

Is it true all metal was liquid first?
Does that mean if we bought our car earlier
they could have served it
in a cup?

There's a stopper in my arm
that's no going to let me grow any bigger.
I'll be like this always, small.

And I will be deep water too.
Wait. Just Wait.  How deep is the river?
Would it cover the tallest man with his hands in the air?

Your head is a souvenir.

When you were in New York I could see you
in real life walking in my mind.

I'll invite a bee to live in your shoe.
What if you found your shoe
full of honey?

What if the clock said 6:92
instead of 6:30? Would you be scared?

My tongue is the car wash
for the spoon.

Can noodles swim?

My toes are dictionaries.
Do you need any words?

From now on I'll only drink white milk
on January 26.

What does minus mean?
I never want to minus you.

Just think: no one has ever seen
the inside of this peanut before!

It's hard being a person.

I do and don't love you - 
isn't that happiness?

be it what it will

This is the first big deep breath in my travels in over two and a half months (including 7 cross-country flights, 3 car rides of 6+ hours, not sleeping in the same bed for more than 2 nights in a row) - and it feels so good to just. breathe.

which is not to say my travels didn't have some huge benefits.  besides being so grateful for interviews, they let me visit new places and see friends and family that I wouldn't otherwise get to travel to see this often (of course that just makes me think: why am I not doing this more?)

I've also become exceedingly good at knowing just what I need - no more, no less - which makes me reflect now on my house full of stuff and wonder why I have it all.  turns out most of what I need on a daily basis can fit in my little backpack.

and probably the best part of these travels is because I've confronted so many situations that are just barely out of my control (a plane delayed, a store not open, a friend having to work late so not being able to pick me up), I've come to trust my own ability to take things as they come so much more.

instead of trying to over-plan for every possible scenario, I try to just set myself up with the resources and information I need, and trust that I'll be able to figure it out.
and not carry too much - that's definitely a big help in being more flexible while traveling.
that could probably be both literally and figuratively, actually.

what I've learned in these travels:
don't carry so much.

~~~~~~~
"I know not all that may be coming,
but be it what it will
I will go to it laughing"
-herman mellville, in moby dick

source

gender income equality by state

In a recent post on Slate, there is an interactive map of all the states, then also by county, how much income differs by gender.  It's astounding (and terrifying).  In the BEST states, women still only earn 75 cents to the dollar of men.

According to their data, the best cities for pay equality include DC and Dallas, followed by San Francisco, LA, Austin, Santa Fe, NYC, and Boston.  In most other major cities it's closer to 70 cents for every dollar men earn.



And for a look at data showing that more equal societies are healthier, a Tedtalk by Richard Wilkinson:

the turnaway study

*according to this new study, this woman is very wrong.

One of the hypotheticals that is always touched on in reproductive rights discussions is what would happen if we simply did not allow women to have abortions?  Well, the Turnaway study from San Francisco-based research group Advancing New Standards in Reproductive Health (ANSIRH), investigated that question and just presented their first results.  

There's a great overview on the Slate XX blog to check out.

In brief, the group followed over 1000 women across the country who went to have abortions.  Most were able to obtain abortions (97% had no regret), but almost 200 women were not able to have abortions, usually because they were farther along in their pregnancies than the places they went to have abortions would perform the procedure.  The researchers interviewed these women extensively and compared them with the group who was able to obtain abortions.  

A few (of the many) things worth mentioning:

1. women not able to have abortions were more likely to be financially struggling a year later.

Compared to the group who did have abortions, a year later (the study is ongoing) those who were "turned away" were more likely to be on government assistance, living beneath the poverty line, and less likely to be working full time.  

2. women not able to have abortions were more stressed.

They also reported more stress and were equally as likely to be depressed as the other group of women (as in, no happier).  

3. women not able to have abortions had more medical problems.

Including pregnancy complications and postpartum complications (abortion is almost always safer than pregnancy, as is birth control).  

4. women not able to have abortions were more likely to be victims of domestic abuse.

The researchers attribute this not to the "turn-aways" being more likely to enter into abusive relationships, but being less able to get out of them while pregnant/with a new baby.  But this didn't mean that men were more likely to stick around - they found that "men were no more likely to live with a turnaway who'd borne their children than they were to live with a woman who had an abortion".

This study is excellent data to add to the discussion of women's reproductive rights - showing that the consequences of our reproductive choices are far-reaching and longer lasting than just 9 months.

~~~~

"As women's access to abortion care...becomes increasingly restricted, it is extremely important to document the effect of unintended pregnancy on women and their families.  The Turnaway Study is an effort to capture women's stories, understand the role of abortion in women's lives, and contribute to the ongoing public policy debate on the mental health and life course consequences of abortion and unwanted childbearing for women."

- taken from the Turnaway study website, under Why this study is Important

(*I copied this image from the Slate XX blog review of the turnaway study, because it was just so good)

Autumn Reading List

Without further ado,

My Autumn Reading List:

1. Bossypants by Tina Fey - a surprisingly feminist novel that is literally laugh out loud funny (I read it sitting in the middle seat on a trans-continental flight and kept elbowing the guys next to me because I was laughing so hard I couldn't hold the book"  Best quote?  "Lesson learned? When people say, 'You really, really must' do something, it means you don't really have to.  No one ever says, 'You really, really must deliver the baby during labor.' When it's true, it doesn't need to be said" 

2. The Tiger's Wife by Tea Obreht - a first time novel (which I always think are worth reading, because it means that person really just had a book inside them that they had to get down) that weaves together stories of the breakdown of the Ottomon Empire, a medical student traveling across Eastern Europe, a relationship of a granddaughter and grandfather, a young girl who becomes a tigers wife and the magic of a deathless man.  Best quote? "Come on, is your heart a sponge or a fist?"

3. Blink by Malcolm Gladwell - different than the tipping point because it's all about dissecting judgement. the same in that it's incredibly well-written, very easy to read, and will provide you with cocktail party (or interview) small talk for days to come.  Best quote?  "...'when we talk about analytic versus intuitive decision making, neither is good or bad. What is bad is if you use either of them in an inappropriate circumstance.'"

4. Fire in the Earth, Poetry by David Whyte - the calmness of autumn and the anticipation of the stillness of winter always have me craving more poetry in my life; as I have more space and time in darkness, I find that my senses hone in more on words - so I want them to be beautiful and profound. David Whyte's poetry could not be a more perfect answer.  A birthday gift, and the start of a collection, I hope.  There are too many great quotes, but one of my favorites right now is, "the flight of amazing freedoms, held in tension, by the menace, of impending chaos"

5. Cutting for Stone by Abraham Verghese - this is actually a re-read, which I love doing, but it's one of my absolute favorite novels.  Verghese tells a compelling story that brings up all the great themes in medicine: choices, fear, love, loss, and more.  Best quote? "You live it forward but understand it backward"

6. The Bookseller of Kabul by Asne Seierstad - a novel that came out several years ago, but is an intimate look at an Afghan household through the eyes of Sultan Khan, a bookseller of prohibited books.  I have only just started this one, so I'll let you know how it goes, but it's one I've been meaning to read forever.

**What are you curling up fireside to read as the cold weather approaches?**

I love suggestions of new great books!

Poetry Tuesday: Live the questions

Today's poem is inspired by a dear friend who has made this her resolution.  It fits so well with the aims of this blog, and of my own life that it seems crazy that I haven't posted it until now.  This friend has been struggling with her own quest to make a difference in this world.  This poem is by Rainer Maria Rilke in Letters to a Young Poet.  What question are you living right now?

~~~~~~~~~~~~~~

"... I would like to beg you, 

dear Sir, as well as I can, 

to have patience 

with everything unresolved in your heart and 

to try to love the questions themselves

as if they were locked rooms 

or books written in a foreign language

Don't search for the answers, which

could not be given to you now

because you would not be able to

live them.

And the point is to live everything.

Live the questions now.

Perhaps then, someday

far in the future,

you will gradually,

without even noticing it,

live your way into the answer.

A New Hope

Some articles that have caught my eye in the news after the election:

*Apparently being against reproductive choices for rape victims makes you un-electable.  Thank goodness.

*A comment from Friedman on why Obama won - and why the Republicans in Congress need a change of heart (and maybe they are, thank you Boehner?)  Best quote:  "Many in the next generation of America know that climate change is real and they want to see something done to mitigate it.  Many in the next generation of America will be of Hispanic origin and insist on humane immigration reform that gives a practical legal pathway to citizenship for illegal immigrants...Many in the next generation of America see gays and lesbians in their families, workplaces, and Army barracks and they don't want to deny them marriage rights held by others.  The GOP is at war with too many in the next generation on all these issues."  I would add to this reproductive choice - which was a clearly decisive factor in voting for many women (and men!)

*20 quotes on immigration from politicians including Rep. Steve King (R-Iowa), "Obama voters chose dependency over Liberty.  Now establishment R's want citizenship for illegals.  You can't beat Santa Claus with amnesty"  Wow.  I'm not even sure what he means by that, but it does not sound either nice or productive.

*A surprise victory in Minnesota for gay marriage rights - where the campaign manager of Minnnesotans United for All Families (around 1:45am) is thanking everyone and telling them to go get some sleep because the results likely won't be in for a while....and then they get a result.  It was the first time in US history than anti-gay marriage constitutional amendment had been defeated.

waiting for a sign

source

I have been interviewing and planning interviewing for residency for a little while now, with the end of the planning - and deliberations of which program is the best fit - still too far off to be in sight.

But I'm reading a series of books for my "Medical Leadership" elective, including Malcolm Gladwell's Blink, where I found a lot of evidence that perhaps I should not worry so much about collecting all the data, and just pay attention to how I feel at these different programs.  This sentiment is summed up by Gladwell at the end of the book with this incredibly helpful quote:

"When making a decision of minor importance, I always have found it advantageous to consider all the pros and cons.  In vital matters, however, such as the choice of a mate or a profession, the decision should come from the unconscious, from somewhere within ourselves.  In the important decisions of personal life, we should be governed, I think, by the deep inner needs of our nature"
-Sigmund Freud

Poetry Tuesday: a poem of three truths

This week a poem by one of the poets I admire most, Mary Oliver.
Her poetry draws on observations of nature that force us to reflect on observations of ourselves.
This one has been running through my mind a lot lately.

Do you have three truths?  What would they be?

~~~~~~~~~~~~~~~

In Blackwater Woods

Look, the trees

are turning

their own bodies

into pillars

of light,

are giving off the rich

fragrance of cinnamon

and fulfillment,

the long tapers

of cattails

are bursting and floating away over

the blue shoulders

of the ponds,

and every pond,

no matter what its

name is, is

nameless now.

Every year

everything

I have ever learned

in my lifetime

leads back to this: the fires

and the black river of loss

whose other side 

is salvation

whose meaning

none of us will every know.

To live in this world

you must be able

to do three things:

to love what is mortal

to hold it

against your bones knowing

your own life depends on it;

and, when the time comes to let it go,

to let it go.

From the fantastic Mary Oliver's New and Selected Poems, Volume One

Reproductive Ven Diagram

This past weekend I went to a friend's wedding in a beautiful park.  The friend had thought she was infertile so had been not using birth control (!!)  But, when she found out she was pregnant, she and her long time boyfriend were both absolutely thrilled.   They decided to get married and start a family all in one year - all things they had hoped to do in the near future anyways.

The way she put it was "I feel like in the ven diagram of when I should have children, the circles are overlapping the most right now - so I want to do it".  She only gave a few examples of circles, but I sort of ran with it.

Here's my image of how this would look - I could have kept adding circles...

How do your circles fit together?

On another note, during the ceremony, they read this poem by Kuan Tao-Sheng (1262-1319):

MARRIED LOVE

You and I
Have so much love,
That it
Burns like a fire,
In which we bake a lump of clay
Molded into a figure of you
And a figure of me.
Then we take both of them,
And break them into pieces,
And mix the pieces with water,
And mold again a figure of you,
And a figure of me.
I am in your clay.
You are in my clay.

In life we share a single quilt.

believing the whole concept

Back to Sarah* (*obviously not her real name) and our counseling session.  Sarah started the session by listing quickly - before we could even ask her any questions - all the reasons why terminating her pregnancy was the right thing.  Reasons that she - and many other woman- have cited included that her "life is a mess" and she could not responsibly bring a new life into it.  Sarah* was living with an on again/off again boyfriend who she loved, but struggled with uncontrolled and unpredictable bipolar disorder.  The two of them had been living in a van under a bridge for the past several months.  They were both having a hard time finding work.  Neither one of them had any support from or connection to family in the area, nor did they have any other resources to draw on.

She went on for several minutes listing these reasons and more.  We listened.  Then she stopped and paused, looking at us to see if we had anything to say, almost looking for our agreement with her reasoning.  But the very wise and experienced counselor said nothing, just waited.  I wasn't sure what to do, so I said nothing, and waited.  Then Sarah* said, "but the truth is, I want to be a mother more than anything else in the whole world.  Even though it doesn't make sense.  Even though it's not responsible.".

And that's when the counseling began, as the counselor started asking questions to help Sarah* work out what she thought and felt.  To help her see her situation in the truest light - without judgement, but without rose colored glasses either.

Sarah* said that she was concerned that if she terminated her pregnancy, that in several months - when the baby that would have been actually would have been - what if her life was better?  What if it was now responsible for her to bring a new life into it? What if she and her boyfriend had figured out jobs, had found an apartment, had organized their lives - would she then feel incredibly guilty and regretful that she had ended the pregnancy?

The wise counselor listened and finally said, "You know, Sarah*, no matter what you decide to do in this situation, your life will be different in several months.  And if you decide to end the pregnancy and your life is better in several months, how will you know that this decision didn't help you to make your life better? And if you decide not to end the pregnancy and your life is better in several months, how will you know that this decision didn't help you make your life better?  We just have no way of knowing how our lives would have turned out if we made other decisions, but I can tell you that this decision you are making now will absolutely affect your life over the next few months - because it will be very different if you are pregnant and expecting a baby than if you are not.  Only you can make this decision, but once you have made it, don't judge yourself for it, or think of all the other possibilities that could have been - because it will be different."

Later, after Sarah* left, without terminating her pregnancy, to think more about her decision, the wise counselor and I debriefed.  We talked about how even though her reasons for why she should not be a mother right now make logical sense to us - that if we really believe in a woman's right to choose, a woman's right to make decisions about her own body, then we cannot judge her decision, we cannot think to ourselves that she should make one decision over the other.  Our role is to help her make the best decision for her, in a non-judging, non-assuming way.

It's definitely hard, but feels incredibly important.

~~~~~~~~~~~~~~~~~~~~~~~~~~~

"A woman's life can really be a succession of lives, each revolving around some emotionally compelling situation or challenge, and each marked off by some intense experience"

-Wallis Simpson, Duchess of Windsor (1896-1986)

Medicine like a Storm

As I was taking the train to my first interview for residency, crossing my fingers that it would keep going to my destination and not be thwarted by wind or rain, I was running through my Plan B, Plan C, and even Plan D for every part of this travel adventure, and realized that practicing good medicine is a lot like travelling in a storm.

First, collect the right data from diverse sources with different perspectives.  Patient history, journal articles, residency training, nursing notes, etc.  Or in a storm, weather reports, news stories, calling friends and family in the area.

Second, create a plan.  Every step - know how it's going to work, know the tools you need and how you will get them.

Third, create a Plan B, a Plan C, and a Plan D - at least one of these should include asking for help.

Fourth, think about any particularly difficult steps where things are more likely to deviate from the plan - try to predict how they would go wrong, and create a plan for those.

Fifth - and possibly most important - communicate your plan.  Keep your team in the loop as the plan changes, ask for feedback on the plan, take into consideration new information provided by the team, and whatever you do, continue to let everyone know what's going on so they can adapt accordingly.

Sixth, stay calm and adapt easily, as you know you have prepared as much as possible.


I was also feeling very grateful in my interview travels for just how much I am cared for by the people I love.  Even with all the craziness of travelling, that is a wonderful feeling.

~~~~~~~~~~~~~~~

"Sometimes God calms the storm.  Sometimes He calms the sailor"

- Unknown

Tuesday Poetry: all here

This week a poem by my new favorite poet, David Whyte, who is just fantastic.

His writing is beautiful, thought-provoking, and speaks to my soul.

(he also writes and speaks in at least four different languages).

Hearing him speak is on my DREAM BIG list.

~~~~~~~

IN THE BEGINNING

Sometimes simplicity rises

like a blossom of fire

from the white silk of your own skin.

You were there in the beginning

you heard the story, you heard the merciless

and tender words telling you where you had to go.

Exile is never easy and the journey 

itself leaves a bitter taste. But then,

when you heard that voice, you had to go.

You couldn't stay by the fire, you couldn't live

so close to the live flame of that compassion

you had to go out in the world and make it your own

so that you could come back with 

that flame in your voice, saying listen....

this warmth, this unbearable light, this fearful love...

It is all here, it is all here.

Choosing What We Show

Recently, I interacted with a woman around my age who had come to the clinic where I was working with the intention of terminating her pregnancy.  It's been so long I can't remember how many weeks along she was, but not far.  Women enter these difficult and emotionally wrought visits with a clinician in all styles.  Some openly weep, some list all the reasons why this is the right decision - as if convincing themselves, some are silent and refuse to make eye contact, many are curious - about the pregnancy, about their options, about what they might see or not see, how their lives may be different depending on how they choose.

I feel so lucky to live in a country, in a time, when women get to make these decisions - though saddened that their decisions were not instead the less emotionally draining one of choosing effective birth control or choosing not to have sex in the first place.  I feel even more lucky to have worked in a clinic that allowed women the space to feel, think, and process whatever they needed.

This woman, let's call her Sarah* (*obviously not her real name), knew she was pregnant but was not sure how many weeks - so we did an abdominal (on the belly) ultrasound to take measurements to date her pregnancy.  There has been a good deal research on interactions with ultrasound technicians by women considering termination and the data is surprising.  But first, because ultrasound is a tricky subject these days, let me set the facts straight: everyone who is seeking or considering a termination usually has an ultrasound to date the pregnancy, because this determines many things about the possible procedures and counseling.  In the vast majority of cases, this ultrasound is done abdominally (on the belly) and is only done transvaginally (in the vagina) if the pregnancy is too early, and therefore the uterus too low in the pelvis and too small to see through the abdomen.  There are some people trying to pass laws about ultrasound and pregnancy termination that require very different things, including transvaginal ultrasounds, narration of ultrasounds, listening to heart beats, seeing moving images, etc.  This has not been my experience.  

In research investigating how to interact with a woman considering termination when conducting an abdominal (on the belly) ultrasound, the results are surprising in that many women are interested in seeing the image, many would even like an image printed to take home.  Even more fascinating is that there does not seem to be a pattern with the choices women make (in terms of keeping the pregnancy or terminating the pregnancy).  Additionally, when ultrasonographers (the people who do the ultrasounds) and clinicians are interviewed, they largely believe that women should not see the ultrasound if they are considering or have decided to terminate a pregnancy.  There are still many questions to be answered - including if the age of gestation matters (many of these papers were only involving women who were intending to have first trimester terminations), larger sample sizes, longer term effects, correlation with other factors such as parity and reasons for termination.

Planned Parenthood has a national policy where every woman is asked, before stepping into the ultrasound room, if she would like to know if she has more than one pregnancy (twins, triplets, etc), and if she would like to see any images.  Anecdotally, I have been told that most other clinics don't ask and do not offer unless the woman asks explicitly to see a picture.  

As I have had more experience with this, and after hearing an amazing presentation on some soon to be published data on women's experiences of ultrasound before a termination, I decided that I am going to ask women if there is anything they would like to see or not see, know or not know.  And I have been fascinated by the results.  

Which brings me back - finally - to Sarah*.  Sarah was very quiet when I brought her to the ultrsound room.  I had already asked Sarah the same question I ask everyone and she had said she would like to see an image.  Again, based on experience, the teaching I have received, and the data I have seen, whenever I show anyone an image, I zoom out so that there's slightly more realistic perspective of the size of the pregnancy, and I point out the abdominal wall, the uterus, and the pregnancy, as well as any other obvious structures.  When I did this for Sarah, she started crying.  In my desire to comfort her, I quickly turned the ultrasound away from her and sat in a chair next to her.  I asked her what was going on her in head at that moment, and if there was anything I could help with.  When she shook her head No, I put my hand on her back and reminded her that the next step at our clinic is to talk in depth with a counselor.  I asked her if she wanted to see any other images, and when she said No, I walked with her to the counselor's office, where the three of us sat and talked for a long time.

To be continued in the next post, as it takes this thought in a slightly different direction.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"I pointed out that she was, by definition, pro-choice.  In its simplest form all it means is that the woman gets to decide".

-Susan Wicklund, Physician and Author of This Common Secret

(click the link to see a NYT review of her book)

Poetry Tuesday: a poem for travels

I have been feeling a need for more poetry in my life.  I'm not sure if that's because this month has brought me to a lot of profound philosophical thoughts, or if its the seasons changing, or my traveling as a nomad again.  But I am going to start, for now, a poem every Tuesday, followed by a question or two that the poem brings up for me.

For my first Poetry Tuesday, I wanted to start with a poem by Pablo Neruda that has resonated with me in my travels lately (though they certainly have not been to uncharted lands).
He has a way.

What stubborn lands have you traveled in lately?  
What questions do you wish you had been asked?

~~~~~~~~~~~~~

Another

From so often traveling in a region

not charted in books

I grew accustomed to stubborn lands

where nobody ever asked me

whether I like lettuces

or if I prefer mint

like the elephants devour

and from offering no answers

I have a yellow heart

Otro

De tanto andar una region

que no figuraba en los libros

me acostumbre a las tierras tercas

en que nadie me preguntaba

si me gustaban las lechugas

o si preferia la menta

que devoran los elephantes

y de tanto no responder

tengo el corazon amarillo

Picking A Watermelon

this past summer, I went to a fruit stand with the most amazing peaches I had ever seen (see below) and the best watermelon sign possibly known to humankind.

"picking out a watermelon is like pick'n out a wife...

you can look at it...thump it...turn it around...and squeeze it.

but you never know much about it until it is TOO LATE."

whahahahahaha.  the owner of the fruit stand was this older man 

he saw me taking a photo of the sign and kinda giggled.

:)

Biking Partners

Two very good friends just got married this past summer

- and for their honeymoon (and maybe the rest of their lives) they will be biking all over.  

so when thinking about what to get them, 

the manfriend and I decided to create team jerseys:

(these pictures are delayed - we got them to them in time for the honeymoon)

aren't they the cutest?

"sometimes in the middle of an ordinary life, the universe gives us a fairy tale"

- unknown

Newport Photo Shoot

It was a stormy afternoon, but just as Pachebel's canon started and our friend walked down the aisle, the clouds cleared making way for blue sky and the best camera lighting we've seen in a while

(these photos are from my phone!)

October

October's Bright Blue Weather

by Helen Hunt Jackson (1830-1885)

O SUNS and skies and clouds of June,

And flowers of June together,

Ye cannot rival for one hour

October's bright blue weather;

When loud the bumble-bee makes haste,

Belated, thriftless vagrant,

And Golden-Rod is dying fast,

And lanes with grapes are fragrant;

When Gentians roll their fringes tight

To save them for the morning,

And chestnuts fall from satin burrs

Without a sound of warning;

When on the ground red apples lie

In piles like jewels shining,

And redder still on old stone walls

Are leaves of woodbine twining;

When all the lovely wayside things

Their white-winged seeds are sowing,

And in the fields, still green and fair,

Late aftermaths are growing;

When springs run low, and on the brooks,

In idle golden freighting,

Bright leaves sink noiseless in the hush

Of woods, for winter waiting;

When comrades seek sweet country haunts,

By twos and twos together,

And count like misers, hour by hour,

October's bright blue weather.

O suns and skies and flowers of June,

Count all your boasts together,

Love loveth best of all the year

October's bright blue weather.

giving thanks

One of my goals for 2012 has been to learn a prayer (just one)

here's one I'm considering:

(I found it taped to the wall at a friends house)

Awake My Soul: Fall Playlist 1

Little Lion Man - Mumford and Sons

One Short Night - Grace Potter and the Nocturnals

Chasing Pirates - Norah Jones

Nine Million Bicycles - Katie Melua

Morning Song - The Lumineers

Dancing Daze - Avett Brothers

Keep Your Head Up  - Ben Howard

Amie - Counting Crows

Man on Fire - Edward Sharpe and the Magnetic Zeros

Treat Me Right - Grace Potter and the Nocturnals

Only the Ocean - Jack Johnson

Awake My Soul - Mumford and Sons

October Road - James Taylor

Wind and Walls - Tallest Man on Earth

My Poor Heart - Allison Krauss

Stuck - Norah Jones

soul mates

I just love this quote from Elizabeth Gilbert - and have found myself referencing it to a few friends lately, so I thought I'd bring it here too:

"People think a soul mate is your perfect fit, and that's what everyone wants.  But a true soul mate is a mirror, the person who shows you everything that is holding you back, the person who brings you to your own attention so you can change your life.

A true soul mate is probably the most important person you'll ever meet, because they tear down your walls and smack you awake.  But to live with a soul mate forever? Nah.  Too painful.  Soul mates, they come into your life just to reveal another layer of yourself to you, and then leave.

A soul mate's purpose is to shake you up, tear apart your ego a little big, show you your obstacles and additctions, break your heart open so new light can get in, make you so desperate and out of control that you have to transform your life..."

-Elizabeth Gilbert, Eat Pray Love

current p

Olallaberries

It's not as seasonally appropriate anymore, but as I prepare to head back to the West Coast, I found a ton of pictures from this summer - including these of visiting with part of my tribe and ollallaberry picking! Enjoy!

here's the manfriend in the orchard

after we took this photo, the manfriend goes: 

I think I want to see how many I can fit in my mouth at once.

We look down at our harvest of olallies and nod,

let's do it!

 we were very successful, as you can see.  What an awesome taste of berry goodness

And here is what we made with them:

(plus a few amazing pies and just putting them on salads, yogurts, anything really!)

"and above all, watch with glittering eyes the whole world around you because the greatest secrets are always hidden in the most unlikely places.  Those who don't believe in magic will never find it" 

- Roald Dahl

Broken Hearted

I know, I'm late! I promised blog posts on Mondays and yet here we are, Tuesday evening.  Well this one took a while because it's a work in progress about a situation that still has me reeling a bit.  But I decided that I wanted to get it down somewhere so that I could reflect on it more.

~~~~~

The first week of my cardiology rotation we admitted an older woman who we will call Betty, who presented with heart failure.  These symptoms tend to include (or at least the ones we ask about are) trouble breathing, lower extremity swelling, more trouble breathing when you lay down, and swelling in the liver.  As I was just explaining to the second year medical students I am tutoring, heart failure is really a spectrum of heart dysfunction; the signs and symptoms depend on the location of the problem and the severity depends on how much the rest of the heart can compensate (and for how long).

When she arrived at the hospital, Betty was a widow of many years who never had children but had an extensive family in the area.  She lived independently, even mowing her own lawn up until a year ago when she started feeling really awful, went to the doctor and found out that she had atrial fibrillation.  Atrial fibrillation is when the top chamber(s) of the heart, the atria are beating too fast and too unorganized to send productive signals to the bottom chamber(s) of the heart, the ventricles, which pump blood through your lungs and into the rest of your body.  It also has a spectrum, but atrial fibrillation makes it difficult for your heart to fill with blood completely because it's always beating.

At first, with Betty, we did everything we could to try to get her heart functioning again.  Afterall, cardiology is a field where we have a lot of options for interventions and medications.  We can control the electrical system of the heart with a pacemaker, we can control the pumping system of your heart with medications and other interventions.  But we can't quite do it perfectly, especially if the heart has plans of its own.

Because she was in the hospital for so long, and had so many people working on her care, I designated myself her point person and tried to stay on top of everything.  This wasn't always easy as lots of things happen without anyone thinking to tell the medical student, however important I might finally feel to this patient.  But when she asked me to be in the operating room with her when she had her pacemaker placed, I said yes.  When she asked if I would hold her hand while she had her dialysis catheter placed, I said yes.  When she asked if I would examine her "down there" because no one had in a while, I did - and found she was bleeding and had stool leaking out of her vagina as well.  When she asked if I would come see her in dialysis, even though she did not have enough energy to open her eyes, I did.

In our daily check-ins, Betty told me about her life, which mostly consisted of her living in her own mobile home and keeping track of everything she needed (up until a year ago when "it all fell apart"), spending time with her nieces and nephews and her grand-nieces and grand-nephews, and mostly getting along just fine.  But she was always tired and while I tried to get her to eat, she would sort of humor me while I was standing with her, then I would come back later to see that she hadn't really eaten much at all.

Fast forward 20 days later - Betty is in complete renal failure with a catheter in her neck vein for dialysis, has had a pacemaker placed in her heart, is on several medications trying to get her heart to pump harder but slower, and other medications to get blood flow to her kidneys and help get the fluid out of her extremities and lungs so that she can breath.  She starts bleeding from her vagina, made worse by the anti-coagulation (blood thinning) medications she is on to prevent her dysfunctional heart from forming clots that could pass to her brain and cause a stroke.

That's when she really started refusing things.  Instead of just refusing her medications occasionally and not really eating much food, soon she was refusing exams, refusing to talk with certain members of the staff, refusing blood draws for labs, and x-rays to see if there was fluid building up in her lungs - along with refusing all her medications and all the food we gave her.

Some of the staff and our team were annoyed by her behavior, thinking - with reason - that if she was refusing our tests and treatments, what was she doing in the hospital at all?  I agree - and ultimately, when she moved to a rehab center, it seemed like the the right move to our staff and Betty and her family.  But I think she stayed in the hospital because she felt safe there.  She thanked me again and again for taking care of her.  She told me how great the staff were and how helpful everyone was in getting her better.  It's amazing to me that she felt that way.  Because I just can't help but think she may have been better off if she had just stayed as far away from us as possible.  She is definitely a person that I'll think about when weighing the risks and benefits of treatments - and maybe make different decisions than the ones that were made in her case.

Mitt Romney's Personal Liberties

The Daily Show with Jon Stewart
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nemo and pasta con le sarde

Recently, my family gathered all together at a big house with a pond.  While we were there, I also made this incredible (both in its deliciousness and its easiness) sicilian pasta recipe that I found over here and slightly (very slightly) adapted - and due to popular demand, have re-posted below!

As soon as we arrived, we jumped in the pond. 

I think Nemo is trying to save me.

I need to come up with a caption for this one :)

and without further ado, 

Pasta Con Le Sarde

Ingredients:

1 bulb fennel,

EVOO

2 tins 3.75oz each, of sardines in olive oil (wild is best according to Seafood Watch)

1 small can tomato paste

handful of pine nuts 

handful of raisins

4 cloves of garlic

box of spaghetti

salt and freshly ground pepper

olives, breadcrumbs (for garnish)

one large pasta pot, 1 frying pan or wok

Instructions:

1. put water in a pot big enough for your pasta on stove, bring to boil

2. cut off green top part of fennel bulb and put the whole bulb (the white part) in the boiling water for 10 minutes or until soft enough that you can stick a knife into it

3. while that boils: chop up garlic and fry in EVOO, using frying pan or wok 

4. add sardines to pan with garlic

5. crush them with the back of a wooden spoon so that they no longer look like sardines

6. add tomato paste, stir in

7. thin sauce to preference, using water from boiling fennel bulb (I used at least 4 cups)

8. take out fennel bulb, put pasta in boiling water

9. cook sardine/garlic/tomato paste/water on med-low for 15 min while pasta boils

10. chop up fennel bulb into 1/2 inch pieces (whole thing)

11. add fennel, raisins, pine nuts, and some of the whispy greens from the top of the fennel to the sardine mixture about 2-5 minutes before the pasta's done

12. drain the pasta, serve with heaping spoonful of sauce.

Buon Appetito!

And two italian phrases that will be sure to get you thinking:

"This is a sweet expression.  Il bel far niente.  [It] means 'the beauty of doing nothing'... 

There's another wonderful Italian expression: l'arte d'arrangiarsi - the art of making something out of nothing."

- Elizabeth Gilbert, Eat Pray Love