i've had some time to think about it

i've had some time to think about it
and watch the sun sink like a stone
i've had some time to think about you
on the long ride home
                       

i got a call this morning from one of my patients daughters. i know them well.  i love them- really- i do.  she told me that he started bleeding yesterday and she called 911. at the local hospital they told him that this was it- his time was near- he had maybe weeks- and he went home with hospice. he was supposed to be going on a cruise next week- his third one this year- since he got his diagnosis of liver cancer.  i saw him two weeks ago and he looked really good- especially for a guy with metastatic cancer. that visit i meant to talk to him about hospice again- he hadn't been ready when we'd talked about it before. i know that this is how it goes with the liver- it stops working and you can't filter things and get kooky and you can't clot your blood and you bleed and you can't make proteins and you fill up with fluid.  but i wasn't ready for it to be this soon.

i met Mr. A about a year ago.  he looks like santa claus- but he was a gruff old man back then.  he was one of those guys who'd never been to the doctor and wasn't about to start now.  he had baggage.  i love this type of guy.  i love letting them know that i get it, and i'm here when they are ready and that i really do care.  i listened to him for a long time that first meeting.  i didn't say much of anything- i remember his intense blue eyes- and they were searching me out- in a deep way.  he wanted to make sure i was being real.

we've seen each other every month since that visit.  now he looks and acts like santa claus.  he brings me pictures of his trips- he brings his stories- and restaurant recommendations.  i love when i see his name on my schedule.

today it's cold and rainy and lonely looking.  and when his daughter called- i bit my lip.  i hate that i hadn't yet set him up with hospice- i hate that he had to go back into an emergency room.  i feel like i didn't do enough to tell him what i knew was coming.  i know in my heart that he knew, and that his daughter knew- but i can't help feeling that i failed them by not laying it out.  because the more connected you are with people- the harder it is to give bad news.  i know that.  i teach that.

when we went to lalibela in ethiopia- one of the last churches had a tunnel to get to the final church.  the tunnel had been built as a metaphor.  the long dark period representing dying and then emerging into the light symbolizes heaven. or the dark tunnel symbolizes those periods in life that are so hard- dark-lonely and coming out into the light signifies the love of Jesus.  our guide was encouraging us to take this tunnel path and not walk outside to the final church.  he prepared us that it would be about a 10 minute walk in pure darkness before we'd be able to see any light.  i really wanted to do it- to feel that- but i was scared.  we started down the tunnel- and once we were about 20 feet in- it was completely pitch black-and we started feeling panicky- what if something happens- what if we got stuck-what if we were trapped- and we backed out the way we came and took the outside route. we had options.

what was i so afraid of? how bad could it have been? what did i not want to know? perhaps that's what it's like in the end- that fear creeps in- the only one who wants to live to be 100 is the guy who is 99. i don't know, i've never died before.

one of the things that my job forces me to do is look life and death in the face.  and it doesn't get any easier.   it forces me to ask hard questions of myself- and to see myself in process.  is it that the patient isn't ready to hear it- or that i'm not ready to say it (or hear myself say it)? death is never, ever easy.  the sorrow comes in what is left unfullfilled- but there is always something left unfullfilled, isn't there? always someone left behind- always someone you could say 'i love you' to one more time.

Mr A will go home today- he will go home to die. he will have his daughter with him.  she told me she has pictures for me, but she won't bring them, she said, until, well....i won't leave his side. she knows.  they know. he will have hospice.  he will be comfortable.  he will not be in pain. and i know he's at peace because we've talked about it. and  i know he's fullfilled because he's said so. 

in two days i will spend my morning teaching first year medical students about death and dying- about being prepared- about helping our patients to prepare- about addressing the elephant in the room. about saying the D word.  ironic that this week Mr. A is showing me my own issues with this very topic, my own fears, my own avoidance, my own desire to have it not be so. sometimes our patients prepare us.  it's an iteritive process for everyone.

perhaps when you know the tunnel is the only path- perhaps the fear is less-perhaps you reframe, you reach peace, perhaps you turn around and say, i love you, to that someone for the last time.




someone dug a hole 6 long feet in the ground
i said good-bye to you
and i threw my roses down
ain't nothing left at all in the end of being proud
with me riding in this car
and you flyin' through them clouds


One day I took your tiny hand
Put your finger in the wedding band
Your daddy gave a piece of land
We laid ourselves the best of plans
Forty years go by with someone laying in your bed
Forty years of things you say you wish you'd never said
How hard would it have been to say some kinder words instead
I wonder as I stare up at the sky turning red

Headlights staring at the driveway
The house is dark as it can be
I go inside and all is silent
It seems as empty as the inside of me

I've had some time to think about you
And watch the sun sink like a stone
I've had some time to think about you
On the long, on the long
Oh the long, on the long
On the long ride home
                                        patty griffin lyrics
                                        the long ride home
                                        (even better with the music)
                                      

gift

i am in ethiopia because i was given a gift.

the gift was to come to ethiopia with one of my oldest and bestest friends and be with her as she meets her son for the first time.

her little, adorable, coy, smiley-eyed almost 3 year old son- Yoyo- (short for Yohannes). not only do i get to share in the joy of seeing lisa love on this little one, but i see him slowly start to realize that now, he has a mama. it's truly indescribable.

she is one of 11 amazing families- who are all meeting their kids for the first time. and they are all first time parents. and they have all been waiting, for a long time. what a gift to see this amount of love. to see the giving of people to each other- from worlds apart. the unity. the joy. the wholeness. the completion. the life bonds of family forming. i feel somewhere between a quiet observer and a doula. i do not share their stories- although i get the loss some have had, and i get the joy of seeing your child for the first time. i get the fear we all share for our children's future. the insecurities that come with having someone ultimately depend on you. the awe in that change, of one minute being just you- and then being someones mommy. what a gift- all around.

the one sightseeing thing we've done while here is to fly north to lalibela- a musical word- and a place of religious pilgrimage- home of the beautiful churches of the 12th century- carved down into the red volcanic rock of the ground- carved from the top down. the countryside is amazing- tall mountains and canyons- like the american southwest but green and covered in vegetation, grasses and acacia trees and flowering aloe plants. and there are shepherds draped in white cloth scarves with staffs surrounded by goats and skinny cows. there are no cars in lalibela- everyone walks on hilly cobblestone streets- lined with tin-roofed huts and purple bougainvillea and yellow flowering trees- the poverty of mans earth and the natural beauty of how it was before. the contrast i find humbling.

at night it is so dark- the poverty is covered under the blanket of the most amazing starry sky- with only the few scattered lights on the hillside joining it. things seem fairer at night. lalibela feels ancient and biblical- but for me- not in the churches themselves. they are impressive in their history- their architectural structure and religious symbolism- but my feeling of spiritual connection came not in those thick walls with their worn grottos and old priests- it came from the dirty houses and the flowers and the night sky- it came in the universality of a smile- when you can't speak the language. it came with the gift from adom of a goatskin cross for our gift of 2 dollars so he could eat breakfast. "something to remember me by." he said. and in this same way addis ababa has been a spiritual experience. the sharing of souls- the joining of peoples. the connection found in common experience and the connection formed despite uncommon experience. it elevates- there is hope-there is joy- there is grace.

so we left lalibela with her flowers and stars and histories. and soon we will leave addis ababa too. and lisa will kiss yoyo 1000 times to hold him over until her return when she will bring him home for good. the gift will be complete and two worlds will begin again, now together.