Life Lessons from a Man I've Never Met

We will be known forever by the tracks we leave. - Dakota proverb

Last spring, I was allowed to participate in two classes because of the generosity of faculty members of the University of Washington School of Medicine. The two classes are "The Healer's Art" (a medical school elective designed by Rachel Naomi Remen, M.D.), and a "Values Clarification" exercise - part of the 4th-year curriculum in the Chronic Care Clerkship for students about to embark upon their residency program. The Values Clarification class was created by a man named Stuart Farber, M.D., who recently passed away from leukemia.

Dr. Farber is revered and loved by his colleagues and students, family and friends. He founded, and was director of, the Palliative Care service at the University of Washington Medical Center. He was a pioneer in the field, helping to develop a palliative care training center at the University of Washington.

In a terrible coincidence, his wife Annalu was also diagnosed with the same kind of leukemia (AML) four months after Dr. Farber's diagnosis, so they each walked in the role of patient and caregiver, supported by their family and community. This journey served to deepen and further inform his sensitivity in what he already believed and taught to his students. In each caringbridge.org update on their health, Dr. Farber and his wife shared their love of poetry by posting a poem chosen to express their feelings of the moment. I learned a great deal about the Farbers (whom I have never met) from those poems, and a great deal about the ways in which art can bring release and healing to patients and caregivers.

The Values Clarification exercise was administered by a wonderful professor named Tom McNalley, M.D., director of the Chronic Care Clerkship (whose specialty is Rehabilitation Medicine), and his gifted colleague, Carol Kummet, LICSW, MTS, a social worker with the Palliative Care Service. Both facilitators exuded seriousness tinged with gentle humor, compassion and empathy. Experiencing the Values Clarification with young medical students was a deeply moving gift to me, and one that I will never forget. It is an important part of Dr. Farber's legacy.

Another vital part of Dr. Farber's legacy is an article which was published posthumously, which I cannot recommend highly enough for EVERYone to read. It was published in the Journal of Pain and Symptom Management, Vol. 49, No. 4 on April 4, 2015, and made available by Dr. Farber's widow here:
http://www.sciencedirect.com/science/article/pii/S0885392415000755
under the heading, Humanities: Art, Language, and Spirituality in Health Care. Isn't that a powerful heading? The article is called Living Every Minute. I have read it twice, and am simply in awe of its grace and power. Whether you are a patient, family member of a patient, a clinician, an artist or a spiritual seeker, this article will be a gift to you.

Many deep truths of living, of the value of quality of life over quantity, and the supreme importance for clinicians and caregivers to seek, find and understand what is most important to their patients is beautifully illustrated in Dr. Farber's words and his life. Much is expressed poetically, with far more accuracy and nuance than the most scientific language could ever describe or quantify.

You can read more about Dr. Farber's life and legacy HERE.

Precious Days

My mom and I had the pleasure and privilege of traveling once again to Rancho La Puerta in Tecate, Mexico for a week of wellness, spending lots of time together, as well as following our favorite individual pursuits. It was the perfect blend of time to reflect, exercise, learn new things, deepen practices, refresh our bodies from the inside (with organic foods and balanced nutrition) to the outside (with fresh air, walking, hiking, yoga and meditation, among other classes).

We serendipitously met (and reunited with) fabulous, fascinating people, finding our second time to be more sociable than our first - perhaps that was due to our greater familiarity with the place. We shared the same lovely casita as we did last year, lighting fires in the evenings and talking, resting and reading in our little "home away from home." I enjoyed self-treating with Reiki every day, before heading out to hike at 6:10 A.M. I could so easily imagine settling there...

We both thrived at the Rancho, and are already looking forward to returning next year (if possible, by the grace of God). Gregg spent the days golfing, playing tennis, watching polo and lounging with my father in California.

We flew down via San Diego so that we could meet KBL2ORD2SAN and her belovED. Mom and I met her at the airport last year, but this year, our husbands got to join us. What a thrill, after being blogging buddies for so many years, to finally be all together "in real life!" We had a long, leisurely lunch, and left still bursting with things to talk about. Until next time...

Driving from San Diego to the Coachella Valley was a beautiful experience to share with Gregg. As we crested the top of the last hill on Highway 74, the valley unfolded before us at sunset.

Unfortunately, while we were away, my dear mother-in-law, Elaine, suffered a stroke. Elaine is 93 years old - in fact, the stroke occurred at her birthday party - and has for several years suffered from memory loss. She has been telling us for the past couple of years that she doesn't know why she is still here - she says it matter-of-factly, without self-pity or complaint.

Elaine and Ed Gerstenberger, "back in the day"

When the stroke occurred, she became paralyzed on her left side and was unable to swallow. Hospice was called, and she was moved to a nursing home with a dismal prognosis. But her miraculous body has recovered enough for her to swallow soft foods. She is sleeping a lot, but can recognize us and speak a few words at a time. We are hoping that she will be able to move back to the assisted living facility where she and Grandpa Ed normally reside, into a nursing-care unit. As for now, it is day-by-day, with lots of family in attendance, sitting by her bedside and driving Grandpa back and forth to see her. Fortunately, they raised four wonderful kids (now adults, with families of their own) who love her deeply, and are all doing their best to care for her and Grandpa.

These are precious days, indeed.

Education and Listening

Sitting in on classes at the University of Washington School of Medicine is a privilege which I could not have imagined 8 years ago - but then, 8 years ago, I would not have been interested in doing so.

After spending intense months with my family in a hospital setting, a piece of my heart has remained there, with the staff who so lovingly tended to Katie and to each one of us. I cannot forget them, nor what families like ours ask of them, day in and day out. They suffer when we suffer; though they have more experience and training, they are human, as we are.

I know that Katie's life and death impacted those who provided her with care.

Because I had over five years of training and experience in pastoral caregiving prior to the onset of Katie's illness, it is natural for me to think deeply about these dear caregivers and their feelings. As my own pain has become less like an elephant sitting on my chest - and more like a stone in my shoe - this concern for medical caregivers has grown. As the national discussion about the state of health care heats up, my concern centers upon a desire to improve conditions for both staff and patients - and questions about the best, most appropriate, effective ways to do that.

In considering those questions, I have been fortunate to meet staff of the U of W School of Medicine who are engaged in teaching, who are willing to share openly and generously, and to include me. Last week, I attended another session of "The Healer's Art" - this one about grief, loss and disappointment. The featured presenter is an experienced doctor who spoke eloquently on the topic, and guided us through personal reflection and sharing afterward. I found it illuminating.

I also had the privilege of participating in a "Values Clarification" exercise with 4th-year medical students. That was deep, interior work. We were invited to privately list 4 things in 5 categories that mean the most to us - categories such as relationships, possessions and so on. Then we were guided through an experience of facing our own critical illness and the loss of most of those 20 things. Eventually, we were faced with our imminent death. The scenario ran parallel to what Katie endured, and it dug deeply into my consciousness.

Though I have already personally encountered many of the issues that were raised, at one point the experience was so intense that I had to mentally withdraw. I came out of the guided imagery and studied my hands, centering myself back in the present moment. That is the hardest part about my desire to contribute in this field: not knowing when emotions may overwhelm me. Because of that uncertainty, I frequently wonder whether I am the best person for the job; yet I know that my experience has value to teach.

I am drawn to these physicians-in-training, and to their mentors and colleagues. I would love to minister to them in compassion - care of the soul - particularly as evidence of burnout and stress, disillusionment, unrealistic demands and the conflicts of cost vs. best-quality care become more and more prevalent in the field. Discerning whether this calling is real, is mine, and if so, how it is to be answered - how to do the work without injury to myself? - is the business of the moment.

I sit with students and staff, listening for answers, and offering the gifts of my heart.

"I Gave My Cat A Bath..."

 

Are you familiar with Steve Martin's stand-up comedy from the 1970s? 

If not, you are missing out on a good thing.

When I was a freshman at Pomona College in 1977, one of my dear friends had this album (yes, it was a record album, in those days). We used to listen to it and laugh until we literally fell down, laughing until we cried. I knew it all by heart, back then, and could do the routines from memory; I was especially adept at the one called, "Excuse Me," because when my father was out of sorts - tired from his job as a traveling salesman - he had a tendency to go off on a tirade that sounded much like Steve Martin did in this sketch.

Just before we left for Thanksgiving vacation last month, Latte came home with a small cut on the top of his head; it looked as if he had been in a fight. I cleaned and tended the cut in the way our local veterinarian taught me to do it, with warm water on a cloth (compresses), and hydrogen peroxide. Latte didn't like it too much, but the cut looked better afterward, and I expected it would heal while we were away.

When we returned from California, instead of looking better, he had a new cut on the side of his face (on his cheek), in addition to the original wound. I will not give you the details, but it looked as if another animal might have had Latte's head in its jaws - or talons (I dread to think). We have a lot of bald eagles around here, as well as foxes, raccoons, at least one coyote and other cats. I proceeded to treat the new cut in the same way, at least 2x a day, and kept him indoors. He loves to be outside, and he didn't like being confined, but it was necessary.

Gregg helped by holding Latte while I cleaned the wounds. Even though Latte whined a bit, he never tried to bite or scratch us (though he did try to get away). What a sweet cat! I felt so badly for him, having to go through the procedures, so I would quietly pet and comfort him afterward. He is looking much better now; he has a sparkle in his eye and is more energetic, so we can see he's on the mend.

Since we've had a very cold spell here, there is a lot of static electricity in the air. This makes sparks and shocks the cats when we pet them. In order to avoid this, after cleaning Latte's wounds, I would take a clean, warm, damp cloth and smooth his fur with it. He loved it; he would purr and relax. Maybe it reminded him of his kitten-days, being groomed by his cat-mother. Of course, it reminded me of the following Steve Martin routine from "Let's Get Small" (track 9: "Funny Comedy Gags"):

"...Oh, this is an interesting thing: I gave my cat a bath the other day. You know, I'd always heard you weren't supposed to give cats baths, but my cat came home, and he was really dirty, and I decided to give him a bath, and it was great. If you have a cat, don't worry about it - they love it. He sat there - he enjoyed it - it was fun for me...you know, and uh, the fur would stick to my tongue, but other than that..."

They say the best comedy is based on every-day life.