thanks

tomorrow is thanksgiving. mike is making pie. there is still some snow on the ground. grounding me here. where i spent my first thanksgivings.

new england.

where i spent last thanksgiving. alone (kind of) most of my family in uganda. zoe in new hampshire in a hospital.
long lonely nights, cold drives home in the dark,
short visits in plastic chaired windowless pastel waiting rooms that locked.
illusions of safety for when the mind is playing tricks. unavoidable fear hanging on peoples faces- the people who didn't think their life would end up like this- or their child's.
people who remember days that looked nothing like this. days that smelled of fennel and summer grass and long light that hung on for hours. who didn't think thanksgiving would ever be so lonely and so blurry. 

last november time divided up like coffee spoons. one thing trailing on another. and the waiting. endless waiting. for a bed. for a space. for the medicine to work. for the dose to be right. for things to settle. for just, time.

it's better now. she is better. but we are here again. together thankfully on thanksgiving. and there is still that question of time in what can feel like coffee spoons and there is still waiting. but there is thanks.

and there is hope. because there has to be. because i'm choosing that. because i believe God doesn't abandon us half way and leave us there. it might take a really long time in a really dark place, but eventually light and life crack there way in and change comes. i've seen it again and again, heard it, felt it and i have known it.

these days zoe does her own shower completely independenly-start to finish. she makes her own oatmeal. and she makes her own packed lunch and she gets herself out the door independently. sometimes i forget that this is big deal. i forget that last year she really couldn't get her own cold cereal. i forget that she couldn't really be left alone. ever. i forget how many coffee spoons of time we have measured out in this past year.

it often seems like baby steps- when you get to places that you feel like you should have been years ago. but it's really important to stop and mark them. to remember where you were last year.
driving away in the dark across the state line with her words echoing over and over, "there must have been a terrible mistake. this is not where i'm supposed to be."

contrast

the first snow is here. my kids ran outside barefoot.  contrast.
into the white. the cold. is this real? is this really where we are?

a day full of patients. it's busy. there are schedules. everything is pale. everyone is pale. life feels devoid of color. but there is contrast everywhere.
it's between what i see and what i feel.
what i live and what i remember.

we had a meeting today about office protocols. about the seconds lost in our current system when an ambulance needs to get called and transport a patient from our medical office to the emergency room. i had to do this a few weeks ago for a patient of mine who was having a heart attack. i thought it went well. she'd had her EKG, an aspirin, oxygen and the ambulance came in under 5 minutes and she was on her way and in the cath lab in 30 minutes having her coronary arteries investigated. they were talking about the fastest way to get the ambulance to the right room. we are talking seconds.

*    *   *    *   *    *
he had HIV/AIDS and TB at least i'm pretty sure it was TB. he was panting for air, wasting away, vital signs were not good. he needed to get admitted from our little clinic in uganda to the big referral hospital. there was no oxygen. there was no ambulance. i wrote a note and asked if someone could organize a ride for him- that he needed to go quickly to the hospital. yes- they could- yes he would. i went on to the next patient. a few hours later i saw him still in the clinic looking worse. i found the nurse and asked what was happening. the man with the key to petty cash is gone she said. she couldn't get money to get fuel for the car to take him to the hospital. she hadn't wanted to bother me with the details.

these are the contrasts i live with. that we hold.

i was listening to someone today. to their lungs. the air going in and out. i was thinking about how many times a day i listen now and how most of the time they sound fine. and of how many doctors each of my patients here have. i am one of so many. a piece in a giant machine. standing beside those lungs today i almost started to cry. i thought what if i do ? what if i just started to cry right here in this exam room in the middle of danvers massachusetts?

and the patient would look perplexed and horrified and ask what on earth i had heard in her lungs that was so awful that i had begun to cry? and i would say it's nothing at all. that's just it. it is nothing at all.