Of Storms and Stars, Whales and Grief

“People gonna be okay, storms never come to stay, they just show us how bad we need each other…how bad we need each other.”

– Mark Scibilia

I’ve been at something of a loss for words over the last few months with the successive hits that mine and the hubster’s families have been taking. Two suicide attempts by young members (one successful and one thus far not) as well as the dignified and loving departure of a beloved elder seem to have taken their toll on even my desire to talk about dying.

Who would have thought?

But this morning I came across an old Yuletide letter I wrote back in 2002 and the tender perspective expressed in it helped me remember the rich beauty and wonder I once found in the rooms of the dying, sprinkled in among all the horrors. Reading it again reminded me that what I saw back then is still true today…the dying world really does contain profound and graceful gifts…even if I can’t currently see any of them in the aftermath of recent events.

suppose this is where some faith helps. I needed reminding that the stars still hang up there in the depths of the night sky and that they’re just as luminous and lovely as ever. Certainly once this storm has spent all its fury and the clouds have finally cleared I’ll be able to find them again.

In the meantime, I can always read my old stories. 

I thought I’d go ahead and paste in the old Yuletide letter here, just in case anyone else is slogging through heavy weather and hoping for a break. Maybe it can help.

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Dear everyone that we hold with deepest affection:

 Cal and I (and all unbeknownst to them—the kids) send our warmest greetings in this season of silence, celebration and relentless Christmas catalog barrage.  Here in Idaho’s banana belt we’re experiencing an inversion—a meteorological event where the warmer air at higher elevations traps the colder and dirtier air at lower elevations and those of us down under reap the harvest of all our months of collected carbon emissions in the form of smog.  A ban on wood burning is currently in effect in the valley so the cord of wood we just split stands leaning precariously by the garage while the fireplace waits cold and patient.  Cal’s primal and eager impulse to poke around in a nest of flaming materials is temporarily thwarted so for his sake I hope a low-pressure system returns to the area soon.

 This year seems to have flown by faster than any year before (a trend we’ve been noticing of late) and I suspect that it speaks to the fact of our aging.  When I think about it, it seems logical enough.  Between the two of us Cal and I now have almost 94 years of collected living to our names with all the learning and memories, laughter and heartbreak, wisdom and foolishness that that much life of necessity contains.  Think about it for a second.  When held up and compared to such an accumulation of time how long can a single year really take to pass after all?  Sometimes I think of an old-growth redwood or an ancient mountain peak or a star and I wonder what a year seems like to them.  I imagine it would be like a breath or a blink.

 A solitary heartbeat lost in aeons of warm and pulsing rhythms.

 Two great things happened this year for us.  One was a cruise to Alaska—a generous gift from Cal’s dad up one of the most magnificent coastlines I could ever imagine—and the other was the work I began with hospice.  Somehow the two are closely entwined although I’m not entirely sure how. 

The cruise was something of an enigma for me.  It was our first time and in preparing for the trip I found myself conflicted around issues of the seemingly decadent opulence of American spending and a very real anticipation of fully immersing ourselves in it. 

The food was everything I’d ever heard it would be.  We ate lobster and shrimp and French dishes and baked confections in lush dining rooms with scores of people waiting on us hand and foot.  All we had to do was ask (frequently we didn’t have to ask at all) and nothing was denied us.  There was even one climactic moment when we were sitting with our aperitifs at a linen-covered table, gazing out a huge window at the dark and choppy waters we sailed through when suddenly, Cal said, “There’s a whale!”  And when I turned to where he pointed a giant humpback suddenly breached about twenty-five feet off the side of the ship, surging up into the air with a mass and drive that staggered the imagination.  As it rose it gracefully spiraled 180 degrees, arching its body back and outwards as it twirled in a movement that looked like some kind of liquid ecstasy, before plunging back into a whitened maelstrom of water to disappear again beneath the surface.

 I felt overwhelmed by the wealth of it all—both the riches of human civilization and the priceless treasures of the wild.  Cal and I tended to forego the lure of bingo and Broadway shows, naturally gravitating toward the decks and railings of the ship where we spent our time watching the mountains and islands and vast tracks of forest gliding by.  During one shore-leave we hiked on a mountain in Juneau, climbing up beyond the hordes of camera-snapping, cruise-line tourists (no doubt attempting to elevate our own camera-snapping activities to a higher moral plane) and on into the mist and muffled silence at the top where I sang to occasional marmots and ptarmigans who tipped their heads in curiosity. 

Throughout the seven days we saw harbor seals whelping, bald eagles flocking, glaciers calving, and ice so old and compressed that it had turned a luminous color of blue.  At the peak of the cruise we sailed up a fjord (I felt such a smug sense of satisfaction to finally experience the thing that carries such an exotic name) and on that morning I stood alone out on the deck for hours, shivering in the drizzling rain and cold breezes, held spellbound by the sheer, green cliffs rising up from icy waters—their towering heads hidden by clouds, their sides split time and again with plunging waterfalls fed by spring-melting snows—and in the cold, wet, wildness of it all a silence of great age, of vastness, weighed upon me, somehow aging me, too.  Lending me a temporary grace that I suspect only comes enduringly with advancing years.

 And I recognize the same vast silence I felt that morning each time I sit by the bedside of someone dying.  It’s such a paradox to me, the moments that exist—tucked in among the bathing and dressing and care of wounds, among the laughter, overwhelm and expressions of tremendous sorrow and tenderness, among the changing of oxygen tanks and long hours of just listening and listening and listening—when I feel that same great weight of grace I felt in the fjord pressing down upon me again.  Whispering to me of an indescribable beauty of great depths and muffled echoes and mist.  And in spite of the moments of horror and heartbreak, I feel strangely uplifted. 

I’ve come to wonder if much of the difficulty in dying lies in the necessity of having to give back all the many and deeply treasured gifts we’ve been loaned for the process of living.  There’s so much to love in a lifetime be it brief or long, so much to wonder at and remember and touch with trembling fingers one last time. There are all those whom we love and our many achievements, the mountains and moonlight and extraordinary beauty of the world, the gifts of walking and laughter and being able to feed ourselves and go to the bathroom alone, and in our last moments the necessity of returning even the gifts of sight and touch and breath.

But in the end, while the gifts themselves must be returned, somehow the deep love and gratitude that they forge within us remains, growing ever more quiet and measureless upon being freed.

 I remember again the brief instant of that breaching whale.  The suddenness of it and surprise, the delight and the awe, the twisting, the power, and the arc of it’s body that seemed to express not so much purpose or deep import as a simple moment of sheer and unbridled joy.  A moment of irrepressible delight, driving it to rise high and higher for an instant of unforgettable and breathtaking splendor.  And so I’m coming to think of life.  Something so brief and unpredictable and extraordinary surging up from invisible worlds, rising within us with such drive and vitality and joy—learning through us, loving through us, touching and being touched for what amounts to only a fleeting heartbeat in the vast rhythms of creation—before ultimately returning once again to the deep and gentle mystery of the waters that are its source.

With our newly graying hair and sagging bodies we wish for you all, this year and always, that each moment of the great wounding and joy of Life will be just such an arc of unforgettable beauty.

With all our love,

Cal and Dia

Should a family suicide be mentioned in a Christmas card? I could use some help on this one.

yellow_awareness_ribbon_greeting_card(I found this card after I wrote the post– Cafe Press.)

For the last couple of decades I’ve been writing a Yuletide letter to stick in with our Christmas cards, a missive that generally includes any big family news along with some philosophical musings on something…anything really…that happened during the year.

And up to now I’ve never been one to shy away from topics that some might consider questionable holiday fare (i.e. working with the dying, menopause, the incredible stench of alligator pits) but this year I’m up against the news of Cam’s recent suicide and it’s the first time a family event has given me pause. Partly because the announcement needs to be handled delicately out of respect for the hubster’s family, but also because suicide is a socially taboo topic that’s never supposed to be mentioned at all, even in the off-season.  So how exactly are people going to react to my breaking that taboo in the heart of a major holiday devoted to joy and good cheer?

I admit, I just don’t know. And I feel kinda caught between a rock and a hard place because, realistically, what could I say instead? I mean, what exactly is the etiquette for glossing over a piece of information that catastrophic?

Hey there! We went kayaking in numerous spectacular places this year and are delighted to share that Beloved Daughter got married in June! We couldn’t be happier.*  Happy holidays all! 

*(Accept for that one loss in September of course, but really. We don’t want to bum you guys out with THAT!)

Yuck. I don’t think so.

The more I think about it the more it seems like I should probably just trust in people’s basic humanity…maybe have some faith that everybody’s caring and compassion will rise up and trump this horrible, hurtful, isolating taboo. I’d love for that to be what this season is truly about…something big enough, loving enough, and resilient enough to wrap its arms around both the joy and sorrow of our lives.  Both those who are hopeful in any given year as well as those whose hearts have been broken.

It doesn’t seem like the holidays should have to be an either/or thing, does it?

‘Tis the season for brushes with an unseen world.

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The Brown Lady of Raynham Hall

Halloween approaches, so it felt like a good time to tell a couple of recent stories about a sense of presence; those moments where a person inexplicably feels the intimate, invisible presence of someone or something benign.

The two stories I’d like to relate here involved the sensed presence of loved ones who died, one fairly recently and one some years back, but experiences of a sense of presence can also, of course, involve the presence of religious figures, friends, acquaintances, or even strangers, and can happen in all manner of situations from childhood isolation to survival scenarios.  But I think the majority of people are most familiar with it during bereavement, where studies put it’s occurrence at anywhere from fifty to sixty-three percent and possibly higher.

As such, I think the experience deserves to be talked about more openly, but then perhaps that’s just me.

The first story is from my sister-in-law and involves the recent loss of our nephew Cam who could sing like nobody’s business.  I’ll never forget the first time I heard him open his mouth and start belting out White Christmas.  My mouth dropped.  Everyone’s mouth dropped.  It was unexpected in the way that Susan Boyle singing The Dream I Dreamed was unexpected, only Cam was fourteen and not as polished yet.  But still.  See for yourself.  He starts singing about eleven seconds in.

You see?

Anyway, my sister-in-law was working alone a couple weeks ago and, out of the blue, one of Cam’s favorite songs popped into her head and she found herself singing it aloud, which wasn’t the strange part.  What was strange was the fact that she was singing it perfectly, because before that moment she hadn’t really known all the words.  But somehow she was singing them all anyway. She confided that in that moment she could feel Cam there with her, sharing the infectious joy he found in song while he was alive and which, it seems, he continues to enjoy afterwards.

Her story made us all laugh and helped lighten the load we’re carrying at his loss a little, which, IMO, is the real, deep, and abiding gift of these kinds of experiences.

The second story was my own and it happened on my mother’s birthday a few weeks ago.  She died four and a half years ago now so, unlike with Cam, I’m already past the initial disorientation of a world knocked sideways by her loss, as well as most of those sharp pangs of grief that used to accompany each memory.

In fact, I didn’t even remember it was her birthday until around noon when I was out shopping and glanced at a calendar for the first time that day, at which point I remembered and felt the usual brief wind of loss I feel each year, quickly followed by all the other, sweeter memories that fill the lion’s share of my heart now.  I savored them for a moment and then folded them away again, going on about my business until I got home, at which point things turned decidedly strange.

While putting everything away I wandered over to the dining room table, a piece of furniture which we never actually eat at but instead use as a long-term depository for all the official papers we’re trying to avoid.  It’s kind of like a limbo world for documentation…behind the veil so to speak…and as such it’s usually invisible to the naked eye.  Or at least to my naked eye, as I trained myself long ago to ignore everything on it.

So I’m not sure why I walked over there that day, or why, out of everything lying there, I happened to notice the back of an old greeting card lying near the corner, a little ways away from everything else.  I absentmindedly flipped it over and thought it looked familiar but couldn’t place why.  So I opened it up to read the inscription and that’s when the memory came flooding back.

It was the last birthday card my mother ever sent me, a scant three months before she died…back when I knew she was ill but didn’t know yet that she was dying.  I’d found it among my things shortly after she passed and grieved over it for a long time before finally putting it away in a box of secret treasures I keep on a high shelf in the closet in the back room.

Which is where it’s been for the last four years. Or so I thought.

I stood there for a long time just staring at it in my hands, confused and reeling a little, trying very hard to figure out how it escaped the box and made it’s way back out onto the dining room table for me to find on her birthday of all days.  I wracked my brain trying to recall when I could have taken it back out again, why I would have, but came up with nothing. Nada. (Which isn’t necessarily saying much since I’m forgetting a lot these days.) But still, it felt very strange.

I’m hardly a died-in-the-wool skeptic when it comes to the possibility of unseen mysteries. For instance, I have no problem believing that we’re all bound together in intricate, beautiful, and frequently mysterious ways, and that the love we forge is probably the most enduring of all these links. It’s long seemed to me that if anything was strong enough to transcend the boundaries placed between us by death, love would be the likely culprit as it seems capable of transcending just about everything else.

But on the other hand, I’m a practical woman and as such lean towards practical explanations.  While I have no problem entertaining the possibility that my mother’s love could bridge death, I have a harder time believing that her hands could. It seems unlikely that she could have pulled down the box, opened it up, rifled through the contents, found the card, and then carried it out to the dining room table to leave it there for me to find.

I’m not saying that she couldn’t do that, mind you…I’ve seen a lot over the years and have decided to stay open to all possibilities.  But still, there are just other, simpler explanations that seem more likely.

However, the timing  of it all was truly serendipitous and that’s what took my breath away.  While that birthday card could have been sitting on the table for a very long time without my noticing it (our unfinished wills have sat there untouched for six years now…yes, six) the fact that I walked over, picked up the card, and opened it on her birthday of all days is what made me feel the brush of some vast and unseen mystery. I couldn’t help but wonder if she’d reached between dimensions and nudged me.

In any case, as my overwhelming love for her spilled out to meet her undying love for me, in that moment I really could feel her there again in the room with me, her presence fresh and sharp and immediate, surrounding and enveloping me like a warm and gentle cloud of Mom-ness.

I don’t know. Perhaps, as the tradition claims, All Hallow’s Eve really is a time when the veil grows thin and we’re able to reach across the divide and touch one another again. I love the thought.

Happy Halloween to all!

copyright Dia Osborn 2013

Returning to the world.

Forgive me. It’s been almost three weeks since my last post which is a record. I’ve kind of let myself go on a lot of levels since Cam died, including eating somewhere in the neighborhood of fifteen to twenty pounds of chocolate and sugar in various combinations…which I admit I thoroughly enjoyed but in a probably perverse way.  Still, sometimes you need to stop doing everything and just float for a while.  Let the wind blow you around.  Drift. Rest. Think. Remember. Digest.

There’s much to digest here.

But this morning I feel myself returning to the world again, both figuratively and physically.  The hubster and I spent nine days out of the last twelve running away to the wilderness every chance we got and there’s nothing quite like getting out on the water surrounded by snow capped peaks, and paddling for miles and miles and miles to help rebuild a crumbling perspective.

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I think everyone develops their own way of finding a path back to that feeling of home at their center when they’ve become lost…prayer, meditation, service, gardening, cleaning house, work, family, friends, community, etc.

For the me the way back has always involved the silence and deep mystery of the natural world. It’s where I instinctively turned as a child for congregation and confessional and where I’ve returned ever since, especially when a wound needs tending.  The stars and storms, mountains and forests, wind and waters have a way of taking the torn, raggedy edges from any injury and pulling them gently back together again, giving them a chance to meet and knit and eventually scar over.

The hubster loves the wilderness, too, only for slightly different reasons.  He feels the silence, too, and needs it as much as I do, but his nature is more wild than mine, or at least wild in a different way.  Where I crave the wonder and mystery of vast and ancient forces, he’s after all the grand adventures that wilderness provides, and over time he’s taught me a little of that particular joy he finds in throwing himself, over and over, against inclement everything…weather, conditions, terrain, the absence of any kind of safety precautions.

Looking back I have to both laugh and shake my head at some of the stupid, stupid, STUPID things we’ve done over the years. The hubster is naturally fearless and impatient of anything that stinks of planning…which I, on the other hand, tend to be a little obsessive about. (My basic nature exacerbated by the depression.)  But he was always so irresistibly charming and relentlessly persuasive that I followed him anyway, over and over again, into situations that were way over my head.  Often over his head, too, but then he loves that.

But since we were lucky and actually survived it all, I now have a treasure cache inside me of memories when I followed him blindly through the labyrinth of all my clamoring terrors to emerge in breathtaking places of grace that were magical and impossible, as if I’d flown there.

My God. I shudder to think what the darkest years of the depression would have done to me without him there to drag me along behind on his adventures, bumping and pointing out every last, little, innocuous threat along the way. I’m pretty sure I would have ended up as a shut-in. It’s really too bad that the man can’t be bottled.

I owe him much, this beloved husband of mine.

Happy anniversary sweetheart and thanks for our continuing grand adventure together. I do so love you.

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“Is it true? Is it kind? Is it necessary?”

I heard these questions posed today in the context of a discussion about how to “think before you speak.”  (Not my greatest strength.)  I was so struck by them that I’ve decided to adopt them as a mantra to try and repeat…every time…before opening my mouth to insert my foot again.

With the highest hopes,

Curious Dia of the Cannot-Keep-Their-Mouths-Shut Clan.

389px-Faras_Saint_Anne_(detail)

St. Anne

A subversive approach?

Blender3D_NormalWalkCycle

There’s a new study out in the British Medical Journal suggesting that exercise is as good or better a treatment than drugs for heart disease and stroke.  With news this good why are we just finding it out now?  An important question but first, the meat of the study:

The BBC article Exercise ‘can be as good as pills’ covers a study published in the British Medical Journal suggesting that exercise might be just as effective as medication for treatment of some heart disease…or in the case of stroke, more effective…when it comes to preventing death.  From the article:

The findings suggest exercise should be added to prescriptions, say the researchers.

Please don’t anyone go off their medications just yet, but definitely start thinking about adding some exercise to the mix.

Now that I’ve covered that important piece of information, back to my initial question: why has it taken so long to find this out?  Since exercise is obviously a healthier, cheaper, more widely available option to drug interventions, with no side effects and ample additional benefits, why in the world hasn’t it been studied before this? To find the answer I turn to the part of the study that I personally found to be the most fascinating.

For a lot of intriguing structural reasons that I don’t have time for, medical research as a whole has been growing increasingly biased towards studying drug interventions vs. other treatment strategies.  For example, in this particular case the number of clinical trials studying exercise is dwarfed by the number of drug trials.

This overall bias means that the existing medical literature (where the research is eventually published) is also increasingly skewed towards medications vs. other options, and this then tends to constrict doctors’ treatment recommendations since they base them on said literature.  Ditto for the treatment options that insurance companies will cover.

In other words, even though drug therapies may not be the best option in every case, there’s no way to know for sure since other options aren’t really being studied much.  From the researchers: 

“Our findings reflect the bias against testing exercise interventions and highlight the changing landscape of medical research, which seems to increasingly favor drug interventions over strategies to modify lifestyle,” they wrote in the review…”The lopsided nature of modern medical research may fail to detect the most effective treatment for a given condition if that treatment is not a prescription drug.”

I’ve been sensing this shift for a while and I’m glad to see it’s being recognized and talked about, but realistically speaking it’s a complex, far reaching, structural problem and I imagine it’ll prove difficult to fix.

So instead, I think I’ll just take the research and apply it for myself.  I’ll take Dane the mangy rescue mutt out for a vigorous walk and start my heart a-pumping without even getting a doctor’s prescription first, which feels strangely subversive.

copyright Dia Osborn 2013

P.S. By the way, the little walking, armless guy above comes courtesy of Wikipedia.

Articles:

Exercise could help stroke, heart disease patients just as well as drugs.

Exercise ‘can be as good as pills’

Stand Up Eight

by

via Stand Up Eight.

*     *     *

Whoops. If you don’t understand the above it’s because this was an unsuccessful attempt at using the “Press This” feature on WordPress.  Not sure what went wrong but 100% certain it did.

What I was trying to do was reblog a great post I found on Nhan-Fiction.  It contained a simple (Japanese?) saying…

FALL DOWN SEVEN TIMES, STAND UP EIGHT

…along with the beautiful characters/calligraphy in the original language.  The message spoke to me today as I’ve been falling down a lot lately. Like when I tried to “Press This” post for instance.

Mental note: Stand up. Again.

Squirrel Rant for the Year

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Ah, yes. No garden season would be complete without a post detailing some of the unique and creative vandalism perpetrated by the darlings of the neighborhood this year. I freely admit, I hate them. I love them. Of all the pests I have to battle for the harvest…slugs, cabbage moths, earwigs and rolypolys, powdery mildew, hail, and Dane the mangy rescue mutt…squirrels are the only ones that make it personal. They could be French with their flagrant insults, chattering at me and biting their nails, throwing green apples down on my head and tossing perfect, beautiful peaches to the ground after a single bite only to stare at me from the branch in defiance, daring me to take offense. If they carried rapiers I’d fear them.

Mostly, they’re all the same to me, these garden rats. Furry. Cute. Rapacious. Infuriating. But twice now, one has been born that stands out from the rest. Six or seven years ago it was Hugo the Great, acrobat extraordinaire whom I swear could fly…fly I tell you. He sprang into this world either fearless or completely insane and his feats of leaping high overhead across impossible distances only to catch the merest twig tip and cling while it whipped him up and down in wild thirty-foot arcs left both me and every squirrel who chased him with mouths agape in awe and terror. I only saw him the one year of course. He was destined to die young. But oh, what a glorious season. I adored Hugo. He lived like a meteor…hot, fast, and brief.

But his memory faded over time and I was lulled into complacence. I eventually forgot that great ones, avatars, sometimes appear among this race…until late July when I discovered the first beautiful eggplant lying mangled in the pathway. Now I assure you, over time I’ve grown familiar with their favorites, these squirrels.  Fruit has always been their main target and I’ve adjusted my efforts accordingly.  The apple tree I gave them early, it’s always been theirs to plunder, and this year I finally surrendered both the peaches and my four espaliered pears as well. I still fight for the grapes as the muslin bags I tie on each individual cluster have so far foiled their best efforts but up until now they never thought to molest the vegetables.

So when I first spotted the eggplant I naturally thought it was Dane the mangy rescue mutt because Dane will eat anything…anything I tell you…but then I glimpsed the second eggplant lying beneath the spruce tree where they nest, and when I walked over to pick it up I found a hole the size of a golf ball with telltale teeth marks pocking the rest of the skin.  That was when I realized, with sinking heart, that a new squirrel god was nigh.

I’ve named him Ivan the Terrible and, unlike Hugo, his presence gives me no joy. He brings naught but destruction and waste and has so far vandalized not only my eggplants and tomatoes, he’s chewed holes in all the pumpkins, half the butternuts, and eaten about twenty percent of my Delicata squashes outright. Five weeks ago he started eating every new, young squash, regardless of variety.  The muslin bags on the grapes thwarted all his efforts but in his malice he chewed the clusters off the vines anyway and left them lying there on the ground for me to find and weep over.

I pray that, like Hugo, Ivan, too will die young, and that this season will be the only one in which the garden suffers such depredations. But secretly, I fear a darker destiny. I’m haunted by the idea that, like the Yosemite bears who learned to peel open cars for the Cheetos inside, he might teach the other squirrels his ways, that they might all look with fresh eyes on the true abundance of food available and give rise to a new breed that would finally consume everything…everything…I grow.

Sigh.

Perhaps it’s a sign.  Maybe I should think about finally downsizing the garden a bit to get out kayaking more.  I must admit, I’m getting older and farming the backyard is getting harder every year.  Could this squirrel actually be Ivan the Liberator? I’ve seen stranger messengers.

Hmm.

copyright Dia Osborn 2013

Mothers carrying the DNA of their children? How exquisite.

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William-Adolphe Bouguereau (1825-1905) – Charity

Here’s something odd and fascinating and kind of beautiful that dramatically shifts our understanding of DNA and genetics.

Researchers have discovered that evidently, a lot of us harbor not only the unique mix of DNA we inherited from our parents, but also DNA we’ve picked up from other people along the way, proving on a genetic level that John Donne was SO right when he said that no man is an island. Scientists are calling these people chimeras, a term borrowed from a mythological creature which was made up from several different animals.

According to the New York Times article DNA Double Takescientists have found cases where people who’ve received bone marrow transplants carry both their own DNA and the DNA of their donor, twins sometimes carry multiple genomes in their blood from fetal blood transfers, and a majority of mothers likely carry some DNA from the children they nourished inside their wombs while they were pregnant.

What I found particularly moving about the last example was this line from the article:

“Chimeric cells from fetuses appear to seek out damaged tissue and help heal it, for example.”

Evidently, pregnant women have been benefitting from a natural form of fetal stem cell transplant for aeons.  Now that’s a loving exchange on the most visceral level.

In addition to sharing our DNA among us, it’s also not uncommon for any one of us to carry alternate DNA resulting from genetic mutations in various parts of our bodies…in other words many of us have multiple genomes inside us that we made up all by ourselves.  We’ve known for a long time that that’s how cancers tend to get started, but evidently other non-cancerous cells can do the same thing, sometimes for better and sometimes for worse:

“Now that scientists are beginning to appreciate how common chimerism and mosaicism are, they’re investigating the effects of these conditions on our health. “That’s still open really, because these are still early days,” Dr. Urban said.

Nevertheless, said Dr. Walsh, “it’s safe to say that a large proportion of those mutations will be benign.” Recent studies on chimeras suggest that these extra genomes can even be beneficial….

…But scientists are also starting to find cases in which mutations in specific cells help give rise to diseases other than cancer.”

Needless to say this is to some extent changing the way that we’ll have to approach everything from genomic medical research and diagnoses to forensic science (a cheek swab might deliver two sets of DNA for instance) as well as the growing field of genetic counseling.  It looks like human beings are not going to be quite as easy to map and label as we once thought.

And I admit, I just love that.

‘No Man is an Island’

No man is an island entire of itself; every man 
is a piece of the continent, a part of the main; 
if a clod be washed away by the sea, Europe 
is the less, as well as if a promontory were, as 
well as any manner of thy friends or of thine 
own were; any man's death diminishes me, 
because I am involved in mankind. 
And therefore never send to know for whom 
the bell tolls; it tolls for thee.

(For any other lit geeks like me out there, you can find the above version of John Donne’s poem as well as the olde english version here.)

copyright Dia Osborn 2013

 

Odd Thing About Dying #2: We’d like some destiny with our death please.

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Atropos of the Morai (One of the Sisters of Fate)

In the previous post Odd Thing About Dying #1: They’ve blocked most of the exits I talked about how challenging it is to die these days because the modern medical system has evolved to prevent it wherever possible, even when a person reaches the end of their natural life and is more than ready to go.  And so far hospice (along with the growing palliative care specialty which often goes hand in hand) provides the only officially sanctioned exit where people are allowed to leave the system without a fight.

Now, that being the case you’d think that everyone who didn’t want extraordinary measures taken to extend their lives would be fighting to get enrolled in hospice as early as possible, yes?

Well, no.  Far from it.  Hospice care is one of the most misunderstood and underutilized services out there while, where palliative care is concerned, the majority of people haven’t even heard of it yet. There are a number of reasons for this (including the fact that most people don’t WANT to understand them because it involves talking about dying) but there’s one reason in particular I’d like to discuss here and it essentially boils down to this:

Most people feel to some degree that, if they enroll in hospice, then they’re choosing to die.

This isn’t true for a couple of reasons:

1) When a person enrolls early enough, hospice is about deciding to LIVE WELL UNTIL one dies.  It’s about life, not death.

2) Dying isn’t really a choice to begin with, it’s a destiny. Choice implies we could decide not to die if we didn’t feel like it which of course we can’t.

People aren’t entirely wrong however. Due to some brilliant medical and public health advances we don’t usually “just die” anymore, we have to choose when; when to stop seeking treatment, when to forego that surgery, when to surrender to that infection, when to decline that CPR, or when to remove that ventilator.  Either we or our loved ones have to huddle with our doctors, weigh all the options, and then consciously decide whether to fight for the possibility of extra time or to let it go.

Of course at first we hailed these advances as unqualified blessings but over time it’s turned out that all the new choices can create something of a burden, and sometimes a curse.

You see, there really isn’t a clear point anymore where a doctor has to tell a patient, “I’m sorry but there’s nothing more we can do.” There’s always something more they can do, which means that until a person get decisive and say, “No, that’s it, I’m through. Please stop now,” chances are the doctors will keep suggesting something else.

Just so you know, this is a sea change in the way we humans face death.  It’s historic.  As far as I know, never before in human history has there been a point where the majority of people had to consciously choose when to die, or have a loved one choose for them. This development is an unintended consequence of all our new medical possibilities and, along with the miraculous blessings it bestows, it also requires that we now stand up and assume a level of responsibility for our own death that was unimaginable just a few decades ago.

Only we don’t really want that kind of responsibility.  Turns out one of the things we actually liked about the old way of dying was that we didn’t have a choice.  Destiny used to shoulder that burden for us, which we thought we hated at the time but are now starting to realize was maybe not as bad as we thought.

For a while everyone thought that of course our doctors would take over from destiny and let us know when “our time” had come.  But it turns out they don’t want that responsibility either and, honestly, who can blame them? The burden of telling someone they’re going to die is extraordinary, even when a person wants to know.  And if they don’t?  Well, that can be a lawsuit.

So doctors try and sidestep any kind of straightforward prognosis and hand us the research and statistics instead, from which we then have to try and divine the tea leaves for ourselves.  In addition, the majority of doctors still tend to encourage us to pursue aggressive treatment, often far past the point where they would themselves, with the stated goal of preserving hope but really for the purposes of distraction.  While they often have a good idea when a treatment will be futile, they also know that even a futile treatment can offer us temporary shelter from our terror of dying, which on the one hand is genuinely kind and deeply human, but on the other is a lot like that old bear attack joke:

Question: What are you supposed to do when you’re being attacked by a bear?

Answer: Run like hell.  It can’t save you but it’ll give you something to do for the last thirty seconds of your life.

Only dying is now taking a lot, lot longer than thirty seconds and people are starting to feel like there are better things to do with that time.  But our instincts work against us.  Seeking further treatment still feels like the most right and natural thing to do, and besides everyone else is seeking further treatment, and on top of that there’s major disagreement about when it’s wisest to stop because it’s completely different in every case.

So to recap, while destiny is still in charge as far as death itself is concerned…we all still die…our medical advances have allowed us to seize more control around the timing issue.  Only that means somebody now has to decide when to treat and when to stop, and while we’d mostly prefer that our doctors made the decision since they know so much more than we do, they’re proving reluctant.  Which leaves us to make the choice ourselves, only 1) we don’t know enough to make an informed decision, and 2) we’re unwilling to educate ourselves because that would mean actually talking about dying and we don’t want to do that either.

The whole situation reminds me of a teenager who wanted nothing more than to move out of the house and call all the shots, only to discover the new freedom requires getting a job to pay the bills.  Well, it looks like our new miracles also demand that we assume more responsibility. We’ve created a bewildering array of new choices around the question of when we actually have to die and our new job is to figure out what, among all those choices, constitutes a wise one.

Next up, I’d like to explore some of the reasons why the current choices we’re making aren’t working out so well.  I’m curious to see if breaking them down and examining them more closely might suggest better options.  And, as always, If anyone else has some thoughts on this subject I’d be eager and curious to hear them.

copyright Dia Osborn 2013

Related articles:

A Better Way To Die

Squashland

20130828_091250

Bert

Bert is a Hubbard squash, the largest this year.  Missing are pictures of Bertha and Beatrix,

also large but harder to photograph as the girls are both shy and hiding under leaves.

Bert is the first Hubbard squash I’ve grown who is too big to fit in the oven.

(He’s deeply embarrassed and keeps apologizing.

Squash are actually quite tender on the inside.)

This means, of course, that he’ll have to be cooked in pieces,

a ticklish affair since the shell of a

seasoned Hubbard squash

is impervious to knives.

Hard.

So

Hammer?

Saw?

Drop him five feet onto concrete?

Other ideas anyone?

We’d be grateful.

20130828_091537

The Pumpkin clan are also doing well.

Fat Hamish in the lower left is a wild thing and recently confided

that when he turns orange

he wants to be shot out of a cannon.

Turns out he’d only ever heard about the flying part

and not the landing

so now he just wants to be carved to look like

Bob Marley.

Simple enough.

copyright Dia Osborn 2013

Odd Thing About Dying #1: They’ve blocked most of the exits.

800px-Emergency_exit_Stockholm_metro

Oh, those Swedes.

I was thinking the other day about important things I learned while working with hospice (and by “important” I mean things like what surprised me to the happy upsideand what do I need to know to make a graceful exit when it’s my turn?) and a few things came up.

The first is a piece of information that falls under the Graceful Exit category and is, I think, pretty important. Perhaps even critical in the same way that knowing where the emergency exit doors are located on a plane can be critical. It goes something like this:

If the current medical system was a building that we’re supposed to enter at birth and leave at death, then there’s a serious flow problem because they’ve blocked most of the exits.  

There’s basically only one official door left where people trying to get out are allowed to leave the building without a fight. (More on that below.)

No doubt about it, we’re living in an unusual age.  Dying has become very hard to accomplish, which is weirdly wonderful until it’s actually time to die and then it totally, totally sucks.  It wasn’t always like this.  For roughly the last thousand years of Western civilization, people used to die according to a fairly simple formula:

a) They lived for a time.

b) They got really sick or severely injured.

c) They realized they’d never get better.

d) They summoned, reconciled, forgave, received forgiveness, and bequeathed.

e) Then they went ahead and died.

(Except for those who died suddenly and went straight from A to E.  It’s interesting to note that while nowadays many feel that’s an ideal way to go, historically it was frowned upon.  Dante for instance, relegated some of the souls that died unexpectedly to the lowest circle of hell which, I don’t know, seems a bit harsh. I’d be curious to know his thinking on that one, although he looks like a scary guy to argue with.)

Portrait_de_Dante

This by Sandro Botticelli.

Due to some of our pretty extraordinary medical advances however, that ancient formula isn’t working so well anymore and while we’re still following the first two steps…

a) We live for a while.

b) Then we get really sick or severely injured.

…once we get to Step C things fall apart at the seams.  Our bodies can now be kept alive almost indefinitely which has made it a lot harder, sometimes impossible, for people to either slip out without any fuss or at least figure out when it’s time to let go.  I’m not exaggerating here.  The bottleneck of bewildered, milling, hospital gowned people trailing IV poles and looking for a definitive answer has grown so massive that it’s threatening not only our healthcare system but our entire economy.

So why is this happening?  Well there are actually a lot of reasons but I’m only going to address two of them here.  The first is that, while modern medicine has a variety of goals, there’s a kind of One Goal To Rule Them All.  Our current healthcare system has evolved around the central purpose of keeping everyone alive for as long as possible which, for the vast majority of our lives, is a good, noble, sacred thing, and one which I think we’re all pretty grateful for.

The problem arises when someone realizes that oh, it’s my time, so they gather their things and head for the nearest exit (these are the doors with signs overhead like Heart Attack, Pneumonia, Sepsis, Aneurysm, Dehydration, Flu, Respiratory Failure etc.)  But there are guards on all these doors who turn them back with shock paddles, intubation, or offers of antibiotics, vaccinations, IVs, etc., sometimes over and over and over again.  People trying to leave the building often have to spend a lot of time and money frantically going from door to door until they’re finally so frustrated that they just overpower the guards and escape anyway.

I read a recent story of an elderly gentleman with a heart condition who decided he’d lived a long enough/good enough life and was now ready to go.  After much deliberation he decided to decline any further interventions and treatments, filled out an advance directive, got his wife and doctors all on board with his decision, and even signed a Do Not Resuscitate order.

Then he went golfing where he had a major heart attack somewhere around the seventh hole.  Panicked bystanders called 911 which, unfortunately, activated the guards standing next to that particular door.  The EMT’s sprang into action and once they arrived on the scene nothing could really stop them.  (Please keep in mind that emergency responders are bound by some strict legal codes to preserve life and deliver it to the hospital.)  Evidently, even the man’s advance-directive-bearing-wife couldn’t get them to stop (I wonder where the DNR was and if it would have made a difference?) and so our elderly gentleman had to endure the overwhelming pain and multiple broken ribs of CPR along with many other uncomfortable resuscitative efforts in both the ambulance and the emergency room before he finally died from his heart attack anyway, just far more broken, disheveled, and black and blue than if he’d been allowed to die back on the green. (And then his wife got the bill.)

Needless to say this was not how he wanted to exit the building.  At all.  Most people don’t want to leave this way.  Nevertheless, this kind of situation happens over and over again because right now there’s still a sizable disconnect between emergency medical services and end of life care.  (And preventive services and end of life care.  And routine care and end of life care.  And…well, pretty much the entire medical system and end of life care.) This kind of thing happens in nursing homes and assisted living facilities and hospitals, too, and everyone knows it’s a big problem. The good news is that solutions are currently being sought.  The bad news is a lot of the problem is structural and hard to change.  Even so I’m confident we’ll figure something out eventually.

So in the meantime, what’s a person who’s ready to go and wants to avoid extraordinary medical measures to do?

Well, this is where that One Official Exit I mentioned earlier comes in.  You’ve probably already guessed by now but the sign over this door reads HOSPICE (and to a growing extent the up and coming PALLIATIVE CARE.)  Just so you know, people who queue up at this door are hands down the most likely to have their passports stamped and passed right on through in a graceful, peaceful, unmolested way.

Sounds simple enough, no?  I thought so too, but in reality this particular door, even though it’s the one that everyone respects and agrees on, is still the most misunderstood and underutilized exit of them all.  Why?

Well, that brings me to the second reason why people tend to bottleneck in end-of-life care these days, but I don’t have room for it here so I’ll have to cover it in the next post:

Odd Thing About Dying #2: We’d like some destiny with our death please.

copyright Dia Osborn 2013

Related articles:

“Maybe we need to redefine “Palliative Care.”

“Hospice Misunderstood by Patients, Providers Alike”

“Why MOST doctors like me would rather DIE than endure the pain of treatment we inflict on others for terminal diseases.”

Banding Hummingbirds for science . . . and the thrill of holding such a mystical being!

Dia:

This is something I’ll have to look into doing next year! I can’t imagine actually holding a hummingbird. Wow.

Originally posted on Rangewriter:

DSC_1103 - CopyBetween May and September, hummingbirds are on the move across Idaho. At least three species of these itsy-bitsy birdies—smallest bird species in the world—migrate from their winter range in Mexico to their breeding range in Alaska and back again.

Rufous Hummingbird

Rufous Hummingbird

The Idaho Bird Observatory (IBO), a department of biological sciences at Boise State University, “monitors the abundance, breeding condition, and migratory timing . . .  of the hummingbirds that use the Boise National Forest during the breeding and migration season.” The data is shared with the Hummingbird Monitoring Network and the Western Hummingbird Partnership. Reliable data helps scientists understand the migration patterns and monitor threats to the continued success of the hummingbird. Last year IBO captured 368 birds, 48 of which were sporting bands from previous captures. The breakdown:

  • 178 Black-chinned – weighs about as much as a nickel
  • 177 Calliope – smallest migrating creature in the…

View original 240 more words

There’s a whole lotta love coming out of Oklahoma

20130812_131340_resizedBook Review: Transitions: A Nurse’s Education About Life and Death by Becki Hawkins.

Some of you may remember an old post I wrote called Someone Else Wrote My Book: What Now? where I expressed some angst at the discovery that a hospice nurse/chaplain from Oklahoma had just published the book I was trying to write.   Well, after a year of dark muttering in my cups I finally read Transitions: A Nurse’s Education About Life and Death by Becki Hawkins and loved it.  Loved.

Her book brought it all back to me again in the best way, what it used to feel like when I worked with hospice and how the people I served strengthened, nourished, and changed me.  Transitions provides an authentic portrayal of the endless number of ways that people face catastrophic illness and death, not in a clinical or grisly way, but in terms of the beautiful and vulnerable humanity that inevitably surfaces.

More poignant still, Becki reveals the transformative power generated by something as simple as accepting the overwhelm and grief of another human being.  There are some terrific reviews over on Amazon that do a better job than I could at describing her gentle, loving handling of the subject matter (especially the one titled Nurse Conquers Attack Geese, Copperheads, Sceptics which I wanted to copy and paste in full here but didn’t for fear of getting caught) so I won’t try and cover that ground again.  I’ll just mention a few of the particular reasons why I loved the book so much myself.

Number one, Becki’s career spanned decades and her stories are written through the eyes of someone who’s seen people die from a lot of different things, something that’s actually pretty rare.  I got to take the journey again with her as she evolved and changed through the work and it took me right back to the mystery, magic, and intense vulnerability one experiences while roaming the dying rooms.  The way that each person winds up teaching what an extraordinary, mind blowing feat it is to live an entire life from beginning to the very end.

There is no such thing as a boring life, just boring ways to talk about it (something one encounters both in and out of hospice.)  But with some practice, good listening skills can overcome that problem and Becki’s clearly a master listener.  She draws out the thoughts of those she worked with in a way that allowed a quality of luminous, trembling soul to shine through and the book is full of the kind of dignity and strength that results from that level of respect.

Which brings me to the second reason I loved the book.  Becki not only captures the full range of experiences of what it’s like to work with the ill and dying, she captures it in the abundant charm of the Oklahoma vernacular.  She has quite an ear for the spoken word and delivers her stories in an enjoyable blend of modern medical language and the older, traditional language of her people. For me, the book was as much a loving portrayal of the culture and people of rural Oklahoma as it was of their health status, and when reading her stories I felt like I was peering in through a window to catch glimpses of an old wisdom tradition passed down through the generations.

A quick head’s up for those who are not of a religious bent, a lot of this wisdom tradition is couched in the religious terms of the region and from a couple of reviews I read this was a stumbling block for some people.  It was actually part of the reason it took me so long to read the book myself but as I got to know Becki personally over the last year I discovered that she’s one of those people who can love her own faith while also respecting and supporting the beliefs of others and that knowledge helped me relax and let down my shields.  I’m really glad I did, as I would have missed something beautiful, heartfelt, and universally true otherwise.  No matter how we express it individually, we all die with the same aching mixture of heightened longing and love.

And the final reason I loved it that I’ll mention here is because in the last section of the book Becki reveals how her professional work with the ill and dying eventually helped her navigate the illness and dying of her own loved ones, and I found her experiences to be a confirmation of my own.  While the illness and death of a loved one is just as overwhelming for those of us who’ve worked with the dying…the loss as great and the grief as piercing…still our familiarity with and intimate understanding of the dying process helps enormously when the time comes.  I can’t say this enough.  A knowledge and understanding of dying is an anchoring influence for everyone involved.

Of course everyone can’t go out and become a nurse and work for decades in the field to gain that kind of familiarity and understanding, but everyone can read books like this and begin to arm themselves with the knowledge of those who have.

I know I keep saying this over and over again but it’s only because it’s so important: We all need to be better educated about this last and greatest journey of dying, and we need to start doing it now.  The number of aging people approaching their final threshold is growing daily and in the next few decades dying will become a central, collective social event.  But that doesn’t mean it has to be a sad, tragic, and horrible era.  At all.  With the tools and perspective that hospice and palliative care provide it’s entirely possible for us to collectively craft a thoughtful, courageous, and wiser way to approach the end of our lives, one that’s dignified, loving, generous, and ultimately life-nourishing for us all.

Transitions: A Nurse’s Education About Life and Death is another book among a (thankfully) growing number that provides a window into such an approach.  I highly recommend it.

Other references:

Here’s a Youtube video of an engaging talk Becki Hawkins gave in Sedona, Arizona about some of the spiritual experiences she saw in her work.

And here’s a link to Becki’s blog Transitions.

People who smoke are not evil.

355px-Mayan_priest_smoking

(Image of a Mayan priest smoking from Wikipedia.)

I’ve been thinking about a different but still dying-related subject lately.

Over the last fifteen years or so I’ve watched with dismay as the denigration of people who smoke escalated into a kind of national past time. I’ve occasionally even heard them described in terms so derogatory that it put me forcibly in mind of parallel language used by hate groups, and this from the mouths of people who sincerely, deeply abhor discrimination and prejudice.

That caliber of conversation can be very seductive and feel so good and right and even funny to those engaging in it, but in reality it’s not terribly helpful to anyone who’s actually trying to quit.  I think we’d all be better off if that part of the discussion took a more constructive direction.

I’d like to mention here that there is no such thing as a smoker.  (Well, there is, but it’s a piece of equipment that dries meat.)  There are human beings who smoke, which are two completely different things that we need to separate in our minds and then deal with accordingly.  It’s perfectly appropriate to condemn tobacco use and the dealers who market and peddle the poison and make fortunes off of the misery they create, as well as the incredible trail of destruction that smoking leaves in its wake.  But it’s misguided and counterproductive to condemn the living, breathing, struggling human beings who have been caught by the addiction.

Here are a few stats from the Division of Periodontology at the University of Minnesota (smoking wreaks havoc on gums, too) that might help explain:

Tobacco is as addictive as heroin (as a mood & behavior altering agent). 

  • Nicotine is:
    • 1000 X more potent than alcohol
    • 10-100 X more potent than barbiturates
    • 5-10 X more potent than cocaine or morphine  

Pressures to relapse are both behaviorally & pharmacologically triggered.

(A pit stop at their website to peruse withdrawal symptoms might also yield interesting fruit in terms of understanding how incredibly hard it can be to stop smoking.)

Please believe me when I tell you that nicotine addiction is a powerful, powerful enemy and it can require an almost superhuman effort to escape from the dingy, coughing, stinking prison it can create in a person’s life. I speak from experience.  In tobacco products, nicotine often behaves like a pusher or a pimp, seductive at first and promising all kinds of good things, then insidious, relentless and, finally, horribly abusive.  Some people can smoke occasionally without getting snared but for the millions of us who can’t, the addiction is dangerous, degrading, and eventually deadly.

After thirty some odd years of failed attempts I was finally able to quit.  I sincerely believe it’s for good this time (nine years now) although I’ve learned not to be complacent because cigarette cravings can spring back to life after years of dormancy with a viciousness that has overwhelmed my defenses more than once.

But I wasn’t able to finally quit because I was surrounded by strangers who were gazing at me with loathing, or whispering snide comments, or making me the butt of cruel and demeaning jokes.  Quite to the contrary in fact.  That kind of treatment was hurtful and humiliating and far from acting as a deterrent it tended to drive me back to the very real and powerful, if costly, relief that nicotine provides.

What did help were the people in my life who saw me as a flawed and smelly but still somehow beautiful human being worth loving in spite of my habit.  Ultimately, I had to enter the trenches and fight my demons alone, numerous times, just like every other addict does.  But the fact that I had people in my corner rooting for me and telling me they believed I was worth fighting for made all the difference in the world in my finally succeeding.

I hope that’s something you’ll consider if you find yourself looking at someone with a cigarette and feeling the urge to flippantly judge or condemn them.  Try and separate the tobacco from the human being if you can and then hate the one and find value in the other.  Of course, set whatever boundaries you need to where the smoke is concerned, but try and do it with respect and encouragement instead of contempt.  I honestly believe that will ultimately be of more benefit to everyone.

Here are some great tips for those who want to support someone they love to quit smoking:

Helping a Smoker Quit: Do’s and Don’t

10 Things Not to Do if You Want Someone to Stop Smoking

And for anyone trying to quit smoking and looking for support here are a couple of places where you might start:

Nicotine Anonymous

Resources for Quitting Smoking (full of hotlines)

Quitnet