Friday, August 4, 2017


I do not usually post so frequently. I am a somewhat reluctant blogger, a sometime writer, a midwesterner turned Californian who has discomfort with sharing and yet knows the only hope is to reach out to others.

I have been listening to podcasts a lot lately. My real addiction is, but as I try to spend less cash, I find I can do without so many books all the time by tuning into the podcast genre. Today, while walking one of my dogs, I was listening to an interview with a poet, Marie Howe. She teaches her students this poem, by Emily Dickinson:

I felt a Funeral, in my Brain, (340)

I felt a Funeral, in my Brain,
And Mourners to and fro
Kept treading - treading - till it seemed
That Sense was breaking through -

And when they all were seated,
A Service, like a Drum -
Kept beating - beating - till I thought
My mind was going numb -

And then I heard them lift a Box
And creak across my Soul
With those same Boots of Lead, again,
Then Space - began to toll,

As all the Heavens were a Bell,
And Being, but an Ear,
And I, and Silence, some strange Race,
Wrecked, solitary, here -

And then a Plank in Reason, broke,
And I dropped down, and down -
And hit a World, at every plunge,
And Finished knowing - then -

Her students were like, "What?" 

She asked them "Have any of you ever experienced a panic attack?"

And if you have, read this again. 

Ahhhhh, poetry.

But Emily is just so-

When I was about 10, I was sitting on the concrete wall next to the driveway of my childhood home. My brother's friend, who happened to be named Emily, asked me what I wanted to be when I grew up. I said "A poet."

How weird was that?

But it turns out that my husband is a writer, my eldest daughter is a writer and I am-

I am-

Today I spoke with two families and patients about "code status". This is where we get to decide, on paper, whether to do cardiopulmonary resuscitation or not. Do we intubate? Do we put in the intensive care unit? 

Do we put a tube down their nose or into their abdomen to feed them when they cannot swallow? 

My advice: no tubes. But then my perspective is that of a doctor. I Know I would not want it for myself. I know that life ends. I know that death can be hard. I know that just because we can do more things to people does not mean it is right.

21 years ago, my Mom died. 21 years ago this weekend, my Mom died.
 I was nursing my eldest child in the waiting room where we slept when my Mom died. I was a medical student, who knew so little about it all but then learned more than I wished to, when my Mom died. My Mom died when we all stepped out at once to have some food. I ate a veggie burger in the hospital cafeteria. I can still taste it. It was not good enough to be absent when my Mom died.

But then again, I can still taste it. It was not like real meat. It had some substance to it though. The bun was whole wheat. I ate it next to my husband and brother. My caloric intake was important, because I was breast feeding.

When I came back to her room, she was no longer gasping for air. She was gone.

I wailed, but my Dad wailed louder. Not 2 years later, he was gone too.

Poets are amazing. They have to condense, speak truth, follow the rules of decent writing, and touch our hearts.

Sitting on the concrete wall of my parent's yard, I did not know it would be so hard. Nor did I now doctoring would encompass so much poetry. Nor did I know life would encompass so much-

So much-


The Emily friend of my brother is now a physician. And so am I.

Thanks, Mom.

Saturday, July 29, 2017


I just started listening to a podcast called Ear Hustle. It is relatively new, only 4 episodes so far. Which works out well because I am relatively new to having a child in prison, and this is like a connection to him. I keep hoping I will hear his voice in the background (as it takes place in his current prison), or maybe he will get interviewed. Yes, I did not really picture this as an aspiration for my child. I can see the bumper sticker now: "My Kid is the Ear Hustle Inmate of the Month!"

Ear Hustle is quite good. I recommend it to anyone, whether you have had a prisoner in your life or not.

I was listening to it today while working in my yard. For perspective, I am on call this weekend, and thus not exactly "free", but as I listened to the stories of the inmates, while sweat poured down my face from pulling weeds (yes, I am a wimp), I felt so very free. Houses, gardens, work so often feel like traps or cages or something we do while we wait for the good part of life to start. Which is ironic given house-garden-work represents the American dream.

Turns out life is just life. You wake up (if lucky), go to work (if lucky), eat some good food (if lucky), try to exercise (if lucky), walk your dogs (if lucky), do the wash for the millionth time (if lucky). Unless you are in prison, or a war zone, or a drug addict or super sick or mentally ill without good treatment or poor or Donald Trump. Whom I do not suppose has done a load of wash in his entire life.


I posted on Strava the other day.

I have not been posting my runs all that often, because I am really slow now. I mean I was never super fast, but could run 7 min miles for a prolonged period, up until that *cough* extra 30 lbs. Freaking steroids. So anyway, I posted the other day all whiny about my slowness and was reminded by someone "yeah, just be glad you can run."

As my teenager would say, "oh, snap!"

So today I ran and posted it because, let's face it, I do like my social media, and just had done my rounds at the inpatient hospice unit, then walked the hospice labyrinth and somehow it felt OK that I ran like a slug on quaaludes. Which might be slightly redundant.

Who ya calling a slug?

Another thing that gave me perspective recently was listening to The Brothers Karamazov on Which took 37 hours and 8 minutes to be read aloud to me. One part was really funny, about the over-specialization of doctors:

"I tell you, the old-fashioned doctor who treated all diseases has completely disappeared, now there are only specialists, and they advertise all the time in the newspapers. If your nose hurts, they send you to Paris: there's a European specialist there, he treats noses. You go to Paris, he examines your nose: I can treat only your right nostril, he says, I don't treat left nostrils, it's not my specialty, but after me, go to Vienna, there's a separate specialist there who will finish treating your left nostril."

I also liked getting to know Stinking Lizaveta (and her unfortunate son). Because a band I like quite a bit derived its name from her.

The perspective I gained in "Brothers K" was:
1) I am not the worst parent in the universe. It is amazing the Brothers K made it to adulthood.
2) It was probably not worth 37+ hours of my life.
4) Stinking Liz is mute though, so that part was easy.
5) Dostoevsky did not like doctors much. His Dad was a doctor, and he grew up playing in the gardens of a hospital for the poor. He did seem to like courtroom drama. A lot. A whole, whole lot.
6) Russian novelists of a certain era seemed to lack editors.

I don't have an editor either, so there. Ha. It's my blog and I can share my perspective for as long as I want to.

My parents both died a long while ago. Coming up on the 21st anniversary (deathiversary?) for my Mom next week. They may have left the earth prematurely, but their perspective on life and love and compassion and humor had a big impact on me. A cousin recently sent me this picture of them.
You might think it odd that they are turning their back. But I know them, and they were just being goofy. Perspective.


Running amongst the giant redwood trees gives me goose bumps, even after all these years. They are really big. Even the young ones. The old ones are just so stunningly massive, it feels like being in the presence of a living piece of history, like the kind of history you find on timelines long before anyone was doing much besides scratching off their cave lice and dragging their fists in the dirt. Perspective.

The point? I don't really know. I thought I did but I see now that life has no point, so to speak. We just keep showing up until we don't. What makes it bearable is noticing. Noticing the funny and horrible and beautiful and goofy and painful.
artist: Jianhong H.

One guy who is a master of this art of noticing is actually playing my town tonight. Still out there playing, after all these years.

I am on call pretty much every day of life. For work, which is truly painful, but hey, I have a job I love so....I try to keep perspective. But I am also on call for life. I am waiting for the next little thing, which I suspect involves walking the dogs given their impatience with this endless blog post. Thank goodness beepers are no longer a thing, because if life was paging me on a beeper all the time, I just do not think I could take it.
Life: "beep, beep, beep"
Me: "Fucking pager, what is it now?"
Life: "come out and play, stat!"

Sunday, July 16, 2017

Ode to Laura

I have known strong people.
I have known hilarious people.
I have known people who run fast.
I have known people who are kind and compassionate.
I have known people who light up the room when they enter.
But it spins my head to know someone who is all of the above.

I would like to be Laura when I grow up, all buff and intelligent and
Such a good story teller.
It hurts to run with her because
1) she is way faster than I am and
2) she makes me laugh so hard

When you are just trying to hang on to a pace, laughing is not at all helpful.
Elite runners might want to take this to heart, and tell killer jokes on the third turn of the track, just before you kick to the finish while your opponent is doubled over with hilarity.

When I have felt shame for my parenting woes, true kindness has been a hand reaching to me with words of solidarity and "it could have been any of us".

When I have felt shame for my health woes, true kindness has been a reminder that just being able to move is a gift and the speed demon inside is only waiting for the next best time to emerge.

When I have wondered what strength is, I get my magnifying glass out and check my Oxford English Dictionary.

Strength: 1. Laura McNulty.
Used in a sentence: Laura is strong as shit. Unbreakable pretty much.
Cuz females are strong as hell.

I have known strong people.
I am thankful for them.

And I am thankful Laura is no longer in my age category for road races. For the time being.

My goal: to be unbreakable as LM. And to be as kind as LM.

Saturday, July 8, 2017

Orange is the New Black

When President Obama said "orange is not the new black" I laughed and laughed.

I am no longer laughing.

For profit prisons have no motivation to rehab their prisoners. And Mr. Trump has no reason to behave, because he was elected while wildly misbehaving. How can you tell your children to strive for a better education, a better understanding, a more compassionate heart so they can be successful, when the Oval Office is occupied by someone who does not read, does not care to read and apparently does not give a shit about his own country?

I like the show "Orange is the New Black", but as a parent of a prisoner, it is no longer just mild entertainment. My son is not a big person, and he has mental illness and he likes to please the people around him which is partly why he ended up in prison in the first place. But all of that makes him a target. I am terrified of what might happen to him. And I cannot do a damn thing.

The local online rag published his arrest, and the comment section was filled with hate for him and my husband and I. Now we are not perfect, but we are parents who love our children, and we both are solid citizens, and we did our very best. Two of our children are pretty darn successful at life--they are kind, smart, caring, funny and capable. And they are not on drugs. It turns out being on drugs really messes up a kid's mind. Naive as I am, I never imagined drug dealers would present themselves to my child's middle school with drugs and make them feel like big heroes with money by asking them to sell drugs for them. Seriously, I am not stupid, and I have cared for many a drug user and pusher in my work over the years, but in my little, rural town, who would've thought drug dealers can just walk onto campus and fuck up your kid?

Once there was a young man (20-30 years old) who was admitted to our hospital for cutting off his own penis in a fit of drug-induced insanity. He was not on my service, but my colleague caring for him commiserated.

I keep thinking of what I could have done better as a parent. Maybe I should have worked less. But they had a full time Dad at home. I grew up with 2 working parents, and I considered it a  luxury to have a stay-at-home Dad.

We loved and sang to and read to and educated and supported and travelled with and did I mention we loved our children? But it was not enough.

All that aside, today I did a house call on a 100 year old person and prevented an emergency room visit and hospitalization. After that, I got a haircut and my teenaged daughter said I looked "on fleek." I think that is good, but I am not absolutely sure.

Today I also ran on the beach and my dog was thrilled. The fog was dense at the beach, though cleared just 1/4 mile inland. I have learned to love the fog. It is mysterious and cool, and thankfully it keeps my runs from being 100 degree torture sessions. The sand was a little like molasses today and I was also not exactly on fire. But I ran, my dog frolicked, the birds ran away from my dog and I kept a 100 year old out of the hospital. So if I die tonight, let it be known, my last day was not so bad.

For profit anything might be super cool for rich people, but it is the pits for everyone else. For profit healthcare? Not compassionate. For profit education? Bullshit. For profit prisons? A good way to ensure young men, especially men of color, stay incarcerated and never get a chance to shine in life.

A house call on a 100 year old is not particularly profitable, in the monetary sense. But I beg the world to listen and understand: when you are laying on your back, with your eyes watching God, the only thing that matters is how much you cared.

Orange is the new black. Now, what exactly are we going to do about it? And how will we live this one precious life?

Sunday, July 2, 2017

Screen Doors

There are certain things I miss as a Californian. I have been here more than half my life now, and it has always felt right for me, with the ocean and mountains and relatively progressive politics. But there are some things I miss as a Californian.

One thing is screen doors. I grew up in a home where the front door was open all summer, as was the back. But both had a screen door to keep the mosquitoes and other sundry flying creatures from making residence inside. For sure, if you left that screen door open for too long, Mom would be on your ass to close that thing. It was almost as heinous a crime to linger with an open screen door in the hot Wisconsin summer as it was to lollygag with an open refrigerator door while deciding which snack (American cheese in those little plastic wraps? Braunschweiger on bread? Mom-made leftovers?) to devour. Refrigerator door lollygagging always led to the following statement from whichever parent was nearest: "Are you trying to air condition the neighborhood?".

We did not have an air conditioner, we had screen doors. An air conditioner might've been better when it was 96 degrees and darn near 100% humidity, but to this day I cannot really get used to air conditioners. Like when I go to a meeting in a warm place (Florida or Vegas) and know (after experience) I need to pack a sweater because in the dead heat of summer it is going to be 52 degrees in the windowless meeting room. When I was at a meeting in Fort Lauderdale several years ago, the beach was not even within running distance. My one free afternoon, I took a cab to the beach. The ride there took 25 minutes, and was uneventful. I walked the white sands, marveled at the entirely different universe that was Fort lauderdale compared to my home beach which is generally almost uninhabited except for seals, crabs, my dog and great white sharks. When I caught a cab back to my hotel, the cab driver was unfamiliar with the hotel, which was somewhere near some mall and which had highly efficient air conditioning. It took 90 minutes to get back, and several times along the way his GPS said "rerouting". During that ride, he told me his life story in a thick Brooklyn accent. He was pretty pissed at his teenaged son. At the time I could not relate, though now I sort of can. Anyway, he charged me only half the fare (which was still considerable) and I was just glad he did not rape me and throw me into his trunk. Guys out there-don't be shocked. I cannot think of a single woman who would not consider that possibility in such a situation.

When it was really hot in Wisconsin, the best place in the house was the basement, which is another thing California lacks. I mean there might be a basement somewhere in California, but I have never yet met one. Basements are innately creepy, but always delectably cool in the summer. My brother made his bedroom in the basement. I was not allowed down there much during those years, but sometimes would sit on the steps of death (as a physician catering to the geriatric crowd, I now know that was what these steps should've been called). There was no way those steps were built to any code, and it is amazing we all did not fall down them and die in a bloody heap at the bottom. Anyway, I would sit on the death steps and listen to my brother playing his Kiss albums when friends were over. If he found me there he got very angry, and I ran like a bat out of hell. Or maybe it was Meatloaf he was listening to on those days.

The basement held spider webs, darkness and the laundry room. We had a storage area and it was definitely crawling with vermin but sometimes in the winter you HAD to go in there to get your ice skates. My brother made a darkroom under the stairs, and he rarely let me in there either. I am concerned about those darkroom chemicals he was breathing in our haunted basement all those years ago. But last I saw he was biking around some mountain lake in California. Which is something we did not have in Wisconsin. I assume the chemicals gave him super powers to bike as he does. Maybe I should have spent more time in that dark room, like when he was not looking.

I sat on those fall-risk basement stairs with my hands over my ears when they came to take away my Dad's body. Now before then and since then I had and have seen plenty of dead people. I am not a serial killer, do not worry, rather I am a physician and it comes with the territory. Especially as a hospital physician, you get called a lot to "declare someone dead." It is an awkward moment, as usually loved ones are at the bedside grieving. I remember my Mom once saying to me "make sure I am dead before they bury me." I was probably like 10 when she said this and I will never forget it. The thing is I did NOT make sure she was dead. But I assume the doctor that declared her dead DID. It is a source of continued worry and guilt.

The other thing California does not have is proper seasons. Granted, I am not complaining. I get to run, bike and take my dogs out year round without freezing my proverbial or actual ass off. And I have become familiar with the subtleties of season change where I live: certain wildflowers bloom at certain times. The redwoods fronds pad my path with pillow softness in the fall. The ferns unfurl and tickle my legs when I run past in the summer. The birds sing in the mornings in the summer, and the frogs peep in the mornings in the late winter and spring. But in Wisconsin, there were at least two distinct seasons. It went like this:
Summer: Yesterday it was 50 degrees, today it is 90 degrees. Suck it up buttercup.
Fall: Oh man, those blood red trees are magnificent. Wait, it is 90 degrees again! Oh, never mind, it is snowing.
Winter: Cold. For at least 6 months. Which is so fun except when the snow turns brown with dirt and salt and it is April and you cannot get your back door open to let the dogs out because there is TOO MUCH SNOW.
Spring: "Professor, can we have class outside?". Three days later: summer.

I signed up for the California International Marathon in December. Can you blame me? It is a "net downhill course". The thing is I am conflicted because the North Face Endurance marathon in the Marin Headlands is in November. I won this race a few years back. It is grueling, with intense climbs. When I ran it, there was also the 50 and 100 mile races, so when people cheered me on I kept saying "Oh, I am just doing the marathon."

Who says that?

My runs lately have been lacking speed. I am not sure whether I have another marathon in me. I really want to PR (personal record) but this might be LI (literally impossible) as I am OOS (out of shape) and have an AID (autoimmune disorder). But my DOG (dog) thinks I should just run a lot to get ready for whichever race I end up doing, and take him along for the ride.

I had a dog in Wisconsin. My Dad named him Brandy because he was the color of brandy. I have never personally drank brandy but it is on my bucket list of things to do before I die. I had better not visit my childhood home and walk down the basement stairs before I have had brandy. And also I should not do so after I have had brandy. Conundrum.

My dog Brandy lived a long life, and he enjoyed walks and runs off leash because he was just that cool. One day I was running and realized he was not at my side. I looked over my shoulder and saw him about a quarter mile behind me running next to my friend's Mom. That's when I knew he was old.

Now I am my friend's Mom. My fate will be sealed when the elderly neighborhood dogs find me a compatible running companion.

Until then, I plan to be inspired by the greats. I plan to unplug my ears while sitting on the stairs of doom and face the realities of loss, aging and grief. I plan to keep the refrigerator door open for as long as I please. When I meet my parents on the Other Side, they can lecture me. I am looking forward to giving them a heavenly eye roll.

I plan to open the screen door of my heart and let it all in.

Except the gosh darn mosquitoes.

Joan Benoit Samuelson. How cool is she?

Thursday, June 22, 2017

Black Lives Matter

I am thinking it is time for another marathon. I have put it off due to slowness and sickness and tons of work and fear. But time just keeps ticking and I am pushing 50 and I think a marathon is in order.

Now both of my parents died in their 60's, so pushing 50 is no joke. When you are 20, time is endless, when you are 30, you still feel pretty invincible. When you are 40 you start to sweat a little, like shit I am 40 and I had better do all those things I meant to do 20 years ago but never did. Except when you are 40 you are likely busy, either raising children or building your career or having a mid-life crisis. But when you are 47 going on 48?

We got a letter today from our son at San Quentin. He is just barely 19 and in the special needs yard. Which is interesting, because he was considered "special needs" when we adopted him. At first that seemed accurate, as he needed thickened formula due to tracheomalacia. But as we got to know him, and saw him (literally) make other mothers nearly cry from jealousy in the sandbox when they realized that at 12 months old he was speaking in full paragraphs, we were not so sure. Then he went on to somewhat wreak havoc throughout his school life. And eventually find drugs and gangs and finally, prison.

My son is white. But I think he has some struggles that made it hard for him to survive and flourish in the world of academia and white bread success. When I think of his struggles, I cannot help but think of the black mothers who  have seen their children be killed. I do not pretend to understand the pain and fear of this phenomenon. But I continue to wonder at the repetitive aspect of this particular type of murder.

Philando Castile.

So marathoning seems a little ridiculous in the face of social injustice and racism. But what it provides is this:
A chance to test limits
A dance with the body and the mind
A glance at the impossible and improbable
A prance with all the other fools who choose to do this crazy race
A look askance at those who judge

I ran early this morning at the beach. It is day 2 of summer. The mist and fog sort of clung to the river feeding the beach. The sun was rising and painting the ocean pink. My dog was fucking crazed to chase the birds. My heart was pounding regularly at a rate of 143 bpm. My resting pulse is about 51. I ran along the sand thinking "will I ever be fast again?"

I think the answer is yes. I may need to lose my prednisone pounds. I certainly have some work to put  in:
repeats on the track
core work

But mostly it comes down to the mind. My son, in his recent letter from prison, said "I need to focus on the present. That's the only way I'm going to make it through this."

Be here now.

Recognize the struggles of those in your community.

Understand life is precious, limited and all in all, sort of hilarious.

Never stop fighting for what is right.

Black Lives Matter.

Saturday, June 3, 2017

Sorry, Not Sorry

Caldera Retreat Center, Oregon, Blue Lake

I ran and wrote with 30+ other women in the wilds of Oregon, near a caldera lake that reflected all the trees and sky into its impossibly deep self, near a rushing stream insistent and serene and rapid all at once.

Caldera derives from the latin caldarium or caldaria, meaning a room for taking hot baths, or maybe a cooking pot. When magma erupts from a volcano especially rapidly, the support crumbles and a big depression forms, kind of a sinkhole. Complete collapse leads to stunning, almost mystical bodies of water. This particular body of water was decidedly not hot. Some of my retreat-mates did skinny dip one early morning in it, and I suspect their screams were heard in California.

Lauren Fleshman led us in running. She is wise and kind and funny and multitalented. One workout we did was "the predator", involving 2 minute fartleks back and forth on a dirt road at noon, wherein you found the last place you stopped a fartlek for the next one and changed directions. Thus someone was always being chased or chasing someone else. We started with warm up exercises to wake up the body and fast twitch muscles. We were hands on the dirt road, knees in the dust and when running dust kicked up and clung to legs, leaving a dirt tan at the end of the day. "Oh yeah, you will get dirty during this workout. Sorry-not sorry", said Lauren.

"Not sorry" came up as a theme, as women tend to apologize a lot. Notice this next time you are with a woman. Especially younger women. I see myself doing it less as I age, and my geriatric patients almost never at all, but almost never means there are still apologies, mainly for bothering me about something that ails them (what exactly am I there for as a doctor other than that?).

Marianne Elliott led us in writing. With her lilting New Zealand accent, she helped is to write wild and true. She is unassuming and inspiring, an advocate for human rights, a powerful presence. Plus she runs well. Lauren writes well. In fact, all of the women at this retreat, from all over America and the world, run and write with passion.

That is about all I can say about the retreat, because it was sacred. And although that may sound hippy-dippy, you will just have to accept it as fact. Sorry, not sorry.

One thing was this woodpecker. I was planning on meditating on the deck of the A frame where I was staying, early one morning, coffee cup near at hand and the light settling on me from the east, rising through the bent pines so gently. "Tap, tap, tap." I am instantly distracted. Opening my eyes I look to my right and there on a log is Woody the woodpecker. I decided that day to meditate on the red-headed woodpecker. He-she had this attitude which was frankly hilarious. So sure about where it was knocking on the log, first one place, then another, then over to this tree, then back to the log. At one point a squirrel was running up near Woody and he-she puffed out breast and feathers and raised wings to look threatening. Squirrel retreated. Sorry, not sorry, but this log grub or whatever it is that is worth pecking at bark for existence, is MINE.

Another thing was a 10 mile trail run. Now I run trails regularly, living in a rural place with endless running loveliness. But on my 10 mile trail run I fell three times. It wasn't like a slow motion "oh-I am fallliinnnggg" sort of thing. I just found myself face in dirt thrice, no warning. It was a metaphorical bonanza, the falling and getting back up, the falling and not giving up the run, the falling and licking dirt like it was humble pie. I was a bloody mess by the end, but Lauren patched me up and I added another thing to my bucket list (check-being administered first aid after a trail run by Lauren Fleshman). I figured out with Lauren's help that it was the polarized sunglasses, which I never wear at home on trails, as I run in the shadows of redwood giants. My eyes, not the best at baseline anyway (having been offered corneal transplants which I declined, sorry eye doctor, not sorry), could not discern root from rock from shadow.

Beneath her feet
Undulating roots
Rocks squat cowardly in shadows, then
Rise up and grab from
Beneath her feet
Separated as they are from trail
With an inch of rubber
Shoes made for gripping
Beneath her feet
Are also apparently made for flying
Then falling so
For a period of time there is nothing
Beneath her feet
Which normally carry her with confidence
So her eyes can gaze
At prehistoric monster-leafed plants and not focus on what's
Beneath her feet
Which love the unpredictability
Which trail offers over boring road
And at least the landing is soft
Beneath her feet
Soft, iron-tasting dirt
Mixing with iron-tasting blood
Where she leaves a bit of herself
Beneath her feet

There is so much to be learned from falling and failing and flailing, all of which I feel an expert. Recently, like in the last week,  Donald Trump's lawyer threatened to sue Berkeley Breathed. He was making fun of Trump, I suppose. A couple of things ran through my mind as I saw Breathed's response, which was to promise to cease and desist because he would rather not be sued by a rich and powerful asshole (side comment-I have respect for the presidency, but I just cannot cannot cannot respect the current president in any way, shape or form, sorry, not sorry). The things I thought were: DO NOT BE SORRY, MR BREATHED! People have been making fun of presidents since the beginning of presidents and we live in the United States of America, where freedom to criticize is one of our rights. I also thought, hmmmm, can this guy not take a joke? Can he not be humble? Can he not find himself face in the dirt and get up and dust himself off and continue on the crazy-assed road he calls his life? Finally, I thought, no he cannot. And he is teaching our children the following: admitting failure is for losers, you do not have to strive for excellence to do one of the most important jobs in our country, and a nerdy cartoonist with a penguin fetish is scary to the leader of the free world.

It was good to retreat, but I am back now, and I am not apologetic for my indignation about the U.S. withdrawal from the Paris Climate Pact. Whether or not you care about the beauty of the Earth or the right of its citizens not to find themselves under water or scorching to death due to climate change, it seems we could all agree that the end of life on our planet is a pretty grim prospect, and certainly not an economic advantage to anyone involved. I am not apologetic about my slowish running pace, because I have a disease with shitty drugs that have altered my body. Good news on that front, as a new potentially miraculous (ha ha , as a doctor that is pure folly, but as a patient one can hope) drug for my condition was recently FDA approved, and prescribed for me. I am currently wrestling with insurance to get the elixir to my hot little paws. My indignation about recent healthcare proposals is personal and political. My elder patients and my child with a pre-existing condition and my own little self is bound to be screwed by the overhaul being proposed by the Republicans. I do not apologize about my indignation, because I have been in the trenches and I am telling you now, whether or not you believe poor people and sick people have a right to have a chance at health, we can all agree that economically it would serve us better to care for everyone equitably so not so many dollars bleed onto the floors of our over-burdened emergency rooms and hospitals. Because we all pay for those under and uninsured folks in our own premiums.

It was good to retreat, but I am present. I am armed with some workouts to spark my speed engine, which has been sitting rusting in the corner of my proverbial garage for quite some time. I am present to my need for daily time in nature and meditation and woodpecker gazing and music and sitting and talking with wise and gorgeous people. Like my artist and philosopher friends of 28 years who came to visit this week and filled my heart and mind and funny bone to the brim with gratitude.

It was good to retreat, but I am not sorry to be nearly back to my daily routine. I do so love life, and though the pain is intense with illness, a son in prison, and a megalomaniac in the White House, I found in retreat that a falling down, a deep depression from hot magma boiling away all the supports can lead to a indentation that fills with the clearest water that reflects all the goodness around it and invites stillness, awe and abandon.

Naked abandon. Sexy? Nope. Sorry, not sorry.

Tuesday, May 23, 2017

So There

I was feeling sorry for myself today, as I often do. I was running on a sunny day along the coast of California and feeling sorry for myself. True, I am fat, slow, injured and have a crappy autoimmune disease. But there were foxy digitalis plants and lilies abloom, the ocean was roaring, the sun was out, it was the perfect temperature and I was running. Not fast, but running. I passed a guy with what I think might have been cerebral palsy, walking awkwardly with his walker. I immediately checked my self pity. Not that he needs me to pity him, because he was just out for a walk on a beautiful day. He would likely not give two fucks about my self image. Slow. Fat. Injured. Sick. Wounded.

I received a letter from my son today, who is at, as he described, the "lovely San Quentin." Now as a Mom I have superpowers and though his letter was all light and airy and "It is all good", I sensed fear between the lines. Good, you say? Well, think what you must, but he is my baby boy. And his little tour through the for profit system of California prisons is costing us all a pretty penny. Ah, if only his parents had been better....

Back to running for a moment, I want the world to know I am going for 4 trail runs this weekend with  Lauren Fleshman. She will, obviously, be toning down her prowess several million notches. But there is this retreat I am headed for that she is helping with, bless her, and it also involves writing. And yoga. And some stand up paddle boarding if I am brave enough to don a swimsuit.

I took some extra work in recent days to help with some bills and found myself in an almost mystical place. No, hear me out. I randomly chose 10 days to be on call and found myself exactly where someone needed me to be at the end of their life. Someone I never met before. But with whom I immediately connected. Someone who needed me to sit and listen and respond and act. In return, I was reminded why I do what I do. Because sometimes it is hard to show up day after day with little accolades, less awards, and no acclaim. I run with the same results. I play piano with the same results. I parent with the same results. But ultimately, it comes down to moments in time that are so perfect that everything else just falls away. A deep instant connection with an ailing fellow person. The smell of the top of your child's head. The feel of your quads pushing against the earth on a perfect northern California afternoon, lupine at the trail side, salt in the air, waves roaring, and a good book playing through your sweat-resistant ear buds.

This past weekend I heard our local symphony play Beethoven's 9th. I admit, I attended with a slight trepidation. It is a very, very enormous piece. They nailed it.  Not perfect, because that would just be creepy, but it rose above all expectations and planted a Beethovenesque kiss square on my brain and heart and musical ear. Carol Jacobson is a marvel.

Humility is growing on me. As a music major, once I left music as a profession I stopped playing it altogether for years, because I was afraid of mediocrity. Now I am thankful I can play at all. As a runner, I am embarrassed by my recent slowness and lack of ability to race, but then again am thankful I am able to be so mobile in such a lovely setting. As a doctor, I sometimes wish I had more credentials, had gone for those fellowships, had stayed in academics, and was considered great at what I do. But today I was just so touched to be at the bedside of a dying person who actually dreamt about me the night before we set his treatment plan, and who is now comfortable and dignified. As a parent, I wish my kids were all on their way to Nobel prizes in terrificness. But wait, I do not. My children are who they are and the one thing I have to offer is unconditional love. And the smell of the top of their head? It makes me swoon, even now.

This weekend, I am going for 4 runs with Lauren Fleshman. So there.

Wednesday, May 10, 2017

What to Hope For

As I was flying home tonight on my E-bike, listening to The Last Season, I was struck by a statement the author made about the subject of this biography and adventure story. It went something like this: "Randy (the hero of our story) was who he was because of his father."

Now it is true that Randy grew up in the Yosemite Valley with a father who loved the outdoors and had him scaling peaks at age 8 and identifying wildflowers and developing environmental ethics before he was old enough to drive, kiss a girl or accurately aim his piss in the pot. And Randy grew up to be an expert mountain wilderness Ranger.

"Randy is who he was because of his father"--This might be absolutely true, but it could also be the College Logic 101 Course fallacy in reasoning: just because A and B occur together does not mean A caused B. Was Randy a typical 8 year old, lying on his belly marveling at the wildflowers on the top of a 15,000 foot peak that he just struggled to climb?  I do not think so. I have known and raised a few 8 year olds, and a hike up a 15K mountain is not the way to bring out curiosity in wildflowers. That kid was clearly primed from the get go to want to do this, to want to love this, to want to be obsessed with this.

So I would say Randy became who he was because Randy was who he was. And I think his father probably just opened that particular door in his mind, through sheer, dumb luck (as Professor McGonagall would say after Harry Potter et al defeated a "fully grown mountain troll" in the girl's restroom).

It is on my mind as my son was sentenced to 13 years in prison the past week. Now I know for some, this will be "what he deserves." After all, he was addicted to drugs and committed a crime. Thankfully, no one ended up being hurt in the crime. Sadly, our DA sees it fitting to make an example of my boy, still so young, having recently celebrated his 19th birthday while in jail awaiting sentencing.

So as a parent what is it you hope for? Is it that your child will be in a wildly successful profession, making lots of money and providing you with beautiful and even more talented grandchildren? Is it that your child wins the science fair? Or runs faster than everyone? Or scores the most points? Or goes to the most prestigious college?

I have wished for all of these things, to be honest, even if just for a few fleeting moments before I came to my senses. I am, after all, the most type A person in my family and pretty competitive.

We as parents, do we "make our children who they are" like the author of the book I am listening to while risking my life on Highway 101 commuting home from work on my E-bike, which, by the way can do 28 miles per hour in a headwind, suggests?

My son would be the first to say no to this. He has expressed to us his love and sadness about choices. I am not so sure though, I just keep trying to think about the "what-ifs" and the "if-onlys".

A couple of things about at risk boys in American society I have observed:
-I am all for girls' rights and empowerment, but I think our boys are being disempowered.
-Boy are expected, in our town, to be tough, or stoners or thugs. If you are smart, you are not looked up to by your peers.
-I do not think this is unique to our town.
-If you are restless, bright and impulsive as a young boy in elementary school, you are pretty screwed, because schools want you to act like a good "girl"--sit quietly, speak when asked to, do not fight or or do things that make people uncomfortable.
-Not sitting still as a boy does not equal attention deficit disorder.
-We need a more flexible education system to tend to the needs of our boys and young men.

So what do you hope for when your beloved child is heading into the system of the American penitentiary? We have been given advice for him about how he should act, how he should "bulk up" to look tough, how he should avoid stockpiling commissary, how he should not reveal too much of his story to anyone.

I don't know. I am just thinking I should keep telling him the same thing I have been trying to tell him for his whole life. Which is have compassion, know you are loved, and do not give up.

Now about girls, I am one and have 2 daughters. There are, of course, many struggles. You have to look a certain way, be compliant and "good", and perform 10 times better than your male counterparts with the real likelihood of getting paid way less in your professional life. So my treatise on the empowerment of boys is not to discount our girls.

Which comes to my final point. Our very survival depends on holding each other up, not cutting each other down. Will putting my son in jail till age 30 make life better for anyone? What will it be like for him when he comes out? Do people addicted to drugs need to be put out of sight? Do we hate each other that much? Do we think that success in life is about money or fame or academic prowess?

Or do we actually know, deep down, that we want each other to be whole and well? I would say yes, even though so much evidence to the contrary exists in our daily news stream and in the very sad case of my young son. I think we are built for compassion. I think we are built to maintain community.

I just think we have a long way to go in putting this into action.

I hope for healing for my community, for my family and really for our country which seems just a tad off course. I do not actually think my own son is more of a danger to society than our current president.

Agree or not, there it is. I was taught to look at my fellow beings with compassion, by my parents. And so, am I what I am because of my parents or did they just happen to open a door for me in my mind and heart?

Try not to run over me on Highway 101. Hug your kids. Ask them to be compassionate and kind and to treat themselves with respect and love. And everything else? Just icing on the cake.

Monday, May 1, 2017

The Heart is a Lonely Hunter

Carson McCullers wrote Southern Gothic.

She wrote about lonely people. About passion arising in the hearts of those who are not destined for greatness, at least not obviously so.

I sit amidst people who are seeking notice. That is to say, I trained at a university that prides itself on greatness. I work with doctors, who wish for great things in themselves and want to leave a legacy. I run in a town where people are really fast runners and athletes extraordinaire. I play piano among champions. I cook among chefs. I parent among parents of brilliant children who go on to do good in the world.

As a woman, nary a day goes by where a patient does not comment on my looks. Now I would like to say I am sure my male colleagues get the same treatment, but I can pretty assuredly say they are not called by their first name and called cute on a daily basis. Nor has their weight gain, hair loss or choice in clothes likely been commented upon regularly.

Science shows, by the way, that women doctors are generally better for your health. No matter what they look like.

It has been awhile since I commented on running. This is, after all, a blog about running, predominantly. That too has been a source of dis-ease lately. I used to be fast, now I am not. I used to be fast, now I am not. I used to be fast, now I am not.

Still, a few things have conspired against speed lately. For instance, I have been on medicines that suppress my immune system, cause weight gain and generally make me feel terrible. Also, I have a son in jail, soon to go to prison which makes me feel terrible. Also, I work a lot. And though this seemed fine at age 30 and even 40, now it just wears me out.

But the positives still abound. I am currently reading The Book of Joy, which chronicles conversations between the Dalai Lama and Bishop Desmond Tutu. It is hard to synopsize, but if I had to I would say: Pain is inevitable, but suffering is optional.

Another positive is I ran 10 miles on the beach this weekend with my dog. Now, as a marathoner this seems trivial, but I have been injured and sick lately, so it is kind of  big deal. My dog was ecstatic, my body was OK and my soul rejoiced.

Positively good includes my daughters who approach life wth interest and humor. Positively good includes the science march in my community that drew a couple of thousand people. I live in a very small town. We care, and we march.

In The Heart is a Lonely Hunter, a young girl loved Beethoven. A black doctor never wavered in his care for the suffering in his southern town. A diner owner, recently widowed, paid attention to everyone he came across. A deaf mute was the person everyone turned to for solace. His ending-maybe not so good, but I will not ruin the ending for those who have not yet had the pleasure of reading her book.

On my 10 mile run, I meditated on the waves crashing at my side. I watched my dog trot by me and chase after gulls. I marveled at the way the beach fog clung to the sand, with a misty, eerie presence. I looked for whales but none were seen. I imagined surfing, oh man it has been too long. I nursed a sore leg and I felt my strong lungs.

I kept thinking about my son, who is lost. If you are a parent, you know how devastating that is. If you are not, just imagine the worst thing you can possibly picture and magnify it by infinity.

The heart never ceases to look for joy, for solace, for love. Today is May Day and my husband of 25 years left me a basket full of fresh picked flowers. In them I bask. In him I heal.

I might be old, slow and a woman, but so help me God, I am not done yet. And my heart is not even a little lonely.

Thursday, March 23, 2017

Dogs, Sons, Perfection

It is some kind of national puppy day today. In our house, every day is puppy day. We:
1) make food for our dogs which involves beef, because store-bought food is kind of sketchy
2) put up wth dogs who choose to shit in the hallway instead of outside
3) allow certain dogs bed access
4) just love them so much, unconditionally

Awhile ago,  OK over a year ago, Buster died. He was a Border Collie who loved to run, who herded stones and who could probably outdo Donald Trump in an IQ test.

We have Miles, Zoe and Shasta now. Miles is addicted to running. Since I could find no support groups for Standard Poodles with Running Addiction, I just decided to run with him on a regular basis.

Zoe is old but spry. She does not enjoy exercise. She does enjoy leisurely walks and food.

Shasta has dementia, cataracts and a strong desire to eat. She is old, beautiful and annoying.

Dogs are relegated to pet status. That is, they serve our needs, and we try to make them happy and responsive to our needs. The question that arises for me is why are dogs our minions? Should they be expected to be obedient, unobtrusive. protective, happy to be on leash and polite in the human sense?

I am not sure anymore. I do think that it is nice that they don't kill us, because they could, with those teeth and that strength. But I no longer buy into the idea that they are supposed to be perfect. Dogs are alive, fairly smart except when they are not (and the same could be said for humans), they want a relationship with us and they are not privy to our fickle sense of polite.

As for me, I am glad to be greeted with unequivocal delight when I come home from work, and I appreciate the love of outdoors and running. Also, the dog spine pressed against mine at night is reassuring.

As for sons? Mine is in jail. But let me tell you this: He is not bad. We have decided, as a society, that good equals academic prowess, or athletic prowess or financial prowess. Just look at our current President. He is a billionaire, so we elected him. My son, behind bars, has more smarts than he does, and more compassion. But my son was:
1) adopted
2) bipolar
3) addicted

So, he was written off as less than. Less than Donald Trump, who has demonstrated that being smart, compassionate and self-aware is not a prerequisite to being the leader of the "free world." But we are not really free anymore. If you are Mexican: screw you. If you are from a country on the Muslim travel ban: screw you. If you are poor: screw you. If you are a woman: screw you, literally. If you are a dog? Well, I do not know Trump's stance on dogs, except to say he does not have one and that might be a sign. Dogs smell bullshit from a block away. Trump is mean, uneducated and rich. Dogs prefer nice, well-read and not so rich that they cannot stand some beach sand in the back seat of their car.

I might be biased, as my dogs are especially cool.

Back to my son: our local website (Lost Coast Outpost) that publishes instant news about criminals and local news has declared my son is evil and my husband and I inept. Here is what I have to say:
My son is beautiful.
Drug addiction is harsh.
Mental illness is real.
My husband and I try our best, and have two other kids who are highly successful.
We do not care what you think.
But why do you? And why are you so mean?

Happy National Puppy Day. If you have a dog, remember they are beings who deserve respect apart from us, who have an existence we cannot fathom and who could literally rip our throats out at any second, but choose not to.

Happy Parenting. If you have a child, young or grown, remember they are beings all onto themselves. They try their best, they are struggling to find their place in the world, and academic and athletic prowess is nice but certainly not the be-all, end-all of success. Success is that they go into the world with humility, respect, kindness and hope.

I am an expert. I have kids, dogs, patients and a chronic illness. I love my kids, love my dogs, accept my imperfect body, and continue to get out of bed every day. Yet, I am not an expert, because I never know for sure what I am doing is right. I just want to express love, respect, and hope.

My final piece of advice is this: Trust Beethoven. That guy was deaf but still wrote the best music ever.  He could hear with his soul, and he loved macaroni and cheese. What else do you need to know?

Wednesday, March 15, 2017

Hashtag No Excuses

As a music major, a hashtag is always a sharp. Not a sharp in the sense of the medical world.

Rather, a sharp indicating a half step higher than the usual note in music.

A double sharp is an X. Meaning two half steps higher on the musical scale than usual, at least in music. In medicine, it is a chromosome associated with females. In movie ratings it means--ick. In sports, like the X-games, it means you are doing a sport which is potentially life-threatening by its very nature.

But I digress before I even begin.

What is on my mind today is not quitting. Not quitting life, not quitting parenting, not quitting running, not quitting music, not quitting hope, not quitting trying, not quitting trying to plant a vegetable garden even though the Redwoods blot out the sun, not quitting checking the microwave to see if Obama is in there somewhere and planning to rescue us anytime soon.

I watch a lot of people struggle in their daily life and try my best to offer some advice on healing. I watched people in Guatemala on my recent trip there, where I was part of a group fitting paralyzed people, mostly children, with wheelchairs, and I saw their struggle and also the mundanity of that struggle. Struggle does not belong to others. Struggle is the human condition. My kid and I learned to fit these people to wheelchairs which reduced the need for their family members to carry them everywhere. Carry them everywhere. Consider that. Like this 14 year old guy with Muscular Dystrophy.

My kid and someone else's kid, Guatemala, 2/2017

Why not give up? In Guatemala, we met a woman who walks a marathon twice weekly to go to the "laundromat" with her family's clothes, which basically is a cement tub that she scoops water into, sort of like taking the clothes to the river, but in the hills, where the Mayan people (who are > 60% of the population, mind you) were pushed, there is no river or water.

The "Laundromat", Guatemala, 2/2017

What compels her to keep this up? I mean she is not getting any race medals or swag. I assume her family appreciates it, but in my experience as a mother, there is not a whole lot of verbal gratitude for doing the scut work of parenting life.

I like to look for examples of geriatric acts of athletic stupendousness. Like this 65 yo sub 6 minute miler. Or like the Iron Nun:

It helps me shift my perspective of the possible. It helps me feel less sorry for myself. It helps me see there are not a lot of great excuses.

This is not to say we should all be doing Iron Man level athletics, or X-Games level daring, or even walking a marathon to do our laundry. Would it not be nice to have a way to do laundry closer to home? But greed begets struggle, and therein lies the rub. It is a First World problem to need to create struggle (Iron Man Triathlons, marathons, going to the gym, and all that excellent stuff). It will be interesting to watch the next 4 years unfold, as struggle for basics becomes more of a reality for many Americans. For the record, by the way, I met no "bad hombres" in Central America. But man, they drive like crazy people. Way worse than even Californians

Why do we create struggle? I defer to my philosophy gurus to answer this, but ultimately I think we need to feel connected to each other (which is a struggle), connected to our bodies (ouch), connected to a higher purpose (what does it all mean?????) and recently, connected to our electronic devices. I cannot count how may times my watch has told me to "Move!" It is disconcerting, honest and fairly hilarious.

Last night, after work, despite my excuses:
-on call 24/7
-worried constantly about my kids and patients
-a horrible parent, I feel
-gas tank almost empty: in my car and in my body

Despite all those valid issues, I drove north and ran some hilly, sandy, rocky, heart-shattering beautiful terrain.

Trinidad, March 2017

I ran. Not away, but to, not in struggle, but in gratitude, not unaware but awake.


Twitter is ridiculous and kind of fun. I am trying to picture the Guatemalan laundromat women posting on twitter.

Marathon and laundry! In my skirt! Take that, gringo gym rat. #no excuses

Struggle on. It is what we do, us humans.

Friday, February 3, 2017

Mother Bear

If you have never watched or read the Little Bear series, do so immediately. Maurice Sendak illustrated the books. The videos (now DVDs or BluRays or whatever) are lovely.

Mother Bear is my hero.

It is not just cuteness and light. I am, as most mothers, seriously protective of my children.
We are faced now with a government who does not consider protection of children a priority. So how do we respond? Yes, call your senators and congresspeople. Yes, march. Yes, sign petitions, yes, join the ACLU.

I think of the Syrian boy on the beach and wonder how we can all go on as if this is OK. What if this was your child? But people like him are not welcome in our country. Not anymore.

My children are diverse. One was accosted in Seattle (in Seattle!?) last weekend for being with her girlfriend in public. One is in jail and faces years in prison for one mistake made with mental illness and drug addiction at age 18. And one is a straight A student who I am leaving the country with for a trip later this month and mildly afraid there will be trouble getting her back in. What if her adoption from a foreign country is questioned? Will my government deem her an immigrant who does not belong here?

She and I are headed to Guatemala, to help fit paralyzed kids into wheelchairs. Now I know, this sounds like a bleeding heart liberal thing to do. But we are joining a group who has done this for years, and we are hoping to learn something in the process.  What is the problem with liberals? Well, I guess it is we keep on trying, despite all evidence against hope.

I was reading today that Donald Trump asked his female staff to dress like a woman. I am wondering what this means. Today I worked to save lives, to lessen suffering and to parent my children. What outfit would best serve these purposes? For what it is worth, I wore pearls.

As a runner, I dress in whatever makes sense for the weather. Oiselle is a good source of women friendly running clothes. They also support strength and power.

I keep thinking about the man who accosted my girl and her girlfriend in a purportedly liberal city. What was it that bothered him so? Was it their beauty? Their strength? Their lack of need for a man?

I keep thinking about the legal system that thinks my son deserves prison for 10 years for one mistake, when he has mental illness and addiction. Will this help him be a better person? Is there any room for compassion and healing?

I keep thinking about adoption and China's weird thing about girls and my absolutely astounding daughter who seriously could conquer the world. In our small town, she faces racism. In our bigger world, she faces questions about who she is and where she belongs. Yet really, she is just a kid with mad skills at dancing and academics who plans to be a surgeon and who wants to make a difference in the world.

I am mother bear. I am angry, and scared and hopeful and protective. I will not stop fighting for my children, and for the children of others.

May compassion return to our dear country.

Thursday, January 5, 2017

Dancing and Death

BJ Miller has been getting some social media attention lately, which is cool. He is a Zen Hospice Physician, motorcycle rider, triple amputee, death expert. In this article my favorite part is "the 20's dude room" that came about when a young man with terminal cancer moved into  the Zen hospice house. But the most important part of the whole article for me was this statement: Regarding the mission of Zen Hospice, "It's also about puncturing a competing impulse, the one I was scuffling with now: our need for death to be a transformative experience. Miller says "Most people aren't having these transformative deathbed moments...And if you hold that out as a goal, they're just going to feel like they're failing."

The other day I was in a visit with a patient who was mortified and frankly in tears because their oncologist told them they had "failed" chemotherapy. Like chemotherapy was this test they should've studied for, and if they had only done better, then well, maybe there would have been something left to do. Because that was the other message they received, "there is nothing more we have to offer."

Recently a friend asked about my work and how it relates to what Dr Miller does. My work is not strictly the business of palliative care, though I have some skills (as any physician should) in this area. And although I do some hospice work, it is not that either. What I do, as my main doctoring gig, is meet people where they are and try to be a guide of sorts, as well as let them lead the dance now and again. Now, I can just see some of my old-school mentors barfing into their mouth a little at this description of doctoring. We are really supposed to be scientists, technicians, and masters of death, right? Our patients come to us for answers and solutions, yes? 

I am going to get back to this point in a minute, while I pause to give you a holy sonnet by John Donne. Which has the point that death should not be so full of itself. Is death the be-all and end-all? Should we fight it with all our might? Should people die, actually? Because when they do it really feels terrible. Is death a beginning or an end? Is death just another phase of life? Should doctors be good at end of life care?

Which brings me back to the barf-inducing take I have on excellent doctoring. I propose though, that it is scientifically sound and as an approach might actually let people live longer. Like, all the way until they die.

A few things about what I believe are requirements for health:
1. Civil Engineering.
2. Freedom from terror, and a place to call home.
3. Trust that your society and community have your back.
4. Healthy food, adequate exercise and decent sleep.
5. Good luck.
6. Knowing what matters to you and what matters to those you love, especially if you are their Durable Power of Attorney for Healthcare.
7. Occasionally, extremely cool technology like transplants, gene therapy, extraordinary medications, and the like.
8. 3-D Printers. So damn cool.

Number 6 above is well explored in Gawande's book Being Mortal. Number 6, that is Beethoven's 6th,  would also be one of the songs on my deathbed playlist, a concept introduced to me by a hospice nurse I don't know well, and whom lives across the country from me but with whom I feel a connection. Maybe we met once in another life too? Do we get more than one life? What say you, Tom├ís?

Number 6 is where I find my groove as a physician. The people I serve are not easily classified, but share being on the older side and medically complicated. I (usually) know just what medications to prescribe, and just what tests to order and when to call in the specialists and when to call in hospice. This is why I spent years of my life training to be a doctor. But none of it, NONE OF IT, matters if I do not understand their goals of living. And then get out of the way, much like BJ Miller got out of the way so the young man in that article could live out his days without the specter of a "physician guru" all in his space.

In a practical sense, there are dozens of examples of doctoring with the spirit of palliative care throughout the spectrum of illness and life. Yes, there are technical aspects (symptom control, a multidisciplinary team approach, excellent and learned communication skills). But often it comes down to recognizing the person wearing their disease(es).

Here are things I consider and my team does and I argue anyone claiming to be a healer, particularly toward the end of life should have some clue about:

Is that person feeling safe and dignified?
Who do they need to see or speak with, especially if they are nearing the end of life?
What kind of atmosphere do they wish to live in as they near death?
Do they need to go down in flames (prolonged ICU stay, last ditch futile medical efforts) to feel cared for, and if so, why?
Would you be surprised if they were not here in 6 to 12 months? If so, might they consider hospice care, which is grossly underutilized? And, ironically, hospice can often extend people's lifespan due to the tender loving care and de-escalation of toxic medical therapies.
Do they need a palliative care consult? There are actually specialty trained physicians with teams who do this well, including a great and innovative team,  right in this town.
In regards to the elderly, do they even want to be hospitalized, and if so, do they have someone to advocate for them while they are there? Hospitals are uncomfortable and can lead to confusion and debility sometimes for weeks to months in older adults.
Do they need spiritual support?
Do they even like harp music? I don't, so please, no harps at my bedside when I am in my last days! No offense to harpists, or lovers of harps or harpists, or family members of harpists, or harp makers or people who kind of like harps.
Do they need their toilet unplugged? Because this is a real issue for some people living in less than desirable housing situations and our team will unplug a toilet in the name of comfort and good health (see number 1 above, civil engineering).
Just some of the other things our team has done: cut invasive bamboo, cleaned massive garbage piles, offered mindful meditation by a trained coach, prescribed tai chi, prescribed writing letters to great grandchildren (on an actual Rx pad, for the person to bring home, and it was tucked into their bra at the visit so I know they took it seriously), provided blankets and heaters for cold apartments and homes, cooked dinner on house calls, gone to bat for people with their slum lords, helped find safe refuge from abusive situations, advocated for the autonomy of our "patients", helped find housing, provided showers for people, including those who have not had access to a shower for a year, prescribed and helped purchase comfortable and appropriate shoes, reunited estranged family members,  and prescribed the 4 important things to say before we die (Thanks, Dr Byock).

The 4 things:
1. Please forgive me
2. I forgive you
3. Thank you
4. I love you

Death, be not a competition. "Dying Well" and a "Good Death" are good catch phrases to get us talking about it, but these sayings also kind of irk me. Often death just plain hurts, and sometimes it is mundane. Frequently it is fraught with the unfinished business of families and friends. Too often it strikes those who have not yet had a chance to live fully, and that does not just mean "too young", because I have known some very young people who died having lived fully, with incredible presence right until the very end. And sometimes death strikes when unexpected, and does not allow anyone to even ponder the idea of a good death. Sudden death is like a meteor out of nowhere and the crater it leaves behind can be formidable.

Death is not negotiable. But excellent care at all phases of life, including the last one, should be expected, the same way we expect good care when we give birth, or when we take our kids in with a broken arm, or when our appendix bursts or when we have pneumonia or when we have a potentially curable yet serious illness. It does not take a master like BJ Miller to offer compassionate and decent care in the face of serious illness or dying. It should be the norm. But thank God for people like BJ for having the courage to show us that suffering can be tended to, most especially if we acknowledge it as part of being a human being.

I have had a fair amount of loss in my life, and in recent months have watched friends and family mourn for loved ones, and a nation mourn for a bunch of iconic, lovely people. Let us not forget the very real fact of mourning. Tending to the dying can be beautiful, but it is never easy. Continuing living after saying goodbye? Now that takes a special kind of courage.


Trying to remember you
is like carrying water
in my hands a long distance
across sand. Somewhere people are waiting.
They have drunk nothing for days.

Your name was the food I lived on;
now my mouth is full of dirt and ash.
To say your name was to be surrounded
by feathers and silk; now, reaching out,
I touch glass and barbed wire.
Your name was the thread connecting my life;
now I am fragments on a tailor's floor.

I was dancing when I
learned of your death; may
my feet be severed from my body.