Friday, January 15, 2016


I want to discuss death.

I have not died, so I am not an expert. I have seen quite a few people die, though, and each time is both the same and entirely different. The same: breath and heart beat stops, person dies. Different: they may be related to me, they may not, they may be serene, they may not, they may have someone they love at their side, they may not, they may be old, they may not, they may be ready, they may not, they may be human, they may not, and the list goes on.

When my mother died, I was 26 and a new Mom myself, with a 3 month old. I was a new Mom, with a 3 month old, and I was a medical student. Mom was not really "old enough" to die, whatever that means. It took sooooooooo long for her final breath, and that has helped me when I sit with families or friends of people who are dying. I know to tell them it can take awhile, and prepare yourself for that. Sometimes people need you to leave the room when they die. My Mom did. We finally left the room entirely, after holding vigil for days and days, and 15 minutes later when we returned, she was gone.

A lesson I learned too is even when you hold vigil, which is to say you KNOW they are going to die, when the damn thing actually happens it is like you are blindsided. It is just so final, that last time you get to touch your loved one, to smell and kiss them, while they are warm and real.

Though a few months after Mom died, I opened the plastic sealed container that held the last outfit before a hospital gown she wore. Her smell pounced on me when I pealed away the lid and I lost my breath with the impact. They say our memory for smells is profound. I still have that container of clothes, but the smell is gone.

When my father died, I was 29, and almost done with medical school. Two children now, and being the "medical expert" in the family, I got the call from the doctor about the end being near and the recommendation to focus on comfort. Dad died at home. It was also a longer process than expected. He too was "too young." When they came to take his body, I sat on the basement steps of the home in which I grew up, and held my hands over my ears against the zip of that bag. We get put in a bag when we die. Arguably, we are not we, so who really cares. But that was my Pops. Zipped in a bag.

When my dog died, I slept on the floor with him. But then I had to go to work, and the hospice veterinarian came over and ushered him into the hereafter while I tended to the here and now. When I came home for work, I sat on the place where he died and wept. My son held me. It wasn't just the dog I wept for.

And the patients I have seen draw their last breath? Those stories I must hold close to my heart, because they do not belong to me.

Death is not bad, in itself. If every human being stayed alive forever, we would have quite an issue with real estate. It is poetic that we return to the earth, matter not destroyed but repurposed, and that we live on in memory and mail. I am here to tell you I still get mail addressed to my parents, now gone about two decades. Mostly political. Also retail-related. It was a long while before Columbia House gave up on my Mom. Bless their capitalist hearts.

This week held the death of two artists. Well, probably a lot more than two, but two very well known artists that made our world a little bit better than it was before they were born. Incidentally this was one of the last things my Dad said to me: "Make the world better than it was". Also "It is over." *fart* "It is not over (chuckle)". Damn, I loved that guy.

Alan Rickman and David Bowie were both 69. Arguably "too young to die". I wonder how they died, and how their doctors treated them, and how their loved ones are coping. I know for me it is a loss. The morning I heard of Bowie's death, my gut twisted and tears threatened when the cafe I was in played "Changes" over the speakers. I saw Bowie play once, and I know he is/was mortal, but somehow you just don't picture these types of people dying. Alan Rickman was more than Professor Snape, of course.  He was an accomplished actor in the theater, on film, and a good man too, by all reports.

I am well versed in palliative care. I have cared for patients in hospice. I have seen many people die. I have sat at the bedside of some of the people I have loved and known best in the world and watched them die. Still, it never gets easier.

Atul Gawande brought this discussion into the mainstream. Well, at least into the New York Times bestseller list, which may not be mainstream, but still, a feat to be appreciated. We are mortal. HOLY SHIT!

So, I continue to show up each day and I love my family and friends. I run, because it is a blast and perhaps will let me usher in old age with some grace. I respect my elders, and I miss my parents. I feel sad about those who have gone and I never lose sight of the gift of each healthy day offered.

We might be like Lazarus. We might not. Either way, freedom lies in making peace with our mortality. And who knows, maybe what comes next will rock our world.

Tuesday, January 5, 2016

Snow Day

I remember my clock radio as a kid, which I used as an alarm in the morning, and to go to sleep with, on timer with about an hour of music from WIZM 93.3 FM. In the snowy mornings, I would turn it on and listen to the school closing reports. They would list off which schools were closed, and if yours was on the list…yes! The day could then be spent sledding, cross country skiing, sipping cocoa and generally annoying your parents.

Now that I live in California, snow days are nonexistent. Though there is snow to be found, in the hills. Up there, we go to sled and ski and generally frolic. And with our smug California attitudes, we note that on the same day we could surf and ski. We could run in our shirt sleeves and later bundle up for winter sports. We are obnoxious in our weather choices. We have it all.

Just the other day, I ran in snow. This was in Portland, while there to drop my kiddo back at college. The snow, unexpected. Because this was Portland, Oregon, not Portland, Maine. We ran with our good friend and enjoyed the muffled quiet of our foot steps. Daughter stated she prefers snow to heat. I am happy at 72 and sunny. But even I will admit our Portland snow run was magical.

What strikes me most about the snow run is the joy. How often do we encounter joy in life?

Life is hard. Our president is trying to talk some sense into our nation about gun violence. If airline or food safety or "terrorism" statistics were like this, there would be mass rebellion, demanding our safety.
Life is hard. I witnessed two care crashes today, one where the person was out cold, then aroused and as I tried to get them to sit still while awaiting the ambulance, they tried restarting their demolished car, with the air bag in their bloody face and smoke coming out of the crumpled hood. It might have been head injury befuddlement, or it might have been the drug paraphernalia strewn in their lap and the front seat. It took 5 cops to subdue them. I hope they are OK. The idiot. The next car crash was an hour later, when I was driving to the hospital and someone ran a red light and plowed into the car in front of me. Not a great day to be on the road. Life is hard. my team and I show up every day to try to lend a healing presence to the people we care for. Yet we meet so many barriers, as the system and the societal expectations are somewhat askew. I am somewhat mollified by Dumbledore, whom quoted at me while I was driving and listening to a Harry Potter book for the millionth time. Not the part where he marveled at finding the room with all the chamber pots when his bladder was very full, though how cool is that? But rather where he notes that looking for universal popularity is folly, and he himself receives at least 2 owls a week telling him what he could be doing better or demanding he resign immediately.

Joy comes as we invite it in. The double rainbow today greeted us in the morning and again in the afternoon. It arced its way over the very spot the likely methamphetamine-induced car crash appeared. Joy comes as we invite it in. Like the person I cared for today who refuses to be categorized as a patient, and delights in every little nice moment, no exaggeration. Joy comes in as we invite it, in the marvels of a well done 3 pointer, or in the case of SOME people, hundreds of well done 3 pointers.

We can close the door on joy, but that seems rather stupid to me.

Life is hard. Joy is abundant. It is like a Shakespeare tragicomedy. Life's a stage or something to that affect.

Joy comes as we invite it in. Little chocolate donuts, for instance.

And, snow days.