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November 14, 1999The fact that whether someone gets treated because of the cost is bothersome, but one thing I feel about medicine is that we're beginning to do too much. We need limits. We're saving too many premature babies. We're saving too many people. There's a time to expire.
A first year intern at a big city hospital,
Quoted in the New York Times, 11/14/99
The above quote was from quite an interesting and revealing story in the New York Times this morning about the brave new world of managed health care and associated cost cutting and niggling over dollars and life and death procedures. The HMO world of medicine wants more accountability, which in and of itself is good, but the question must be raised, "Accountability for whom? and "What gets paid for and what doesn't?"The young intern, whose father before him was a doctor, is facing this new world of high-tech medicine with all the potential bedside manners and psychological acuity of a jaded accountant. And, horror upon horrors, he says people just have to be prepared to bite the bullet, throw out the tubes, and conveniently "expire" so the rest of us have more of a chance.
Oh, how I detest that word. I wonder, was he taught to use that word in medical school? In the course of incurring his $100,000 in debt to get his degree, did he lose some of his basic humanity in the process? Why can't people just say it: "Expire" means to die. What a repulsively clinical term "expire" is. I'm glad I won't be around to read my death certificate.
Well, you say, the young intern was just being bluntly honest. Who's going to pay the hundreds of thousands of dollars to prolong life without accompanying quality of life? Who makes the decisions? Some accountant or clerk in an HMO office?
It's is no wonder people don't want to go near a doctor's office. Is it any wonder hospitals are filled with only the sickest of the sick now and that the average stay is 4-5 days?
I quake before the fact of my own mortality, but I mourn the loss of health care that is compassionate and humane. The bottom line speaks.
November 12, 1999It's a very strange feeling to face possible major change in your life. I had an interview yesterday for a job at another branch of our organization. It involves significantly more pay, a couple of levels up on the scale of responsibility, I guess you could say. Yet, I have very ambivalent feelings about leaving the place and people I've worked with for the past five years. It's amazing how utterly accustomed one gets to the people, routines and very job one does day in and day out. Predictability, sameness, consistency in the outer structure of the work day and work environment, though not in the details of the day-to-day work, make for a kind of plateau effect. It's soothing, but not always challenging. It's painless, but sometimes we need to be bumped, rather painfully, out of our complacency. The status quo is just that.
So, I think maybe I'm stagnating. Maybe the change will be good if I get the new job. Colleagues have been leaving right and left for other jobs. There's constant flux. It's just that I've had my seasons of flux and endless change. I'd like to stay put, but I don't think I can, even if a major change will upset and greatly disturb the equilibrium I've managed to maintain over the past few years.
Never before have I faced such a choice because I've never been in any one job or place anywhere near this long. It gets harder to adapt to change as you get older, at least it does for me, though it's probably true for most people. We are both repelled and attracted to novelty and change because that can lead to personal growth and maturity, if we handle it well, and from that springs a higher level of fulfillment and autonomy.
When I was younger, I'd always face these big moves with butterflies in my stomach. A nervous, upended feeling took hold, especially when the actuality set in and I was driving one of those rental trucks with all my belongings to a new town or city and a new job.
This change, if it comes about, will not involve moving from where I presently live. It will be within the same organization. But in every other way, I will have cast off from my safe moorings in search of a new port, a new safe harbor, another place to continue the journey.
November 11, 1999College of Charleston, Nov. 10, 12:30 pm:
The wind feels good on this warm, Indian summer day. I notice, as I did yesterday, that there's that certain smell in the air -- of earth and leaves and trees that's somewhere between summer and winter. There's still a lot of life left in this November garden at the college. It's mild and humid enough for big, white clouds to be about, traversing the sky above, slowly, oh so slowly. Soon, the unadorned blue winter sky will be the norm, except on days like this. And then I will long for spring.
Day after day I come to this same spot to sit and observe, and to write, if I can. Yesterday, I watched two yellow butterflies tagging along after each other in that seemingly random hopping around that they engage in. I'd like to go to the Butterfly Barn north of here and watch a lot of them at one time, and in one place, or else take a trip to Cypress Gardens to see them there. I never tire of watching them.
It seems that sometimes, like butterflies, I never know where I'm going to land or whether the wind will blow me suddenly off course. Also, in the past, it has been my general pattern of life to alight somewhere, remain there for a short while, and then move on. On and on. From one place to another.
Today, in this garden, surrounded by trees and shrubs, the confusion and movement of the city around me blotted out for a time, I'm where I want to be, for now. At this moment.
November 10, 1999Yesterday at work, I had one of those little epiphanies, I think it could be called, a brief and fleeting moment of utter satisfaction and sense of belonging in a place, a job. I was so involved in my daily routines and work that I really wasn't too conscious of time or place at all. It was rather like being in that psychological state called "flow" that was the subject of a book a few years ago, in which the author wrote about "the psychology of optimal moments." He was referring specifically to writers, artists, inventors, scientists and other creative types of people, but aren't we all, in some sense, these things? Can't we be artistic, inventive and creative in the course of our ordinary, daily lives? Time stands still, you feel connected with the world and others. You are in right order with the universe. It doesn't last long, this feeling.
I remember as I was walking from the staff kitchen, back to my desk thinking how at ease I felt with my job, and how comfortable with it and the people I work with. How I really enjoy those co-workers and that being with them day in and day out has come to seem as natural as being with family or close friends. Since I have very few close friends, and they are many miles distant from Charleston, my friends at work have become my nearest close friends. As close as I seem to be able to get, that is. There is a comraderie, an effortless rapport that just struck me forcefully, for a quick moment yesterday. Dare I call it a fleeting moment of happiness? I suppose it was. Maybe that's what epiphanies are -- keen and penetrating insights into the nature and essence of happiness and contentment. We flow along in life's current. That's why I remember it and am writing about it.
November 8, 1999At the College of Charleston garden this afternoon at lunch time, I sat facing the pecan tree and looked up to blue skies and a tree growing increasingly weary and restive for the transformation it must undergo as its leaves begin to turn brown more noticeably now and start to fall. I had my notebook in my lap writing, and as I gazed up a second time, a small, light twig with six leaves attached came floating down from high in that tree directly toward me. I opened the palm of my left hand, outstretched, and it gently brushed my fingers and fell to the ground.
November 7, 1999It's a beautiful Sunday morning in autumn as I post this journal entry. I wrote most of it, except for the concluding paragraphs, a month or so ago, and just forgot about it for awhile, not knowing if, or when, I'd put it in my journal. For some reason, this morning I dug up the notebook it was in from among a pile of papers, found the handwritten entry, and decided now was the time. It feels very strange and disquieting revisiting all this. I'm not even sure if I should. I may change my mind later and delete what follows. It's a continuation of an earlier entry on the same subject.
It's a heartache, nothing but a heartache...Bonnie Tyler
Why?It was the summer of 1995, six months after I started the job I presently hold. I was not taking any medication at that point for the depression I was suffering, just a generic version of the benzodiazepine, Ativan, that I had started taking early in the battle to quell potentially devastating and unremitting anxiety. I mean total anxiety. The kind that takes over and is a potent and awful force unto itself, above and beyond the depression. This is the same drug my father was given in the days before he died of cancer. My aunt took it for a long time. She fought cancer and depression for many years. I was psychologically, if not physically, dependant on that drug, which is for short-term use. I, who never drink alcohol and who had only the briefest flirtation with a mind-altering substance in my youth. Some people seem to need it for longer periods of time. Ativan is related to Valium. Most people know of that infamous cousin. It works wonders in relieving anxiety, briefly, for it is truly a mind-altering drug. But the repercussions of continued use included the paradoxical side effects of even worse depression and anxiety than before taking it. Some refer to this as the "rebound" effect. I knew I had to get off it. But how? I didn't think I could get through the day without it.
But I resisted taking any antidepressants because of vivid and terrible memories of older drugs taken for depression 20 years ago. So, I marched through the days at my job, sensing that having work to do, plus living in my own apartment, would finally cause the depression to lift. It would disappear into the shrouded, dark mists from which it had come.
I was pinning my hopes on the very fact that I had rejoined the human race through the work world, so to speak. Here is how it came about that I got my first job in over a year.
It was an afternoon in late November. The gincko tree outside the window had long since changed to yellow and its leaves were gone. Winter was approaching. My aunt asked me once again if perhaps I didn't want to try getting a job at the ______. I finally relented and let her make arrangements for someone to call me and see if I could do some volunteer work. I felt I could barely carry on even the briefest conversation at that point, much less put myself forward for a job, even if it was as a volunteer.
I'll never forget the day the volunteer coordinator called. I was in bed. I felt as if a compress made of lead, literally, was putting pressure on my head. My brain felt like it was being squeezed and twisted. I could hardly get up. I had almost no energy. The small room I was in was like a cell. The phone rang. It was the woman from the ______, a person I cherish to this day beyond words to describe. It's a wonder I could form a sentence. But somehow I ended up going in to talk to the department head who needed some work done in an area where I was quite qualified to help. It was something I could easily do with a little bit of training. Fortunately, my cognitive powers were holding up enough for me to get through this initial phase. In a month's time, I was hired part-time to do the job, much to my relief. It later turned into a full-time job.
Soon, I was into a regular work routine once again. I no longer punished and berated myself for being useless. I wasn't as paranoid and preoccupied with my endless troubles and worries. Depression lowers your self-worth so precipitously that even the most innocent comment by a stranger or even family member can be twisted by the person who is ill into attacks and condemmation.
That afternoon, when the call came, I had just about given up ever finding a job. I couldn't imagine how anyone would hire me. I had even registered at a temporary agency months before and gone through the agonizing ordeal of filling out a simple application form.
So I had a job, I had a place to live. But the anxiety was still there. The vise-like grip of the depression clung to me. Months passed. I finally went to a doctor. I started on a low dose of Prozac. I phased myself off of the benzodiazepine.
To this day, I'm not sure what actually lifted the depression -- the Prozac, or eliminating the benzodiazepine. I'm not sure I'll ever know. I want to believe it was the antidepressant.
I do know that the experience changed me fundamentally and permanently. I'd like to say it has made me a more compassionate person who can understand more fully why people suffer. I'd like to think the experience cleansed me. It did and it didn't. I'm still the same person, troubled by the same internal and external conditions and internalized conflicts that have plagued me all my life and won't go away. I can, however, emphathize more fully with people when they hurt deeply. I revisit my own past. It pains me terribly to see anyone hurting.
Depression robbed me of life for a time, and also of many of the nuanced feelings and emotions I had before, however intense, disordered and unhealthy those emotions and moods might have been. At least I had them. Something has replaced the depression, for sure. But I am not certain at all what that is or how to explain it. I don't "feel" the way I used to.
That is one reason why photographs, writings, souvenirs, mementoes, and old letters and journal entries from years past are so important to me. They are records of who I was before and after periods of major depression. They are capable of letting me acknowledge and relive memories and feelings from the past, sometimes, unwittingly, very unpleasant memories, too.
To attempt to be whole once again, I have to continually try to integrate those same memories and experiences into the present, those that can be revisited or recalled. Some might say this is a preoccupation with sentimentality or nostalgia, of with the past itself, because so many pleasant associations are stirred up and brought to the surface, but I know deep down it's much, much more than that.
November 6, 1999Sometimes photography soothes, inspires and helps create a mood and sense of place that I want to inhabit for awhile. This happens whenever I take a look at William A. Bake's photographs in "The American South: Four Seasons of the Land." I've enjoyed this book every time I've retrieved it from the shelf over the past 20 years. It's one of my favorite books, one of those books that I would take with me if and when I have to throw together some of my belongings and evacuate Charleston in advance of another hurricane, as I did this past September. I'll be better prepared next time.
I can't describe the photos, except to say that they convey universal attributes about the landscape and the people of the South that transcend notions or stereotypes about this geographic region. A lot of the scenes are in and around the foothills and mountains of the Blue Ridge in western North Carolina, a favorite area for Bake to photograph, as he has come back to that area for other books. But the scenes range all over the South, from Harper's Ferry, Maryland to Big Bend National Park in Texas.
The pictures capture all the seasons so beautifully and knowingly. Bake truly has such an intimate acquaintance with, and appreciation for, each of the seasons and their moods that he can intuitively reveal them to us through his compositions. They are as timeless and lasting as any photographs I've ever seen. I never feel the same way about them. It's always a different experience, and that's what I like so much about this photographer and his work.
November 5, 1999If one reaches the point where understanding fails, this is not a tragedy: it is simply a reminder to stop thinking and start looking. Perhaps there is nothing to figure out at all. Perhaps we only need to wake up.
Thomas Merton
There are times, like this week, when I just want to withdraw into myself, and get away from the slings and arrows of people, whether at work or elsewhere. I don't want to see people or have to deal with them. It's just been a bad week, I have to say, one where suddenly things get turned upside down and bad feelings flow out of open wounds in the soul. Words hurt. They ignite the slow fires of indignation and injured pride, just when you think they have been damped out.And then, there are the words that simply come from out of nowhere like projectiles which explode in your consciousness. But actually, they're more insidious than that. There're like silent strokes that may not at first appear to have done any damage. You're at a loss for words. It happened at work, and I found myself trying, and once again masterfully succeeding, in letting on that I was not fazed by it, that I had instantaneously forgotten and moved on, when I most certainly had not. I play the game well.
You get to a certain point in life where you've been hurt by words enough that you've built up a hard shell, enamel-like in its seeming impenetrability. Hard and impregnable. But like chinks in armor, the enamel develops cracks and weak spots. It's not so impervious to injury as you might think.
People say and do things unthinkingly. Maybe the malice is only subconscious. I know that's a possibility. I should be more understanding. What bothers me is why I still feel vulnerable. If I was capable of intense emotion, I would be seething inside. Maybe that is a blessing. It lessens pain and makes me less reactive in a destructive way. But it doesn't make me feel any less injured.
So tonight, I almost wish life was simpler as when I lived in southern Mississippi 14 years ago and the enemy was so clearly defined and obvious. And I could take off in my car to the piney woods and creeks and lose myself in the country air and quiet roads that led away from the source of what was wrong, if only for a short while. I'd like to do that tomorrow -- just get in the car and drive, drive, drive like I once loved to do and did so frequently.
But it's much harder now. I tend to stay put. The enemy is more elusive. Maybe I need to stop thinking so much about it, as Merton says, and start looking elsewhere, and then, maybe only then, will another new beginning be possible.
November 3, 1999It's real cool out this morning -- 42 degrees -- and at last it feels like fall is approaching winter. We've been in kind of an Indian summer haze of generally mild days with an almost imperceptible march toward the middle of autumn. Outside my window, the one tree in all the surrounding area that actually changes color -- a small oak tree -- is once again turning red. It does so all of a sudden each November about this time. It's my one connection to the fall leaf change in more northerly areas where oranges, reds, and yellows dot the hillsides. Each year this one tree gives me a little glimpse of what Autumn is like elsewhere.
Late last night while I was trying to get sleepy enough to turn in, I spent some time looking at the autumn issue of Vermont Life magazine. And there, of course were those spectacular New England foliage scenes I've heard about and seen pictures of all my life, but which I've never actually seen. I've traveled all over the country, been to some states out West multiple times, but I've never been to New England proper (Maine, New Hampshire, Vermont). The sight which always stands out are the big, flaming-red maples and the farms and villages seen across long vistas to faraway hills and low mountains. I'll go there some day, at leaf-turning time.
November 2, 1999Today was the kind of day I wish I had off from work. I would have grabbed my camera and headed to Folly Beach to take pictures. A cold front pushed through last night late with a lot of rain and wind. And it was a powerful front, too. Tonight it's much cooler than it was even this morning, and tomorrow may, in fact, be the first really cold day of autumn. It felt so good and bracing to feel the wind when I went out briefly just a little while ago.
At around 1:30 this afternoon, I went outside for my lunch-hour walk to the college, and all I could do was look up in the sky. The blue was a kind of cobalt blue, but what was most remarkable and beautiful were the cloud patterns. Moving quickly across that blue sky and changing shapes and texture, the clouds were just brilliantly white and were in such sharp contrast to the sky. Everything about the atmosphere, as I looked up from my earth-bound vantage point, seemed washed clean, pure, cystalline.
There are very few days in the year when these exact conditions prevail, and so, I felt like I did that day in 1996 when I took the background photo for this Web page at Folly Beach. Perfection. I was in awe then, and I was today.
I sat for a short while in the garden at the college, no notebook and pen with me, and just watched the clouds, framed by the trees, moving overhead. No reading or writing. Just sitting there thinking about things. Blissful nothing. Of course, the wind continued to blow briskly, adding even more to the Fall-like character of the day.
As I walked back to work, it was more looking up to the heavens and reveling in this perfectly awe-inspiring day in mid-autumn, in Charleston, in early November.
November 1, 1999I've been thinking about something that's quite simple in theory, but extremely rare in practice. I think it can be justly called the "art" of conversation. Or, true or "real" conversation. So rare a flower is this most sought-after gift shared among two or more persons, that most of the time we don't even realize what we're missing. We go about our daily lives at school or work, engaging in the endless banter, verbal ripostes, joshing, kidding, inane questions, and pretending to listen that passes for most of our interactions with others.
Most human conversation, it seems, is directional, and, by and large, has some utilitarian purpose, if you wish to call it that. We seek answers to simple questions. We clarify. We explain. Or, we have time to kill and are bored, so we go up to friends, colleagues, classmates, or family members and pour out words, words, words. Do we remmember any of what was said five minutes later?
It's nice to feel like we're funny or clever, and have people we like respond with warmth and reciprocity, or laugh at our jokes. We enjoy the momentary kinship; the bonds of friendship and familiarity seem tighter. We laugh knowingly. We share inside jokes. We even, watch out now, gossip. We sometimes find ourselves engaged in that quite unattractive habit of talking about others when they're not present. We know we shouldn't do it. It's unseemly, really. You know that old saying, "If you don't have anything good to say about someone..." This, too, passes for conversation, and for some people it's that most sought-after jewel in the diadem, the be-all and end-all of verbal exchanges. After all, it's not about you, but it is about someone you perhaps think less than flatteringly about, at least in supposed private conversation. "Don't tell anyone I said this, but...." Or, "I really shouldn't talk about so and so, but...."
So the days pass and we have these multiple little conversations with people about the weather (always the appropriate, if banal); what we did over the weekend (that's the first question I'll be asked this morning when I get to work, in all likelihood); or food, restaurants, and lunch coming up in two hours (always a safe topic because everyone has some restaurant they recently have cause to like or dislike). Well, the list goes on. Generally forgettable words, strung together affably, are the social glue which holds together our ordinary discourse with people, without which life would be pretty glum.
But every once in awhile, we meet someone who is after more than this. A seeker of knowledge, a questioner of the status quo, a serious, thoughtful and extremely perceptive inquirer who is not afraid to ask you the toughest questions, generally in a civil and courteous manner, and who, when doing so, will respect your right to decline to talk about certain subjects or issues. But what this person is doing is letting you know that you are also valuable for what you can say to him or her. You are also a seeker of knowledge and insights. What you are capable of sharing with the other person is intuitively known, or at least sensed by the other, so he is not at all reluctant, and, in fact, is quite willing to see if he is accurately discerning your interests and your intellectual prowess.
What sometimes ensues when I have a *real* conversation, oftentimes quite suddenly and unexpectedly, is an unwitting opening up to another and, quite possibly, a challenge to all the received wisdom I have supposedly acquired in a lifetime, however long or brief, and with which I may not be as comfortable as I think. Sometimes, therefore, it takes another person who intelligently, and sometimes quite persistently, insists on having a conversation, rather than the usual friendly banter and exchange of words, however necessary that is..
It's so rare nowadays for me to have this kind of discussion or conversation with someone that the stimulation and wonder of it all washes over me for days afterward. I'm exhilarated and angry; frustrated and yet eager to rejoin the fray; bewildered that my ego's defenses have been so readily penetrated, but also glad I have an opportunity to at least say what is most important to me, or try to articulate what I feel has lasting value.
I am talking here about universal subjects of crucial importance: destiny, religion, spirituality, identity, aims in life, values, beliefs and, yes, our very purpose for being here. Why avoid these questions? Why not try to recognize that there are chinks in our armor? We're vulnerable. I acknowledge it. I have to believe I am experiencing growth as a human being, that I am on this journey for a purpose.
Once in a while an individual will come along who adds a good measure of zest, challenge and momentum to the journey, someone who doesn't let me get away with the usual facile answers. And that's good. It results in perhaps a painful, though necessary, confrontation with, and even acceptance of, another's beliefs and worldview. We're all learning, all our lives.
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