Quote

New Born Evergreen

Wandering questions before a wooded labyrinth

Whisper, asking for a grand theory

A cannon filled with run on unpunctuated sentences

And questions unanswerable.

Yet, those barely audible whispers!

For the life of me

I couldn’t tell you who or what they said.

But that’s the sounds of trees for you. Supercilious, taller in unison without harmony

Singing together then humming as a bee swarm choir.

Orchestrating an opera of my delicate sensibilities,

Dramatic, broken crystal by the secret octave of deception.

Blindly sliding through a wooded curtain

Where roads disappear.

We’re led nowhere by maps on the night’s inky sky.

Long unbroken lines of highway rose with voices

Of ash and elm along dashes of dirt roads.

Cold ice baby blue bodies of water

Surrounded by brown paper mountains, all

Legendary but-meaningless without keys to open

Our car doors – how perceptive the parents of nature?

Seeing the horror films on the backdrops of snow caps

Screaming at mouth of the forest.

At its fang – the sharp firs shredded my skin.

With a swipe of a long arm the burly beasts took me whole.

Right down the throat of the past.

Disgusted by my taste I’m spit out

Tumbling beside the lines (as anyone’s seen in a dream )

Imagining the inconsequential creation of myself

Taped up from fragments of past particles

Pieces of who I wanted me to see and warning what you may notice:

In mirrors I’d become larger than I appear.

This moment – now – burnt by fire

Burnt up and afraid time knocks down our front door.

Standing there looking at us it sends up red flares

Hot and melting pin-sharp icicles from the eaves

Dropping off cold, stabbing the porch

As only water can – cold for an instant and gone

Alive for no reason.

In my mind I rename myself something simple, biblical: Ruth or Rebecca.

Shape my name as long as the Mississippi or

Cut it short as the Nile.

Name me Superior or after another lake

Yet besides water tricking the ground into moving away afraid lakes

Simply wait for the rain.

But in my digression

I must admit my remission…

…for then

Bullies can spit me out

Like grizzle from a

Buzzards beak for they’ve

A taste for carcasses

And a parents’ outdated tastes yet

Salivate for the stench of the dead.

II.

Is life that much better now has forgiving myself given gratitude a new name? Grace drowns in the rain. The storms, the lightening ahead, and the heavens applaud my truths in thunder. Children learn to count: one one thousand, two one thousand. Time to find safety in miles, time to find shelter from the storms? While wind shakes my bones like wintered leafless branches, I tremble from deep inside my trunk, inside of me.

The Cancer’s Tale

We wait.

All born souls queue

Up to ascend where

Unknown certainty begins

And known uncertainty ends.

We sit.

In stillness our

Hair billowing, bodies

Skin covered in ripped sheets

The bark on eucalyptus trunks,

Bent from blow back towards

The earth, arched away from the sea

Arms outstretched

As if to grab something

That’s behind them

Like a runaway a dream

Or a lost child.

I thought, “how limber”

Coats lined in misplaced trees

Searching the land

But not belonging in

This continent where

Their branches suffocate sparrows

Dead and flightless

Laying in the shade.

Let’s use those tourist trees

For lumber instead of our

Native redwoods and sequoias

Whose needle hair holds

Those human-sized

Rotund trunks where

Locked inside the bark

We saw off gifts worse than its bite.

We drink

Clear cool water running

Down our throats.

Stopping to read

Pages of gold red fire leaves

Unbound. We drink

Like the trees

Sipping through tiny wells, the roots

Magic fingers flip the rain in the sunlight

Tricking the sap into the trunks turing it into blood.

The ax wielded by

The mind thirsty still

We read —

Pulp fiction

Dedicated to the willow

Growing in the fringe

Of the yard where

Someone’s mother planted

Her husband or sister

And we see her from the rotted old wood swing

Moored like a ghost ship

Out of time, out of our sites.

We travel.

Returning from the east

Heading out to the desert, west

On the horizon where warmth sinks fast in winter.

Hurry back to the coast.

Now it’s late and dinner’s cold

Shivering very quietly with my hands on my lap

Sudden and without a sound

Slips the ship sails, Tattered between the shadows,

over the curved earth

We finish.

Bookends holding up

Our bodies on the shelf

Related to no one

Left to right.

Packed up and traded

To clear the way

Leaves fall, memories

Raked up and bagged

Hauled away.

Nicely mowed lawn,

Honey.

Spring bulbs pop

And remind you of

Someone you knew

Or a character

From a book

You borrowed for a while.

Palliative Care Is Everywhere

Today my sister and brother-in-law took a huge risk to travel from Georgia all the way to Northern California. After collecting them from the Sacramento airport, we arrived at the house greeted by my husband and an immanent call with my palliative oncologist from Stanford. He’s a wonderfully compassionate physician. In the specialty of palliative medicine the most important aspects of a competent practitioner, aside from the obvious foundational and ongoing education in their medical specialty, includes all the nuances of compassion and empathy. Can one learn the two most important humane personality traits, regardless of intelligence? I certainly have my theories in the matter: you can fake it but not make it if you’re not sincerely so. And therein we find the art of medicine, the details of human suffering and healing.

Since she’d not met my care team I invited her to join the telemedicine appointment with Dr. H today. As a trained nurse with 40 years of experience, she’d not yet had the privilege of experiencing the graciousness of palliative medicine. And like many people – medical professionals included – she had, prior to my telemedicine appointment, only a vague idea of the importance of palliative care. It’s not simply the path leading up to the edge of a graveside with a bed in a hospice facility as the next place we lay our ailing heads before life’s end. We travel to to that great unknown and universal mystery – death. However, before we reach that great democratizer, we come in and out of pain, feel the side effects of medications and chemotherapies, as well as the psychological hardships that arrive hand in hand with a cancer diagnosis. Palliative physicians see the patient as a whole being and treat us with the tools that science provides them with but in a more nuanced way than a breast oncologist in my case. As a treatment protocol and important part of the health and well being of a patient, palliative medicine in my experience remains a mystery to most, including myself before I entered the realm of the terminally ill. Yet one needn’t be terminal to benefit from palliative medicine either. If you have some time, and I reckon with Covid still thrashing the global population, you do, a worthy use of an hour or so can be found in this conversation between Dr. BJ Miller (yes he’s very good looking) and Michael Lerner, author of the de facto book published by MIT press on integrative therapies. https://youtu.be/5YDbq7vBT-A

Mission: Impressionable

After our hour long video call, my sister connected the dots on her own after asking a few questions and experiencing the interaction between myself and Dr. H. She was especially impressed by his clear respect for me as a human being – gasp! an entire hour of conversation between doctor and patient – and not only a number to rush through a five minute visit with and quickly hand off to a nurse for scheduling and prescription refills. She observed the mutual respect and intellectual relationship we clearly share as “refreshing and very unique.” She added that it was “unfortunate that it’s also very unusual.”

I took some time to educate her with a brief overview of Dr. H’s role in my care, palliative medicine in general, and why it’s so important for the well-being of someone with a terminal or chronic illness: it’s not the step before hospice, although sometimes it is; it’s not only prescriptions for pain, although sometimes it is; it’s not only referrals to specialists outside of oncology, although sometimes it is.

In my follow up to my doctor, I decided to include some photographs for him since he already asked for a picture of my left lower leg and foot because I have another case of cellulitis. We also discussed my thoughts about an ooprhectomy, or removal of my ovaries, so that I might avoid the side effects of hormone suppressing medications like letrozole, which take a huge toll on my entire system. All non targeted medicines are by nature systemic and therefore so are their side effects. He agreed with my assessment of including surgery in my care plan and will discuss it with my oncologist as will I bring it into our conversation during my visit next week. Welcome scanxiety – after my next head to toe PET scan on Wednesday.

Not only lay-people, but medical professionals lack education regarding the roles of each member of an ideal care team in dealing with a terminally ill patient. Not because they don’t want to provide the ideal care, but because those specialties aren’t homogeneously available.

Pass It On

I’ll use American football as my metaphor for sake of making a longer story short. The patient ideally becomes the quarterback position and the palliative oncologist becomes the offensive line and the oncologist is the coach as well as the defensive line. We all work together to battle our way down field to reach the same goal: to have me live as long as possible with the best QoL along the way. The oncologist fights off the opposition, being the cancer itself while providing tests, therapies and other specialized oncologists to keep the patient in the game as long as possible. While we may never win, we hope to get to the super bowl and beat the odds of living 2.6 years from diagnosis. Each year is like a touch down for us. Each time we take possession of the ball without cancer scoring a point and outsmarting our medical strategy is another chance at more time. And if the team falls apart the entire game is over. A good metaphor for how we all participate in the life we pray to extend as long as possible with the best quality of life as possible.

Photographic Evidence

Dr. H asked for a photo of my leg for a baseline of my cellulitis. Of course I sent it using the Stanford MyHealth application that very day. I’ve had cellulitis in the past and my sister’s opinion as a seasoned nurse concurred that indeed that is the correct diagnosis. However I thought I’d send him some more personal photos as well, since he is a very personal part of my life.

The photos consisted of the following: Simon my cat, my mascot, my side kick, my tear sponge and fur baby was in the. Simon follows me everywhere and always stays by my side when I’m not well. There were two additional photos I decided to send: the first from Jan’s 40th birthday (I was 33); the second of us at a wedding in 2014. How time does fly. I was not smoking a cigar in that photo but pantomiming the powerful act of puffing on a heater, as my ex fiancé’s was fond of saying, whose cigar it was, and my way of exerting my executive privilege at that time. In both photos my biological mother, who is Jan’s step mom. My mom died from Alzheimer’s four years ago. Too young… she was 74. Long history there for sure – Jan and I have been together since 1980. It’s been over 40 years. So many lifetimes ago yet like yesterday.

How life takes its great turns and and we walk along along its pathway together and alone, until we must change our direction or take an entirely different road to meet the moment we find ourselves.

Yet, after all, love is all we remember and all that matters as reflected in the photographs. And a life without love isn’t a life well lived, it’s a mere existence and makes no mark at all – I believe love is our true legacy. You’ll remember your vacation but unlikely that week at work you chose in its stead. Enjoy making memories with the people you love. While work seems important to us – it’s not what truly supports us.

Healing Circles

I’ve just completed my training to host a Healing Circle. It’s a sort of support group, except no one gives advice or tries to fix anyone else, and confidentiality is a must fir giving people room to share their truth with the use of a metaphorical tribal campfire as it’s basis.

“Healing is what the person says it is. (Like pain is what the person says it is),” quoted from Michael Lerner a founder of commonweal and its cancer help program, which if you’ve read this blog for some time you’ve read of my effusive respect and through which I’ve found my own personal style of healing.

In healing circles people take take the risk of being vulnerable, just as I do with my palliative oncologist- and this is a very difficult emotional task to say the least. I feel accepted, no matter the content of what I share, no matter the emotion I express. I see his capacity to be truly present and know me as a whole person, and the good and bad experiences of my life. I’m inspired by our talks to express myself regardless of the situation. And in his listening he’s able to treat me with respect and care.

I wish more physicians and more oncology practices included palliative care as a part of the team. I hope you find some guidance in what palliative medicine truly is – not the fear of the call I first received about five years ago when I was first introduced to my original palliative doctor. I was so frightened I was closer to death than I originally thought, but not so. The nurse who called to schedule the appointment was just not adept at creating a safe space by explaining what palliative really meant and that it wasn’t the last stone in the path before my grave.

I couldn’t have been more afraid, but today I owe my health in so many ways to the five physicians who have been a deep part of my life and my healing. I cannot thank them enough.