Transitions

Yesterday I saw my chiropractor and asked if she could recommend a new PCP. She immediately gave me a list of names of doctors her own patients love. One of the people she recommended very highly is a Nurse Practitioner who works with an MD who's also trained in medical acupuncture. I'd already heard good things about him and had been considering checking him out -- here's his bio, which I find both honest and compelling (I especially like his definition of illness as "the human experience of disease," which is a precise and helpful distinction) -- so that was an easy sell, especially since he's on my insurance! I've had good results from acupuncture for my sinusitis, although I'm skeptical about a lot of "energy work," especially Reiki.

When I got home yesterday I called and got an appointment with the NP for 10:30 this morning. How convenient is that? As a plus, she's considerably closer to my house than my old PCP (although the office park where she's located is an absolute maze, and I kept getting lost).

I think she's great: warm, personable, empathetic, a great listener. She looked at me instead of at her computer, although like everyone else these days, the practice uses electronic medical records. She had, for a wonder, heard of Narrative Medicine! She shares my skepticism about the energy stuff and says she's had a hard time wrapping her head around acupuncture, but she keeps seeing patients respond really well to it, so that's convinced her. She adores the doctor. When I said, "I've decided that allopathic medicine is great for acute illness and life-threatening stuff like cancer and heart disease, but holistic medicine is better at treating chronic problems," she nodded vigorously and said, "That's so well put. I'm going to use that."

She recommended a new orthopedist, a knee specialist who's doing her own knee replacement next week. (Ouch!)

She talked about the fact that normal lab values -- while they can reassure you that you don't have cancer or whatever -- aren't a reason to dismiss complaints that people aren't feeling well. (My old doc's response tends to be, "You're fine. Your bloodwork's splendid.") She said, "You don't need more lab work or pharmaceuticals. You need to be treated as a whole person. We need to monitor your depression to make sure it doesn't become a problem, and we need to help you work through your grief." She asked if I was currently in therapy; I said I've stopped getting good results from talk therapy, although I process a lot through the blog, and that led us into a discussion of writing and healing. She hadn't known about James Pennebaker's research -- here's his writing and health homepage -- and was fascinated.

So her recommendation is that I see the doctor for a consultation; I have an appointment with him for June 9. When I left, she both shook my hand and hugged me. My old doctor's fallen into a pattern of walking away without a backward glance, not even responding to "thank you" or "good bye."

So I'm feeling vastly relieved and cautiously optimistic. A small voice in my head is saying, "You know these folks will burn out in five years, just like everybody else you've seen," but I'm trying to ignore it. And even if it's true, five years is better than nothing. So thank you to all of you who urged me not to settle for a doctor with whom I'd become uncomfortable!

In other news, today's my last fiddle lesson with Charlene. Her husband has a job in Madison, Wisconsin, which of course is one of the coolest places on earth, and has a much better music scene than Reno does. They're moving later this month.

I'm hoping, at some point today, to finish the extraordinarily rough first draft of Mending the Moon, and then to start revising like a maniac. I'd love to have it done by Mythcon, although that may be overly optimistic.

They Can't All Be Winners

As I've noted here before, February 20 is the anniversary of the day I was offered the job at UNR (in 1997), the day of my very unexpected and grace-filled first communion (some months before I was baptized, in 2000), and the day when we learned that my mother's lung-cancer surgery had been so successful that she needed neither chemo nor radiation (in 2004). I believe it was also the day (in 2006?), when Rita Charon spoke at UNR, sparking my interest in narrative medicine. In any case, it's a day when many nice things have happened to me, a day I tend to expect to go well.

Today, alas, was a little disappointing. I finally booked the ninety-minute massage my sister gave me for my birthday, and was looking forward to it tremendously. I'm glad I got it -- I certainly needed it -- but I think my massage therapist was having a bad day, because she seemed very terse and untalkative, and also worked on me so fiercely that I'm still sore. (To be fair, she told me I should let her know if she was applying too much pressure; it felt okay at the time, and I'm sure I'll be fine tomorrow.) I used to have long, warm conversations with my old massage therapist, who left to go to nursing school, and although I was fine not talking today, it felt odd that this therapist didn't even respond to my tentative openings. She wasn't exactly rude, but the interaction felt brisk and impersonal.

Also, halfway through the massage, I developed a stomachache that lasted a good four or five hours. It's gone now, thank heavens. I don't think the massage had anything to do with it. Still, this definitely wasn't one of my better February 20ths.

Better luck next year.

Tolkien and Trauma

So I said (or implied) in my last post that I probably wouldn't be blogging for a bit, but something really neat happened today, and I wanted to write about it.

Background: I've been having some trouble with job satisfaction lately. Partly this is because I've been through a lot these last few years and am simply tired. (That sabbatical can't come soon enough!) Part of it comes with the territory: all teachers have spells when they can't see if anything they're doing is making any difference to a soul. And part of it -- a lot of it -- is because of the hideous state budget situation, especially in terms of education. Our "no new taxes" governor is talking about cutting higher education by twenty-four percent, after a series of cuts that's already been disastrous.

I've long argued that our society claims to care about kids and education, but clearly doesn't, based on spending priorities. The current leadership of Nevada couldn't say any more clearly that it doesn't care about education. If you're a teacher, that's bound to make you feel, well, a little . . . undervalued? I think my job is safe -- lots of students major in English, and we're responsible for several courses all students need to graduate, and we're so understaffed right now that we're actually being allowed to make some new hires -- but let's just say that university morale in general isn't terrific at the moment. My personal fatigue, against that community background of despair and paranoia, has been a fairly toxic brew.

Fortunately, I'm teaching my Tolkien course this semester, which is always one of my favorites. (Tolkien's a great antidote to despair and paranoia!) Today my students read, among other things, part of the Foreward of Tom Shippey's J.R.R. Tolkien: Author of the Century. Shippey begins by claiming that the fantastic is the dominant literary mode of the twentieth century, and goes on to observe that many fantasists are survivors of combat or other traumas, a fact he calls "strange." Talking to the class, I said that I don't find it strange at all; I gave them a brief overview of my theories about fantasy and trauma (basically, that the "strangeness" of fantasy allows writers to represent the strangeness of trauma more realistically than realism can). I mentioned that there's well-established research about writing and trauma, which I could talk about more later were anyone interested.

I'd thought there wouldn't be time to talk about that material, but it was one of those days when discussion never took off. I wound up with about ten extra minutes at the end of the class. All teachers know that this happens, but it can also make you wonder what you're doing wrong. Today, a bit desperate, I said, "So, is anybody interested in hearing more about writing and trauma?" (All teachers also know that we tend to keep material in reserve for just such moments.) To my relief, a few people nodded.

So I gave them the condensed version of my speech about why writing is the opposite of trauma, even though it wasn't strictly on topic. Most of them looked interested. One student actually seemed teary-eyed, but I assumed that was allergies or a speck in the eye or something.

After class, though, that student came up to me -- openly weeping -- and thanked me for the trauma lecture. This is someone who plans to go into healthcare. "My friends have been asking why in the world I'm taking this Tolkien class, because it has nothing to do with my field, but now I can say, 'Hey, she has some really interesting ideas about trauma!' Now I know that I'm supposed to be here." The student has experienced personal trauma, which made the lecture especially applicable (to use a favorite phrase of Tolkien's!).

During my office hours, another student showed up and thanked me for the trauma lecture. "That was really moving." This student, too, has a personal history with trauma, and has dealt with it partly through writing.

So, hey. Just when you think you aren't getting through and have nothing to contribute, it turns out you're saying something other people need to hear. It's a good feeling, I have to say.

Fun!

I just finished teaching a two-hour class on Narrative Medicine to the first-year medical students. I always enjoy this; I even enjoy reading the sixty-odd papers that result from the assignment. My regular classes won't start until next week, but now I feel like I'm warmed up. It's a great way to start the semester.

This week I have to prepare course materials for this semester and revise my essay on using Tolkien to teach trauma theory. On Saturday, instead of going to the hospital, I'll attend a two-hour presentation on mental-health issues in pastoral care, offered by a local priest who's also a psychologist. I think the audience is primarily clergy offering pastoral care in parish settings, but the information should help me at the hospital, too.

Saturday evening will be a real treat. Yesterday, Charlene sent e-mail to all her fiddle students saying that Vishten will be giving a concert in Minden, a small town about an hour south of here. She can't go, but urged all of us not to miss it. So Gary and I ordered tickets online and made a reservation at a restaurant a few blocks from the concert hall. I've driven through Minden several times, but I don't think I've ever stopped there. Maybe for a regional church meeting? I can't remember if that was in Minden or neighboring Gardnerville. Anyway, I like little towns, and it's a very pretty drive, so I'm looking forward to the trip.

Best of all, Minden has a yarn store I haven't visited yet. Bliss! I've told long-suffering Gary that we have to get there early so I can shop.

Today I saw the chiropractor for the first time. He's a nice guy, low-key and matter-of-fact, and what he said made sense to me. He did a physical exam and took x-rays; tomorrow I go back for a discussion of the test results and my first treatment. I'll be curious to see how this goes!

Chaplain Sighting

Y'know how I gripe a lot about how TV medical shows rarely show chaplains, and when they do, the depictions aren't very accurate?

Gary and I just watched the HBO documentary Baghdad ER. It's an incredibly powerful film, and you'd better believe that ER has a chaplain. Of course, it's a documentary, not fiction, so that's why.

If you know anyone who still has a romanticized view of war (is that even possible now?), make sure that person sees this film. For good measure, show it as a double feature with Alive Day, which shows what severely wounded soldiers -- saved by dedicated medical personnel and remarkable technology -- face when they get home.

Jangle Bells

Readers please note: In this post, I express a number of minority, and perhaps heretical, opinions. If you disagree with me, that's fine, but please don't flame me for having a different take on things.

Okay, so: The last few days have been a bit stressful. Yesterday my sister called to talk to me about closing out Mom's estate before the end of the calendar year, which the lawyer had recommmended. I hadn't seen this coming, and although the procedures she outlined on the phone weren't that complicated, they sent me into a tizzy. I went totally into scarcity space: hyperventilating oh-my-god-I'm-gonna-starve-to-death-in-a-cardboard-box mode.

On the face of it, this makes no sense. Why would one feel a sudden surge of panic on learning that one's acquiring several thousand unexpected dollars? At the time, I couldn't analyze it past the point of recognizing that financial matters always send me into a cold sweat. To calm my nerves, I went to the gym and swam for an hour. That sort of worked, although the perky Christmas music in the lockerroom left me with the strong and un-Christian urge to take a flamethrower to Frosty the Snowman. (I heard two other women complaining about the music, so I wasn't alone in my reaction.)

After the swim, I managed to get more of a handle on why I'd gone off the deep end, so to speak. After this, there will be no more estate. This is really the end, finis, the last money I'll get from my mother, and it's coming at the darkest time of the year, and on the heels of a conversation Gary and I had with a financial advisor who told us that I have to work for at least another fifteen years; I'd hoped for only ten. (And yes, I know: at least I have a job! And I'm indeed grateful!)

Once I'd figured that out, I started organizing my Christmas packages to the East Coast. It always amazes me how long wrapping takes; I'd economized -- probably unwisely -- by packing the wrapped gifts in old boxes we had in the garage, which meant that I had to wrap the boxes in plain brown wrapping paper to cover old Amazon labels and so forth.

I thought I had enough brown wrapping paper. I did, sort of, but only if I covered each box in two or three pieces of the stuff, which led to lots of fun with packing tape -- our only roll was playing "let's hide the end so you can't find it!" -- especially since Bali and Figgy had gotten into my study and were prancing through boxes and wrapping paper, getting themselves stuck to the tape, and so forth. The upshot of this ridiculous situation was that I spent all night wrapping two frigging boxes and went to sleep in a really bad mood.

I woke up this morning, feeling only marginally less cranky, to find the promised e-mailed documents from the attorney. I printed them out, ran around getting stuff notarized and mailed (the post office lines were shorter than I expected, and the boxes should arrive next week), and dashed home for lunch. I called my sister to tell her that I'd mailed the legal stuff, and discovered that she'd just been in a minor car accident -- she'd skidded into another car in snow -- and was very shaken up, despite no damage to people and only minor damage to cars.

That conversation made me a few minutes late for my beloved annual mammogram, which I've been superstitiously nervous about because my mother's breast cancer was diagnosed the Christmas after her father died. (This was in 1987; obviously she survived it, although the cancer was far advanced even though the mammogram supposedly caught it early.) No one I know enjoys these procedures, anyway: a friend who refuses to undergo them says, "I'll let them do that to me when men start having annual cancer screenings in which their testicles are smashed between two plates."

I don't agree with this sentiment, but I sympathize. Even for modestly endowed women like me, mammograms hurt. Also, I recently taught Barbara Ehrenreich's scathing and brilliant Welcome to Cancerland to my freshman-comp class, so her critiques of breast-cancer culture were fresh in my mind. Ehrenreich is deeply alarmed by the consumerization of breast cancer, which normalizes it and helps transform it into a rite of passage rather than a huge injustice perpetrated upon women's bodies by environmental toxins. (My completely non-activist mother's first words, after her diagnosis, were, "Well, that's what I get for living in New Jersey all these years." Even she got the environmental connection.) Ehrenreich cites studies that call into serious question the efficacy both of current screening methods and current treatments, and points out that if people gave their money directly to cancer research -- rather than supporting runs, walks and rallies with large overhead costs, or buying pink-beribboned teddy bears, jewelry, etc. and so forth -- we might make more headway against the disease. She's especially withering on how the rhetoric of breast cancer, with its pink everything, infantilizes women. In short, she thinks women are being lulled into complacency, whereas anger at the situation might result in more effective action (think Act Up).

Ehrenreich dislikes the color pink. So do I. So does my friend who refuses to get mammograms, who was ecstatic when I told her about the Ehrenreich essay. She hadn't known that anyone else felt the same way.

So I was thinking about all of that while sitting in the very crowded waiting room. I waited over thirty minutes, and finally all of us in the outer waiting room were summoned into the inner waiting room, which was warmer and more comfortable. There we found a large bin of hideous pink plastic Christmas ornaments in shiny purple mesh gift bags. A beaming hospital employee invited each of us to take one home.

I saw pink. Channeling Ehrenreich, I said to the beaming hospital employee, "I have a question. Wouldn't the money that went into manufacturing these ornaments be better spent on actual cancer research?"

She didn't even blink. "Yes. Yes, it would." (Good for you, lady!)

I gave her a brief overview of Ehrenreich. A woman at the other end of the room looked interested and asked me some questions as she cradled her pink ornament. Everyone else ignored us. ("If we don't look at her, maybe she'll go away.")

The hospital employee told me about various hospital projects that do contribute directly to research. Good for them! She and the patient with the ornament decided, between them, that the point of the ornaments was to "give people hope." Hey, if a tacky plastic ornament gives them hope, good for them. I, personally, don't find Christmas trees festooned with kitschy reminders of serious illnesses profoundly hopeful, but we all know how weird I am.

Finally they called me in. I got squashed. The tech was very deft; everyone was very nice. This is the place I always go, because they're very deft and very nice, and the one time I got called back for further scrutiny of an "area of concern" (which turned out to be a shadow), the male doctor was immensely kind and spent much more time talking to me than the situation actually warranted. That interpersonal skill is worth dumptrucks of plastic ornaments.

I went from the mammo place to the gym, where I worked out for forty-five minutes on the elliptical, traveling 3.3 miles and burning 350 calories. I was very pleased with myself, but leaving the gym, I discovered the lobby festooned with pink and white balloons and "See Pink!" banners, as more and more people (including musicians with instrument cases) piled into the building. Some kind of breast-cancer fundraiser was underway. The club staff assured me the money would go to research, which makes me wonder if the refreshments and music were donated.

I blew my workout on three yummy cookies from the tables piled high with treats. I went home to find more treats from my sister: a box of chocolate-dipped fruit. Yum. Goodbye, workout.

At least, thank God, my sister's okay after her accident. And Gary and I will now have a slightly larger financial cushion during my sabbatical. And -- this is the really exciting news -- I just performed my first felted join in a knitting project, and am thoroughly enchanted. No ends to weave in! Yay!

Oy!

I've heard teaching described as an exercise in plagiarism. Most of us cheerfully use approaches, material and exercise we've gotten from colleagues, and most of us also cheerfully share our approaches, material and exercises with colleagues. I do plenty of this myself, although -- mindful to model academic accountability for my students -- I try always to acknowledge my sources.

At the same time, syllabi are intellectual property. Professors put weeks, if not months, of work into these documents. Actually, it probably amounts to years, when you think about all the background reading and thought that culminates in designing a course. Many of my professor friends no longer post syllabi on websites, for instance, because they don't want strangers just lifting their work.

I'll always share syllabi with colleagues in my own department, especially graduate students designing their own courses on similar subjects. But last week, I got an e-mail from a stranger (who shall remain nameless and de-identified, to use HIPAA language) who plans to teach a freshman-comp course about narrative and medicine, and who more or less demanded a copy of my syllabus from this fall. This individual also asked if I'd be willing to read an essay he plans to submit to medical-humanities publications.

The tone and cluelessness of this letter left a seriously bad taste in my mouth. First of all, I spent a long time writing that syllabus, and I'm not just going to hand it over to a stranger. Design your own course, dude! Also, c'mon: it's mid-December, when academics are up to their necks in grading. If you're an academic yourself, surely you know this? And if you're an academic, you must be aware that we all have our own writing to do. No, I don't have time to read your essay. (I have a long-standing policy of only reading manuscripts by current students, unless I'm doing a formal manuscript review for a press, something for which I'll be paid and/or receive service credit from my department.)

Aside: I know that the world is full of people who assume that writers, and writing teachers, greet unsolicited manuscripts with cries of joy because they have nothing else to do with their time. "A 900-page novel about telekinetic gophers! Riddled with grammatical errors! Printed in green ink on butcher paper! In a shoebox! Be still, my heart! My life's dream has been fulfilled!"

Okay, obviously I'm being unkind and sarcastic here. I can identify with the desperation of beginning writers -- been there, felt that -- but there are accepted ways to get people to read your work. Take a class. Enroll in a workshop. Do your homework, and by all that's holy learn the conventions of the field. Be professional or be toast.

I'm sure my correspondent's unread essay was, at least, professionally formatted. But I wouldn't expect a college instructor to fall into the arrogance of sending his work to a stranger without an explicit invitation.

Annoyed, I put off answering this missive until this morning, when I informed him, as nicely as possible, that I wasn't comfortable sharing my writing assignments until he told me how he planned to acknowledge them as my work, not his. (I also reminded him that composition instructors need to be very sensitive to tone in their own writing, since it's something we try to teach our students.) I did send him a list of the reading my students had most enjoyed. I closed, though, by saying that I was sorry I didn't have time to read his essay.

I clicked on "send" and then saw that I had a new e-mail from him. Our e-mails had crossed in cyberspace. His second one copied the text of the first and repeated, with evident exasperation, his demand that I send him my syllabus. He'd also attached his essay so I could read it.

Um.

Dude: it's mid-December, when you may safely expect fellow academics to take a week to answer an e-mail. No, I'm not going to read your fracking essay -- find someone who actually knows you to do that -- and if you want my writing assignments, you'd #!$%* well better footnote me on your syllabus.

Honestly.

I've deleted the second e-mail, since he now has my response to the first. Frankly, I think I was generous to share any information with him at all. I'll still send him my writing assignments if he can promise me that they'll be acknowledged; I'm very curious to see how he'll respond to that request.

In happier news, I turned in my grades yesterday. In even less happy news, grim weather's forecast for the mountains for Saturday through Wednesday, so we may not get to San Francisco at all. Pray for sunshine!

Later: I got back a much nicer e-mail than the other two -- and he seems genuinely engaged with the subject -- so I went ahead and sent him some material. I'm glad the conversation ended better than it started!

Try, Try Again

In 2001, Ellen Datlow bought my story "Cucumber Gravy" for the late, lamented Scifiction e-mag. I describe this story as "C.S. Lewis meets the Coen Brothers in the Nevada desert." I've always been very fond of it, so when the good folks at Tachyon started going through my short fiction to figure out what to put in The Fate of Mice, I hoped they'd choose CG.

They didn't. They weren't fond of the story, which features a slightly challenging central character, and they didn't think the tale fit the marketing label of "literary fantasy," which is what they were going for with my book. (Me, I'd have been fine with a marketing label of "versatile," but, you know, just try finding that section at Borders.) They're very good editors, and the collection hangs together beautifully -- largely because of their selections and ordering -- so when they said CG wouldn't be a good fit, I acquiesced, trusting them to know what they were doing.

I was a little sad, though.

A while ago, John Joseph Adams at Lightspeed sent out a request for reprints. I mentioned CG, but he said that while he loved the story, he didn't think he could use it, partly because it's too long. But a few days ago, he e-mailed me to ask if he could reprint it. Naturally, I said yes. It will be posted in January, along with a short "Author Spotlight" interview with me about the story. I'll post the link here when I have it.

I'm really glad that story will get some more readers. It's always nice when a piece that seems to have been consigned to oblivion gets to come back that way.

As many of you know, I've been publishing the occasional medical poem (and still hope to turn the ED sonnets into a chapbook; that will be one of my sabbatical projects if I get the sabbatical). Quite a while ago now, I wrote a new sonnet about an ED experience and sent it off to The Bellevue Literary Review, which is more or less the New Yorker of the medical humanities, and where I've now been rejected several times. (Getting published there is one of my new life goals.) They rejected this poem, too. Disappointed, if not terribly surprised, I sent the poem off to Pulse, another place I'd really like to be published sometime.

They rejected it. I got that note the same week -- possibly the same day -- as a lovely, warm rejection note from Sheila Williams at Asimov's, who couldn't use a long story I'd sent her.

As I constantly tell my students, writers have to learn to handle rejection, but I hadn't gotten quite that much of it in a while. I was feeling a teensy bit flattened (although Sheila's friendly note helped lessen the sting).

But it's not like this has never happened to me before, so I came up with a new longterm goal for the story, and yesterday I sat down to study the sonnet again. On a whim, I submitted it to the Annals of Internal Medicine, a major medical journal which happens to publish some poetry along with refereed scientific articles. I didn't think I had a chance of getting in, but why not try?

Like many journals these days, Annals uses a computerized manuscript tracking system. Yesterday I submitted the poem and got an e-mail acknowledgment. This morning I got another e-mail, congratulating me on having my manuscript submitted. Blinking, I reread the thing. Surely it was a computer glitch? Surely there'd been no time for anyone there even to read the poem?

But at lunchtime today, I got an official acceptance e-mail from one of the editors, talking glowingly and in great detail about the poem. Needless to say, I was flattered and delighted.

So it's been a good week, writing-wise: not just because of the publications, but because I've been reminded how important it is to persevere.

Onset

And speaking of mental health, one of my poems has just been posted on the Cell2Soul blog (whence, I believe, it will eventually be collected into an issue of the journal).

Friends who've read this have found it creepy and disturbing, so if that kind of thing bothers you, be forewarned.

How to Conquer the Cylons

Thanks for all the comments on my last post; I'm glad everyone enjoyed that particular bit of whimsy as much as I did! (And inky, we've seen the pilot of Caprica and liked it a lot, but will have to wait until the first season comes out on DVD to see more. We're currently behind on our DVD watching, anyway, because I've been so busy at work.)

I didn't even know about the MacMillan-Amazon imbroglio -- Gary filled me in over dinner last night -- but I'm glad it's over.

Now, for the important news. Those of you who've been worrying about the Cylon menace, fret no more! We have the answer!

Cats! (What else?)

I walked into my study yesterday and found Bali on top of the Yarn Vault with his head and front paws dangling over the edge. From this vantage point, he swatted at the shiny Cylon foot poking out from the top shelf, until he'd sent Cylon, knitting and yarn careening to the floor. He then jumped down and proceeded to have his way with the robot and the yarn.

I rescued both; the Cylon now sits in the middle of the shelf rather than the edge. I also took the opportunity to arrange his knitting properly. The experienced knitters among you will have noticed that his right-hand needle's in completely the wrong place in the photo (I'm surprised no one called me on that!). That problem's now fixed. I may post another shot when he gets a bit more done on his scarf.

I'm tempted to buy a teensy-tiny violin for him, but I haven't found one small enough yet.

In any case, it's deeply reassuring to know that in case of Cylon invasion, Gary and I are well-defended.

In other news:

I'm back to practicing my fiddle, and I think my tone's slowly coming back.

My hospital shift this weekend was eventful but satisfying, even though I made several missteps during one visit. At least I know what I did wrong, though.

This morning I sent off a poem I wrote about this weekend's shift. I started with the top market, BLR, which is the New Yorker of the medical-humanities field. I don't expect them to take it, but there are plenty of other places to try.

I swam an hour today, using various combinations of resistance equipment.

Go, me.

More Matters Medical

We took Harley to the vet yesterday for bloodwork and urinalysis. He's been acting just fine, although he's lost a bit of weight (possibly because he's not entirely convinced about the new food, although he is eating it), but midway through his testing, the vet came back into the exam room and said gently, "I need to show you something." She held up a syringe full of his urine, which was dark red from blood. She said it had been a clean stick and his bladder looked normal on ultrasound, and that he didn't seem to be in any pain when she palpated him. The blood will interfere with the protein measurements they wanted to do, though, so he'll need another urinalysis when we've gotten this problem cleared up.

It's most likely a bladder or kidney infection, so I'm hoping it will resolve with antibiotics. We're waiting to hear back from her about test results and next steps.

Last night over dinner, Gary said, "No animals or humans are allowed to die around Christmas this year." Amen. I called his mom yesterday to acknowledge that it would have been my father-in-law's 83rd birthday, and she was grateful.

I'm having bloodwork today, too. I've been unaccountably exhausted in uncharacteristic ways (i.e. exercise makes me sleep more, not less), so my doctor wants to check hormone levels, among other things. The last time this happened, it was because of my sleep disorder, but that's being treated, so it's most likely something else. I've been doing things like sleeping through church, and even for someone who's admittedly not a morning person, that's a bit much!

Oh, I have a new favorite thing to do while I'm knitting (if we're not watching a DVD, that is): listen to audio books on my BlackBerry! I downloaded the BB software from Audible, and I've been having a great time. Their books are expensive, but they're having a Thanksgiving promotion where selected titles are free. Check it out! This will be a wonderful thing for plane trips, too.

So what am I listening to? First I checked out a History Channel program on combat medicine, and now I'm a few chapters into Steven Johnson's The Ghost Map, about a deadly cholera epidemic in Victorian England. Fascinating stuff, but not for the squeamish!

Narrative Medicine in Action

I subscribe to a medicine-and-humanities e-zine called Pulse. Today I got this story in my in-box.

Last week, my freshman-comp students and I were talking about the differences between doctors who listen to their patients and those who don't. I'm going to give the students this story to read; it's as powerful an example as any I've seen.

I hope all of you appreciate it, too.

If You Want God to Laugh . . . .

. . . tell people how much your sock-knitting skills are improving. Then happily turn a heel, only to find that somehow you've produced a lopsided heel, a Quasimodo heel. Rip it. Start the turn over. Get into enough trouble that you have a blankety-blank gusset hole where none should be, although you've at least managed to progress to the ankle. The gusset hole can be fixed: still, it's a set-back, and this sock is much less lovely than the first.

Sigh.

Gary, bless him, isn't bothered by this: they're utilitarian hiking socks anyhow.

In happier news, this morning I gave a presentation on Narrative Medicine to an over-50 adult education group in town. I've spoken to them before, and they're a lovely audience. This class went especially well because I asked the students to do a writing exercise, and three of them came up to the mike to share what they'd written. We were all blown away by what they read. These were very personal, very brave pieces -- incredibly moving and well-written -- and I felt really good about having helped facilitate their creation. That's awkwardly phrased, but I think you know what I mean! Anyhow, it was a great experience.

After teaching that class and two others today, though, I'm tuckered out! And so to bed!

Yet Another Time Sink

A few days ago, I got yet another invitation to join Facebook. Gary caved in a while ago, but I've stayed away, because I was afraid that if I got sucked in, I'd spend hours there and would get even less done than I get done anyway. In fact, although I'm very fond of various dear friends who've invited me there, I was feeling rather self-righteous about the fact that I wasn't on Facebook. I felt that way before blogging before I started, too.

No, I still haven't joined Facebook. But I have become much more active, perhaps disastrously so, on Ravelry. I signed up months ago, looked at a few patterns and joined two or three groups, and never went back. But in my quest for new and better sock patterns, I revisited the place last week, and since have spent hours downloading free patterns, browsing groups (I now belong to nine, a modest number in Ravelryland), and, yes, getting great sock advice.

My latest project -- as if I need another thing to do! -- is to start a Ravelry group for fiberfolk interested in any aspect of Medical Humanities, especially Narative Medicine or Literature & Medicine. And if this sounds insanely specialized, you haven't browsed Ravelry groups. There's one for people who clean house while listening to their iPods (I swear I'm not making this up). There's one for clumsy people, which I should join but haven't yet. There are zillions devoted to various aspects of charity knitting, and there are a lot of medical groups: for doctors, nurses, patients, physician spouses, med students, medical transcriptionists, and pharmacists, among others.

But to start a group, I need to be able to invite three people. So I've put up notices on various boards asking if anyone else would be interested. So far I've only gotten one response -- although it's early days yet -- so I may not be able to carry through. Which, really, would be just fine, given my time constraints! But if you're on Ravelry and interested in MedHum, give me a shout, okay?

The good news is that last night and today, I got a lot of work done for my freshman comp course this fall, which will be about, you guessed it, Narrative Medicine.

Good Docs

Yesterday was a very bad day, the kind of day that involves emergency services and insurance companies. (I'm fine. I'll post about this in more detail when doing so seems prudent.) Today, thank God, was better.

The big event was going to the rheumatologist. He and his resident, between them, spent ninety minutes with me. Can you imagine? I mean, yeah, I'm a new patient, but still! Not only did they take a detailed history and do more of an actual physical than I've had for ages now, manipulating various joints, but we talked about medical education and narrative medicine and the doc's underwater photos hanging on the office wall. He dives, so I told him about Steve's family, and talked about how even though I can't do SCUBA because of sinus issues, I love to snorkel and have swum with sea turtles off Maui.

Medically, I left them puzzled. I always do this to doctors. I'm the Queen of Inconclusive Symptoms. According to the doc, the arthritis in my knee isn't connected to the positive ANA, but I don't have symptoms that would suggest what's causing the positive ANA; furthermore, everything else in my bloodwork (specifically sed rate and rheumatoid factor) is normal. He says there's no such thing as a "false positive" ANA; a positive is a positive, although some people are positive and normal otherwise. He's rechecking the ANA -- especially since the previous lab didn't give numbers, which are important -- and is also testing for antibodies specific to Sjogren's Syndrome, since I have a number of symptoms that fit with that diagnosis (but also fit with other things, like living in the driest state in the country).

It would be pretty funny if I had Sjogren's, since Gary's mom has it. Yet more proof that men marry their mothers! I don't think I have Sjogren's, though.

Anyway, we'll see what the bloodwork shows. If the antibodies aren't there and the ANA titer's low, we figure I'm fine; if antibodies are there and/or the titer's high, I've got something. I'm pretty sure I'm fine, though, except for the blasted knee.

I started having trouble with the knee about fifteen years ago, when he says I was too young for osteoarthritis, although I definitely have that now. (I've got some fluid on the knee, although only a bit.) He's put me on a new anti-inflammatory, Relafen, for the knee pain. Relafen's easier on the stomach than ibuprofen, but it's a generic and only costs $5/month, versus the $100/month the pharmacies want for Celebrex.

I'll be very happy if this stuff works. In the meantime, I'm very happy to have met two nice doctors.

I also wrote today, and knit a little, although I neither swam nor walked. Still, a much better day than yesterday!

Saying Goodbye

Today was the last day of the Narrative Medicine workshop. I woke up nice and early, but still rushed out the door to get to the conference on time. There was a birthday party here yesterday for Larry and Laura's daughter Nicola, who's ten today; the party activities included building geodesic domes out of toothpicks and mini-marshmallows. Very cool! But the family also has a no-shoe rule in the house, so as I came downstairs this morning, I stepped on a bent, upward-sticking toothpick. It pierced the sole of my foot, resulting in a fair amount of bleeding. So I had to hobble back up to the second floor, where Laura and the kids were, to get a bandaid.

My foot's fine now, and several doctors at the workshop told me that while it's probably a good idea to get a tetanus booster, I can wait until I get back to Reno; I don't need a $1,000 ER tetanus shot.

We did a lot of great stuff today. The morning started with a terrific lecture about Narrative Humility, the willingness to have your own perceptions twisted upside-down by a stranger's story or observation. Then we broke into small groups and did an interviewing exercise. We paired up with a partner. For five minutes, Person A told Person B whatever story felt most pressing to tell at that moment. For the next five minutes, A wrote how it had felt to tell the story, and B wrote "what you heard." This could be a verbatim transcription, observations about how A told the story, B's responses to the story, or -- most commonly -- some mixture of the three. Then, for yet another five minutes, B told a story to which A listened, after which B wrote about the telling and A about the listening.

It was a very productive session. We heard fascinating stories, equally provocative responses to them, and then engaged in thoughtful (and thought-provoking) analysis.

After lunch, though, I started to fade. The afternoon plenary was about the process of witnessing in medicine. The speaker was very funny and told wonderful stories, but I kept looking for some overarching argument and not finding it (completely my fault, I'm sure). Then we went back to our small groups for the last time, this time without a faculty facilitator, unless we requested one; we were also given an activity, although it was optional.

My group was already down several people who'd had to leave early. When I got to the room, three of the other members were having a long discussion about saying good-bye: when it's comfortable, when it's not, good and bad ways to handle it in a group setting, etc.

Ordinarily I'd have enjoyed the conversation, but today it reminded me too much of Dad. The last time I saw him, before I left the nursing home to go back to the house for dinner, he said "good-bye," very distinctly and forcefully, twice. I didn't let myself know or think about what that meant; I missed my final chance to say farewell to him, to tell him I loved him. I don't have many regrets, but that moment of denial on my part is definitely one of them, and the conversation was like salt in a wound.

As a result, I was a bit cross and snappish during the group activity, through which we took shortcuts. For instance, we'd been given a writing exercise, but we didn't write -- just talked through the exercise -- because someone in the room was tired of writing. I think everyone had hit a wall, and a few people were impatient to leave. There wasn't the sense of focused attention there'd been for the rest of the weekend; everyone, at least to me, seemed distracted.

It was still a great weekend, though. The faculty and other students were amazing, and I feel privileged to have met them and worked with them.

Oh, I have to share a story someone told me during a break, and which I have his permission to post here. He's an addiction doctor, and we talked about how stigmatized addicts are, and he said that their medical caregivers are often stigmatized by other medical professionals, too: "Why would you want to do that? I said that my family experience has taught me never to give up on anyone, and told him my mother's story. In return, he shared a story from his own practice.

A family contacted him and asked him to admit an 83-year-old man, an alcoholic, into a detox unit. The doctor's colleagues, even the other addiction specialists, were very skeptical. "He's been drinking for so long that detoxing will probably kill him." The patient had reluctantly agreed, though, and his daughters desperately wanted him to have the treatment, so the doctor agreed. The patient was admitted for a standard seven-day stay, and discharged to home and AA meetings.

A year later, the patient's daughters called to tell the doctor that their father had just died. He'd been sober since his hospitalization, though, and they wanted to thank the doctor for what he'd done. They'd finally gotten to know their father without alcohol in his system, with that barrier removed. They'd had a year of relationship with their dad, learning who he really was for the first time, and that was priceless to them.

This is why we need doctors who aren't burned out and embittered, who are willing to see patients as people instead of stereotypes. Go, addiction medicine!

And the adventure continues. Tomorrow: Amtrak to Amherst!

Three Months

In his photo album, my father kept several Father's Day and birthday cards Liz and I had given him. The fact that today's the three-month anniversary of his death makes the Hallmark holiday much more poignant than usual.

In one of our small-group sessions at the Narrative Medicine workshop yesterday, we were given the prompt, "Write about someone whose suffering moved you," and then wrote for ten minutes. Here's what I wrote.

Ambulance Chasing

Through the ambulance window, I see your face, white and glowing. It's raining. I follow the ambulance as closely as I dare. We're on the highway, but it's late, a Monday night; there's not much traffic.

Dad, for almost all your life I feared your drowning as your father did, a suicide, that final visit to the river. They called you to identify the bloated body. For years I saw you bloated with alcohol, living on your sailboat; I feared a fall, or worse.

Instead, you moved to the desert to be near me. I never realized you could drown in the desert, too, the fluid from your CHF rising like tides responding to the moon. Tonight the paramedics said your lungs were almost full.

But you don't want to die, not now. You're going to the hospital, your face the moon I follow through the rain, my own face wet with tears.

Three weeks from now you'll die. The fluid from your skin will soak the sheets. I'll always have known it's you. I never lost you underneath the water. I kept close and watched you breathe.

This piece is about Dad's last ride to the hospital on March 2. The image of the ambulance window -- that rectangle of light, with his whiter face centered in it -- has haunted me, and I'm glad I wrote about it, even for ten minutes. I may do something more with this at some point. We'll see.

Other highlights from yesterday: Talking to Marsha Hurst about the MS program in Narrative Medicine at Columbia, which I'd dearly love to do. Taking a year off for a $50,000 (!) degree isn't feasible, though. They're trying to figure out how to start a low-residency program, which would be much more practical. That's for the future, though.

Also, I had a lovely dinner with Daphne Noyes, the Episcopal deacon and chaplain. We talked about family and loss and chaplaincy and parish life. It was a great conversation.

I didn't write yesterday, because I overslept and had to race to the workshop without even showering. I did better today -- I've had coffee and eaten breakfast, and I'm obviously blogging -- but I doubt I'll write today, either. Maybe tonight, if I'm not too tired.

Happy Father's Day, and if whomever you call father's still alive, cherish him.

Narrative Medicine Workshop, Day One

The first day of the workshop was great. Rita Charon greeted me at the door of the conference room and, when I introduced myself, said, "We're so glad you're here! We were just talking about your blog!" Evidently some of the Narrative Medicine faculty at Columbia read it; Rita told me later, "You're our PR person." That's a bit of an overstatement, but the recognition was still flattering.

During the registration meet-and-greet, I mentioned to Rita that I'm doing a Narratve Med freshman-comp course in the fall. She grabbed my arm and pulled me over to a young woman who's at the workshop to figure out if she wants to go to medical school, but whose faculty mentor from college has done a lot of work with both Narrative Med and composition. "You," Rita said to the young woman, "have to introduce Susan to Ann," and then walked off to let us get acquainted.

The participants are diverse and fascinating. There's a psychotherapist who specializes in clients with chronic and terminal illness; a writer who started a volunteer program pairing professional writers with cancer patients, who work on a writing project of their choice; an oral historian who specializes in trauma narrative; a massage therapist who treats patients with chronic pain; and a family physician practicing refugee medicine in Canada. And that's just a few of the thirty-odd people at the workshop. Quite a bit of geographical diversity, too, with attendees from Canada, the UK, Israel, and South Korea, not to mention from all over the U.S.

And, of course, three of us are chaplains (although I'm really there more as university faculty). The other two chaplains are lovely people, and the one in my small group is an amazing close reader.

It was a busy afternoon. We registered, attended two plenary sessions in an auditorium, moved back to the main conference room to sit in a large circle and introduce ourselves, and then broke into small groups (we'll be working with the same peers all weekend, although faculty will rotate) to do a bit of writing. My group's leader for the first session was Rita Charon herself, and the writing prompt was: "Tell me the story of your name." We had four minutes to write, and she asked us to read aloud exactly what we'd written. We could opt out of reading aloud if we chose, but no one did.

You can't write much in four minutes, and the prompt didn't especially interest me. I was amazed by the results, though. The group analyzed each person's short text in great detail, and in my case, at least, the results were remarkably perceptive. The other group members came out knowing a bit more about my psychology than I'd have chosen to reveal to strangers!

The point of this, of course, was that all writing reveals self, but that the writer him or herself often doesn't see what a reader will. I could have told you that from twelve years of teaching fiction workshops, but being on the receiving end from a group -- rather than one or two individuals -- was both fascinating and unnerving. (Another, even more basic point is that we learn who we are only by narrating our histories, by being our own witnesses to the creation of our own stories.)

After the small-group session, we all went out for a buffet dinner at a nearby Dominican restaurant, and then I walked the fifteen minutes home to Larry and Laura's. I'm hoping to get to sleep early tonight. For one thing, the workshop resumes at 8:30 tomorrow morning (luckily, there's a place across the street that sells very strong coffee!), and for another, I wrote a few pages of a New Secret Project today before the workshop started, and hope to write another few tomorrow.

All will be revealed when I'm able, but it's too soon now.

Meeting Dr. Dino

Today I sat around, trying without success to untangle the mess-o-yarn (which is, as I pointed out to Gary, a fitting metaphor for my life), and then went swimming for the first time since I've been here. Swimming felt great, except when I bashed my head against the end of the pool. The last time I did that was the week before Dad died. Tomorrow I leave for NYC, where, as Gary pointed out to me, I may be physically safer.

In the meantime, though, something really cool happened: I got e-mail from #1 Dinosaur saying, "You're in Philly? Want to meet up? It would be fun to put a face to the blog!" (Lest anyone be alarmed for my safety, my sister and I spoke to Dr. Dino on the phone several months ago, after I got an e-mail saying, "Your mom's in the hospital and homesick for pets? How about a visit from my dog?" That plan didn't work out, so we didn't meet in person, but Liz and I were fairly sure we weren't dealing with an axe murderer.)

The upshot of this was that the esteemed doc stopped by the house after dinner, and met Liz and Lloyd and Mom, and patted kitties and ate chocolate. We talked for three solid hours about blogging, writing, healthcare reform, American attitudes towards medicine, end-of-life care, cats, chocolate, family, grief, TV shows, and the challenges of running a personal practice. I can now happily report that #1 Dino is as funny and smart in person as in cyberspace. It was a terrific visit, and I hope we can do it again sometime.

One of the more interesting parts of the discussion was our debate about how to define "medicine." Dr. D. wanted to limit it to the scientific aspects, which would leave out many people on the healthcare team (chaplains, social workers, etc.). I wanted a broader definition. Okay, said Dr. D, what about breaking it into the art and science of medicine? Too blurry a dichotomy, I said. We didn't get the issue settled, but it's interesting food for thought.

Maybe the wider idea I wanted was simply 'healthcare," with science-based medicine a necessary but not sufficient component: true healthcare, in that model, is bigger than mere medicine, as essential as medicine may be. That's the best solution I can suggest right now, anyway. Healthcare incorporates science, art, policy considerations, economics, sociology, and any number of other disciplines. This leaves Dr. D's initial definition intact, but also makes medicine only part of the picture.

Anyway, it was a lively discussion, good for the brain. After Dr. D left, I watched TV with Mom and Liz. Tomorrow I'll do laundry and, i hope, swim again -- without mishap this time! -- before catching my train for Part II of the Great Adventure: New York City!

Stay tuned!

Wist

If the adjective is "wistful," the noun should be "wist," not "wistfulness." Fewer syllables are always better. (Yes, I know I'm an English professor, but I'm on vacation!)

It feels pretty weird not to be at WisCon this year, especially since two of my favorite writers, Ellen Klages and Geoff Ryman, are the Guests of Honor. Given recent expenses and my general exhaustion, combined with how much else I have to do this summer, skipping WisCon was a mature and grown-up decision (me? grown up?), but I still can't help wondering what's happening in Madison.

This morning, I read through some of the participant bios for the Narrative Medicine workshop I'll be attending in June. One of the professional chaplains who'll be there is also an Episcopal deacon. That gave me a real pang, since I've foregone both of those credentials. (I may yet do CPE sometime -- like, when I retire -- but I don't intend to revisit ordination.) Also, I'm a little nervous about how the ProChaps (TM) at the workshop will respond to my lowly volunteer status. This is not mature or grown up, I know, but the feelings are there anyway, given what a charged issue accreditation is in the field. I got a blog comment once from a ProChap informing me ever so sweetly that I wasn't even entitled to call myself a chaplain, since I'm not board-certified. Oy!

Yeah, I know: it shouldn't matter to me what other people think of me (and the good folk at the workshop probably couldn't care less). I've gotten a lot of lectures on this topic. Kinda ironic, since the people doing the lecturing seem to think I should care what they think about my caring about what other people think. Isn't there, um, a contradiction in there somewhere . . . ?

This afternoon, I cheered myself up by buying lavender and yarn. The woman who runs the lavender store has just gotten a six-week old golden retriver *PUPPY!* which is the cutest thing on four legs, even if it did try to eat my skirt and my hand. At the yarn store, I bought some Noro sock yarn to make myself a scarf, in colors that will go beautifully with the gorgeous cat pin Inez gave me at last year's WisCon.

Oh, a coupla new wrinkles on the medical front. First, the piece of putty covering the donor site for the gum graft popped off last night (the periodontist had said it probably would, although the one covering the actual graft should stay in place), so I've now learned that this procedure can be very painful indeed. I'm back on alternating Advil and Tylenol every four hours -- I haven't needed the Vicodin, thank goodness -- and my mouth lets me know about it if I'm only a few minutes late. And I'm back on a semi-liquid diet. Smoothies rule! Applesauce is good, too.

Which brings us to medical item #2. Longterm readers will recall my talking about how my father always choked on food and liquids; he had dysphagia from a stroke in 2001. He was supposed to be on a thickened diet, but hated it, although he loved applesauce and mashed potatoes with gravy, so we fed him as much of those as he'd eat.

For a while now, I've tended to start coughing when I drink water, because the water goes down the wrong way. I didn't think anything of it -- and didn't even notice that I hadn't been having the same problem with the smoothies -- until two nights ago at dinner, when I took a sip of water and started choking. Suddenly, everything clicked.

"Oh my God," I told Gary. "I have dysphagia! Have you noticed it? That I choke on water?"

"Yeah, you do that all the time. It's really alarming."

"How long have I been doing it?"

"Years."

Since then, I've tried using some of the swallowing techniques Dad's speech therapists taught him (like tucking my chin when I swallow), and those help. I can't believe it took me this long to figure it out, though!

A lot of things can cause dysphagia, including the various autoimmune diseases that would also bump up my ANA. So I'll definitely mention it to the rheumatologist, although I still don't think I have any of those diseases. I called that office yesterday to try to make an appointment, but they hadn't gotten my paperwork from my primary yet. They'll call me when they do.

We're going to a barbecue tonight, although between my sore mouth and the fact that it's looking like thunderstorms, I'm not sure how long we'll stay. If we come home early, we'll watch some more True Blood, which we started watching last night on DVD and adore.