an existential crisis

Moskenesoya, Norway

Something shifted this week. After a month or so of stubbornly cold, gloomy weather we awoke to clear blue skies and temperatures that soared into the eighties. Suddenly everything turned green. The air was thick with the fragrance of honeysuckle and lilacs. I had just received a message from my daughter with a video of my granddaughter receiving an award at school (she's in kindergarten) citing her for being mindful, hard-working, kind, helpful, and inclusive. I was sitting on my deck watching a couple of deer in the woods out back, enjoying the sound of birdsong and the acrobatic antics of the squirrels, thinking to myself, "This is a perfect day." Then I received a second message from my daughter. 

She is a Child Life Specialist which means she supports children and their families when they come into the hospital where she works. Using age-appropriate language, she educates them about what they can expect to happen, and she uses calming and distraction techniques to help them through it.

This message described a child she was seeing who had been admitted with RSV a few weeks earlier but didn't seem to recover completely, so her parents brought her back to the ED. She was displaying some behavioral changes which led them to perform an MRI of her brain, and there it was: a massive midline tumor with hydrocephalus and metastatic spread all the way down to her lumbar spine. BAM!

She is six years old. My award-winning granddaughter is six years old.

How does anyone process this? One child happy and healthy, the other doomed to pain, fear, and suffering that herald an early death. In a few months. On an otherwise normal day.

How can we hold space in our hearts for both of these children? For their parents and siblings? 

How would you? 

"Hope is the last thing ever lost."

~Italian Proverb~

I ended up on a path through the woods. This is my "go to" refuge when I need to think things through, when I need peace, or strength, or insight. A walk in the woods serves as the perfect metaphor for the duality that sometimes throws us for a loop. One minute it's warm and sunny, the next it's cloudy and cold. One minute the path is straight and smooth, the next it's stoney and steep. One minute the air is quiet and calm, the next it's windy and wild. One minute you know the way; the next minute, you're lost.

Like life.

"Of all the paths you take in life,

make sure some of them are dirt."

~John Muir~

The child my daughter supported during her MRI will be transferred to a medical center that is better equipped to treat her. My daughter will never see her again. Nor will she ever forget her. 

Nor will I.

"At the end of the day

people won't remember what you said or did.

They will remember how you made them feel."

~Maya Angelou~

jan

no mud, no lotus

 

Gimsoya, Norway

If you are a healthcare provider in any field, or the caretaker for someone you love, you are well aware of the duality that permeates every aspect of reality...the coexistence and contradiction between joy and sorrow, between kindness and cruelty, between life and death. We feel this deeply every day in our work, but never more acutely than with the care of our patients. 

If you are writing about your experience, you may feel the push and pull of duality in your narrative.

First there's the story you have pictured in your mind...and then, there's the process of translating it into words on a page. It can take you from soaring with enthusiasm to slogging through the muck. You may find yourself stuck.

"No mud, no lotus."

~Thich Nhat Hanh~



Inspiration wanes, fatigue sets in, and the story line languishes. Self-doubt creeps in. And even though the end is in sight, like a desert mirage, it fades away the closer you get to it.

"What makes the desert beautiful

is that somewhere it hides a well."

~Antoine De Saint-Exupery~



This is a lonely place for writers. Your memoir or manuscript isn't polished yet so no one else has seen it or commented on it. Therefore, you don't get to enjoy the inspiration that comes with an exchange of ideas, weighing in on suggestions from writing partners. You need a fresh infusion of incentive, like the energy that emerges when composing a query letter or submitting to an editor or agent. But you're not there yet. This is just hard, lonely work, day after day.



How do you cope with it? 

Sometimes I'll take a little time out to dash off a piece of flash fiction, a short essay, or, like today, a blog post. It's like indulging in a little snack when you can't wait for supper.

 

Sometimes I have to tear myself away from the keyboard and polish off a few necessary chores before I can concentrate again. For example, when there's no food in the house, or I run out of clean underwear. I mean, priorities do change. Writing sometimes has to wait, especially at this time of the year. There is spring cleaning to think about and yardwork to do. Storytelling may have to take a back seat for a while.

What can you do in the meantime?



When I'm stuck for an idea or unsure how to put one into words, I'll pick a random passage to edit and revise, backtracking a bit until I'm sure I'm on the right path again.

"Real writing begins with rewriting."

~James A. Michener~



It also helps to read something by another author on a similar topic. A couple of my go-to favorites are:

"Memoir as Medicine" by Nancy Slonim Aronie

and

"Still Writing" by Dani Shapiro

Right now, I'm reading "Good Writing--36 Ways to Improve Your Sentences," by Neal Allen and Anne Lamott. Next will be "Dharma Dog," by Stephen Cope when it comes out later this year.

Just the process of reading beautiful writing invites the mind to get in on the action. 

Do you ever get bogged down in the middle of a project? What do you do to recharge? To move ahead? How do you get it all done?

"Many of life's failures

 are people who did not realize

how close they were to success

when they gave up."

~Thomas A Edison~

jan

the aftermath of childhood illness

 

Reine, Norway

I post a lot about the importance of telling your story...the one that needs to be told, the one that won't go away, the story others need to hear. But have I mentioned how hard this can be to do? Have I told you how hard it is to get started? How long it can take? How confusing it can be?

 

"If I'm gonna tell a real story,

I'm gonna start with my name."

~Kendrick Lamar~

 

The story I need to write has been nagging at me for over 70 years...since I was three years old. That's when my brother and I both went into the same hospital with the same illness at the same time. The story explores the divergent paths we took through life in the aftermath of our shared experience. And how long it took to share our separate truths.

 

It begins:

          "The aftermath of childhood illness can linger for a lifetime. You think you’re over it when, out of nowhere, you remember the way the nurse rolled you onto your side and bared your little buttocks. First came the jab, then the dull ache that lasted until the next shot was due. One moment you’re a fully functioning adult. The next, you’re a sobbing three-year old.
          Like a stain that won’t come out, like a fog that never lifts, it stays with you. It can send you down a path you never intended to follow. It has the power to transform you into someone you never wanted to be. The memory of it catapults you back to a time you'd rather forget."

I started working on this project in earnest six years ago. This is as far as I've gotten. The details are vivid in my mind, the story arc is clear, and I already know how it ends. What, then, is so difficult about telling it?

 

I think the hardest part is convincing yourself that your story is worth telling. And after that, engaging the reader. Convincing him that your story is also his. Compelling him to read on in order to make sense of his experience in light of yours. Finding meaning not so much in the recitation of events, but in their cause and effect, in your process and outcomes, in the truth you summoned the courage to share.



"When you stand and share your story...

your story will heal you

and your story will heal somebody else."

~Iyanla Vanzant~ 

 

For reasons that will take a full-length book to explore, my brother spent most his adult life battling the anxiety, fear, shame, and insecurity that followed his hospitalization, as well as the addictions that helped him cope. His story is an epic quest for healing.

 

I went on to study medicine.

 

If you are mystified by the way your life unfolded as it did, if you have spent sleepless nights reflecting on the people, places, and circumstances that shaped you as a human being, if you have ever wished things had been different, you have an important story to tell.

 

"Other people are going to find

healing in your wounds.

Your greatest life messages

and your most effective ministry

will come out of your deepest hurts."

~Rick Warren~

 

If you are discouraged about telling your story because you don't know where to begin, start by writing something. Anything. Start with your name.

jan

 

 

do the right thing

 

Guess where I've been all week. Here are a few hints. Imagine:

~charming fishing villages~

 

~sheer mountain cliffs~

~endless fjords~

~reindeer~

~and, yes, awe-inspiring views of the Aurora~

...not to mention kind and smiling people (especially the ones who gladly went out of their way to track down and recover a couple of misplaced carry-ons of ours), and delicious food...all of which we enjoyed despite a few days of dense fog, freezing rain, sleet, snow, and gale force winds! 

"There is no such thing as bad weather, 

only bad clothes."

~Norwegian Folk Saying~

If you guessed Norway, you would be correct. Norway...where we were treated to a sampling of life lived with intention above the Arctic Circle, complete with unimaginable beauty in a sometimes harsh and uninviting environment. Where the indigenous Sami people have protected herds of reindeer for generations out of reverence for their shared space. Where solitude is cherished, and community is celebrated.

This is where we spent almost ten days. We went from exclamations of "Wow! Wow! Oh, wow!" on the first day...directly to (pardon our French) "HOLY F--K!" the very next day! Because, you know, the Northern Lights. The pod of orcas we spotted. The bright blue-green water and how painfully cold it was. H.F. We fed the reindeer. We went snowmobiling in a blizzard. We jumped straight out of our hot tub into a snowbank. We ate reindeer stew. When in Norway...do as the Norwegians do.

And then it was time to leave, no small challenge when our flight home was cancelled. I won't bore you with the details, except to say this. When we arrived at JFK, we still had a two-hour drive home...along roads that were disappointingly, disgustingly littered with garbage, notably so because there was no such thing in Norway. Not a cigarette butt, or a gum wrapper, or a beer can anywhere. I mean, we knew we were returning to political mayhem, to cruelty, deception, and greed. To war. But to so much litter? To the trashing of our homeland?

This is the thing. People in Norway believe it is honorable and sacred "to do the right thing." To lend a helping hand without expecting so much as a "thank you." To care for one another and for their wildlife because they all benefit from it. To keep the land and water clean and beautiful.

Americans? Not so much. 

That said, my new mantra is: 

"DO THE RIGHT THING"

...whether you're tossing out a gum wrapper, or reaching out to someone in need, or going to the polls. Do the right thing!

jan 

relief may be just a small kindness away

As healthcare providers, we choose to devote our lives to caregiving. This trend continues for many of us after we retire from our careers as nurses, doctors, first responders, and therapists in every field. Many of my former colleagues continue to work in food banks and soup kitchens, to teach, and to volunteer to help those in need.

I do not. The pandemic forced me into isolation, and I discovered that I rather enjoyed it. It afforded me uninterrupted time for reading, writing, walking, and meditation. For silence. For reflection. I prefer to call it solitude...and I have continued to cultivate it in my life.

Still, I do help out here and there. With family and friends, their dogs, and especially the grandchildren. The goal is to make life just a little easier for them whenever I can. This week it involved a trip to Pittsburgh to deep clean a house for my son as he prepares to move in...a task he did not have the time for. Luckily, a friend offered to help me, someone who (for reasons I do not comprehend) actually likes to clean! And clean, we did...even though we all know that:

😉

But this is the thing. We were rewarded with his deep and sincere gratitude. His mood shifted. A burden lifted. It marked a new start for him. It was a joy to see.

And it also worked for me.

The gloom that blankets the world because of the steadily deteriorating state of the news, day after day witnessing cruelty, dishonesty, greed, and now war...also lifted for me. I felt a quiet sense of joy. Of accomplishment. Of connection. 

Of course, we all extend kindness to others. We help out when and where we can. We don't always expect or enjoy an outpouring of appreciation or any compensation. We do it out of the generosity of our hearts whether or not we are thanked or even acknowledged for it. Still, our intentions, our efforts, and the sacrifices we make are rewarded when what we do brings relief, gratitude, and even a faint ray of optimism to someone else. When their spirits lift. When they can relax and breathe a sigh of relief. When they can smile again...which is what we all need right now.

"No act of kindness,

no matter how small,

is ever wasted."

~Aesop~

If things are getting you down right now--your finances are suffering, you're in poor health, a relationship has gone sour, you've experienced a major loss, you feel frustrated by the state of the planet and its people, war scares you...whatever--remember there is hope. If you want to feel better, extend a small act of kindness.

"The world is full of kind people.

If you can't find one, be one."

~attribution unknown~

 

If you can't muster the strength or motivation to reach out and you need help yourself, do as Mr. Rogers suggests:

"Look for the helpers.

You will always find people

who are helping."

~Mr. Rogers~

jan

 

the healing role of neural coupling in storytelling

  

 

The motivating principle behind the study and practice of narrative medicine is the conviction that storytelling has the power to heal, not just psychologically and emotionally but physically, as well.

“Dancing, singing, storytelling and silence

are the four universal healing salves.”

~Gabriella Roth~

It is easy enough to understand how an uplifting story can raise one’s spirits. Let’s say you have been diagnosed with cancer. Hearing the stories told by people who have faced the same thing and have healed can offer hope, optimism, and strength for the journey you are about to embark upon. Ok, so you feel better emotionally and psychologically. The question is, does this shift in the psyche translate into physical healing?

Consider the vast literature concerning the mind-body connection. One simple but compelling case in point: the disappearance of warts with self-hypnosis. Pretty straightforward. We are also aware of the accumulating research on neuroplasticity and the effect of meditation and practice on the course of illness. We have learned about the neural connections that modulate the release and function of stress and growth hormones, and how those processes influence our physiology.

“The purpose of storytelling

is not to tell you how to think,

but to give you

questions to think upon.”

~Brandon Sanderson~

And then, there’s this: the demonstration of neural coupling on functional MRIs during storytelling. Researchers scanned the brains of storytellers and their listeners before and during storytelling. While different areas of the brain were active before the story began (maybe the listener had skipped breakfast and was focused on where he would go to pick up lunch, while the storyteller was worried he might leave something out), as the listener became engaged in the story, the scans changed. They came to mirror one another. The same areas of the brain started to light up in both the storyteller and the listener…proof that the person sitting across from you has the power to affect you physically by how he engages with you mentally.

This is no great secret. We have all experienced a racing heart while watching a thriller on TV, or shed a few tears during a sad interlude at the movies. And, who hasn’t lost track of time while reading a good book? Something happened to our bodies while we were engaged with the story.

In the medical setting, the storyteller is the patient. The listener is the physician or provider. Their brains come into synch by virtue of their mutual engagement in the process of obtaining the medical history. Their physiology changes. They become connected.

“There isn’t a stronger

connection between two people

than storytelling.”

~Jimmy Neil Smith~

If a story can bring us to tears…or to laughter…it doesn’t take much to imagine that it can affect our health and wellbeing…whether through a mindful change in our attitude or a beneficial surge in certain hormones.

This is why narrative has a role in the practice of medicine. The patient who is telling his story and the physician who is listening to it are affected not only cognitively, but physically, as well. They are connected.

“Storytelling is the essential

human activity.

The harder the situation,

the more essential it is.”

~Tim O’Brien~

jan

how to wring a little humor out of troubling times

 

~bamboo~

"The human capacity for burden is like bamboo,

far more flexible than you'd believe

at first glance."

~Jodi Picoult~

It shouldn't surprise any of us that people are responding with worry, fear, sorrow, resentment, and anger to the state of our nation, to the daily news, and to the everyday stresses that are mounting in ways we never imagined. People living in fear. Having trouble making ends meet. Losing their jobs, and with them, their income. Their health insurance. Their businesses. Their homes. We are subject to arrogance, dishonesty, cruelty, misogyny, and rampant racism. Not to mention the pervasive problem of sexual abuse. Most of us have had enough.

"There is nothing worse

than thinking you are well enough.

Don't turn your head.

Keep looking at the bandaged place.

That's where the light enters you.

And don't believe for a moment that

you are healing yourself."

~Jelaluddin Rumi~

What might come as a surprise is the fact that some people have found ways to wring humor out of these troubling times. It may seem inappropriate to trivialize the tragedy unfolding around us by making jokes about it, but this is another example of the duality that keeps our heads on straight. Some of us are well, some are ill. Some are scared, others are safe. Some look on the bright side while others are stuck in the dark. 

I had to smile at a few of the posts that have appeared amid all this.

If you're not ready to entertain humor yet, maybe you can appreciate something of beauty or sweetness. 

If it's still too soon for that, you could simply go to the window and watch the clouds scoot across the insanely clear blue sky, or you could toss some corn and apples out to feed the deer, or you could listen to the birds singing their little hearts out. 

If you simply can't muster a smile right now, don't worry. It will come. You will get through this. You'll know it the next time--or the first time, if it hasn't already happened for you--someone or something brings a smile to your lips. 

"It is both a blessing and a curse

to feel everything so very deeply."

~David Jo~

jan

living in a state of perpetual awe

One of perks you enjoy as a physician is that you get to live in a state of perpetual awe. It starts with the first pass of the scalpel on the first day in the anatomy lab. It continues as you tease out every organ, blood vessel, and nerve in the body you've been assigned to dissect. A sense of wonder punches you in the gut the first time you hear a beating human heart and realize your own heart has been pumping steadily and predictably without any effort on your part since before the day you were born. In fact, your heart has been beating, on average, 72 times every minute of your life. This adds up to approximately 100,000 times every day, or 3,600,000 times per year, and depending on how long you live, as many as 2.5 billion times...until the moment it stops.

But then, who's counting?

That, in itself, would be amazing enough, but I learned a few more facts this week that astounded me. Did you know that the human eye can detect a single photon? That the inner ear can detect vibrations less than the diameter of an atom, and it can distinguish sounds that are just ten millionths of a second apart? That the human olfactory system can detect a trillion distinct smells? Did you realize we can detect tactile sensations down to one billionth of a meter? 

Yay, human body!

"There is more wisdom in your body

than in your deepest philosophy."

~Friedrich Nietzsche~

This is how reality manifests on the quantum level. It reminds me once again that every process in the human body is carried out with utmost precision, perfect timing, and uncanny coordination...in ways we are just beginning to appreciate. 

But what if you've never heard of the quantum domain? What difference does it make whether you know this about your Self or not? 

The way I see it, if knowing this brings you a sense of wonder, you might be motivated to take better care of this one amazing Self you live with. Feed it well. Give it some exercise. Let it rest. Avoid poisoning it with chemicals. Encourage it. Love it. 

"Self care is a divine responsibility."

~Danielle LaPorte~

Knowing this about your Self might bring you closer to the perpetual state of awe that I enjoy. And it might affect the way you see everyone else...as something of a mystery. A wonder. A miracle. 

 

"We touch heaven when 

we lay our hand on a human body."

~Novalis~

The fact that the body knows what to do to keep itself healthy is extraordinary. The fact that it knows how to heal itself--to heal a broken bone, to close an open wound, to reanimate a lifeless heart-- is beyond the wildest imagination. The way it accomplishes it is incomprehensible.

Biologists, physicians, philosophers, theologians, and quantum theorists are hard at work trying to figure out what it is that makes us tick...while our bodies are mysteriously, silently, and predictably doing what they do best: making us who we are...beings worthy of reverence, loving-kindness, connection, peace, and joy. 

"Be good to yourself.

If you don't take care of your body,

where will you live?"

~Kobi Yamada~

To this I would add: 

Be kind to everybody.

If you don't take care of them,

how will you live with your Self?

jan

something to laugh about

 

True story.

Yesterday I learned, via Facebook, that an old friend of mine had died. Our friendship dated back to the 1970s when her husband and I were in residency together, when she and I were both pregnant at the same time, and we both chose the same name for our first-born sons. Her son, however, died in a car crash in his twenties. I hadn't seen her for years, but she seemed to be in good health at our last visit together.

I called a mutual friend to confirm the news. Yes, she had passed, the cause of her death apparently some variation on the theme of dementia. We were the same age. 

Surprising. Very sad. A little scary. 

Yesterday's phone call lasted over an hour as we reflected on our shared friendship over the years. And then, the storytelling started. Like the time she handed a waitress her library card instead of her credit card and the hilarity that ensued. This drew forth a few chuckles. And then, more stories. And more laughter.

It occurred to me that this may be a worthy goal in life: to leave people laughing when they remember us. 

Respect and admiration are nice.  Affection is lovely. Sorrow is natural. But laughter! 

"Laughter is the best medicine."

~various attributions~

jan

how much more can we take

 

I decided to surrender and post another political rant. After all, I'm not the kind to march in the streets, and I've already shared my thoughts, in writing, with every member of Congress and with Governor Newsom. Still, we're all being urged to do something to support the survival of our democracy. And what I do is write.

As a health care provider, I have a special interest in the changes that have been made to what has proven to be a safe and effective program of immunization against dangerous and preventable infections for many years. We are already witnessing a resurgence of these diseases. Children are suffering, even dying, because of it. 

I'm also not happy that the food pyramid has been turned upside down.

On a personal note, I am especially concerned about the threatened incursion into Greenland as I am planning to visit Norway in March, and I prefer not to be regarded as the enemy when I get there. That is, if the airspace stays open.

I could go on.

Here's the thing. I am reluctant to add my thoughts to the mix for several reasons. First, IMO, we've heard enough. We know all we need to know about who Trump is and what we can expect from him. We don't, or shouldn't, need to hear any more political commentary, any more lofty speeches, or probing interviews to know what kind of trouble we're in. To know how dangerous Trump and his minions are. How deranged, delusional, and yes, even demented he may be. It's time to stop the analysis, investigation, and opinion peddling that add little insight to the conversation anymore.

What we need now is action! 

...because every day, we are confronted with another report of unimaginable, indeed intolerable, cruelty. Bigotry. Lying. Cheating. Ignorance. Arrogance. Greed. Indifference. Stupidity. All of which are a threat to our democracy, to our neighbors, and to each of us individually.

Instead of holding Trump accountable...a futile effort...now is the time to hold Congress accountable. To call our senators and representatives out for their failure to take action. For their indifference. For their ineptitude. For abandoning their moral and ethical duty to protect and defend the Constitution of the United States of America. For bowing down and out at Trump's bidding.

How much more can we take?

If marching in the streets unites us and you can get out there, you should GO! If we can flood our congressmen and women with calls to act with sanity and courage, let's do it. If expressing our opinion changes one person's mind, or moves one person to action, or gives any of us hope, we should all be speaking up. Sending emails. Calling. Conversing. Writing. We should be doing whatever we can...peacefully, courageously, and deliberately...to hold Congress accountable.

"The world will not be destroyed

by those who do evil,

but by those who watch them

without doing anything."

~Albert Einstein~

jan

when things get to be just too much...

One of this week's walks...

This past week was difficult for many of us as we tried to process the cold-blooded murder of Renee Nicole Good, an American citizen who was exercising her lawful and constitutional right to protest against ICE, peacefully, in the streets of Minneapolis on Wednesday.

When I woke up on Wednesday morning, my first thought was:

"I wish there would be some good news today...

for a change."

Then I poured myself a cup of good strong coffee, and I turned on the news. The rest is history...and it always will be.

I was trying to process that tragedy when my phone rang. It was my cousin calling to tell me she had been diagnosed with breast cancer over the holidays. Her mastectomy was scheduled for the next day.

Then, my brother called to say that his wife was on the way to the ED for evaluation of some neurological symptoms that have persisted since she suffered a minor concussion a few weeks ago. Her doctors wanted to rule out a stroke or a slow bleed.

Next in line was my daughter calling because she was worried about her great big gorgeous Great Dane. He wasn't eating. He was unusually clingy. He was also having tremors. He appeared to be in pain, but the vet couldn't fit him in that day. They'd been through something like this before...when her last Dane developed bone cancer...so that was worrisome.

Then we got the news about the couple in Portland, Oregon who were shot by federal agents during a traffic stop.

This is hard. It's hard to process the violence, pain, suffering, injustice, and heartache that seem to have become predictable themes in our collective experience, and as well, in our personal lives. We feel a combination of disbelief, grief, anger, and worst of all, despair. It can stop us in our tracks.

My question for you is this: What do you do when things get to be just too much? What do you do to take care of yourself at times like these? To calm yourself. To strengthen yourself. To catch a glimmer of hope, or joy, or peace.

I walk. It's a five-mile round trip that takes me out into the woods and along a little stream. This week, thankfully, the weather cooperated. The skies cleared, and the sun came out with unseasonable warmth. Even the wind quieted down. Twelve deer greeted me along the way. People waved hello.

It helped.

I hope you can tap into your own wellspring of beauty, wonder, peace, and possibility. A moment of joy. A reason for hope. 

Remember:

"Not everything that is faced

can be changed,

but nothing can be changed 

until it is faced."

~James Baldwin~

jan