what if the tables were turned

Are you ready for Christmas? I think I am, as ready as I can be given the fact that this isn't the easiest celebration to pull off every year. A snowstorm can sweep in and ruin everything. A simple cold can lay a person low. People we love may be missing this year.

This is always a bipolar time of year for me. We can be full of eager anticipation one day...empty, the next. With the approach of Christmas, we enter a time of irreconcilable contradiction. Undeniable reminders of the dualities that coexist in our lives--joy and sorrow, poverty and wealth, anticipation and dread, indulgence and denial. Good health and bad. Which, when you stop to think about it, feels so unfair.

The problem is that I have friends who are sick...so sick, in fact, that this could be the last Christmas they see. I have friends who are grieving. I know people who are lonely. Angry. Depressed.

And most likely, you do, too.

The holidays have a way of putting life's inevitable struggles into perspective. The bright lights and merry carols that the rest of us enjoy can dampen the spirits, deepen the grief, and aggravate the loneliness that so many feel at this time of the year. 

 

www.personal.psu.edu



I wish everyone could be happy and healthy at Christmastime. That everyone was at peace. That everyone had hope. It's hard to know what to do for those who don't. What help are presents when pain is the problem?

I am left to reflect on what I think would be helpful to me if the tables were turned:

If I were sick, if I were the one receiving chemo, or struggling against pain, I would want a friend at my side. Don't bother bringing me fuzzy pink slippers or bubble bath or flowers...unless, of course, it makes you happy...in which case, bring it on! Even though it's your presence I really need.

If I were grieving the loss of a loved one--my spouse, or one of my children, or my best friend--I would want you to sit at the kitchen table with me and share stories--the sweet, funny, important moments that we enjoyed with them. I'll make the tea. You bring the cookies.

 

If my house turned to rubble in a storm or turned to cinders in a fire, I would need you to hold me up, to cheer me on, to shelter me if it came to that. Don't say, "Call me if you need anything." I would need everything, and I wouldn't have the strength to pick up the phone. Just come. Sit. Stay.

 

www.weheartit.com

 

One of the best presents we can give is exactly that--our presence. Our halting, not-sure-what-to-do-or-what-to-say presence. Our I'll-be-here-for-you-no-matter-what friendship. Our I-wish-I-could-do-more-for-you selves even though some of us may have been planning and preparing for weeks, now. Shopping. Baking. Wrapping. Tending. Caring. Hoping to make everyone happy...

...not that we have much control over it.

Still, if Christmas with your family is happy, loving, and peaceful, I wish you a merry one.

If not, I wish you hope. Courage. Friendship. Beauty. Time. Snow if you like it…sunshine if you don’t.

~What Gift Will I Give~

You have no idea how hard 

I've looked for a gift to bring you.

Nothing seemed right.

What's the point of bringing

gold to the gold mine, 

or water to the ocean.

Everything I came up with

was like taking spices to the Orient.

It's no good giving you my heart

and my soul because you already have these.

So I've brought you a mirror.

Look at yourself and remember me.

~Rumi~

jan

there is more than one way to tell your story

 

The approach of the holiday season has a way of magnifying whatever trouble we are dealing with in life. Just last evening I learned that the friend of a friend of mine was recently diagnosed with early-stage breast cancer, just in time for Thanksgiving. She opted to undergo bilateral mastectomy even though she could have chosen a more conservative approach. She is post-op and doing well now, though not with her usual holiday spirit. Others I know are not faring as well.

This week’s post presents a brief excerpt from my novel, The Bandaged Place. I wrote this scene years ago, but it still rings true today.

It goes without saying that this scene is fictional, but it could just as easily be part of a memoir. It connects the reader with a moment she may have experienced in her own life--when she had to share bad news with friends, when she needed their support, when she knew how hard it would be for them to come to grips with her predicament. The fact that it is fictional does not diminish its impact, suggesting there is more than one way to tell a story.

"One of the most valuable things
we can do to heal one another
is to listen to each other's stories."
~Rebecca Falls~

In this scene, the protagonist, a physician, has just told her two closest friends she has been diagnosed with breast cancer:

          My kitchen is as silent and as still as any place on the face of Earth has ever been—the deepest cave, the holiest shrine, the eye of the storm. I have just finished explaining to Sophia and Barb why I need them here today. It’s one thing to sit at your desk with a patient and break the news to her, “You have breast cancer.” It’s another thing entirely when you are seated at your own kitchen table with your best friends, saying to them, “I have breast cancer.”
          They’re sitting across from me stunned, expressionless, struggling in vain to access whatever words they need to say to me right now. But there are no words for this. Silence reigns.
          I am tracing the pattern of the grain in the wood on the tabletop. Sophia is looking out the window, her chin resting on her hand, gazing as far away as possible. Barb is staring at me, searching for some sign, some indication that would explain how she missed it, as though she should have known something was wrong. And I am having second thoughts as I watch both of them wrestle with this—as I watch everything change for them—knowing what I just unleashed in their lives.
          I break the silence, “Well?”
          Sophia slowly turns her attention back to the present. “Well what?”
          “Well, what’s going through your heads?”
          Barb turns to Sophia for help with this one.
          “Me?” Sophia sits forward and braces herself as if she’s preparing for turbulence, in full upright and locked position. “If it were my decision, Kate, I’d have them both off. And I wouldn’t bother with reconstruction. I mean, what purpose under heaven do they serve anymore?” She waves her hand as if she were scooting the dog away. “That’s what I think.” She sits back as if the voice-of-reason has spoken. Clearly, she doesn’t understand.
          Barb stares at my chest as though the answer is scrawled in capital letters across the front of my sweater. True to form, she sums it all up, “You know what I think? I think you're going to need a puppy. And lots of wine. Red wine. For medicinal purposes."
          Sophia closes her eyes and wags her head. “You’re impossible.”
          I have to giggle. I can’t help it. Barb would come up with something like that. Why is it, I wonder, that the worse you feel, the better bad jokes sound—silly, stupid, crude—as far from reality as you can get?
          “When I was ten,” I tell them, “I went crying to my mother because I had this little sore bump on my rib, right about here.” I point to my heart. “Mimi had just died, and I knew that she had breast cancer, so I was convinced that I’d caught it from her. At ten! I was so sure of it—so scared—I waited a month before I told my mother about it. By then it was even bigger, so I was certain I was doomed. But Mother just smiled and told me, ‘It’s part of growing up, is all. It’s perfectly natural.’”
          “That was natural,” Barb quips. “This is not.”
          Nor is it fair. Nor is it even conceivable.

*

And so the narrative begins with the physician as the patient.

"Stories are not material to be
analyzed;
they are relationships to be
entered."
~A.W. Frank~

The fact is that scenes like this unfold all the time in real life. If you have shared bad news with your closest friend, you know how hard it was. If someone made you smile on the worst day of your life, you witnessed a miracle of sorts. If you have a friend who was willing to sit quietly and patiently at your side, she helped you heal.

The point is that each of us has a story to tell. If you write, you can translate what you experience, think, and feel into words. But if what happened is too painful or too difficult to chronicle, try wrapping it up in a story or a poem. If you are an artist, you may be able to express yourself better on the canvas. If you compose, in your music. If you act, on stage.

There is more than one way to tell a story but tell it you must. Which way is right for you?

"Everybody's got a different way

of telling a story, and 

has different stories to tell."

~Keith Richards~

jan

when you just can't write and you shouldn't even try

 

Let’s face it. Old Man Life sometimes insists we take a break whether we want to or not...a break from work, or from serving as a caretaker, or from parenting. 

It might be an unexpected illness or injury that stops us in our tracks.

Anterior shoulder dislocation (image: compliments of my son)

A flood or a tornado might sweep through. Worse yet would be the death of a friend or family member. You can’t work and you shouldn’t even try.

Likewise, you may sometimes be forced against your will to set aside your creative efforts, whatever it is you’re writing, drawing, composing, or performing, your efforts to create something new and beautiful, or meaningful, or entertaining. You may be sabotaged even when you’re speeding along page after page, stroke after stroke, verse after verse. Just when the finished product is within reach, you may have to take a break and tend to the Old Man. Maybe you come down with the flu, or a neighbor needs your help, or your new puppy slips out the door and disappears down the street. It may be time to give your muse some time off. Tell her you need to take a break. Promise her you'll be back. She’ll thank you with new insight, inspiration, and passion as soon as you're ready.

Maybe you’re looking forward to planning a move, or you’re preparing for a wedding or a birth in the family, or you have an exciting vacation coming up. There’s a lot to do, not a moment to think about the masterpiece moldering on your desk or which chord sounds better. You may want to invite your muse to take the day off. Then, when you're ready to get back to work you can sit down together and share your memories of the event. 

"Muse:

that mischievous little sprite

that whispers inspiration in your ear

when you least expect it."

~Dale Kinkaid~

There are times you can’t work, and you shouldn’t even try…not because you’re blocked, or lazy, or distracted, but because Old Man Life has other plans for you…plans for you to gain experience, to grow in understanding, and to tackle your feelings about it. All of which will appear sometime later on, in a melody, or on the page, or on your canvas...when you least expect it.

"Taking time to live life

will only inspire your work."

~www.artofyou.com~

It isn’t always how much we accomplish, but who we become that elevates our work. A walk in the woods elevated my work last week:

This week, I hope Old Man Life is good to you and that you and your muse have a blast together!

jan

how to write like a horse

 

This past week, a lone horse in a pasture captured my attention. I spotted him running full speed ahead from one end of his football field-sized enclosure to the other--back and forth, back and forth. No one was chasing him. No one was cheering him on. He seemed to be galloping along for the pure joy of it. To feel the wind in his mane. To stretch his legs. Like this one:

~www.123rf.com~

When he'd had enough, he simply stopped and rested. Like this one:

~horseandrideruk.com~

This, I believe, is how we should write: for the pure joy of it. Letting loose on the page. Stretching our imaginations. Letting our spirits soar without anyone questioning our motives. Writing what we can simply because we can. Without prodding. Without apology. Without restraint.

"Writing is the most fun

you can have by yourself."

~Terry Pratchett~

And we, too, should feel free to stop and rest when our joy is satisfied and our energy is spent, knowing that we can take off again any time.

Go ahead. Write like a horse!

"Release your majestic mind,

embrace your untamed inner spirit.

Break free from captivity,

avoid society...

You were born to be free."

~Melanie Moushigian Koulouris~

jan

what are you afraid of?

If you are a healthcare provider, a caregiver, or worse, if you are a patient...you're probably all too familiar with the word "fear."

"It is both a blessing and a curse

to feel everything so deeply."

~Noah Weiss~

Patients probably bear the brunt of it. When they have to wait for the test results they know will determine their fate. When they face a painful or risky procedure. When the phone rings in the middle of the night, and it's the ER calling. Parents bolt out of bed, and they are on their way. Fear can show up as dread, as hatred, as shame. It can also alert you to danger. It can deliver a jolt of adrenaline. It can be a great energizer. A motivating force. 

Fear is also fertile soil for avoidance and denial. For procrastination. For the imagination. Take the case of the middle-aged man who presents to your office with chest discomfort he describes as "indigestion"...because he's afraid to admit it could be his heart. So he fails to mention that the pain gets worse when he walks uphill. That it radiates into his neck when he lifts something heavy. That antacids haven't helped. He's afraid, all right.

Imagine the fear a parent feels when his child is rushed to the hospital because of an illness, injury, or overdose. 

What is it like for a woman who is in labor if she lost her last newborn because of a heart condition or some other unforeseen complication at the time of delivery? What could be scarier?

"Be brave my heart.

Have courage my soul."

~attribution unknown~

As ordinary human beings trying to orchestrate our personal lives outside of the office or hospital, healthcare providers are prone to some of the same fears. I take good care of myself, so I don't worry unnecessarily about my health. But I will admit to a twinge of anxiety when I was asked to return for additional views on my mammogram last year. 

I wasn't worried when my PCP picked up a few irregular heartbeats on my physical and ordered an echocardiogram. I drink a lot of coffee, so what did he expect? I wasn't worried until the tech started spreading goop all over my chest. Suddenly, I was a bit anxious about what they might find. I had rheumatic fever as a child, by the way.

There's that...and then there's the fear that stalks us through the workday. Who hasn't felt it on the way to a "code"? Will the patient need to be intubated? Will we remember the dose of bicarb or atropine to give, and when to give it? Will we be able to save this life? Fear is never far away.

"The greatest mistake we make

is living in constant fear that

we will make one."

~John C. Maxwell~

What about the patient who shows up unannounced at the office with a bad laceration? Fear kicks in. Will I get the layers right when I stitch it up? Will it look OK when it heals? What if it gets infected? 

Will the delivery go smoothly? Will the baby be okay?

Will the Narcan work in time?

"Do what you can,

with what you have,

where you are."

~Theodore Roosevelt~

Patients would probably be surprised to know how fearful healthcare providers, even physicians, can be. Deciding which tests to order and how to interpret them. Afraid of making the slightest mistake. Worried we might miss a diagnosis or botch a procedure.

Fear is like a shadow on a cloudy day. It follows us from patient to patient, unseen. They may not know it's there, but it is. It might reveal itself as frustration, impatience, or disengagement. It can cause headaches, rapid pulse, nausea, sweaty palms, or shakiness. Even in doctors. Like everybody else.

"Great fear is concealed

under daring."

~Lucan~

What are you afraid of? What will you do about it?

jan

the bridges we cross vs the bridges we burn

 

My current WIP is, roughly speaking, about breaking away from learned and/or conditioned beliefs and behaviors that no longer ring true to us...and why we should. 

Given today's political climate, this is relevant as we encounter people whose deeply entrenched convictions offend our beliefs about justice, lawfulness, and compassion. We wonder if there is anything we can say or do to change the minds and the behaviors of MAGA supporters who discriminate against whole classes of human beings, who have withdrawn support from the neediest among us, and who put our health at risk. What would it take to convince them otherwise? Is it possible to change their world view?

"Sometimes you change your mind.

Sometimes your mind changes you."

~Binyomin Scheiman~

When we learn something new or are exposed to a different way of thinking or responding to life's twists and turns, it can lead to a shift in perspective so that we see the world differently. This comports with the principles of Transformational Learning Theory, introduced by Jack Mezirow, a sociologist and Emeritus Professor of Adult and Continuing Education at Columbia University, in the 1970s.

Transformational learning considers how people make sense of life. It refers to the ways we adjust our thinking based on the acquisition of new information...how we make sense of what happens to us and around us. It is based on the contradictions between newly acquired knowledge and previous knowledge, and how this alters our way of thinking about an idea or situation. These changes can arise from sudden moments of insight, or they can unfold gradually as the learner reflects upon what they have learned, or observed, or experienced, and how that affects their beliefs. Their world view.

Mezirow taught that in childhood, learning is formative, meaning it is derived from formal sources of authority such as parents and teachers, and from socialization including adherence to cultural norms and expectations.

In adulthood, on the other hand, learning can become transformative, as adults acquire the ability to discern distortions in their own beliefs, feelings, and attitudes. This opens the door to change.

How does this happen? Mezirow believed that the change occurs when we face what he labelled "a disorienting dilemma", an experience that does not fit our expectations or make sense to us without a substantial change in our world view, our conditioned assumptions, our previously held beliefs, or our tightly held convictions. It forces us to reconsider our beliefs in a way that brings us into alignment with what we have learned.

"Sometimes the hardest thing in life

is to know which bridge to cross and 

which bridge to burn."

~Daniel Russell~

Transformational learning refers to the ways we develop and use critical self-reflection to adjust our thinking based on the acquisition of new information. There’s nothing surprising about that. We do it all the time. For example, we might quit our job when we learn that our boss is employing unethical or illegal business practices. The thing that sets transformative learning apart from, say, what we learn from reading a book or taking a class is the fact that transformative learning always involves a "disorienting dilemma".  It can be painful. What we learn, or witness, or experience leaves us stunned. Confused. Unsure. It forces us to ask several questions:

• What have I been thinking all this time? Why?
• What is important to me?         
• What am I really committed to?
• What is preventing me from accomplishing what I am committed to?
• What path will I take going forward?

Let's consider a specific example...something that directly affects us as health care providers: the theoretical case of a diehard MAGA supporter who loses his unvaccinated child or grandchild to a totally preventable disease, such as measles or RSV. He was convinced that RFK was right about the dangers of vaccination, until he was forced to confront the truth.

 
Mezirow describes ten phases in the process of transformational learning:

1.     Encountering a disorienting dilemma...in this case, the totally preventable death of a child

2.     Self-examination accompanied by feelings of guilt or shame, in this situation, for having rejected the science behind vaccination

3.     Critical assessment of the epistemic, sociocultural, or psychic assumptions that guided one's choices

4.     Recognition that one’s discontent and the process of transformation are shared…that others have successfully navigated a similar change, that others have changed their minds about the risks and benefits of vaccination

5.     Exploration of options for new roles, relationships, or actions...such as transforming from an antivaxer to an advocate for vaccination

6.     Planning a course of action

7.     Acquisition of knowledge and skills for implementing one’s plans

8.     Provisional experimentation with new roles, such as encouraging others to reconsider the issue

9.     Building competence and self-confidence in new roles and relationships

10.  A reintegration into one’s life based on the conditions dictated by one’s new perspective
 
While Mezirow's theory was intended to reference learning in adult education, it is applicable across a broad spectrum of behavior, thought, and experience. It is at work our relationships, in our careers, in our faith, and now, in our politics.

I wouldn't wish a "disorienting dilemma" on anyone except that it might lead to the kind of transformation we can, otherwise, only hope for.

 "When the wind of change blows, 

some people build walls.

Others build windmills."

~Chinese Proverb~

jan

 

 
 

let nature heal you

 

My hike in the woods this week was more about meditation than getting exercise. It was silent, and still, and peaceful out there. It slowed me down. I paused to meditate for a few minutes every so often, until finally, I just sat down and let everything else go.

"Sometimes you find yourself

in the middle of nowhere,

and sometimes in the middle of nowhere 

you find yourself."

~A Living Rock~

~Circe Sola~

I've been studying and practicing one form of meditation or another for over fifty years. As far as I know, none of my friends or colleagues practices it, although I do know several women who practice various other forms of energy healing, including accupuncture, therapeutic touch, neurofeedback, hypnosis, and Reiki. Most traditional Western providers shun these techniques out of ignorance, or disdain, or denial, but I've seen them work for others, and they have worked for me, so I have an intuitive attraction to them. 

While there are many other forms of meditation, these are some I practice:  

• Insight meditation involves focusing the attention to let go of the cascade of thoughts that pass constantly through the mind. A basic training involves simply observing one's breath in order to achieve a state of calm, clarity, and detachment, letting go of thoughts as they arise.
• Mindfulness meditation teaches us to maintain moment-by-moment awareness of our thoughts and feelings without judgement, in order to see things as they are in the present moment rather than rehashing the past or projecting into the future. 
• Loving-kindness meditation is the practice of sending loving intention to yourself, to the people you love, to people you recognize but don't really know, and finally, to people who have offended you. It usually involves an invocation. Mine goes like this:

May you be happy

May you be healthy.

May you be safe.

May you dwell in peace and loving kindness.

My practice goes on to include all people, especially the suffering, to all animals including pets, to farm animals who die painful deaths so we can eat meat, to animals in the wild, to sea creatures, and from there to the environment. It takes about an hour depending upon how detailed I get.

• Tonglen involves the mental process of taking on the suffering of another person with the in-breath, and sending them peace, comfort, and love on the out-breath, starting with people you love, moving to people who are neutral in your life, and ending with those who are hard for you to love.
• Mindfulness based stress reduction (MBSR) integrates yoga and mindfulness with science and Western medicine to reduce stress, anxiety, illness, and chronic pain.

"If meditation were a drug,

failure to prescribe it would

constitute medical malpractice."

~Robert Delozier, MD~

• ECO meditation ("energy ecology meditation") uses methods that retrain the brain to avoid defaulting to conditioned or learned patterns of reactivity that reinforce negative emotions such as anger, hatred, and fear. Instead, we learn to reframe our emotional reactions and behaviors to acceptance/tolerance, compassion, and loving-kindness. It utilizes Emotional Freedom Techniques (EFT) such as tapping accupressure endpoints.
•  Guided imagery is another technique that can lead the meditator to a peaceful, loving emotional state.

"Of all the paths you take in life,

make sure a few of them are dirt."

~John Muir~

Meditation is a restorative practice, and mindfulness is its foundation. Among its numerous health benefits are stress reduction and the accompanying decrease in blood pressure and cortisol levels, reduction in measurements of systemic inflammation, and therefore, improvement in the immune system, alleviation of chronic pain, and management of PTSD.

If you are a health care provider, you should explore every option, every path to healing for your patients. If you are in need of healing, in addition to the surgery you need, or the chemotherapy or antidepressant you are taking, consider this:

"Go home to nature

and let nature heal you."

~Thich Nhat Hanh~

jan