Friday, December 23, 2016

Comfortable in My Skin

The other morning, about 6am, my eldest kid and I were running in the woods. It was dark, because it is December. But we had headlamps and the mountain lions dared not approach us with our trusty and fierce poodle at our side. We ran in the 38 degree, starry morning. All was good until my kid suddenly caught her foot and flew into the air, landing hard on her hand and arm. Thankfully no broken bones but her hand got good and ripped up.

The skin. Our largest organ. Just sitting out there for the world to abuse it and for people to see it. It is a great source of money for industries of beauty. It can get you shot, depending on the melanocyte count. It is waterproof, it stretches with holiday overeating, it keeps our bones from showing and it let's the world know what we do for a living or for fun. Farmer's tan? Red neck? Calloused fingers? Smooth and perfect skin of the white collar world? The finger bump of a writer, the shorts and sock tan of a runner, the "I wash my hands 700 times per day" red and dry hands of a healthcare worker, the wrinkled palms of a bath enthusiast, the speedo tan of the lifeguard, the scars of accidents, surgeries, and births. The hickey marks of a good date and the blisters of a soldier with ill-fitting boots. Our skin can show our diseases from autoimmunity or infection or heart disease or high cholesterol, like vitiligo, butterfly rash, Janeway Lesions, or my personal favorite, atopic dermatitis.

I take medications to suppress my immune system so it does not attack my skin quite so viciously. I need to work, after all. Have you ever had poison ivy or a bunch of mosquito bites? Imagine that 24/7, head to toe. Anyway, it could be worse. But the 60-100 mg of prednisone it can take to battle my inner demons has made me lose 1:30 minutes per mile speed on average in my running. And that just plain bites. I mean, gosh yes I am glad I can still run at all, and holy moly, things could be much much much worse. But I like to run, and I like to run fast, and I just cannot anymore, because the largest organ in my body is being dive bombed with a nuclear arsenal every second of the day.

Speaking of skin issues and nuclear arsenal.

But I digress.

My daughter's hand (back to our early morning run) will heal. That is the other thing that blows me away about skin. We can shoot each other, saw open the sternum and sew it back together, get blistering sunburns, and falls and accidents and we still can heal. And even when the skin is not broken, but our hearts are torn apart, we can heal. And even when hate seems to be the new love, as cool to us as a president who is stupider than most of us and somehow therefore makes us feel better about ourselves, even with that cold, hard fact-we can still heal.

My skin, well that is another story. But despite it being the most uncomfortable organ I own, I will still keep walking around in it. My Dad, who had a heart transplant, learned to be wth a brand new ticker. My Mom, who lost a breast to cancer, learned to stuff the fake breast into her bra and head out for the day. I cannot remove or transplant my skin but I can remember the strength my parents showed in hard times, and I can also appreciate the fact that beauty is skin deep.

And although all I want for Christmas is beautiful skin, like the kind of skin where I could bare my arms and legs and back and midriff and face without embarrassment, and the kind of skin that would allow me to be a fast runner again and the kind of immune system that didn't make me bald every couple of years and the kind of skin that did not make me feel like a freak of nature, I can see that things could be worse. I just wish the world was a kinder place and that how we looked did not matter quite so much. I fear the next four years will not offer us a leader who will be kind to those of us who are not beautiful, who have "too much" melanin, who have outward evidence of disease or imperfection. I hope the American spirit of kindness kicks in and saves us from descending into truly believing that hate is the new cool thing. I hope.

Sunday, December 4, 2016


The days are getting shorter. In a couple of weeks, we will have the least daylight of the year. Already the evening dog walks and runs are in darkness. We step through our backyard cathedral of redwood trees, headlamp as lucifer, the fog as incense. The dogs are unmoved by daylight savings. At first, they demanded dinner an hour early because their internal stomach clocks were not privy to the ways of humans. They seem to have adjusted. They do wonder at the live, piney tree with honest to God sap still flowing sitting in our living room. Once decorated, they will eat at least one ornament, as if it is their sacred duty.

Darkness seems appropriate as we complete this year. Certainly no year can be all out "bad". Years do not actually have feelings, qualities or actual existence. We create our calendar, our weeks, days, hours, minutes and seconds to define a life passing by us indescribably fast. Time is not real, but it is all we have. 2016 has brought us personal grief: a son in jail, death of loved ones. 2016 has brought us public grief: somehow hate has become OK, and we are soon to lose a leader of grace and decency. Also, he knows what the hell he is doing, and though one might not agree with his policies, one must at least agree, he studied for the job, and understood his duty.

Darkness might include getting rid of Medicare. So many people I have cared for over the years depend on Medicare.

Darkness might include registering my Muslim friends. Yep, I won't take that one.

Darkness might include disrespecting my brown daughter, my lesbian daughter, my son with mental illness.

Darkness might include disrespect for women.

After December 21, though, the light takes over again. It is cyclical, like many powerful things in this life. January 20 might try to be dark, but January 21 will involve women shining light upon many American cities. It is a time for us to be awake. Awake to poverty, racism, sexism, homophobia and xenophobia.

In the realm of running, I find solace. I go to the woods and the beach and realize I am a small part of a much bigger beauty. I count, but only insofar as I am aware and awake. I count on Mother Nature for healing and for getting dirty, quite literally. Mud, sand, redwood fronds and the rain soaking my clothes and shoes and dogs into a mess of smell. The floors I walk on cannot escape the detritus of our outdoor excursions. My home welcomes what the peace of wild things bring inside.

Time is irrelevant and irreverent. But it is what we have. As a doctor of elders, a mother of precious beings, a cousin of young mothers who have been lost to cancer, a daughter of parents gone too soon, I recommend never taking time for granted.

Also, Barack Obama? Yep, he knows what he is doing, and he cares. About all of us.

I think though, we have seen the light. And no one can ever take that away from us.

Thursday, November 10, 2016

Full Catastrophe

Donald Trump is the newly elected President of the United States of America.

There, I said it.

I have people I love whom voted for him, and though I don't get that I admire them for at least showing up and voting. Why did almost 1/2 of our country not vote at all? Seriously, voting is an honor, a privilege, something people died for the right to do. This, maybe more than anything, is what infuriates me about this election.

I have been pondering the concept of giving up a lot lately. I mean, I have a kid in jail, I have barely tolerable health on risky immunosuppressant medications, I have become wildly out of shape, and my work, though I love it in many ways, is Sisyphusian.

My yard is overgrown, my driveway needs sweeping, my car needs cleaning, my piano needs tuning and there are a couple of upcoming presentations that I have written up and prepared only in my mind, which unless Spock teaches me to mind meld stat will do no good on the day people show up to hear my thoughts.

I was signed up for the California International Marathon in December, but deferred till next year, because...wildly out of shape My foot has been hurting. My work days lengthening. My energy ebbing.

My hair has the Obama effect, and though I am glad to have hair, I have more salt and pepper now than either of my parents did at age 60.

And then, a guy whom the KKK wants to cuddle with is my new President. Sheesh.

I am currently re-reading Full Catastrophe Living. It is a treatise of sorts, on mindfulness. I have been dubbed Zennifer at times in my life, but honestly I am so type A and so constantly on the move that I see myself as far away from Enlightenment as Sarah Palin is from cleaning the maggots off a homeless person's wound. Which I have done, but that's a story for another time. The other day I was cracking myself up: having 25 minutes to grab a bite to eat, I went to my local co-op (check-mindful), ordered some organic stuff (check-mindful), opened up my magazine with a lead article "Hope & Healing- Buddhist Wisdom for a Troubled Time" (check -mindful), then shoved down my food while reading the magazine and rushed back to work with a sort of leaden feeling in my belly (yeah....not so mindful).

For the doubters out there, mindful meditation has been shown to reduce pain, stress and other symptoms of chronic illness and of being human. You don't have to be Buddhist to do it. It is kind of all the rage right now, which makes me a little concerned that it is a potentially mis-used or poorly executed therapy or practice. Best to seek someone who knows what they are doing and learn how to meditate.

Learning to be mindful is like doing a mind meld with a toddler. Or a very old person with dementia. Can our experiences be distilled into a literal breath-to-breath wonderment? Can we let go of our talkative inner mind and allow space for something less judgmental and toxic?

Yep, I am pretty much a Californian now. Born in Michigan, raised in Wisconsin, and always, always drawn to the coast. My first ocean experience was the East Coast. As a kid, and this is the Gospel truth, the first time I saw the ocean I just sat there and stared for at least an hour. Now I am a connoisseur of the North coast of the Pacific. I love the smell, the wildness, the fog, the sharks, the sandy dunes and the steep cliffs and the complete lack of pretense. Unless you count my poodle, who could've been registered for his purebred glory, but I was too cheap to fork out the dough and too embarrassed by the prospect of giving him some weird name, like Sir Poops A Lot or whatever.

All of this is to say I could very easily quit. I could quit trying so hard. I could quit my country. I could quit reading and quit meditating and quit running and quit trying to heal the broken people who show up for care.

But then I turn off my mind's chatter and I just be.

There are certainties in life:
1) we will all die
2) this too shall pass
3) I was fast once, and again shall I be fast
4) number 3 refers to running, not some Trumpism about my female attributes
5) I could quit, but where is the fun in that?

You guys, if you are type A like me, this election is like the best, most challenging assignment any teacher or boss ever gave you in your entire life! And if you are better than I, i.e. Type B--well then, just breathe, and be kind, and most likely, things will sort themselves out.

The full catastrophe is life. Life is precious. People are generally good. We have some work to do.

First of which is I totally gotta get back to running.
Second of which is I better get my presentations out of my brain and on my computer.
Third of which is we ALL must fight tooth and nail for compassion, rights, and sanity in this, our country. We shall overcome.

Wednesday, October 26, 2016

Spirit Animals

I was running along the bay in San Francisco the other afternoon. It was a crisp, overcast but not foggy day. I was on the flip side of an 8 mile out and back, just going down the hill above Fort Mason that I had climbed on the way out, when a huge thing swooped next to me and alit on the branch of a cypress to my left.  I stopped, having identified it as a bird of prey. A red-tailed hawk, I believe.
It was not as if I had never seen such a hawk before, but the way it swooped in so close and landed there, then eyed me, in the middle of a city? That was different.

Hawk, SF, October 2016
Next morning, I ran before sunrise. I was running up Lombard and hit that weird dead end at the top at Kearny where you have to either break into someone's gated stairs down the big hill near Chinatown or run further up a hill around the corner to God knows where, and as I stopped to ponder what to do next I saw just ahead of me, in the middle of the street, a coyote. My head lamp made its eyes glow and I was not particularly scared. Just a little thrown off. Too thrown off to snap a photo. It finally trotted away after eyeing me for awhile. I am surprised it did not try to eat me. God knows I have enough meat on me these days to keep it hale for a good week. I turned around and found my way back to a feasible route. Headlamp was also helpful to avoid stepping on any of the homeless folk sleeping on the sidewalks.

I never get used to that. I bet they don't either.

I used to work for a mobile medical clinic in San Francisco, back in residency. We would search out the homeless in their various haunts (i.e. places they felt safest). I remember coming to work at clinic on that day we call 9-11 now. But clinic was cancelled, which I could just never quite figure out. The city was eerily quiet that day. Maybe the lack of airplanes flying over, and people just sort of huddling close together indoors. At least the people that had indoors to huddle within.

While driving home along the 101 today, there was a golden retriever in a truck. But not in the flatbed like you are picturing. He was in the cab with his people, sitting on his haunches but facing backward, and the middle back window was open. He had his paws up on the window frame and his head sticking out with the biggest smile on his face.

I count that as 3 spirit animal sightings in 3 days. Now I have always considered the whale my personal spirit animal. I seem to have intense dreams involving whales whenever something big is about to happen in my life. But I am open to the idea that we are constantly being offered messages from the world around us. We are mostly too busy with our nose in our iPhone screen to notice them. I am guilty as anyone of this. I also often stop to wonder what would happen if you plated out a culture from everyone's iPhone screens. But I digress, into potentially award-winning middle school science fair projects and my own insecurities thanks to my medical school infection and immunity professor. I only ever flush the toilet with my elbow, thanks to him.

According to my highly dubious sources, the hawk may represent being able to see meaning in ordinary experiences. Also seeing the bigger picture, having vision and intuition. It might be telling me to step back and look at a difficult situation with a new perspective. The hawk is telling me to pay attention. So I tried to ask it for more details, as I am a scientist and I want some details gorramit, but this is what it said:

I interpreted that as "See ya, sucker. You ask too many questions. Now go finish that run."

The coyote made me so happy. Apparently it is meant to make you stop taking yourself so seriously. It might be time to let go, and get on with things. Irony and a trickster spirit are its specialities. Wisdom and folly go hand in hand, and, for heaven's sakes play more often.

I told a friend about my sighting and she said if I see a roadrunner next she is calling a doctor for me.

That dog in the truck, well it could mean letting go of doubt, as there is plenty of knowledge, skill and support to achieve my goals. Also,  it is telling me to let go of material things and stay focused in the present moment.

OK I buy that last part. Has anyone out there ever in your entire life met a Golden Retriever not focused on the present moment? Or any dog, for that matter? OK, my dog Miles is often focused on getting to the beach, which is often in the future and past, but he is also an avid fan of television and likes to hump 12 year old Zoe the golden doodle in the window for all to see. So, Miles may not be the best example of the deep wisdom or spiritual awareness of dogs. He likes the Warriors (even after last night!), hates the Simpsons, and patiently watched the presidential debates. He prefers long beach runs to food, likes to lay on his back and stretch his front legs out as far as they go. He burps, snores and irritates the hell out of my teenaged daughter. He chews on good literature (literally) and doesn't mind butting my hands with his curly head in the middle of a technically difficult piano piece. He gets upset if the family plays raucous games with each other and likes to sit on our feet and lean against our legs till he slides over onto the floor. Mainly because he, like most other standard poodles, has no ass.

Tomorrow I board not one but 3 planes to go and see my beloved GodMom get married. She is just the best GodMother ever. I know for a fact she and my Mom used to hide in the bathtub, fully clothed, drinking coffee and chatting while 7 kids pounded on the door at various times looking for whatever it is kids look for from their ever-suffering parents. But aside from bath tub escapes, she, like my Mom, always has shown up. Shown up with spirit and tenderness and humor. Plus she rode on the Harry Potter ride with me at Universal Studios in Orlando a few years back. I thought I was going to have a heart attack, but she took it all in stride.

It has now been over 20 years since my Mom died. A few years after her death I found myself at a mindfulness retreat along the coast of California. I was out walking on a silent day, and there was a small wooden shed in the field on a cliff overlooking the Pacific ocean. I went in, and found it to be a shrine of sorts, with an altar and various significant pieces set there by many people over what appeared to be years. Some found, natural objects. Some photos and icons and treasure of sorts. As I sat there, I suddenly felt my Mom's presence. And then a small songbird flew in and fluttered about this small space while I sat there. It finally came to rest and we sat together for awhile. Then it spread its wings and sailed away from me.

Pay attention.
See the extraordinary.
Do not take yourself too seriously.
Consider play important, and material things overrated.
Sit quietly, and see what happens.
Show up for those whom you love, and those you don't love and those you don't even know.

Stop asking so many questions.

Finish the damn run.

Thursday, October 13, 2016

The Blog Before the Storm

My dogs will not leave my side tonight. I am not sure why. There is a storm brewing. It has been brewing all day. I did my house calls early in the day for fear that weather would preclude reasonable travel later. A smattering of rain, some bit of wind. No major storm yet though. It is sitting there in the air, like an about to be lit stick of dynamite. I feel like it is inevitable that things will explode, so please, just touch the lighter to the wick already.

My dogs may sense the storm. They may know of a "big one"coming. They may think I am a big piece of bacon. It is hard to say for sure.

Maybe they read the news. What is happening in the world is certainly scary enough. And the coming election is like being stuck as a character in To Kill a Mockingbird. Racism is over, right? Nope. Sexism is passĂ©, yes? Nope. Unwanted sexual contact is illegal, YES????

When I was 16, I was on a bus to the Vatican in Rome. It was packed. A man came from behind me and as I held onto the hand rail above me for dear life, he grinded into me from behind. I was horrified. It happened again in Venice, on a gondola. When I was 18, I was in college, walking home from a café at night. A man followed me, I quickened my steps, he followed closer, I got to my destination and nervously got inside. I have a dozen more similar stories. I hardly get through a day, much less a week in my profession without a comment on my appearance. It is not OK. It is not OK.

It is not OK, because I am human. Not because I am a Mom, a wife, a daughter, an Aunt, a sister.

I like to run. I like to study. I like to play piano. I like to read. I like to think I can walk in the wilderness alone. I like to travel. I like to be a Mom of daughters and also of sons.

Here is what I have been told:
To run is to be thin.
To study is geeky and not lady-like.
To play piano is to wear the right dress and to be presentable.
To read is to like chic lit.
To walk in the wilderness alone is dangerous.
To travel, as a woman, is also dangerous.
To be a Mom is to be perfect. To be an example of hard work, morality, and to make the best cookies in town (which I do, if I do say so myself). And to work but not too much. To be present at every major developmental stage. To keep your kid out of jail, and send them to a big name college. To be presentable, perfect, kind, adaptable, and pretty.
Be pretty most of all. It might become law if The Donald becomes president.

My dogs are probably mistaken. Nothing big ever happens when we expect it. But I respect their commitment to me, or my perception of their commitment. They love me, for sure. They are not filled with hate or prejudice or misogyny. They just like a good run, a soft place to sleep and the knowledge that they are part of a pack that matters.

I think my pack matters. I love my family, my community. I welcome the coming storm. I run from nothing. I run to everything. Everything that matters.

And, please, Michelle, can you run for president?

Saturday, October 1, 2016

Big Business

I have read Runner's World magazine for most of my adult life. And why not? Every month there is a whole cover to cover magazine dedicated to the best sport ever! Granted, it does seem like there is a finite amount of things that can be said about putting on shoes (or not--barefoot running is in, after all) and going out the door to run. They always come up with something good though. And now there is even a new set of running magazines dedicated to trail running.

Trail running is becoming big business. There are hundreds of trail races all over the world, many of them ultra-marathons. People are starting to dope for them, so you know they are real competitions. They now have dogs sniffing the granola and gatorade at rest stops to ensure everyone is following the rules. Not really, but they might have to start doing this. They could have the athletes pee in a cup at mile 72, but their impending renal failure might preclude that, so dogs are probably the best option. I have long suspected that gatorade IS urine, derived and purified from the bladders of the athletes who advertise for them. It is magical and tastes a little like sucking on distilled kidney stone juice. Disclaimer: I am not getting any kickbacks from Gatorade corporation.

I love trail running. I am sort of bummed it is turning into such a thing, but I guess maybe I should be happy or at least a little pleased because it gets folks outdoors and has more people passionate about protecting our environment. They might be less likely to have the bumper sticker I saw this past week on a truck in front of me: "Environmentalism is a disease". When I pulled into work I immediately when to Harrison's Principles of Internal Medicine to read up on the disease of environmentalism. It kept talking about how hurting the environment can be linked to the rise of certain diseases. Maybe that's what that guy meant with his/her bumper sticker? Anyway, trail running is a big business now. All the shoe companies make "trail running shoes". I used to think this was stupid till I ran the Headlands Marathon a couple of years ago, and was slip-sliding on these steep single track sandy, rocky, slick trails. I could of used some serious traction.

These days my running is pathetic. I am too sad about my son to run much, and have slowed down considerably. I suppose I will get it back at some point. I probably just need to drink more magical Gatorade.

I did visit my son, in jail, today. He is on day 61 or so. He has not seen the light of day except through a distant window. He does try to exercise during rec time. For awhile, he balled up papers to play basketball, as they had no ball. He also walks laps around the room. It takes 35 steps to circle the room. I may be choosing not to exercise as much, but honestly cannot imagine being barred (literally and figuratively) from moving my body, and from being outdoors. I get people in jail and prison are being punished, but I wonder exactly how helpful it is for making an 18 year old with addiction into a better person?

Prisons are a big business. Our president helped move along the phasing out of private federal prisons. This is a good step. The more profit in it, the more prisoners there will be, and prison is not always the right answer. Also, if you profit from someone being in prison, why would you want to rehabilitate them? I never pictured myself having a personal stake in this whole issue, but therein lies the rub. We need to care about stuff because it could affect others in our community, and maybe one day us. I think Jesus' whole thing about visiting the prisoners and tending to the sick is akin to doing the same for Him should be reason enough for the Christians in our country to give a shit about healthcare and justice equity. But I digress, and too many Christians see profit as a God-given right. Bah humbug.

Nursing homes: big business. Locally, we are facing the closure of 3 of 5 of our nursing homes, because they are not profitable. The mission of a nursing home should be rehabilitation (sound familiar?) and for those not rehabilitatable (now there is a mouthful), a place to be housed, fed, cared for, loved, kept clean, kept safe. How, exactly, should profit fit into this? I work for a program, PACE, that serves people at risk of losing their independence due to health issues and frailty. The nursing homes, under the company The Devil--oops I meant Rockport, decided last year they did not want to work with us because we "take away business from them". We found a solution to care for people who needed temporary or longer term placement for support and rehab. But my eyes were opened to the absolute folly of making care of other humans a profitable endeavor. Some things can be big business: running shoes, cell phones, um.....hold on. Do I want 10 year old in China making my running shoes or my iPhones? Dang, it is hard to be a good person in this day and age.

It is certainly an opportune time for our community to rethink how we care for seniors. I wrote about it a bit in my column this month on person-centered care. Maybe money is not the most important thing. I know Mother Teresa supposedly said "without money, there is no mission" but truth be told, the money to do good works is not nearly as much as the money it takes to please a board of directors to a big business. A community can decide to support a good cause. A community can help create change.

I am a preacher's daughter, as well as the niece of 6 other preachers, so forgive me if this is getting preachy.

Take home points:
-Environmentalism is not actually a disease. I looked this up.
-Trail running is awesome and does not take a magazine to tell you how to do it.
-For profit institutions meant to rehabilitate people are a really bad idea.
-The Netherlands gets it right. See below, if you don't believe me. This is well worth 20 minutes of your life to watch.
-I need to get back to my running.

Saturday, September 3, 2016

Objectify Lesson

Today was the Fifth Avenue Mile. Jenny Simpson won. She and 4 others were just in Zurich. Let' has it here:

"Four-time Fifth Avenue champion and Olympic 1500m bronze medalist Jenny Simpson; training partner and Olympic steeplechase bronze medalist Emma Coburn; British national record holder and 1500m Diamond League champion Laura Muir; American 800m national champion Kate Grace, and 2015 world championships steeplechase finalist Stephanie Garcia all will depart Zurich this morning –albeit a bit tired– and are ready to run down Fifth Avenue."

Man, they were fast. I mean, for women. 
Actually the press coverage of Fifth Ave is pretty balanced. Unlike the olympics. 

I might be a little touchy on this issue today. As a doctor, I am in a still male-dominated field, although that is changing when you see the breakdown of medical school classes by sex. And by sex I mean gender, not what happens in every call room every day during every episode of Grey's Anatomy.

Today on call, I was soundly treated with disrespect by both a physician (man) and nurse (woman). All while protecting and caring for a dying patient who was in agony but now has symptoms controlled. After I cooled down a bit from the idiotic discussions I had, I realized the following:
1) No one would EVER speak to a man doctor like that
2) Patient well-being is something I have to fight for on a regular basis, because if you want to do something right, you have to be able to take shit from others who are perhaps following the party line without one ounce of subtlety or compassion
3) It does me no good to get all upset about these things
4) I miss Matt Miller, who always had my back

Being a female physician who is bald and not particularly beautiful does not help the situation. 

Still, I know my stuff. I put patients first. And I can run faster than a lot of "boys" my age. Also, I have a kid in jail so I am totally bad ass.

It is actually too soon to joke about that, but I am trying to keep my chin up and be tough. 
I recently attended a wilderness medicine course (a very testosterone-heavy field, btw). I took a half day session on women in the wilderness, from an amazing nurse in her 60's who is a back country skier and can find her way around with a compass and map. No GPS needed. Anyway, I learned some great skills, including how to pee standing up without pulling down my pants, and while writing my name in the snow or dirt or whatever. This nurse is part of a team leading a medical mission trip to Guatemala next February, and my youngest daughter and I plan to go. My youngest daughter, age 15, is thinking she wants to be a general surgeon someday. She has the toughness, the dexterity and the work ethic for it for sure. I cannot wait to travel with her on our first medical mission trip together. That is, if I survive this call weekend.

Toughness: inherently male? Maybe. Though I do remember giving birth and that was pretty gnarly. Also, I remember being told my worth was based on prettiness, not how I moved through the world with others. Also, I recall that I cannot get through a single day at work without someone commenting on my looks, usually a patient. It is tiring, actually. I sometimes fantasize about looking like Cristina on Grey's Anatomy, thinking then everyone would love me for my looks AND my toughness.

Then I recall how my 15 year old Chinese-American daughter has to deal with assholes discussing her eye shape, or her skin tone, or "where she is from". So maybe Meredith is the better choice, though being blonde and slight probably carries its own struggles, when trying to be a serious player in the world of male professionals. .

Yeah, I definitely would go with Cristina. 

Or Jenny Simpson. Especially if I could have her 4:18 mile pace.

Here is the thing. Michelle Obama gets criticized for wearing no sleeve dresses. Hillary Clinton is ridiculed for wearing pants suits. Malala Yousafzai gets shot for trying to go to school. France wants Muslim women to wear bikinis at the beach. College women are taught how to avoid rape, instead of college men being taught how to not rape. Crazy.

I could write a list a mile long about the injustice and the idiocy and my righteous indignation. 

None of us should be objectified. None of us should be disrespected, afraid, or shamed. 

Now excuse me while I dismount from my high horse and share my absolute favorite moment from any olympics ever, with the coolest running cat in all history. First time the women were allowed to compete in the marathon in the olympics. I think it is (about damn) time for some other female firsts too.

Wednesday, August 24, 2016


I just finished listening to Middlemarch by George Eliot (AKA Mary Ann Evans) on If you do not know what is, go Google it immediately. Basically, an app on my phone where I download books and listen to them while driving, or biking. I commute to work on my bike not infrequently, and I put one ear bud in, leaving the other ear bud out to hear the approach of the guy about to mow me down in the bike lane. My ear bud pours stories into my right ear. I hope my left ear is not too jealous. Maybe I should start alternating ears?

If you have not read Middlemarch, but are a fan of "Downton Abbey", I recommend you stop everything you are currently doing and go to your local independent bookstore and read this book. Or load it on which I do not have stock in, but if you drive or bike or run a lot, this is a good thing. I sometimes do long runs listening to novels.

I like to hold a book in my hand and read too, so while listening to one book, I am always reading another. Currently that is The Best Care Possible, by Ira Byock. He is a medical doctor, a palliative care specialist, and a philosopher of sorts. He talks about how to improve care during complex illnesses and toward the end of life. It sounds all heavy and stuff, but should be required reading, along with Being Mortal by Atul Gawande and Flight of the Wren by Atthys Gage.

The latter is my husband but he is a damn fine writer, so please read his books, if you have any sense in your brain at all.

My son, now in jail, was never "in" to reading. He sort of rebelled against us in this way, because husband and I were always sitting with our face shoved in a book. Teenagers are supposed to eschew the passions of their parents. It is, like, their job. I would not say that there is a direct correlation to my son being in jail and not reading, but there may be some argument for it, as reading opens your mind to seeing the viewpoints of others, and also challenges you to rethink what you hold as true. Crime and Punishment comes to mind, which my eldest daughter once wrote a brilliant essay on. One day I came home from work to hear her and my husband discussing this book, but she and he had renamed all the characters as Sponge Bob characters, as the Russian names were too hard to remember and pronounce. This argues for a nice healthy balance between TV and books. And a trivia point: the original creator of "Sponge Bob Squarepants" was a guy who attended the college in our home town.

My son in jail is now reading a lot. Because jail offers little else to do. Video games? Nope. Television? Nope. Drugs? Well, I certainly hope not. A glimpse of the outdoors? Nope. Yes, an 18 year old, scared kid who made bad choices is stuck without any sun exposure for months on end. I am sure this will be the key to a healthy reentry into polite society. least he is reading.

Reading while running seems natural to me. I mean, you cannot actually read while running, though maybe you can if running on a treadmill, but you can run while listening to someone reading to you. Just like music. Or the sound of one hand clapping, which the purists would probably prefer. Reading while in prison seems essential. And reading at all is a rare thing in our society. Apparently about 10% of people read regularly. And we wonder why Trump is a serious candidate.

All snarky comments aside, I do have some observations to make.
1) Prison is inhumane.
2) Reading is a luxury that we take for granted.
3) If my son hangs for poor choices made at age 13-18, but Donald Trump becomes our next President, then no book in the world can explain to me the logic of the Universe.

Our local bookstore sells a bumper sticker. If you do not like swearing, please look away:

Read a Fucking Book.

Tuesday, August 9, 2016

Apples and Oysters

Once long ago I said to a friend that I felt stupid complaining about my suffering, because in the world there was such profound examples of suffering and mine paled by comparison. She said: "Well, that is like comparing apples and oranges. Who is to say that your suffering is less than that of anyone else? Does it matter? Suffering is suffering".

Apparently, this saying, "like comparing apples and oranges" originally was "as an apple to an oyster," like in Taming of the Shrew when Biondello does an eye roll when being compared to Tranio's father, and says out of the corner of his mouth "as much as an apple doth an oyster..."

Pointless comparisons aside, there is plenty of suffering in the world.

Recently, California passed the End of Life Option Act, which makes it legal for a physician to prescribe a lethal dose of medication to someone whom is likely to die in the next 6 months and whom requests it and whom 2 doctors certify as terminal and whom is in their right mind. This has been law for awhile in Oregon, Washington, Vermont and Montana. Oregon was first, and the main reason people participated there was not pain or other physical symptoms, but rather loss of dignity and dependence on others.

I cannot say how much suffering is or should be tolerable for any one person. I do know that I cannot personally end a life, at least not as my primary intention.

Hear are a few things I have learned about suffering in my life to date:
1) It is universal
2) We do not like to talk about it
3) It will only get worse if we elect Donald Trump as POTUS

In Amsterdam, there is an ubiquitous symbol, on flags, on man holes, on sides of buildings, on billboards: XXX. This is not an allusion to the debauchery of this City, which, truth be told, although is a place for tourists to smoke pot and visit prostitutes, is one of the more kind and unassuming places I have ever visited. Triple X refers to the cross of St Andrew. It is the official symbol, and may represent "compassion, heroism and resolution." It may also represent the suffering of the city, including fire, floods and the black death. Either way, I kind of like that it is just right there, reminding you of sorrow and higher values, whilst the inhabitants ride their bikes and tolerate the shenanigans of visitors. Amsterdam has good food, and you would never be able to do any hill workouts there. On the upside, you could very well run a PR anywhere in the Netherlands. And you could fuel it with excellent cheese and a decided lack of pretense.

Recently, my son was arrested and put in jail. After jail, it appears prison is in store. I did not know there was difference until now, and I am learning new things every day. If you go on line to local news sources, you will see a lot of opinions about how awful he is and how terrible the parents must be that raised him. But I have this to say: "(he) that is here without sin among you, let (him) cast the first stone..." Yep, it is super easy to judge people when you have no idea about their suffering and the blows life has dealt to them. My apples, your oysters, but the suffering is real no matter which fruit or fruit of the sea you identify with.

So, how does one proceed through suffering? This is really what the bulk of my professional career is about. I can prescribe medications to diminish suffering. I can recommend lifestyle changes to reduce health problems that cause suffering. I can legally prescribe death for your suffering now too--but I will not. I think a certain amount of suffering is expected as human beings.

As a parent, I can say I will show up and acknowledge my own suffering, the sadness of my son and the impact on my family. I can apologize to my community and hope for a better future for my child and others who struggle. I can get up each day and show up for work and go for runs and play piano and appreciate the small beauties presented to me.

I can enjoy apples. I can enjoy oysters, though as a vegetarian I am not overly fond of eating them outright.

I do have a prescription to offer to all who suffer, whether it be from a bad haircut, a child in prison, or a life threatening disease:
Kindness. Take every minute of every day, and give to everyone you meet every minute of every day. Side effects: happiness, calmness and hope.

My Boy. I love him, no matter what.

Wednesday, July 20, 2016

Little Beauties

You know who would have made a great blogger? Anne Frank.

We visited her hiding house in Amsterdam. The line to get in was around the corner and through an entire square, as it is, I understand, every day the place is open. There is good reason, though it occurred to me an hour into waiting that it sure would've been nice if people could've rallied around them with such fervor in the 1940's. I guess it was not that simple. Actually the thing that moved me most about our visit was this little video clip of her father, after the diary was published, years later, saying "most parents don't really know their children." He was close to Anne. But still.

In this day of helicopter micromanagement we like to think we know everything there is to know, and more than they know themselves, about our kids. Actually, Anne pretty much felt that was how the adults in the secret annex acted. I guess you cannot get more chance to micromanage your kid than to live in an extremely small space with them, unable to go outdoors for a break even once for years.

I don't have profundity to add to this observation of myself being so moved by that particular part of the Anne Frank house. It just struck a chord, especially as my little beauties enter into adulthood.

Which means I must be entering into something beyond adulthood. Maybe middle age or something like that. I was going to run this morning, but my body creaked in protest when I awoke, still deep in REM when my alarm went off. I have been running and biking and swimming and playing big chords in this Chopin piece and my body is feeling good in a sense--dropping some of the prednisone weight and getting a smidgen faster on my feet (and my fingers). But I can tell that if I push just a bit too hard, I am going to hobble myself and have to take a chunk of time off and go pool running or something equally terrifying in its monotony. Nothing makes the clock tick slower than pool running.

So instead of running, I did core work. Meb and Laura M says I should, so I do. Instead of running, I am writing this, and sipping some pre-work coffee. And trying not to think too hard about the future of humanity.

Yesterday, at least 70 people were killed by accident in Syria, by US led coalition forces. The footage is gruesome. Little kids buried in rubble. Syria is a complete mess. Why are we not more worried about it? It is like the situation with Anne and her family. After the fact, we will build museums and solemnly charge eager tourists to stroll through and contemplate the sadness. Not that I do not think these museums are worthwhile--they keep the stories alive, and maybe some people will come away with real motivation to fight for justice right here, right now. But today, I am just perseverating on my core and the fact I did not run and that my children are leaving the nest one by one and my coffee is delicious. I am not sure what to do about Syria. Or gun violence in our country. Or drug abuse in my community.

I will probably just keep going to work, and loving people. My middle child, who has had his fair share of woes, told me the other day he has decided the point in life is to make other people happy. He says he finds it makes him happier himself. Wise rapscallion.

Little beauties helps pass the time tolerably, as does remembering who we are at our core (the proverbial one, not the burpee target).

Leaves and Blossoms Along the Way, by Mary Oliver

If you're John Muir you want trees to
live among. If you're Emily, a garden
will do.
Try to find the right place for yourself.
If you can't find it, at least dream of it.

When one is alone and lonely, the body
gladly lingers in the wind or the rain,
or splashes into the cold river, or
pushes through the ice-crusted snow.

Anything that touches.

God, or the gods, are invisible, quite
understandable. But holiness is visible,

Some words will never leave God's mouth,
no matter how hard you listen.

In all the works of Beethoven, you will
not find a single lie.

All important ideas must include the trees,
the mountains, and the rivers.

To understand many things you must reach out
of your own condition.

For how many years did I wander slowly
through the forest. What wonder and
glory I would have missed had I ever been
in a hurry!

Beauty can both shout and whisper, and still
it explains nothing.

The point is, you're you, and that's for keeps.

Friday, June 3, 2016

The Iron Nun

At the end of my 50th lap the other day, I pulled myself out of the pool and realized the life guard was going around telling others to leave the pool. I caught a few words as I walked by with my pool-watered ears. "Someone hmmphed in the pool". I guess it was vomit or shit. I was oddly unconcerned.

I just recently took up swimming again. I am concentrating mostly on my breathing for now. My friend who swims in the ocean every day gave me some tips. Exhale in the water, and if it seems like it is taking too long to get a breath, exhale in puffs "like a preemie baby with too much CO2". Switch sides-better for the neck. Keep the crown of the head toward the opposite pool wall-do not lift the chin. Just tilt to the side and breath under your armpit.

I try not to suck in too much pool water, because of the whole infectious disease issue. When I was in medical school, we took a class called "I & I" (Infection and Immunity). Let me tell you the salient points: the toilet seat covers they provide in public restrooms are ridiculous. Fanny flora (this is a actually what my professor called it, disdainfully) is not what you need to worry about! Its the things you touch with your hands. Thus I never touch the flush handle directly, nor the bathroom door, nor any door handle for that matter. Also, don't flush and put your face into that space! Flush and run away fast as you can. Will you look crazy, elbowing door handles and running away from the toilet? Probably yes, but so much better than a bad case of E. Coli from that person who never washes their hands, not even once.

I almost never get sick with contagious diseases. Though I hardly need to, since my own immune system is too busy attacking me, myself and I to bother about getting excited about outside threats.

I started swimming recently in my quest to re-achieve some semblance of fitness. I still run of course, though I like to think of it as more of a Frun (flubbery run) or a Pshruffle (pathetic shuffling run). Where the holy heck has my speed gone? I know the cops did not confiscate it. So, I suppose it is hidden like Waldo in the crowd and it is not dressed in stripes but rather well camouflaged. I will find it, if it is the last thing I ever do.

I also do core work. Which is to say, I try to make my middle section feel really beat up. The other day, after the vomitous, feculent swim, I was doing core at the gym and in a small room with 3 other quietly suffering and hard-core women. Three 20-something year old guys came in, and were immediately intimidated by us and turned tail and ran away. Strangely satisfying, was that. I was actually standing on my head at the time. I like to do headstands. It makes me feel age-defying.

When I was a kid I used to do headstands while watching Star Trek and Disney and Little House on the Prairie re-runs. Michael Landon, by the way, looks good upside up or upside down.

I have been thinking lately about choices. We choose whether or not to exercise. Or to stand on our heads. Or to wash our hands. Or to lie or speak truth. We choose whether to run or swim or sit on our couch and eat a donut.  Pretty soon in California, you can choose whether to expedite your own death. But only if you are declared to have 6 months or less to live by 2 separate physicians and perhaps a mental health specialist and have 2 verbal requests in person and one written request and another attestation signed 48 hours before you take the pills, by yourself, because no one else can administer them to you, and the attestation shows you still want to do this and are mentally and physically capable and by the way, the drug companies have increased the cost of the death-hastening medication by several hundred percent and your insurance company cannot tell you if they cover any of this unless you ask for that information and the act of trying to accomplish all of this might just make you decide that you would rather spend the last 6 months of your life standing in line at the DMV.

I care for people who suffer. It is my calling. I am a little concerned about this new legislation. But I am willing to support my fellow humans in finding their way. I won't prescribe death, though.

The thing is, I wonder why we are so averse to upholding dignity, to using the great tools we have (hospice, palliative care) and to not being defined by this culture of youth and ease? Yes, I like to be physically active, and yes I want to run as fast as I can. But I am still a valid person just as I am now: vaguely overweight, extremely bald and just not as fast as I used to be. The people I care for are also disenfranchised, because we have no definition for the value of the aged.

I have looked into the eyes of the most demented person, and have come away changed. How can I explain this? Maybe this way: visit a child, especially a newborn or someone aged 1-2. Are they of value? They are all new and they see the world with different eyes. Same with dementia. It is not a tragedy. It is just human-ness in a different way. Different than the hyper-productive, show-offy, Facebook and Strava-worthy way. Different, real, sad, happy and occasionally incredibly annoying. Like the rest of us, actually.

Which brings me back to the pool. Someone either very young or very old managed to shut down the pool with their bodily functions. I had my workout done, so no skin off my back. Also, I am on a mission to regain my (sort of) athletic prowess. Poop in the pool is good preparation for the actual scariness of sharks in the waters of Hawaii, say if I was doing an Ironman or something.

Maybe I ought get my MMSE checked?

Nah. I want to be like the Iron Nun when I grow up:

Friday, May 13, 2016

R is for Reality

You haven't known fear until you've lost your 9 year old in China. It was not the first time he was lost. That was in Toys R Us. The second time was in Golden Gate Park, which I would rate as just slightly less terrifying than China. You look away and he absconds. In China, it was along the Yangtze River, flying kites. The city has about 7 million people.

Don't worry, we found him. He was surrounded by women helping him untangle his kite string and pull it out of the river.

Sometimes you are concentrating on flying your kite and are oblivious to everything else. Or maybe chasing a butterfly down a path by the boat playground near Ocean beach in San Francisco. People think you should be concentrating on the slides and sand box. But there is so much more to see and do.

What is important in this given moment and why is the world the way it is? A friend recently sent an article from the Atlantic regarding the illusion of reality. Although I have no doubt the author is right, I also have no doubt he is wrong. Who am I to say that what I see is what you see or that it even exists beyond what my brain has constructed as reality for my daily consumption and survival? Is my sky your sky? When we simultaneously ooh and aah at things of beauty, are the beautiful things even there or just a product of mathematical and hormonal  and axonal constructs? My answer: yes. Like one hand clapping, grasshopper.

The other day, a patient mentioned they wouldn't be making it to their specialist visit (for which they had waited for months), as there was a luau that day. The doctor part of my brain was like, are you fucking kidding me? The human part of my brain was like, yep, good choice. Both truths existed and my brain exploded, and they are still picking pieces of it off the walls in my office.

When my 9 year old was lost, I freaked out but also became very focused. There is this thing about mothers, where the little annoyances can make you completely lose your shit, but when big things occur you become like a hawk who has focused upon a mouse far below you in a field. Nothing else exists, and everything becomes still and silent and you dive with dead accuracy and a stony demeanor. You get the job done. My son, he was found, and my daughters who were also flying kites never suspected anything amiss. Job done.

It helps to have a good mate, with a cool head. Dads can be cool as cucumbers. But I don't think they have that same instinct, the mother bear, the hunting hawk, the do not mess with my children or I will rip your head off sensibility.

Once, long ago, my youngest was playing basketball. Just rec basketball. She was 6, and very, very small for her age. She actually weighed less at 6 than many of my friends' 2 year olds. Anyway, there was this Amazon-sized 6 year old guarding my daughter and she kept knocking her down. Hawklike, I rose from the stands and walked onto the court and went chest to chest with the ref. My child was mortified. But seriously, don't mess with my children.

 I am reading H is for Hawk right now, and perhaps this is why hawks are on my mind. In this memoir, the author deals with the grief of loss of her father, and tells a tender and harrowing tale of training ("manning") a goshawk. Her perception of the world is changed by her interactions with this bird of prey. It preys on her heart and not in a bad way. It turns out hawks can play and they see so much more than we do. They are tamable but not domesticated. And they really, really like raw meat.

So, when someone chooses the luau over medical intervention, is it real? Is it wise? The longer I parent and the longer I doctor, the less I know about what is right or wrong. But the more I know about how each creature, each human, approaches their life with hawklike intensity and a faulty grasp of reality. We see what we think we should see and our brains play along. We think we know what will make us healthy, happy, rich and perfect, but this all changes as fast as our browsers refresh and our attention spans waver.

I propose the following: nothing is real, everything matters and the luau is always the right choice. Also, don't mess with my kids or I will tear you from limb to limb, like a hawk and its prey.

But if my kids are reading this, remember: Compassion is the greatest power.

What does this have to do with redwoods and running? Well, hawks (and falcons) are super fast. And watch how they maneuver through the woods. Compared to them, we are slugs. Slugs with uncertain reality and prone to losing our children in large, foreign cities. Slugs who love a good luau.

Could be worse.

Monday, May 2, 2016

I Pulled on Trouble's Braids

I pull on trouble's braids. I diagnose the enormous vertebral artery aneurysm, the unalterable dementia, the untouchable pain and the metastatic cancer. What kind of cancer, you ask? What does it matter, I know them all. Disease brews in all shapes and forms and pulls on trouble's braids. Eosinophils gather and gather in my own blood and wreak havoc, along with antibodies that fuel the fire that puts me in my place, unable to run, unable to play Beethoven, only concentrating hard on the well being of those I serve.

I pull on trouble's braids, asking the healthcare system for more than it wants to give, both for myself and for those I treat. The ridiculous expenses, the misguided goals, the unrealistic expectations all threaten to extinguish my dedication but they won't, at least not to to others and at least not today. My medical school loans will be paid off by age 65 or so and I think every penny was worth it. I know how to stay one step ahead of trouble.

But I pull on her braids. Just like that kid who sat behind me in 3rd grade. We met on the playground at recess and in those days no teacher lurked at every corner to micromanage every interaction. 3rd grade boy no longer pulled my braids. But grown up trouble has not been able to catch me at recess just yet, probably in part because on my proverbial recesses I curl in a ball and lick my wounds and try to talk my eosinophils off the ledge or back into their box.

Trouble's braids bite back. But I know the sweet tune to lull them so I am unafraid. As I have taught my children,  compassion is the greatest power. That tune lulls the worst kind of trouble. Compassion, compassion. Compassion for others, and for oneself.

I pull on trouble's braids, fighting for the most vulnerable. It is what my parent's taught me, and so I do it.

I pulled on trouble's braids, and took up a sport some say ruins the knees. Some say running too far can damage the heart, the feet, the vertebral column. Ask Ms Ida Keeling about running and I think her opinion might differ. Trouble probably just lets her pull on its braids, no questions, no complaints.

I pulled on trouble's braids, and I lived to see another day. I found solace in the arms of those I love. I laughed at the jokes my elder patients told me. I fought side by side with the disenfranchised to get them the care they deserve, or don't deserve, because care should be unconditional. I curled up into a ball and prayed for someday soon being able to run, to play Beethoven. To play Bach. To play Chopin, To play.

I pulled on trouble's braids. I pulled on trouble's braids. I pulled on trouble's braids.

Tuesday, April 19, 2016

Guardian Angel

Today a patient gave me a gift. Now don't get all excited or up in arms about doctors accepting gifts-it was not a Ferrari or anything. This was an elderly person who is kind of on the gruff side, so it took me by surprise. It was a necklace, an angel, a guardian angel they said. They see me all rash-covered and bald, and they care. I am not easily moved. Well, I am pretty easily moved actually, because the beauty of the mundane and the wondrous punches me in the gut just about every other second. But this was just such a kind and simple gesture. It made my day.

I also got a crown today, of the dental category. I am currently reading this book called The Piano Tuner, which takes place in the late 1800's in London and Burma. As I sat in the chair listening to that terrible whine of the drill, smelling the tooth and prior filling being ground into dust, I was thanking my lucky stars for anesthesia. In my book, the part I read today included a scene where a boy had to have a few fingers amputated. They just tugged his ear real hard to distract him, then cut away when he was not looking. I am a wimp at the dentist, but have to admit it was tolerable, and there was no surprise ear tugging involved. Plus I got to watch my crown being made. Basically they do digital mapping, shape it to match the shape of your real tooth, and they put it in a "mill" which, like a 3D printer, takes the information from the computer and shapes you a brand new tooth cover. A tooth tiara. Then they shove that thing in there and voila! You can go home and chomp on some steak or whatever. Tofu in my case.

The guy who wrote The Piano Tuner was top of his class at Harvard, then graduated with an MD from UC San Francisco. His book was published at age 26. So annoying. My dentist is very beautiful, like an Elf in Lord of the Rings. She is also obviously smart and she can wield a drill like a total bad ass. Annoying. I was contemplating this fact today, how certain people are annoying in their seeming perfection. Why does this bother us? Or is it just me? Maybe I am the annoying one.

My dentist.

Speaking of annoying, the other day, my dog was laying on the window seat, minding his own business, and in recovery from a run in the woods, when the neighborhood black cat showed up. She likes to torture my dogs. This particular time, she came right up under the window and just sat there. My dog was apoplectic. I am unsure if he thought she was a real threat, like a black panther or something, or if he was just pissed off that she was in our yard and a cat. Nothing I said convinced him that he was tilting at windmills. So I just kept playing Chopin which sounded better than ever as I could not hear it over the din of his barking.

My dog(s)-Guardian Angels.

One of the chaplains at hospice (where I work at times), gave me the book My Grandfather's Blessings. There is a story in it about the biblical Jacob wrestling with an angel. The Angel attacked him, but when the angel let him go, Jacob held on and refused to release until he received a blessing. Jacob was hurt from their fight, and the angel touched him where he was hurt. And the angel gave him a blessing and departed. Rachel Naomi Remen, MD, who wrote this book, ponders on this story, told to her multiple times by her aging grandfather. She struggles with inflammatory bowel disease, and has had severe bouts which required prolonged hospitalization. She says "How tempting to let the enemy go and flee. To put the struggle behind you as quickly as possible and get on with your life. Life might be easier then but far less genuine. Perhaps the wisdom lies in engaging the life you have been given as fully and courageously as possible and not letting go until you find the unknown blessing that is in everything."

Doctors who struggle with their own illness are like fish on bicycles. We are supposed to be disengaged from suffering, so that we can face it off every day like a tough teenage boy in a brawl. We do not feel good about weakness, at least not in ourselves. Medical school and residency teaches us that.

We strive to avoid suffering, which is understandable. I, myself, cannot wait to get back to my prior level of exercise, my prior athletic body habitus, and my prior lack of outward signs of illness. I see myself as less than whole right now. Though I suppose that could be because I spent 2 hours staring at my gorgeous dentist today. Sigh.

Yesterday I encountered one of the toughest women I know at the grocery store. She made me laugh, right there in the produce aisle. And reminded me that toughness is not about bullshit, but rather it is about meeting yourself where you are and acknowledging that angel who is beating the shit out of you. The you ask the angel for a blessing, and get back to business.

Which makes me think of Beyonce. Which seems like a good way to end this. However, I would not be hired to be in her video, given my rashy, bald self. Beautiful people are so annoying. They need a Guardian Angel to kick their ass.

Sunday, March 27, 2016


"Now the reason we're here, as man and woman is to love each other. Take care of each other."
-The Pretenders

When I was 12, my Dad took me on a road trip. We drove (actually he drove. as a I was 12), from LaCrosse, Wisconsin to Kalamazoo, Michigan to Toronto, Ontario, to Montreal, Quebec, to Quebec City, Quebec, to Bar Harbor, Maine, though Boston, Massachusetts, to New York, New York, to Gettysburg, Pennsylvania, to Philadelphia, Pennsylvania and back home to Wisconsin. In retrospect,  I respect my father for all that driving. On that trip, I perfected my knowledge of the capitals of all the states, about which I was mercilessly quizzed. This came in handy on one of my first days in practice as a doctor out of residency, when I said to a patient "do you have any questions?" and he, a crotchety old man (bless his heart) said "Yeah, what's the capital of Vermont?" Without an instant of hesitation I said "Montpelier." He looked at me with a newfound respect and I secretly thanked my Dad for the previous road trip state capitol torture.

On that same road trip, we were camping in Quebec. The people in the tent next to us had wild and verbal sex. My Dad was a minister and I was 12. Shudder. The next morning, as Dad and I were eating the pancakes he expertly cooked for us on our camp stove, the people next door stumbled out of their tent. My Dad raised an eyebrow at me. Like that commercial says: priceless.

Fast forward 34 years (holy hell, how did that happen??). With my daughter at a respectable hotel in downtown Portland. It is late, we are tired, we finally stop watching Say Yes to the Dress. Not before I have had a complete laughter meltdown regarding the topper to the wedding cake of this one couple, a 3D thing that reads #SOULMATES. I am not really sure why this totally cracks me up, but certain things do and when they do, I am a slave to my laughter. Just ask my nephew Mark, who has the best joke delivery of any person I have personally known. Sometimes I cannot stop laughing.

So anyway, we turned off the show and settled in to sleep, as it was almost midnight. Only then did our hotel neighbors start having the loudest sex known to human history. My kid and I laid in silence for awhile, because, what DOES one say in these circumstances. Finally, I said "hashtag soulmates". Sigh. Credit to the river side Marriott in Portland: the next day I requested a (cough) "quieter room", and they came through and also gave us a complimentary breakfast. Hashtag hash browns.

The day after the said event, we were walking about Portland and stumbled upon a bridal boutique. When we stepped inside, a young woman strides toward us. "So, who is the bride?" she asked with confidence bordering on the obnoxious. Well, it is sure as hell not me, thought I, with my bald head and bad skin. I asked if a kid and her Mom could just peruse with dreams about the future, and she said sure (obviously disappointed, but fuck her anyway). My kid was mad that I did not let her spin some story about her wedding dreams, right there on the spot. And she was right, because she could have spun such a story as never was heard in that boutique. We could have been legend. Even so, we had fun fondling the dresses and discussing our preferences. I have decided I am getting married again if only to get the chance to wear one of these dresses as a self-possessed woman of the 21st century. Husband, get busy re-proposing to me.

Speaking of which, I ran a lot during my Portland trip. My kid, who is a fair bit faster than I, was too sick to run. So I went out solo, each day, on the river front in this town with many bridges. I grew up on the Mississippi River, so rivers sort of tug at my heart. I mean, look at this:

I ran and I swooned for the beauty of Oregon. I ran medium fast. Last time I ran this route, there was snow on the ground. But now it is spring and the weeping willows called to me. We don't really have weeping willows in California. But they beckon me to recall my youth. My best friend and neighbor Amie had weeping willows in her yard.We played Ghost in the Graveyard and Kick the Can amongst those willows. I was afraid and courageous all at once while hiding during these games. I remain afraid and courageous. Ollie ollie in come free.

I am lucky though, because I am married to my soulmate.

My soulmate plays Sudoku while he runs. He understands Beethoven, even the late quartets. He writes prolifically and reads. When he reads, his mind is like a steel trap. He also remembers the lyrics of every important song every written. He and I spent our honeymoon penniless, but happy. We camped in the snow of Vermont and the tangible stars that hung low on a freezing cold night in Bar Harbor, Maine. Now we have 3 children, and still, he is my soulmate.

We adopt our soulmates. We have adopted two children as well. Some say adopting children is not the same, but let me tell you, once you decide to parent a child, they are yours. Only yours. Decidedly yours. Like soulmates. Those that don't understand think soulmates must have genetic relations. Genetics is great. Parenting is greater.

Hashtag: I showed up for you day after day.
Hashtag: I love you.


P.S. Although your wedding dress is awesome, can you please tell me how once dances with such a long train?

No wait, don't tell me. I want to decide for myself.

Atthys, will you marry me?


In Provence, in a new dress.



Hashtag: The Reason We Are Here::

Saturday, March 19, 2016


On Wednesday, I just drove 11 hours for a 90 minute doctor's appointment. It was a good doctor. On that ride, I listened to a book, The Martian. This book, now also a movie which I have not yet seen, proves that it is well worth paying attention in science and math class, and also learning how to plant a garden in an inhospitable place. If you don't know math, science and botany, you are pretty much fucked if you get stranded for 18 months on Mars. Also, air is important and complicated.

While waiting for the doc to come in, I had time to read much of the book When Breath Becomes Air. Paul Kalanithi was a neurosurgical resident and neuroscientist at Stanford, who died just after completing his training. Of cancer. In his 30's. Just months after he and his wife had a baby. What I got from his book is that he loved life. And that his love of life, literature and knowledge saved him. Not literally, of course. But like our fictional friend stuck on Mars, it was the air provided that gave him sustenance. Air in the form of literature, poetry, love of family, knowledge of a greater purpose. He liked to operate. And he wrote this book for us and for his family, even when he was so exhausted. He quotes Samuel Beckett: "I can't go on. I'll go on."

When we run and are out of shape, or when we run at elevation when used to sea level, we suck air. That is to say, we feel like we are breathing through a narrow straw and sucking greedily to get what we need to survive. It is a luxury, of course, to suck air in the pursuit of a workout or race. Illness that causes this same sensation is not a choice. Thankfully we do have medications to help with such sensations, in those with illness. For the out of shape runner, sucking air is just part of the hazing process for induction into the fraternity/sorority of Delta Delta Pheidippides.

When I was young, Nike Air Jordan's were the shoe to get. The name made sense to me, in that the amount of air between MJ and the floor was epic. I wonder really if flubber was in play there. Now Nike has all sorts of shoes in the "air" line, including these:

Image result for nike air shoes pictures
In the literal sense, air is composed of 78% nitrogen, 21% oxygen and a touch of CO2, water vapor, argon and whatever the local factories and cars and farting cows add to the mix.

We air our thoughts and air out our stinky camping gear. We put on airs. We look at the skies as "air space". Airiness can mean a lightness, or unconcerned quality, an open space, something insubstantial.

I am in the midst of a rather intense flare of an autoimmune problem. My best treatments are toxic, in that they slap down my immune system, which is, after all, an important thing to have except when it is trying to destroy you. My self-treatment for the stress of this, and the stresses of my work and life is a complicated regimen of petting my dogs, laughing with my family, watching the Warriors obsessively, playing piano and being out in nature, especially running. Illness can make all of the above tough to do while also holding down a rather intense job. But being outside, being in the open air, this is crucial. Turns out my immune problem gets revved up further by sunshine, DAMN. IT. But the fine doctor I saw on Wednesday did not suggest I stop running or avoid nature at all costs. Nah, he Rxed "sun beads" to monitor things, sunscreen that won't make my skin fall off, and special magic stuff "to wash your running clothes in", some kind of sun guard thing. I love this doctor for not telling me to stop running outdoors. Rx: get out and get some air.

And here is the thing. Paul Kalanithi knew that language, literature, science, religion all matter, in the sense of this is how we relate to each other and to the devastating reality of illness and death. I think "when breath becomes air" might be referring that old style Shakespearean concept of words as breath that flies into the air. Attention to our words matters. Please note this, Donald Trump and all ye who support that fiend.

To be a good healer, listen well, rush not, prescribe exercise and nature,  and read as many books from all genres as you possibly can. Understanding everything as well as possible is a quest worth tilting at, I think. Chased by a healthy shot of "I actually understand nothing." And when the headache from all of this heady thought and self awareness sets in, take 2 pills of "holy shit, does any of it matter anyway? I can't go on! I will go on." Witnessing suffering on a daily basis can get to you. Kalanithi puts it so well, referring to the "endless barrage of head injuries", saying "I began to suspect that being so close to the fiery light of such moments only blinded me to their nature, like trying to learn astronomy by staring directly at the sun." Later in that chapter he returns to the ER after just losing a patient despite resuscitation attempts, to rescue his melted ice cream bar, which he actually then successfully resuscitates in the freezer and enjoys very much.

In second grade, all of my daughter's little essays ended with the phrase "all in all…" , like "all in all, redwood trees are very interesting." So I would like to pay tribute to her here.

All in all, air is very interesting, very insubstantial, and highly under-appreciated.

I can't go on. I'll go on.

Thursday, March 3, 2016

That Feeling

The frogs are chirping outside right now. They come alive after dark, with so much to say. This sound is third in my favorite playlist of things to hear while laying abed, after crickets and the roar of the ocean. I suppose I am less the city mouse than I thought I was as a youth. There is a certain feeling I get hearing these sounds, and it may be nostalgia or serenity or clarity. It may be my serotonin levels are directly linked to singing frogs.

I was eating at a local place on the marina the other night with a dear friend who mentioned that feeling one gets from a run, that no other sport quite offers. Now I am sure people would argue this point, but there is probably a reason it is called "The Runner's High". Only it is way better the getting high (or so I assume, I never inhaled). Biologically, I assume it is built in to us as we once had to run for days to tire out our prey, then hone in for the kill and finally eat. If the running part was highly unpleasant, we might not have survived as a species. Granted, we don't need meat to survive at this point, as we can just trot on down to our local market and get all the plant-based protein our heart desires. But the runner's high persists. It must be there for a reason.

I get that feeling from running even when I am in my worst physical condition. Which is about where I am now. I have an immune system that attacks me and it is rather unpleasant. The medications to treat it are almost worse. Still, when I put on my shoes and head out there and hit the trails, I feel strong and I smile. I can feel my tense muscles relax, and my worries fade. It is not unlike the serotonin burst the singing frogs provide. The real bonus is when I can get up early in the dark dawn and hear the frog choir while running. Mind blowing.

If you think this is a public service announcement for exercise in the outdoors, then you are correct. I spend my days trying to diagnose and treat disease, but here's the thing: If you exercise and spend time outdoors, you wildly increase the chance of good health. At any age.

Art and music also helps us be healthy. I wrote about it here, in my glamorous side career as a columnist.

The smell of eucalyptus in the rain is a balm. The touch of a loved one, leaning or pressing against us, is a strong cure, that has held up against the FDA and time immemorial. The memory of a first kiss, the strains of a song of import, the aroma of your mother's best comfort food: it matters.

That feeling. It will haunt you, the rest of your life.