I am asked from time to time if I am happy. The easy answer of course is yes; saying no would then require some explanation that the concerned party probably has no interest in hearing.
But the truth is, I usually do not think of myself as being happy or unhappy. Happiness is too general a word to convey what is important to me in my life. In fact no single word or term serves that purpose. Some that do are engagement, purpose, & meaning, and of these, engagement best expresses what I hold valuable.
First, let me create this image in your mind. Imagine a sailboat on a very windy day. Its sails are billowed taunt with wind and the keel is buried deep in the water as it moves swiftly across the surface, harnessing the forces of nature. All the elements are working, and the boat is engaged in doing what it is meant to do.
This is what I strive for, to be engaged in doing the work I am meant to do, whatever it might be. I am most content with life when I am engaged in my life’s work; it gives me a sense of purpose and meaning. So isn’t that happiness? Perhaps, but I avoid that description because engagement doesn’t mean serenity and peace of mind. The work of one’s life is usually accompanied by anxiety, stress, and a roller coaster of emotional states. Certainly there are times when I feel happy, but there are other times when I’m anything but happy.
A word about “work”. I use it frequently in my writing referring in a broad sense to what we do to fulfill our life’s purpose. Of course this implies that we have a sense of that purpose.
Think of this work as “good work”, work that replenishes the energy it consumes, work that may leave us exhausted, but with a sense of satisfaction and fulfillment. For me, my years in private practice and most of my emergency room experience was this good work, as is the time spent creating art. I feel the same about writing and journaling. In each of these endeavors, especially creating art, I have experienced the extremes of emotions -, anxiety, self-doubt, distress, frustration, as well as satisfaction and gratitude for the opportunity to be doing all of this.
OK, so in the end it is all semantics
Saturday, September 29, 2007
Thursday, September 27, 2007
AN ARTIST'S STATEMENT...of sorts
I have lost track of the number of times I have tried writing about my art, only to give up in frustration. I don’t know why it is so difficult for me to do. Perhaps because I don’t completely understand it. Then again, maybe I do, but don’t know how to bring all of the complexities of the forces that drive my art together, into a single, comprehensive notion. Regardless of the reason or reasons, this time I will simply “explain” myself in a series of observations which may or may not relate to one another. By necessity these observations will be rather general, and exceptions exist in abundance.
MY ART IS BORN out of an encounter with the world around me. Something stirs within when I see broad visions of a rural landscape, the rich texture and colors of an urban market, or the enchanting lines of architecture. My art is a response to these encounters.
I have been accused of seeing the world through rose colored glasses and of being a “friggin Pollyanna” by none other than my loving wife. And I suppose she is right. I do look for the best in everything and everyone, and that is what my art is all about. Of course it is an unconscious act, taking away from the encounter what I deem to be beautiful and worthwhile, finding the remains of elegance and pride in long abandoned barns, farms, and storefronts.
If there is one common thread in all of my art it is my desire to CREATE A SENSE OF PLACE. I want the viewer to see the piece of the world that I’ve created, to discover new ways of looking at the elements of my landscapes. Of course it is the world I see through rose colored glasses!
Rarely are people seen in my work (never say never), but I usually include some evidence of the human presence. It may be as elaborate as an intact structure, to as brief as a single line of fence posts.
My work on canvas is in sharp contrast to my watercolors. The broad landscapes are loose and intuitive, often imaginative; I feel no need to be absolutely literal in my depiction of the scene. The watercolors however are usually very tightly conceived and executed. Once started there is little deviation from the plan (not so with the work on canvas). All the creative effort takes place in the conception of the composition.
The work with soft pastels fall somewhere in between these 2 extremes.
Wednesday, September 26, 2007
MY GRANDFATHER'S GRAPES
From a Journal of Dreams
I am walking through the flat south Jersey fields of my childhood, heading east into the land that once was the Renzulli farm. To the south I can see the Goffredi homestead and the fields where we played so many baseball games. To the north, beyond Siciliano’s farm is the silhouette of the cannery; I could still see the trucks, overflowing with ripe tomatoes, lined up during the glorious late summer days, the air smelling heavy from the tomatoes being processed for canning.
I am explaining all of these images to whoever might be with me on this dreamy journey, as we enter the overgrown field where our vineyard once so proudly thrived. ( It was a small vineyard, perhaps 15-20 rows of grapes about 500 ft long. But to me it was a magical playground, where the large leafy plants offered many intimate hiding places, nurturing so many fantasies and dreams of a young boy playing his games. And the best part? At any time you could pick a handful of large grapes, white, blue, or red, and squeeze the skin and pop the pulpy, juicy grape directly into your mouth.) Once I am in the field, I am alone, and my only thought is to look for signs of the long gone grapes, hoping there might be one or more small shoots that have survived after all these years. I begin to dig and scrape away some of the surface soil, and to my amazement, and delight, find old, thick, gnarled roots, one of which has a small green shoot trying to extend upward. I continue digging and looking and am rewarded with several more roots with signs of tender life. There are no words to adequately describe the joy and elation that my discovery prompted. It was a feeling that survived, intact, the transition from my dream state to consciousness. I wanted so desperately to see that vineyard one more time.
Before attempting to remove them I know I must do two things, first, get permission from the current owners to do so, and second, do some research on how to safely remove and transplant the roots.
I want to restore-resurrect the grapes of my grandfather and father. I want to see the Renzulli vineyard, producers of Father & Son Claret, thrive, one more time.
I am walking through the flat south Jersey fields of my childhood, heading east into the land that once was the Renzulli farm. To the south I can see the Goffredi homestead and the fields where we played so many baseball games. To the north, beyond Siciliano’s farm is the silhouette of the cannery; I could still see the trucks, overflowing with ripe tomatoes, lined up during the glorious late summer days, the air smelling heavy from the tomatoes being processed for canning.
I am explaining all of these images to whoever might be with me on this dreamy journey, as we enter the overgrown field where our vineyard once so proudly thrived. ( It was a small vineyard, perhaps 15-20 rows of grapes about 500 ft long. But to me it was a magical playground, where the large leafy plants offered many intimate hiding places, nurturing so many fantasies and dreams of a young boy playing his games. And the best part? At any time you could pick a handful of large grapes, white, blue, or red, and squeeze the skin and pop the pulpy, juicy grape directly into your mouth.) Once I am in the field, I am alone, and my only thought is to look for signs of the long gone grapes, hoping there might be one or more small shoots that have survived after all these years. I begin to dig and scrape away some of the surface soil, and to my amazement, and delight, find old, thick, gnarled roots, one of which has a small green shoot trying to extend upward. I continue digging and looking and am rewarded with several more roots with signs of tender life. There are no words to adequately describe the joy and elation that my discovery prompted. It was a feeling that survived, intact, the transition from my dream state to consciousness. I wanted so desperately to see that vineyard one more time.
Before attempting to remove them I know I must do two things, first, get permission from the current owners to do so, and second, do some research on how to safely remove and transplant the roots.
I want to restore-resurrect the grapes of my grandfather and father. I want to see the Renzulli vineyard, producers of Father & Son Claret, thrive, one more time.
Monday, September 24, 2007
A LIFE WITHIN
In the mid 70’s, between the ages of 35-40, my life underwent a major transformation with consequences far beyond anything I could have imagined.
The simplest description of what happened is this - I discovered the inner life, a very significant part of who and what I am. Until then my life existed almost entirely in the consciousness of the world around me. I was oblivious to the richness and extent of those creative and spiritual resources lying deep within me, waiting patiently for their time. Undoubtedly these hidden forces had been directing and guiding me in spite of my ignorance of them (For example, my choice of medicine as a career). The moment I became aware of their existence my life changed, forever. My dreams, fantasies, aspirations and sorrow...all took on added meaning and became tools for emotional and spiritual growth. It was as if I had a built in counselor. It was my soul.
This happened both suddenly and gradually, as a number of revelations coincided to form an undeniable message. Let me recount two experiences that have been branded into my memory.
The first was overwhelming in its simplicity. It occurred during a period in my life when I was agonizing over a very difficult, life changing decision, could I find a way to liberate the artist that was calling me and still continue to practice medicine. Pursuing art as a hobby was not a choice, yet to leave my medical practice after spending 12 years preparing for it was almost unthinkable (at that time I had only been practicing for about 6 years). I awoke one morning with an incredible and unshakable sense of knowing that I need not be afraid! The feeling was powerful and overwhelming, unlike anything I had experienced before...I knew that I had nothing to fear, and making the decisions I needed to make suddenly became that much easier. That admonition, a gift from somewhere showing me there were ways of “knowing” that I had not been aware of, has become a guiding principle in my life. I now think of difficult life decisions as workable or non-workable as opposed to right or wrong.
The second experience involved writing. It was a pleasant spring day, and I decided to sit in the yard and sketch some of the flowers in our wild flower garden. I can’t remember what prompted me to begin writing, but I did, and what followed was a lengthy poem, spontaneous and fluid, and uninterrupted by any conscious thought or deliberation. The words just came, unannounced, and when it was done, I knew what it meant to be visited by the muse. That experience confirmed for me, without a doubt, the existence of the subconscious and its role in our inner life. This experience has been repeated frequently in my daily journaling, and I have since learned that it is a familiar phenomenon to writers and other artists. Psychologists tell us that these unconscious forces are at work in all of us.
Whether it is called revelation, inspiration, intuition, or whatever, these experiences have taught me the reality of another dimension to life, one that is there to serve us if we take the time to cultivate and nurture it.
In so many ways these, and others, marked the beginning of a new and richer life for me.
The simplest description of what happened is this - I discovered the inner life, a very significant part of who and what I am. Until then my life existed almost entirely in the consciousness of the world around me. I was oblivious to the richness and extent of those creative and spiritual resources lying deep within me, waiting patiently for their time. Undoubtedly these hidden forces had been directing and guiding me in spite of my ignorance of them (For example, my choice of medicine as a career). The moment I became aware of their existence my life changed, forever. My dreams, fantasies, aspirations and sorrow...all took on added meaning and became tools for emotional and spiritual growth. It was as if I had a built in counselor. It was my soul.
This happened both suddenly and gradually, as a number of revelations coincided to form an undeniable message. Let me recount two experiences that have been branded into my memory.
The first was overwhelming in its simplicity. It occurred during a period in my life when I was agonizing over a very difficult, life changing decision, could I find a way to liberate the artist that was calling me and still continue to practice medicine. Pursuing art as a hobby was not a choice, yet to leave my medical practice after spending 12 years preparing for it was almost unthinkable (at that time I had only been practicing for about 6 years). I awoke one morning with an incredible and unshakable sense of knowing that I need not be afraid! The feeling was powerful and overwhelming, unlike anything I had experienced before...I knew that I had nothing to fear, and making the decisions I needed to make suddenly became that much easier. That admonition, a gift from somewhere showing me there were ways of “knowing” that I had not been aware of, has become a guiding principle in my life. I now think of difficult life decisions as workable or non-workable as opposed to right or wrong.
The second experience involved writing. It was a pleasant spring day, and I decided to sit in the yard and sketch some of the flowers in our wild flower garden. I can’t remember what prompted me to begin writing, but I did, and what followed was a lengthy poem, spontaneous and fluid, and uninterrupted by any conscious thought or deliberation. The words just came, unannounced, and when it was done, I knew what it meant to be visited by the muse. That experience confirmed for me, without a doubt, the existence of the subconscious and its role in our inner life. This experience has been repeated frequently in my daily journaling, and I have since learned that it is a familiar phenomenon to writers and other artists. Psychologists tell us that these unconscious forces are at work in all of us.
Whether it is called revelation, inspiration, intuition, or whatever, these experiences have taught me the reality of another dimension to life, one that is there to serve us if we take the time to cultivate and nurture it.
In so many ways these, and others, marked the beginning of a new and richer life for me.
Saturday, September 22, 2007
A GENTLE MAN AM I.....BUT!!
Notes from an emergency room journal
At least that is how I think of myself, and I believe those who know me would agree with this humble assessment. I abhor violence of any kind and would never think of striking someone, well, OK, maybe I would think of it, but would never do so! (When I was 9 years old I did punch Eddie Siciliano and his cousin in their noses, but that was only because they provoked me.) Except in very rare circumstances I do not yell and scream at others. In fact, my life in general has been focused on making other people feel better about themselves, both physically and emotionally. So the incident I am about to describe is totally out of character for me, in fact looking back I cannot believe it really happened, but it did.
Emergency medicine in a busy city hospital can be challenging and stressful, especially late on Friday and Saturday nights when there is no telling who and what will walk through the door. The experience can drive an otherwise sane and gentle person to uncharacteristic behavior. THAT is my excuse, and I’m sticking to it!
Shortly after the ”last call” in the local pubs we could count on several patients scattered about the ER on gurneys in various states of acute intoxication. Most of the time they were understandably subdued and quiet, but there was always the occasional obnoxious drunk who could not resist articulating his (they were almost always men.) alcohol-tainted feelings about his current life’s circumstances.
It had been an especially busy night and I was near the end of my shift in the acute care unit. I was tired and depleted, struggling to cope with all that was required of me, and this one very noisy and obscene drunk was beginning to get on my nerves. A constant stream of obscenities flowed from his mouth, loud enough to be heard by the other patients in the area. I politely asked him to be quiet, repeatedly, to no avail. I tried pleading, coxing, and even bribing, but nothing worked. Finally in desperation I threatened him! I told him that if he did not cease his yelling I would remove his filthy socks from his equally filthy feet and stuff them in his mouth!! Actually I believe I yelled something like, “if you don’t shout your goddam filthy mouth I’ll’....well, you get the idea. He told me to F___ off, and continued to yell and swear. So I did it! To the shock of the nurses and staff, and to the patient, I pulled off one of his socks, balled it up, and shoved it into his mouth.
I don’t know how many of you readers have had the occasion to remove socks from the feet of some one who hasn’t bathed in who knows how long; the skin of the lower legs and feet is dry, flaky, and dirty, and when a sock is pulled of the foot it is invariably accompanied by dry flakes of dirty skin.
I really don’t know how long it remained in his mouth, far less than a minute. But it was effective. He knew I was not some one to be antagonized; in his alcohol-saturated mind I was mean and evil, and certainly not a compassionate healer. I suspected that even the ER staff looked at me a little differently after that.
There is no telling what a Friday night shift in the ER will do to a person
Thursday, September 20, 2007
Notes from an emergency room journal
After leaving my practice to pursue a career in art I spent the next four years working in a busy city emergency room. Covering vacations for the full time staff, I worked full time for 3 months (with no regular shift pattern) followed by 3 months off. The psychological “swing” between 3 months in the emergency room and 3 months in my studio was incredible. Within a year of this change my marraige of 17 years came to an end andI was entering the most difficult period in my life. My sketchbook/journal was a constant companion. I don’t know if I could have survived without it. What follows is a sampling of that experience recorded at all hours of the day and night whenever time and circmustances would permit.
In order to keep my drawings fresh and spontaneous I restricted myself to using only pens, my favorite being a pilot permanent felt tip or my old but faithful Parker 45 fountain pen (no longer available). Pencils and ballpoint pens were verboten!!!
A few words about our emergency room.
Area I...where all non life threatening problems were seen. Usually a very long lonely 10 hour shift which felt more like 14 hours.
Area II...Trauma and life threatening illnesses and injuries were managed here. Almost always a hectic, stressfull, but very fast 8 hour shift. This is where all the “action” was, as well as most of the ER staff, including the ever eager emergency medicine residents.
Military time...0800 to 1600 hrs-8am to 4pm
1600 to 2400 hrs-4pm to midnite
0000 to 0800 hrs-I’d rather not talk about it!
Room 21...Ob-gyn
Room 22...Acute psych cases. Patients frequently shackled and cuffed when brought in by the police.
Some of the sketches have been reworked or touched up when necessary to protect individual identies, or, when my handwriting required translating.
I hope you enjoy the babble from my pens: drawings, comments, and meaningless doodles, all created in my effort to survive the major crisis that was my life for those few incredible years.
*****
In order to keep my drawings fresh and spontaneous I restricted myself to using only pens, my favorite being a pilot permanent felt tip or my old but faithful Parker 45 fountain pen (no longer available). Pencils and ballpoint pens were verboten!!!
A few words about our emergency room.
Area I...where all non life threatening problems were seen. Usually a very long lonely 10 hour shift which felt more like 14 hours.
Area II...Trauma and life threatening illnesses and injuries were managed here. Almost always a hectic, stressfull, but very fast 8 hour shift. This is where all the “action” was, as well as most of the ER staff, including the ever eager emergency medicine residents.
Military time...0800 to 1600 hrs-8am to 4pm
1600 to 2400 hrs-4pm to midnite
0000 to 0800 hrs-I’d rather not talk about it!
Room 21...Ob-gyn
Room 22...Acute psych cases. Patients frequently shackled and cuffed when brought in by the police.
Some of the sketches have been reworked or touched up when necessary to protect individual identies, or, when my handwriting required translating.
I hope you enjoy the babble from my pens: drawings, comments, and meaningless doodles, all created in my effort to survive the major crisis that was my life for those few incredible years.
*****
Tuesday, September 18, 2007
Wired for sound
OK, it’s time to lighten up. The last two posts have been pretty heavy. In case readers have not caught on yet, my posts mirror the way in which I live my life, moving between things in what appears to be a random fashion. A visit to my studio would quickly confirm this.
As many of you know, I live with my lovely wife Patience and nine dogs, all of which have to be walked everyday (the dogs that is). I am currently responsible for walking two of them, but for a while I was walking 3 at a time, and when Patience is out of town I walk all of them. Because they tend to go bonkers when they see critters, a.k.a., cats and squirrels, both of which are in abundance in Lowertown, we limit the number on any walk to 3.
One day I wondered what it would sound like if I were wired for sound:
Who wants to go for a walk? Delia, Sam, and Charlie, ok.
Mamma, down! I’ll take you next. Down!! I won’t forget you.
Good boy Charlie, you’re a good dog. Maria, stop that!
Guys wait...I gotta get some baggies...stop pulling!
Be a good girl Delia...good boy Charlie.
Delia don’t pull! Good girl.
Stop it Sam...Delia be good...Sam drop that...OUT SAM...DON’T EAT THAT!
Delia Don’t! That’s better...just walk. Good boy Charlie.
Good girl Delia...Sam don’t step in the poop...Dammit Sam. Come on...let’s go, just walk. No Delia!
It’s just a bird...good girl...you guys are good dogs.
DELIA, NO! STOP IT!!! Quiet dogs...gooood dogs...just keep walking. Good boy Charlie.
%@#@!^#@! I can’t believe I’m picking up dog poop in front of all these people.
Be a good dog Sam...we’ll be home soon. Good boy. No Delia...keep walking.
Stop that! STOP PULLING!!! NO...DON’T EAT THE WORM! Charlie keep walking or I’ll step on you.
Delia stop it...stop pulling...I know you know exactly what you’re doing. Sam don’t. No peeing on bushes!
You guys....no, it’s just a bird...keep walking. Quiet dogs...good guys.
DAMMIT DEHLIA...STOP THAT!!! No Sam, you can’t eat that. Just wait. Good boy. Delia!
OK, that’s better...good dogs...you’re all good dogs. Yes Delia...you’re a good dog. You too Sam...I know...I love you too.”
As many of you know, I live with my lovely wife Patience and nine dogs, all of which have to be walked everyday (the dogs that is). I am currently responsible for walking two of them, but for a while I was walking 3 at a time, and when Patience is out of town I walk all of them. Because they tend to go bonkers when they see critters, a.k.a., cats and squirrels, both of which are in abundance in Lowertown, we limit the number on any walk to 3.
One day I wondered what it would sound like if I were wired for sound:
Who wants to go for a walk? Delia, Sam, and Charlie, ok.
Mamma, down! I’ll take you next. Down!! I won’t forget you.
Good boy Charlie, you’re a good dog. Maria, stop that!
Guys wait...I gotta get some baggies...stop pulling!
Be a good girl Delia...good boy Charlie.
Delia don’t pull! Good girl.
Stop it Sam...Delia be good...Sam drop that...OUT SAM...DON’T EAT THAT!
Delia Don’t! That’s better...just walk. Good boy Charlie.
Good girl Delia...Sam don’t step in the poop...Dammit Sam. Come on...let’s go, just walk. No Delia!
It’s just a bird...good girl...you guys are good dogs.
DELIA, NO! STOP IT!!! Quiet dogs...gooood dogs...just keep walking. Good boy Charlie.
%@#@!^#@! I can’t believe I’m picking up dog poop in front of all these people.
Be a good dog Sam...we’ll be home soon. Good boy. No Delia...keep walking.
Stop that! STOP PULLING!!! NO...DON’T EAT THE WORM! Charlie keep walking or I’ll step on you.
Delia stop it...stop pulling...I know you know exactly what you’re doing. Sam don’t. No peeing on bushes!
You guys....no, it’s just a bird...keep walking. Quiet dogs...good guys.
DAMMIT DEHLIA...STOP THAT!!! No Sam, you can’t eat that. Just wait. Good boy. Delia!
OK, that’s better...good dogs...you’re all good dogs. Yes Delia...you’re a good dog. You too Sam...I know...I love you too.”
Sunday, September 16, 2007
Saturday, September 15, 2007
A few comments on the care of the terminally ill
It is helpful to consider the physician(s), the patient, immediate family (spouse, children, and parents), and hospice when appropriate, as a team working together for the benefit of the patient. This does not trump the physician - patient relationship that remains inviolable.
A physician cannot and should not care for the patient without family involvement. Caring for the family is critical to the care of the patient.
WHOSE FEELINGS ARE BEING CONSIDERED?
For the physician - be certain you are acting on behalf of the patients feelings and well-being and not your own. Some physicians seem to have difficulty acknowledging the futility of treatment when that stage is reached. The physician must recognize when hope becomes detrimental and the patients best interest is better served by a reality check.
For the family - It is painful to learn that a loved one has been diagnosed with an incurable disease, and it is understandable why someone’s difficulty in letting go can result in advocating care choices that are not in the best interest of the patient.
COMMUNICATION
It is imperative that everyone be informed of conditions critical to care decisions. It was my practice to tell the patient and family clearly and accurately the diagnosis and possible implications and prognosis. I did this early, usually at the time of diagnosis. After that I spoke in more guarded terms, letting my feel for what the patient was able to accept be my guide. This is important to nurture hope. Later, when conditions become clearly irreversible, and unrealistic hope may become detrimental, it might be necessary for the physician to inject a more realistic appraisal to the patient and the family. This is when the art of medicine is called for.
*****
The physician’s role does not end when hospice is called in. and yes, there is still a place for a house call, even if it is just to say hello and hold a hand. Saying you are too busy is a feeble excuse.
My daughter Beth, who does not do in-hospital work, informs me that when her patients are in the hospital she calls them directly on their bedside phone to ask about them and let them know she is concerned about their well being. (Is it any wonder that I am so proud of her?)
More than anything else, I believe the role of the physician is to communicate to the patient and their family that dying is a natural phenomenon that every one of us will face, sometimes prematurely, and that it is in everyone's best interest when the imediate family plays and active role. The time a family spendds together during the final stages of dying is invaluable to everyone. I learned this from my mother.
A physician cannot and should not care for the patient without family involvement. Caring for the family is critical to the care of the patient.
WHOSE FEELINGS ARE BEING CONSIDERED?
For the physician - be certain you are acting on behalf of the patients feelings and well-being and not your own. Some physicians seem to have difficulty acknowledging the futility of treatment when that stage is reached. The physician must recognize when hope becomes detrimental and the patients best interest is better served by a reality check.
For the family - It is painful to learn that a loved one has been diagnosed with an incurable disease, and it is understandable why someone’s difficulty in letting go can result in advocating care choices that are not in the best interest of the patient.
COMMUNICATION
It is imperative that everyone be informed of conditions critical to care decisions. It was my practice to tell the patient and family clearly and accurately the diagnosis and possible implications and prognosis. I did this early, usually at the time of diagnosis. After that I spoke in more guarded terms, letting my feel for what the patient was able to accept be my guide. This is important to nurture hope. Later, when conditions become clearly irreversible, and unrealistic hope may become detrimental, it might be necessary for the physician to inject a more realistic appraisal to the patient and the family. This is when the art of medicine is called for.
*****
The physician’s role does not end when hospice is called in. and yes, there is still a place for a house call, even if it is just to say hello and hold a hand. Saying you are too busy is a feeble excuse.
My daughter Beth, who does not do in-hospital work, informs me that when her patients are in the hospital she calls them directly on their bedside phone to ask about them and let them know she is concerned about their well being. (Is it any wonder that I am so proud of her?)
More than anything else, I believe the role of the physician is to communicate to the patient and their family that dying is a natural phenomenon that every one of us will face, sometimes prematurely, and that it is in everyone's best interest when the imediate family plays and active role. The time a family spendds together during the final stages of dying is invaluable to everyone. I learned this from my mother.
Thursday, September 13, 2007
MY MOTHER’S LAST GIFTS
My mother died in 1991 after a year long srruggle with cancer . Six years earlier she and my father moved into a small house they built on our farm so they could be close to Patience and me. They were both in their seventies, and as an only child we thought it would be good to have them nearby. We didn’t know at the time just how good that would prove to be. I was working two 12 hour days a week in an urgent care area and Patience was working part time as a recovery room nurse. So, when my mother’s illness progressed to the point where she needed more attention we were there to provide it. In addition, my daughter Beth was living with them at the time and was also available for additional help.
I graduated from medical school in 1965, completed 4 years of residency and 2 years in the US Navy medical corps, became board certified in internal medicine, and completed nine years of private practice, and in all that time I cannot remember one class, conference or other teaching experience in dealing with death and the dying patient. All that I knew came from reading Kubler-Ross’s book, Death and Dying. My mother was about to change all of that!
My parents managed to maintain some semblance of a normalcy in the early stages of the disease, in spite of several hospitalizations. But as the disease progressed, and her condition deteriorated, Patience, Beth, and I became more involved in her day to day care. Eventually our local hospice was called in. As my mother’s pain increased, managed by morphine, she never complained, even as she became increasingly dependent on others to manage the routines of daily living. In the weeks prior to her death we began taking turns sleeping in the bed next to her because of increasing mental confusion and unexpected needs. She began to withdraw from us, not speaking, and often calling out to her beloved Gace, a deceased older sister who was more like a mother to her during her childhood. When my mother died, my father, Patience, and I were at her bedside holding her hands. (The circumstances of her last few hours were remarkable and will be described in a later post on this blog.)
The relief I felt from her death was overshadowed by the sadness of our loss. We were all tired from the time and energy, both emotional and physical, that we spent on her care. But in the days that followed I realized how fortunate we were to be able to be by her side through all of the stages of her dying and death. She was not alone; we had the opportunity to tell her all of the things we wanted to say, especially how much we loved her. In her suffering, she gave us that gift, to be a part of her illness and her death. I cherish every moment of those final months, weeks, and days, as well as the final moment itself.
My mother also taught me everything I needed to know about death and dying, and how it effects both the patient and the family. That knowledge served me and my patients well when I decided to return to a full time general medical practice one year later. (We opened an office in the front part of the old pig barn on our farm, but that is also another story.) I learned how incredibly important is for both the patient (and the family) to be at home, surrounded by family and friends when they die, And, I learned that it is imperative that the physician caring for a terminal or near terminal patient also consider the family within the scope of his or her care.
Then there is her final gift, one I cherish every day of my life. Beth, who had been looking for her place in life since she completed college 2 years ago, turned to Patience and me at the dinner table some months after her grandmother’s death and said she knew what she wanted to do. We both looked at her in anticipation of this announcement, and when she said she wanted to go to medical school...I could not believe my ears! Even now, as I recall that moment, my eyes get rather moist. Beth is now practicing medicine (internal medicine) with a partner in Middletown, Delaware and she is a wonderful physcian.
These are only a few of the memorable gifts from a dying grandmother and mother.
I graduated from medical school in 1965, completed 4 years of residency and 2 years in the US Navy medical corps, became board certified in internal medicine, and completed nine years of private practice, and in all that time I cannot remember one class, conference or other teaching experience in dealing with death and the dying patient. All that I knew came from reading Kubler-Ross’s book, Death and Dying. My mother was about to change all of that!
My parents managed to maintain some semblance of a normalcy in the early stages of the disease, in spite of several hospitalizations. But as the disease progressed, and her condition deteriorated, Patience, Beth, and I became more involved in her day to day care. Eventually our local hospice was called in. As my mother’s pain increased, managed by morphine, she never complained, even as she became increasingly dependent on others to manage the routines of daily living. In the weeks prior to her death we began taking turns sleeping in the bed next to her because of increasing mental confusion and unexpected needs. She began to withdraw from us, not speaking, and often calling out to her beloved Gace, a deceased older sister who was more like a mother to her during her childhood. When my mother died, my father, Patience, and I were at her bedside holding her hands. (The circumstances of her last few hours were remarkable and will be described in a later post on this blog.)
The relief I felt from her death was overshadowed by the sadness of our loss. We were all tired from the time and energy, both emotional and physical, that we spent on her care. But in the days that followed I realized how fortunate we were to be able to be by her side through all of the stages of her dying and death. She was not alone; we had the opportunity to tell her all of the things we wanted to say, especially how much we loved her. In her suffering, she gave us that gift, to be a part of her illness and her death. I cherish every moment of those final months, weeks, and days, as well as the final moment itself.
My mother also taught me everything I needed to know about death and dying, and how it effects both the patient and the family. That knowledge served me and my patients well when I decided to return to a full time general medical practice one year later. (We opened an office in the front part of the old pig barn on our farm, but that is also another story.) I learned how incredibly important is for both the patient (and the family) to be at home, surrounded by family and friends when they die, And, I learned that it is imperative that the physician caring for a terminal or near terminal patient also consider the family within the scope of his or her care.
Then there is her final gift, one I cherish every day of my life. Beth, who had been looking for her place in life since she completed college 2 years ago, turned to Patience and me at the dinner table some months after her grandmother’s death and said she knew what she wanted to do. We both looked at her in anticipation of this announcement, and when she said she wanted to go to medical school...I could not believe my ears! Even now, as I recall that moment, my eyes get rather moist. Beth is now practicing medicine (internal medicine) with a partner in Middletown, Delaware and she is a wonderful physcian.
These are only a few of the memorable gifts from a dying grandmother and mother.
Wednesday, September 12, 2007
Life Changing Quote
“…have patience with everything unresolved in your heart and try to love the questions themselves as if they were locked rooms or books written in a very foreign language. Don’t search for the answers, which could not be given to you now, because you would not be able to live them. And the point is, to live everything. Live the question now. Perhaps then, someday far in the future, you will gradually, without even noticing it, live your way into the answer.”
Rainer Maria Rilke
Rainer Maria Rilke
Why Medicine?
(This post is a preamble to one that will follow in the next few days.)
I have tried to recall the thought processes that led me to decide I wanted to be a doctor and could only come up with a rather embarrassing few. I was an 18 year old freshman at the Philadelphia College of Pharmacy & Science when, at some point late in the spring semester I remember deciding I would rather be writing prescriptions than filling them. And, acting in a manner that would come to be rather common place for me, I very quickly notified the proper people of my decision (my parents, the Dean of the college, and my best friends, Carmen and Dezi). The following fall I was a pre-med major at Lebanon Valley College.
And that’s it! No dreams about serving others or saving lives, no aspirations to be on the forefront of the medical frontier, either in research or teaching. In fact I cannot remember ever having any concrete ideas about what my life's work would entail. All I knew was that I was going to be a physician...that it was the right thing for me to do, and that was all I needed to know at that time.
Why did I do that? How did I know it was right for me? What information did I sift through, consciously or unconsciously to arrive at that decision? When I think about it now I am amazed. At that time in my life I was completely unaware of what might be considered my aptitude, gifts, or of anything remotely resembling an inner life, drives, needs, etc. And yet the choice to practice medicine was to tap into what I would later recognize as one of the major defining characteristics of my life, caring about others and wanting to be a positive presence in their lives.
Was there more...has time blunted my memory of the events of that defining time? If so, maybe in my terminal years, when we somehow find old memories, in place of the short term ones, I’ll have the answer.
Note: At no time did art, in any way, shape, or form, enter my mind as a career choice.
I have tried to recall the thought processes that led me to decide I wanted to be a doctor and could only come up with a rather embarrassing few. I was an 18 year old freshman at the Philadelphia College of Pharmacy & Science when, at some point late in the spring semester I remember deciding I would rather be writing prescriptions than filling them. And, acting in a manner that would come to be rather common place for me, I very quickly notified the proper people of my decision (my parents, the Dean of the college, and my best friends, Carmen and Dezi). The following fall I was a pre-med major at Lebanon Valley College.
And that’s it! No dreams about serving others or saving lives, no aspirations to be on the forefront of the medical frontier, either in research or teaching. In fact I cannot remember ever having any concrete ideas about what my life's work would entail. All I knew was that I was going to be a physician...that it was the right thing for me to do, and that was all I needed to know at that time.
Why did I do that? How did I know it was right for me? What information did I sift through, consciously or unconsciously to arrive at that decision? When I think about it now I am amazed. At that time in my life I was completely unaware of what might be considered my aptitude, gifts, or of anything remotely resembling an inner life, drives, needs, etc. And yet the choice to practice medicine was to tap into what I would later recognize as one of the major defining characteristics of my life, caring about others and wanting to be a positive presence in their lives.
Was there more...has time blunted my memory of the events of that defining time? If so, maybe in my terminal years, when we somehow find old memories, in place of the short term ones, I’ll have the answer.
Note: At no time did art, in any way, shape, or form, enter my mind as a career choice.
Tuesday, September 11, 2007
OCASSIONAL QUOTES FROM A MEDICAL JOURNAL
Medicine is a noble calling that is at risk of being transformed into an impersonal, technical, market driven occupation, devoid of any nobility.
Monday, September 10, 2007
In My Mother's Home
the following is from a journal entry in July of "04
I have been here many times before, south Philly. Not Philadelphia or south Philadelphia, but south Philly; that is what it has always been, and always will be. I am visiting my cousin Danny who lives on S. 12th St., just blocks away from his childhood home. Usually when I visit we sit around the kitchen table and drink red wine and eat cheese, peppers, bread, and other goodies until it’s time for dinner, which is always pasta, salad, and a variety of “side dishes”. (As far as I’m concerned, with pasta, there is no need for anything else, except some sausage, meatballs, or other gravy meat.)
But tonight I wanted to take Danny & Linda out to dinner, preferably to one of the restaurants that provides their patrons with singing waiters, and so we walked the two blocks to Franco & Luigi’s place. There, in the intimacy of their dinning room, we enjoyed both the mouth watering food and the joyful sound of Italian songs...and for all the times I have been here, it was a very special evening for me. I was aware, as never before, that this was the place where my mother was born and raised, this neighborhood was her “hometown”. I was in my mother’s home, and my experience here was to pay homage to her.
My mother was born in this city in December of 1917. We always celebrated her birthday on Christmas eve, and it wasn’t until after her death that we learned it was actually on the 16th of the month. Her father, who she never knew, died when she was 2 years old, leaving her mother with 5 children. My grandmother soon remarried to a widower with 5 children, and shortly thereafter they had 2 more of their own. Because of the lack of space and resources, my mother, at age 12, and three older brothers moved into an apartment of their own where she assumed the role of cook and housekeeper for her siblings. She spoke little of this time in her life, and much of what I have learned came to me second hand from family stories told by others. When I learned enough to ask her questions about her early years she would reflect on that time with an obvious fondness for a life that was as good as it was difficult. (I am mindful of mom’s tendency to protect her son from life’s unpleasantries.) I saw the smiles, not the tears, when she would talk about her brothers with a filial affection that I will never know.
That apartment is within one block of where Danny and Linda live...I pass it many times in my visits to them. Also within on block is uncle Sammy’s house and the houses where uncle Alfred, uncle Tommy, and grand mom and aunt Eleanor lived. I remember clearly the childhood visits to the city, the sights, the sounds, and especially the smells of grandmom’s kitchen.
Tonight, more than any other time here, I feel surrounded by my mother, her history and her stories connecting me to this place as never before. Oh how I long to honor her; to acknowledge all that she has given to me. Tonight is one small celebration of her. I want my life to be a celebration of her.
I have been here many times before, south Philly. Not Philadelphia or south Philadelphia, but south Philly; that is what it has always been, and always will be. I am visiting my cousin Danny who lives on S. 12th St., just blocks away from his childhood home. Usually when I visit we sit around the kitchen table and drink red wine and eat cheese, peppers, bread, and other goodies until it’s time for dinner, which is always pasta, salad, and a variety of “side dishes”. (As far as I’m concerned, with pasta, there is no need for anything else, except some sausage, meatballs, or other gravy meat.)
But tonight I wanted to take Danny & Linda out to dinner, preferably to one of the restaurants that provides their patrons with singing waiters, and so we walked the two blocks to Franco & Luigi’s place. There, in the intimacy of their dinning room, we enjoyed both the mouth watering food and the joyful sound of Italian songs...and for all the times I have been here, it was a very special evening for me. I was aware, as never before, that this was the place where my mother was born and raised, this neighborhood was her “hometown”. I was in my mother’s home, and my experience here was to pay homage to her.
My mother was born in this city in December of 1917. We always celebrated her birthday on Christmas eve, and it wasn’t until after her death that we learned it was actually on the 16th of the month. Her father, who she never knew, died when she was 2 years old, leaving her mother with 5 children. My grandmother soon remarried to a widower with 5 children, and shortly thereafter they had 2 more of their own. Because of the lack of space and resources, my mother, at age 12, and three older brothers moved into an apartment of their own where she assumed the role of cook and housekeeper for her siblings. She spoke little of this time in her life, and much of what I have learned came to me second hand from family stories told by others. When I learned enough to ask her questions about her early years she would reflect on that time with an obvious fondness for a life that was as good as it was difficult. (I am mindful of mom’s tendency to protect her son from life’s unpleasantries.) I saw the smiles, not the tears, when she would talk about her brothers with a filial affection that I will never know.
That apartment is within one block of where Danny and Linda live...I pass it many times in my visits to them. Also within on block is uncle Sammy’s house and the houses where uncle Alfred, uncle Tommy, and grand mom and aunt Eleanor lived. I remember clearly the childhood visits to the city, the sights, the sounds, and especially the smells of grandmom’s kitchen.
Tonight, more than any other time here, I feel surrounded by my mother, her history and her stories connecting me to this place as never before. Oh how I long to honor her; to acknowledge all that she has given to me. Tonight is one small celebration of her. I want my life to be a celebration of her.
Saturday, September 8, 2007
Friends I never knew
The following journal entry was written in response to the death of Johnny Cash, but the sentiment applies equally to the other friends I have lost. I have mourned the loss of these artists whose work has, in ways I cannot explain, inspired me to pursue my own creative dreams. Their music, their voices, their stories, all reach deep into a place within me that unleashes sentiments and will that were previously unfamiliar to me. I miss them dearly.
Harry Chapin, John Lennon, John Denver, Johnny Cash, Jerry Orbach, and now,
Luciano Pavarotti.
9-13-03
Amy called me at 7:30 in the morning to tell me Johnny Cash died, and sadness and melancholy quietly settled in and accompanied me for the rest of the day. The man whose music has been so much a part of my life for over 25 years is gone, and I feel like I have lost a friend. I saw him perform twice in my life, but never met him, yet he was there, looming larger than life as someone who represented what I admired in a man...strong, independent, loving and sensitive, fragile and vulnerable, and creative, taking life on his own terms. In my mind, the man in black felt the worlds pain, and responded to it with love, for only love could allow someone to create such an abundant body of work, spanning generations and cultural divides, as his has done.
Whether or not Johnny Cash really contained these attributes is immaterial, what matters is that through his music and his life, as I chose to see it, they were available to me, to admire, and try to embrace in my own life.
His music encompasses such wide range of emotional experience, both individually and as a body of work, but the common denominator is the evocation of all that is human and personal. There is nothing abstract in his songs, only the presence of the personal, and I admired and respected him for that. His music makes me feel what I want to feel.
Johnny Cash was a man who successfully pursued a creative life, doing what he wanted to do, on his own terms. For that he was my hero.
Harry Chapin, John Lennon, John Denver, Johnny Cash, Jerry Orbach, and now,
Luciano Pavarotti.
9-13-03
Amy called me at 7:30 in the morning to tell me Johnny Cash died, and sadness and melancholy quietly settled in and accompanied me for the rest of the day. The man whose music has been so much a part of my life for over 25 years is gone, and I feel like I have lost a friend. I saw him perform twice in my life, but never met him, yet he was there, looming larger than life as someone who represented what I admired in a man...strong, independent, loving and sensitive, fragile and vulnerable, and creative, taking life on his own terms. In my mind, the man in black felt the worlds pain, and responded to it with love, for only love could allow someone to create such an abundant body of work, spanning generations and cultural divides, as his has done.
Whether or not Johnny Cash really contained these attributes is immaterial, what matters is that through his music and his life, as I chose to see it, they were available to me, to admire, and try to embrace in my own life.
His music encompasses such wide range of emotional experience, both individually and as a body of work, but the common denominator is the evocation of all that is human and personal. There is nothing abstract in his songs, only the presence of the personal, and I admired and respected him for that. His music makes me feel what I want to feel.
Johnny Cash was a man who successfully pursued a creative life, doing what he wanted to do, on his own terms. For that he was my hero.
Thursday, September 6, 2007
NOW AVAILABLE
ABOUT THE BOOK
The author is a physician and an artist, and indeed this book is lavishly illustrated with his bold, colorful, imaginative paintings. But in his words we see a father dedicated to the task of passing on to his children the wisdom and values he holds so dearly. His writing, grounded firmly in personal experience, is clear and succinct, each message confined to a single page. His comfort and confidence in each subject is evident, whether it be claiming a personal destiny, finding God, or dealing with love, marriage, and friendship. Facing each page of the father’s reflective text the reader is treated to one of the artist's vibrant illustrations. This small book belongs on the bedside table of everyone embracing the challenge of finding their own unique path in life.
$19.95
Available from Authorhouse Publishers online at www.authorhouse.com or
at - 888-280-7715
Also available at Gallery 5 (270-444-2020), Amazon.com, Barnes & Noble, and other leading bookstores
Sunday, September 2, 2007
Remembering Sunday Mornings
From the time I was old enough to eat table food, until I left home at the age of 18, we ate macaroni (it was always macaroni, or spaghetti...I never heard or used the term pasta until much later in my adult life) every Sunday, Tuesday, Thursday, and before all the other dishes on every holiday. On special occasions my mother would make ravioli, lasagna, manicotti, or stuffed shells.
Before going any further with this, let me explain another Italian-American twist on culinary language; our macaroni or spaghetti was served with “gravy”, not sauce. That is another one of those words that did not find their way into my vocabulary until I began eating “pasta”.
During the week the macaroni was served any number of ways...with cheese and butter, with marinara (a loose, almost soupy tomato gravy cooked at the time of the meal), with beans or peas, with clams, or with only oil and garlic. But on Sundays and every holiday except Christmas eve (that's another story) it was served with a deep, rich gravy with a variety of meats (chicken, beef, meatballs, sausage, or a combination of two or more) that only my mother could make. And she did this every Sunday morning.
It’s time to diverge for just a moment. There is no recipe for making gravy, its done intuitively, and or course everyone's intuition is just a little different, so it follows that everyone’s gravy will be just a little different. And sure enough, I could tell without difficulty my mother’s gravy from aunt Dolly’s, aunt Era’s, and uncle Fatty’s, all of which were wonderful. But of course mom’s was the best.
Back to Sunday mornings, my favorite morning of the week while I was growing up. The kitchen would be filled with the aroma from the large pot on the stove filled with the tomatoes, spices, garlic and meat that was in the process of being transformed into my mother’s delicious gravy. A late breakfast, we didn’t know about brunch at that time, would consist of a thick slice of bread covered with the gravy in process and a piece of the gravy meat. If I close my eyes and concentrate real hard I can see my mother standing by the stove and smell the cooking as it fills the room
Before going any further with this, let me explain another Italian-American twist on culinary language; our macaroni or spaghetti was served with “gravy”, not sauce. That is another one of those words that did not find their way into my vocabulary until I began eating “pasta”.
During the week the macaroni was served any number of ways...with cheese and butter, with marinara (a loose, almost soupy tomato gravy cooked at the time of the meal), with beans or peas, with clams, or with only oil and garlic. But on Sundays and every holiday except Christmas eve (that's another story) it was served with a deep, rich gravy with a variety of meats (chicken, beef, meatballs, sausage, or a combination of two or more) that only my mother could make. And she did this every Sunday morning.
It’s time to diverge for just a moment. There is no recipe for making gravy, its done intuitively, and or course everyone's intuition is just a little different, so it follows that everyone’s gravy will be just a little different. And sure enough, I could tell without difficulty my mother’s gravy from aunt Dolly’s, aunt Era’s, and uncle Fatty’s, all of which were wonderful. But of course mom’s was the best.
Back to Sunday mornings, my favorite morning of the week while I was growing up. The kitchen would be filled with the aroma from the large pot on the stove filled with the tomatoes, spices, garlic and meat that was in the process of being transformed into my mother’s delicious gravy. A late breakfast, we didn’t know about brunch at that time, would consist of a thick slice of bread covered with the gravy in process and a piece of the gravy meat. If I close my eyes and concentrate real hard I can see my mother standing by the stove and smell the cooking as it fills the room
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