Conversation With A Shaman

We were at a “Welcome to the world” party this past Saturday  for a new nephew.  One of the guests was from Ireland, a  woman named Stacy.  I’d met Stacy on a previous visit and had a great conversation about inner peace, life purpose, worry, etc. Stacy is a counselor who specializes in addiction issues.  When I’d noticed she was sitting @ the same table as my wife I plopped across the table from her….

Fifteen minutes later we picked right up where we left off.

This conversation  went rather quickly from counseling addicts, to aura’s, chakras, to crystals to card readings, to the statement she was a practicing Shaman.

Pause.

Last Summer I lined up an overnight stay for a casual acquaintance with a friend of ours who lives in Ohio.   Somehow during the brief time they were together, the two of them got to talking about spiritual things.  A few weeks later when I asked how the stay went, the casual acquaintance recounted a portion of their conversation and concluded  by saying, my friend was  (quoting now) .. “An absolute loon.”

It is amazing how much we can learn about another person if we just keep our mouth shut and just listen.

As I talked with Stacy the Shaman,  I was genuinely interested in understanding what she believes, (because I really do enjoy talking with her)

We are worlds apart in our understanding of the spirit realm, but we do share a common understanding that there is more to life than the physical here and now.

I had no illusions of changing her worldview in a 15 minute conversation at the party. In fact, I felt no pressure to do so. Heck, I can’t even change my own heart in my own strength, so why in the world would I think it my business to effect change in her???

The  spiritual component of my life did not quicken until my early 20’s.  Before that, spirituality was confusing at best, and not relevant the rest of the time.

And then…. best way I can describe it,  there was a stirring and hunger for absolute truth that awakened within me….I didn’t go looking for it…it just happened.  I went through a couple of year period of sifting that was very scary at the time, but came out the other side  utterly convinced in the reality of the spiritual realm and a very basic, simple working knowledge of it.

Do I have it all figured out? Absolutely not.

If you ever meet someone who tells you they have it all figured out, run…Run in the opposite direction as fast as you can because you really are dealing with a loon.

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A Loon

What I find interesting however, is how quickly our generations has abandoned a Christian world view,  and then turn right around and opened the door to  the  dark side not even realizing it.

Apple Harvest

little girl eating apple

Well, apple picking time has arrived  full force.

( I could really use your help Kristina for the next month!)

My goal this past week has been to pick 12 crates of apples each night after work.

The volume of fruit this season is overwhelming, but I have to start somewhere.

Everything is two weeks early.

And multiple varieties are ready at the same time.

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I thought I had a lead on a used apple washing machine this past week, but found out  too late.  A new set up is several thousand dollars which I simply can not justify.  Neither do I have time to hand wash 25,000 apples, so once things slow down this winter, I am giving serious thought to fabricating my own set up from scratch.

My days  the past several weeks have been so packed between my real job building houses, the harvest table business that seems to be taking off, and now the apple harvest, I haven’t had time to read or comment on many of your blogs as much as I would like to.

I did place an order with Visti-prints and had 5 of my photos turned into post cards…(let me know if you’d like to purchase some..they are $.50 each or (5) for $2.00.  (just leave me a comment and I will be in touch via e-mail)

Here are  a couple of the pictures:

brainards Oaks

Sunrise West of Mom and Dad’s

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Cortlands

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Ginger Golds

Tell me something about apples and your life.  (It could be a memory of going to a favorite orchard when you were little, an apple recipe, a variety you like and why,), It just has to have some connection (however small) with apples. 😉

Thanks for reading along! DM

How Doctors Die

It’s Not Like the Rest of Us, But It Should Be

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Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds–from 5 percent to 15 percent–albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen–that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).

Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.

To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.

How has it come to this–that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.

The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.

But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.

Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.

Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.

It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.

Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.

Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.

But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.

Several years ago, my older cousin Torch (born at home by the light of a flashlight–or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

Ken Murray, MD, is Clinical Assistant Professor of Family Medicine at USC.

Here is a link to another article titled “Knowing How Doctors Die Can Change End of Life Discussions  DM

The Quiet Of A Private Life

“All I ever wanted was the quiet of a private life.”  

Edward from Sense and Sensibility

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Wife and I just finished watching season 5 of Downton Abby earlier this week.  Both of us  have enjoyed watching something that didn’t leave us feeling like we licked a mental ashtray, so we decided to check out Sense and Sensibility by  Jane Austen last night.

That line “All I ever wanted was the quiet of a private life.” caught my attention,  so I wrote it down.

For the most part these days, I (DM) am enjoying the quiet of a private life. Not so much the past two months due to an intense work schedule and multiple family get together s, but that is the exception rather than the rule.

In Church this morning Marilyn was telling us about some interviews she is sitting in on to hire her replacement.  She works in a pressure cooker work setting. One of the questions they asked the applicants was,

“How do you handle stress?  followed by, “What do you do for self-care to deal with stress?”

I thought those were great questions to ask those of you that read this blog…;-)

(I bring that up because just because a person has a private life, is no guarantee they will automatically enjoy the quiet that goes with it.  You may have a private stress filled life.)

For myself, I’ve  learned I need to  schedule plenty of “margin” into my work calendar, Things regularly happen outside of my control, in spite of my best efforts.

I could tell this morning I am still not completely “unpuckered” from my latest roofing project (see recent blog post The Man In The Law Chair)

So I headed out to the apple orchard in my bare feet.  Three days ago I mowed, so between the dew and dead grass, my feet were covered in grass clippings..and it felt earthy.

This is my version of pulling a John Muir. 🙂

Unpuckered:the art of unwinding and relaxing after a period of intense activity, (could be physical or mental)

Read a story (whether it’s true or not is another thing) about  Muir visiting a friend out in the Pacific North West.  Thunder storm was fast approaching, Rather than hunker down in the log cabin,he headed out into the woods to climb a tall pine.  Told his friend later he wanted to see what it felt like to experience a thunderstorm, in the top of a pine tree, as the winds whipped the forest.

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Here’s a little taste of Muir’s writings…

      “The mountain winds, like the dew and rain, sunshine and snow, are measured and bestowed with love on the forests to develop their strength and beauty. ….  the winds go to every tree, fingering every leaf and branch and furrowed bole; not one is forgotten; the Mountain Pine towering with outstretched arms on the rugged buttresses of the icy peaks, the lowliest and most retiring tenant of the dells; they seek and find them all, caressing them tenderly, bending them in lusty exercise, stimulating their growth, plucking off a leaf or limb as required, or removing an entire tree or grove, now whispering and cooing through the branches like a sleepy child, now roaring like the ocean; the winds blessing the forests, the forests the winds, with ineffable beauty and harmony as the sure result….

….. pines six feet in diameter bending like grasses before a mountain gale…..”

Wanted to share that snippet of Muir’s writings with you this morning because reading them, somehow they vicariously takes me to the woods with him.  😉 DM