Live Imperfectly, Dad is dying, and I Have no Power.

wilted flower

Living with someone like tomorrow might be their last is much harder to do when it is actually the case.

My dad told me, after my nine-year old niece died, that a parent should never outlive their child.  When I look at my own children, I know that is true. But with my parents aging process, my dad’s long and difficult past twenty years, and now near end of life condition, I just don’t know how I’d order things, if I could, between us.

When God, (Morgan Freedman,) told the complaining Bruce Nolan, (Jim Carey,) that he could have all of his powers, the audience of “Bruce Almighty” projected both a positive transference and a schadenfreude. Bringing the viewer into the character’s identity is every actor’s aspiration. And we went there. Up. “Yay! Bruce can answer everyone’s prayers with a ‘yes’!” And then down, down, down. The multidimensional disaster’s created by misplaced power, power without wisdom, love, or altruism, was just painful to watch. Power does not God make.

My Dad is dying. Not likely from cancer. Not likely from a failed liver, floppy heart, or baggy lungs. He is just dying.  He’s confused on and off. His spine is failing so he can barely walk. He has repeated blood clots. And he’s recently risen out of a deep depression. Rison right into a confused grandiosity, full awkward, awkward like pants ripping when you bend over type of awkward, and inter-galactic soaring thought content.

The first “word” Dad played in Scrabble last week was “vl.” He explained, “vl, like vowel.” …Okay? For thirty minutes Dad played without playing one actual word. I started crying when he finally stopped connecting letters. The letters floated on the board like California will look after the “big earthquake” finally hits and it falls into the ocean. (We’ve all been waiting.) Now he tells me he called and spoke to Obama and Magic Johnson. Reference point. This is bizarre and out of his character.  He’s been delirious with waxing and waning level of consciousness for a month and a half. He’s dying. Sheez.

Living well while Dad dies is not easy. Would I use power to restore him to his healthy twelve-year old self, like Elli’s seventy-year old grandfather did, in “The Fourteenth Goldfish,” by Jennifer L. Holm? Would I use power to change the order of death? Would I do anything more or less or different, while my dad is dying?

Power does not God make. I am not God. (Ta-da! It’s out of the box now.) But both of us are watching Dad die. I trust that She, with the power, wisdom, love, and altruism, is living with him well, during this time.

In Life and Other Near-Death Experiences, by Camille Pag√°n, Libby Miller decides to live, just live, rather than die perfectly.  And maybe that’s my answer to this unasked question. Living with someone dying will not be perfect for me.

Self-Care Tip: Live imperfectly to live well, like this is your, his, or her last day.

Question: How do you “live well?”

Keep on!

Memorial Day – My Graduation Thank you

IMG_3342My Mom saved a bunch of “stuff” from years gone by (sniff) and I came across this. I was moved to snuffles. Thank you Mom for valuing my life.

I remember it so poignantly, working on these words with my brother Cam, and laughing a lot. Then before I knew it, there was the after graduation party, standing at the mike and those many faces. I blubbered mostly. Mortifying. But I do remember who I saw.

You! You! You! It’s all about you! We’ve done this together, and it’s God in you people that got me through. Thank you.

Medical School was hard for me. All that book work was as exciting to me as my acne, one of those things you hope just sort of goes away. I found that whenever I had some book in front of me, I suddenly became the best conversationalist. In fact, I learned to start taking them on dates. I started having a lot more success… with dating.

But still, all those years of book work were a form of security. There’s security in book work.  When third and fourth year came round, I got a little nervous. You know. You’ve got to perform.  By now I’ve learned if flirting doesn’t work, hey! I can always cry! I can do that because I’m a girl. Being a woman in medicine is neat like that. The only problem I really ran into with being a woman in medicine, is that guys are soooo competitive!!! Aren’t they!!! In med school especially. But you know what I like? I like to just CRUSH THEM!!! No I’m just kidding. I wouldn’t crush anyone …irreparably.

Growing up with Dad being a doctor was inspirational. From him, I thought what you mainly learned in medical school was that if it hurt, all you needed to do was put ice on it. Now I know you have to use tape too.

But on bad days, it was Jesus and Jesus in you that got me through.  You my friends who sent notes, you my family, brothers, Mom and Dad, who know me so well and survived my selfish demanding life, who kept me laughing and smiling and inspired, you all, you who prayed.

And I know this is just the beginning of a lot more practice of depending on God and God only for power. So here we go, together. You and me and Jesus. Thank you. You you you. It’s really all about you.

And 18 years later, even without the security of book work, the distance between me and medical school could still not get far enough! Thank you for trolling down that lane with me. May you all celebrate your history. Happy Memorial Day!

Keep on!

I’m peaking in my career

  
Supposedly, I’m peaking. And this isn’t about egg yolk and marenge pie. I’m 43 years old, have been in medical practice for fourteen years, and am looking at a canyon in 360-degrees from where I stand. That’s what the data says. I wonder if I am going to do the electric slide or how I’ll boogie through the next years of medical practice. I try to think, “This is the best moment of my life, right now,” any time self stigma and fear of mortality creeps in. (That’s not saying, “This is as good as it’s going to get!” Ha!) I want to cherish the gift of practicing medicine, for however long I am blessed with it. 

It’s a popular discussion amongst my colleagues these days, about how long a physician should practice. There’s a newer’ish respected program called, PACE, that evaluates physician competency to practice as they get old.  This is a huge shift in the culture of medicine. It’s meant to respectfully assist rather than discriminate with ageism. I try to imagine what it might feel like if I were approached and asked to take the test. 

So what does a psychiatrist rocking her best jeans have to show for herself anyway, you may ask. Well, (tapping the mike), “I’d like to first say thank you to my sponsors….” Wink.  I mean my patients! Thank you. 

…Hey! This peak is crowded! Give me some room!

Ahem. But at my “peak,” at the best of my career, I thought it would be fun to play around with, “Why?” What’s in my doctor’s bag that is so special?

  • Ask, “Why do you want to be alive?”
  • Start all work-ups with a medical work-up. 
  • Give full informed consent with the 5-Treatment Paradigms of Psychiatry
  1. chemical (medication), 
  2. psychotherapy, 
  3. hospitalization (inpatient and outpatient), 
  4. alternatives (such as acupuncture, massage, sleep hygiene, lifestyle change, etc.), 
  5. stimulation therapies (such as ECT or TMS).  There’s nothing else (that I know of ūüôā ) that anyone is going to offer you in psychiatry, no matter who’s clinic you go to. 
    • Push to full treatment response. 
    • Work toward quality of life, not cure, not perfect.  Ask again, “What makes like worth living for?” Design treatment toward those goals. 
    • Routinely and deliberately consider the flow of patient’s treatment agendas with physician treatment agendas. 
    • Mood journal. Nobody believes they were “that bad” after they feel better. Everyone wants to stop treatment when they feel better. (This is why there are so many repeat pregnancies, for example!). We all need our own voice (mood journal) to look back on and speak the truth. 
    • Fight for oxygen. If your patient has sleep apnea, don’t stop working toward treatment compliance. There are no medications that can take the place or make up for oxygen to the brain. 
    • Community. More community. 
    • The third eye – a therapist. None of us can be a mirror into ourselves. We all need someone outside of the “triangle” to speak.

    I’ll be thinking of more as I try to go to sleep tonight, but it’s bed time. I’m off! Sleep hygiene! Arg!

    Self-care Tip: Evaluate your position in your lifeline, and treasure where and who you are with deliberation. Keep on!

    Questions: Where are you in your lifeline? Are you struggling with ageism? What gives you value? Please speak! I, and the rest of us, really need your voice. 

    How Do We Age Well?

    photo

    Ella Rose

    In preparing for retirement, for aging, we put money away like Smaug The Dragon who knows his coin.  We imagine we will gain freedom, retain vitality, interest, and motivation, perhaps enjoy the affection of those we served through life.  But do we prepare for what is really coming?

    I’ve been asked, how do we age well? ¬†And guess who asked. ¬†An aged man. ¬†I tugged on my chin a little to hide my discomfiture. ¬†After all, I would like to sit at his table and listen in on his story of doing what he had inevitably done, grown old. ¬†I’d like to hear what he is pleased with. ¬†And what he regrets. ¬†I’d like to hold up the memories, like picture slides to the light, and see if I recognize anything. ¬†Maybe something I might relate to. ¬†Something I might more deliberately emulate. ¬†I might feel more secure, knowing what he has done before me. ¬†Maybe I’d think I am safe.

    Remember that song,

    A foolish man built his house upon the sand, A foolish man built his house upon the sand, A foolish man built his house upon the sand and the rains came a tumbling down.  The rains came down and the floods came up, The rains came down and the floods came up, The rains came down and the floods came up and the house upon the sand went splat!

    (The hand motions make the song.)

    But why ask me about aging? ¬†Do I look so old already? ¬†What the!? ¬†Fine then. ¬†I’d like to say, grow old continent and stock full of Botox. ¬†Nah. ¬†That wasn’t it. ¬†(Mind wandering already you see.)

    Or maybe, we who are aging wonder quietly if this person, or that might have a trick of doing it better. ¬†This person wants to hold up my picture slides to the light and gather security to them. ¬†That person wants to do more than hoard coin, and another doubts the vitality and wonders if she’d know what to do with it if it were waiting there for her after all in the end any way. ¬†“How do we¬†age well?”

    Start with Me.

    Me, where there is freedom to choose, the chance of change, the place where cause begins. ¬†(The 3 C’s done our way at Friend to Yourself :).)

    As a psychiatrist, it’s easy for me to think first of the biology of aging of course – brain health over time and to recall¬†that the brain is connected to rest of the body. ¬†I could tell this aged man that he’ll be wanting to get oxygen to his brain at night and use his cpap regularly. ¬†I could speak of motility and exercise, of caloric intake and sleep hygiene. ¬†We might spend some time on medical care for psychiatric illnesses common in again, depression, dementia, anxiety, and so forth. ¬†We might speak of the inevitable process of losing friends and family, aging past a child or losing pets. ¬†But as many so often remind me, psychiatrist’s only have the truth that their perceptions allow. ¬†ūüėČ

    A dear Obstetrics and Gynecology specialist told me the other day that she has become more convinced than ever that the processes of coming into the world and that of leaving the world are the same.  Having delivered countless souls into life, she has been marked, as if the luminescence of so many branded her.  She carries the knowledge of their entry and of those who have already died.

    I remember my niece who died at 9 years and 28 days.  Not so old.  Not so aged.  Some how we think of death when we think of aging, not when we think of nine-year-olds.  However my niece did age well.

    I suppose aging is like any system, as strong as its weakest member.  The wonder is that if we believe in aging, we believe our lives run on a line, on Time, which is after all, a human construct, a philosophy and based on Magic. Aging well as implied by my OB-gyn colleague, is looking at it from both ends, looking at what is in between, and looking at what is outside of birth and death.  Aging well includes exploring the essence of Me, what bit of Magic came before Time and before zero and numbers and philosophy turned into math.

    How do we age well? Does¬†aging¬†imply disease?¬†Aging¬†is linear. They’re different but definitely paired… Help me on this?

    keep on.