Monthly Archives: June 2008

Goodbye is not the same in any language

Last week I watched my granddaughter lounging on the swing in our back yard. It was a bright morning, but still cool in the shade under the maples. Her little dog—a malti-poo—sat by her side, eyeing her buttered toast. Periodically she would tear off a small piece of crust and hold it out for the puppy, who gladly accepted the tiny offering. Renoir could have done this portrait justice on canvas, had he been alive to see it.

Today we are up early, long before the sun, sitting on the front porch steps, waiting. It is still night, and the air is cool and damp. The yellow porch light burns like a beacon in the darkness. Overhead, beneath the sliver of a waning crescent moon, a bat leafs its way through the night air. All else is still.

My wife cradles a small urn in her hands, delicately decorated with tiny flowers and birds. The inside she has lined with leaves of lemon verbena, her favorite herb. “I put our telephone numbers inside on little pieces of paper,” she tells me.

Morning light appears on the horizon. Mist blankets the distant hills. The call of a lone mourning dove breaks through the stillness at first light.

Across the street a door opens. A man emerges with bundles in his arms. He carries them to the rental truck and stows them in the back. I lift a hand in greeting.

A woman comes out with a small dog. “She needs to go out before the long drive,” the woman tells me. “It’s thirteen hundred miles to Florida. We’re hoping to make Richmond by this evening.”

Suddenly, the little girl is out, dancing across the street to our front porch, where she sits on my wife’s lap and fingers the small urn in her hands. “Open it,” my wife says. “Smell.”

“Oooh, lemon!”

“It’s a music box,” my wife says. The little girl pushes the button on the bottom and listens to the notes of the childhood song.

Once more my wife and the little girl descend from the porch and make the rounds through the gardens. The frog is sitting by the fish pond in the back yard. The day lilies are blooming; the irises have faded. The yellow primroses are just opening up.

Now that the clothing and linens and dishes and utensils are packed, now that the beds have been taken apart and stowed in the rental truck along with the sofa and kitchen table and chairs; now that the appliances have been unplugged and wheeled out strapped to the hand-truck and securely fastened by ropes passed through the steel rings embedded in the interior wall; now that the metal paneled door is pulled down and locked with the heavy safety latch and the apartment door is shut for the last time—now the time has come to say goodbye.

Goodbyes have always been awkward for my granddaughter, this little girl who barely tips the scales at 46 pounds. In her eight years she has moved nine times (this will be the tenth), she has had to say goodbye to two fathers (failed relationships of her mother), and now she is put in the position of having to say goodbye to us, her grandparents, for what will undoubtedly be the last time for a long time. She has learned to keep the goodbyes short.

When the final moment comes, the men shake hands, the women hug each other. The little girl climbs into the back seat of the car where her mother and the dog are waiting, and waves through the window.

Goodbye—just another moment in time. Goodbye, from the Old English “God be with ye.” Not aufwiedersehen, until we see each other again; not au revoir or arrevidercci, but vaya con Dios—the Spanish is closest—go with God.

The Bridge is Out

For fifteen years now I’ve been rising before dawn three days a week to drive to the YMCA for my morning workout. Our group congregates every Monday, Wednesday and Friday for a two-hour interval workout in the pool. All roads may lead to Rome, but the most expedient route to the local YMCA passes over the Floydville bridge. Like many concrete rural bridges in the state, this one was constructed in the early 20th century. And like most of them, it is now in need of repair.

I noticed the sign posted by the bridge two weeks ago: “Bridge Out, Under Construction, 6/9/2008 to 11/30/2008.” I was not happy. This would mean taking one of two alternative routes, each adding several miles to my morning trek.

The first day the bridge was closed, my automatic pilot drove the car along the usual route. At the intersection, I was greeted by several large concrete barriers blocking the way. I shook my head, dismayed at the folly brought on by a faulty memory, and preceded along the detour several miles up the main road.

“You’re later than usual,” the receptionist at the front desk said.

“The bridge is out,” I replied, handing her my card.

“I figured as much,” she said. “That one little bridge is wreaking havoc in the lives of a lot of folks.”

Conversation in the locker room substantiated her observations. Many members were upset at the inconvenient lengthy detours. Not only did they have to go out of their way to get to the facility, but a majority of them had to backtrack miles to access alternative routes to their work in the city.

More than that, it soon became apparent that the closing of this one small bridge would result in major changes in traffic flow patterns. What had been a quick return home afterwards turned into a nightmare traffic jam from countless drivers seeking alternative routes.

As time goes on I realize other things: I will have to take my loads of leaves and brush to the landfill through the middle of town now. The increased distance will mean longer driving times and more gasoline consumption. This one little bridge construction project is going to drastically alter life as we know it for months to come.

You can still get to there from here, but it costs a bit more in time and effort.

It’s like that when we lose a significant person in our lives through a major relocation, illness or untimely death. Suddenly, the bridge is out. The way that we had taken for granted can be accessed no longer. We have to find alternative, less satisfactory routes.

Many times it takes a long time to rebuild the bridge. Some bridges never get rebuilt.

Fireflies

Earlier in the week my wife and I sat outside in the coolness of the evening, watching the sharpness of the silhouetted trees fade in the twilight. The spring peepers had long gone; lately a bullfrog has taken up residence among the lilies in our small fish pond. Idly, I glanced across the back fence to the neighbor’s garden. Suddenly I saw them, small ethereal flashes rising up through the darkness—the first fireflies of summer.

When I was a boy, fireflies marked the end of the school year and the start of summer vacation. My sister taught me how to pinch off the bug’s lower abdomen and smear it on the base of my finger to make a ring that glowed softly in the darkness. A boyhood friend and I would catch fireflies by the hundreds and keep them in an old glass Mason jar. Together we would lie on the grass to watch their tiny beams flash like miniature lighthouses in the summer dusk—the final moments of their ephemeral existence.

Later, as an adolescent, I would read about fireflies. There are several varieties in North America, and two theories as to why they flash in the darkness. One is to attract a mate; the other is to warn potential predators of their unappetizing taste.

Last night from the front porch I watched our granddaughter and her friend run in circles on the soft summer grass. Her mother had lighted sparklers for the two of them. Like pixies they giggled and danced as they twirled the tiny sticks flashing with fire—ephemeral fireflies that burned briefly in the darkness, and then in a flash were gone.

EGGS-STOCK

A good friend from Arizona writes: “I think we should throw away our cars, most of the medicines and technology we have, ride bicycles, grow vegetables, forget the insane work schedules, subsist and be happy. Oh, and read books.”

Last weekend my wife and I took our granddaughter to the 4th annual EGGS-STOCK concert. The gathering was held on a local farm. You’d recognize the name as a derivation of the 1969 rock concert held in Woodstock, NY. Originally, the idea was to raise awareness (and money) to save this local farm. (The farm has been placed in the community land trust. Although it can be sold, the land can never be developed—it must remain as farmland in perpetuity.)

The event was not nearly as big as Woodstock was, of course. Two bands played on a sound stage through the hot afternoon. The female vocalist in the second band, Lori McKenna, is becoming a recognized recording artist. She’s produced five albums to date; three of her songs were recorded by Faith Hill, one of which—“Stealing Kisses”— she sang as part of her afternoon repertoire. Ms. McKenna lives in Stoughton, Massachusetts, with her husband of 20 years and their five children.

In addition to the music venue, there were a number of booths run by local conservation groups and vendors. They had pony rides for the kids and wagon rides for families. It took my granddaughter some time to work up enough nerve to sit up on the pony, but she finally did. I sang Neil Young’s “Hello Cowgirl in the Sand” to her as she beamed from the saddle, her small feet tucked tightly into the stirrups.

I imagine that, all told, several hundred people came out for the event—somewhat surprising, as it was an extremely hot, humid day.

A number of portly men sporting thin grey hair pulled back in pony-tails sauntered about on the grassy knoll, most assuredly reliving a few poignant moments from their youth, when they had only their freedom and their dreams ahead of them, just as we once did.

Medicine and Madness

What heals the patient with mental illness: psychotherapy, the doctor-patient relationship, daily exposure to a therapeutic community, or psychotropic medication?

In his book The Soloist, LA Times columnist Steve Lopez explores these options in his efforts to help a homeless black schizophrenic musician, Nathaniel Ayers. Mr. Lopez quotes Dr. Mark Ragins on the treatment of mental illness as outlined in Ragins’ book A Road to Recovery: “Making a diagnosis isn’t as important as making a connection. We’re not even sure what labels like schizophrenia and bipolar disorder mean, nor do we have very strong evidence that medication is the best response.”

According to Dr. Ragins, the history of mental health treatment—diagnosis, prescription—has been a colossal failure. While there is no cure for mental illness, Ragins believes that patients can rebuild their lives in the setting of therapeutic communities—places where they can develop a sense of belonging and learn how to manage their disease.

Ragins’ approach is refuted by a psychiatrist from the Los Angeles County Mental Health Department, who plays down the notion that doctors should focus on patients’ lives rather than just treating their symptoms. “A ‘warm and fuzzy’ embrace won’t get the job done,” she argues. “Chronically mentally ill patients are sick, sometimes dangerously so. They need psychiatric counseling and medication, not sunshine and hugs.”

Traditional allopathic medicine relies on pharmaceuticals to treat illness and disease. The humane medicine movement seeks to create awareness in the power to heal through attentive listening, empathetic understanding and therapeutic touch. Many patients still look to their doctor to prescribe the appropriate drug for their illness. Where do patients place their faith: in the expertise of the physician or in the curative power of the drug?

Many psychiatrists now recognize that patients’ candid discussions of their experiences can help their recoveries. In a recent New York Times article, ‘Mad Pride’ Fights a Stigma, Dr. Robert W. Buchanan, the chief of the Outpatient Research Program at the Maryland Psychiatric Research Center, notes that it’s critical for patients to have open dialogue. “Problems are created when people don’t talk to each other,” he says.

In family-focused therapy, relatives are being enlisted to help manage the patient’s illness. “If you combine medication and family-focused therapy, you get quicker recoveries from episodes and longer intervals of wellness,” said David J. Miklowitz, a professor of psychology and psychiatry at the University of Colorado. “Relapses are less common, and functioning improves, including relationship and family functioning.”

Some people need medication to survive. But no two cases are alike; there is no right and wrong way to treat such patients, no universal therapeutic model.

Mr. Lopez concludes that in the treatment of the mentally ill “there are no magic pills, and thousands have gotten better only to chuck the meds and sink back into the grips of incurable disease.” In the end, Mr. Lopez learns to accept Mr. Ayers as he is, “to expect constant backsliding, to prepare for the possibility that he could be homeless again or worse, and to see hope in small steps.”

And finally, in striving to help another individual, Mr. Lopez learns a valuable lesson himself: “I’ve never had a friend who lives in so spiritual a realm as Mr. Ayers, and I know that through his courage and humility and faith in the power of art—through his very ability to find happiness and purpose—he has awakened something in me.…He has wiped away my professional malaise and shown me the dignity in being loyal to something you believe in, and it’s not a stretch to say that this man I hoped to save has done as much for me as I have for him.”

Endings

Just home from a three-day conference in San Antonio, I was upstairs in the midst of unpacking, opening the mail and returning a phone call when my wife approached me with the news that Avery was in the hospital.

Avery’s wife had called that morning to report that his breathing had gotten much worse while I was away. Repeat x-rays and CT scan showed that the tumors and lymph nodes had enlarged considerably; they were now putting pressure on the breathing tubes in Avery’s lungs. He had developed fluid in the chest, and one lung had partially collapsed.

The fact that I had just facilitated a conference workshop on breaking bad news did not make this latest news any easier to take.

I sifted through the papers on my desk to find the telephone number. The hospital operator patched me through to the critical care unit.

Heavy doses of opiates had paralyzed Avery’s bowels. When he strained at stool earlier that morning, he developed sudden chest pains. His blood pressure shot up to 240/180. Another chest x-ray showed a completely collapsed right lung. Avery was struggling now for each breath.

I told Avery’s wife that I would leave immediately for the hospital.

I found her sitting by the bed, holding Avery’s hand. “Come in,” she said.

Avery lay on his back with his head elevated. The pale green transparent mask covering his nose and mouth fogged with each exhalation. I could see him struggle for every breath. I walked to the opposite side of the bed and stood by the rail.

“You’ve got a visitor,” Avery’s wife said.

Avery opened his eyes and looked at me. “Hey,” he gasped. It was as much as he could muster at the moment.

“You don’t have to make polite conversation,” I said. “I was out for a drive and thought I’d stop in to see how you’re doing.”

Avery flashed a short smile. “Not so good,” he whispered.

“Believe it or not, he’s a bit better than he was this morning,” Avery’s wife said. “They seem to have gotten his pain under control.”

I looked at the IV pump and glanced at the label on the bag of fluid: an infusion of Dilaudid, 5 mg per hour—equivalent to 25 mg of morphine. The massive dose of opiates that relieved Avery’s pain was also suppressing his respiratory drive: a classic Catch-22 situation.

Above Avery’s head a monitor displayed graphs of his heart rate, EKG pattern, respiratory rate and oxygen saturation. Even with the re-breathing bag in place, Avery’s oxygen saturation was only 85 percent.

“Next month would have been our 41st wedding anniversary,” Avery’s wife said. “The way things look, I’ll probably be celebrating it by myself.”

I started to talk, modulating my words and the volume of my voice. Standing on the left side of the bed by his good ear, I told Avery about my recent trip to San Antonio, about the Alamo with its gardens of exotic plants and ancient live oaks, about the Menger Hotel where I stayed, which houses the bar where in 1898 Teddy Roosevelt recruited a number of his band of Rough Riders. Avery flashed his eyes when I talked, acknowledging that he heard what I said.

During my monthly visits over the course of the past year, Avery had done most of the talking. I had been most happy to listen.

Now that Avery was breathless, I found our roles reversed: I was cast as the orator. It wasn’t a role that I was entirely comfortable with. I wanted to give Avery the chance to tell me all those things that he might have wanted or needed to say. Now, because of his physical limitations, he wasn’t able to speak. Feelings of anger began to well up within me, stemming from this injustice that fate had dealt him.

Then I realized something: Avery had spent the last year telling me those things that were important to him. Like a clever old sage, he had drawn me into his web of stories. Little by little, visit after visit, Avery told me everything that he valued: the wonder of life itself—reproducing, nurturing, growing, reaching out, consoling. He spoke about his love for the natural world, the beauty of it, the desire to treat it with respect, even when parts of it had to be sacrificed. He talked about simple pleasures—baking fresh bread or cinnamon rolls, hearing his granddaughter laugh, potting his perennial plants, enjoying a fine cigar or a walk in the woods with his dogs. His extended family, with their quirks and idiosyncrasies and eccentricities, was most important to him. Everything he had told me—all of this—is what he valued. I felt honored to have heard it.

I stayed for a while, then decided to head out. I gave Avery’s wife my cell phone number and asked her to call me with any news.

A thunderstorm broke shortly after I arrived home. I sat on the front porch and watched flashes of lightening shoot across the smoky yellow sky. I turned my shirt collar up against the cold wind. Rain fell in sheets; rivulets formed in the street.

Afterwards, the evening sunlight blazed beneath the parting clouds, turning the fresh spring leaves lemon-green on the hillside. In anticipation I looked up, and there it was: an arc of brilliant colors crowning the dome of sky. Above it, more dimly, a second rainbow glowed.

Out in the yard the violet irises rested atop their long stems. Red impatiens filled the flowerbeds. I noticed the stalks of tiny pale blue flowers scattered throughout the front lawn: telltale forget-me-nots.

Once, during one of our long afternoon conversations, I asked Avery why owls don’t make a sound when they fly. He told me it had something to do with the design of their wings—the primary wing feathers have comb-like fringes that deaden the sound of air as it passes over them during flight.

In the forest I’ve seen owls perch in their roost trees. I’ve strained to listen to their wing beats as they glide down through the forest out of sight. A few silent wing beats, and they are gone.

The following morning they moved Avery to the hospice unit, where his family could rest more comfortably. There, Avery was surrounded by those he loved most. Everyone had a chance to say goodbye.

One never knows about these things, of course—not the minute, not the hour. But when at last the final moment arrived, like an owl in the forest, Avery momentarily spread his wings, dropping down from the branch on which he had been precariously perched, and glided out silently through the trees.

A few soundless beats, and he was gone.

Down in the Valley

Like the Irish mystic John O’Donohue, I grew up in a limestone valley.

As a boy, I remember standing on a large outcrop of the grey rock on a grassy knoll in the middle of a field, surveying the vista, the summer sun warm on my face.

In our valley, local farmers worked endlessly to extract large pieces of limestone from freshly plowed fields, piling them up in huge mounds like ancient Celtic cairns. Many of the old farmhouses were built with limestone. Their thick stone walls kept occupants cool in the heat of summer and shielded them from harsh winter winds.

Sometimes in summer, while out on my bicycle, I would pass by newly formed sink holes and stop to peer into their bottomless depths. Deep down where you couldn’t see, people said there were underground caverns, hollowed out over eons of time by streams running beneath the valley floor. I wondered what it would be like to explore those deep recesses; and, if you succeeded in your descent, whether you could ever hope to rise to the surface again.

Some days I would ride my bicycle out Old Forge Road up Coffeetown Hill and pause to look back over the town spread out in the valley below. Looking east, in the distance you could see grey dust billowing up above the limestone quarry. It was a wide valley, filled with rolling farmland. In spring the fields were limed and manured, then cultivated for corn, alfalfa, clover, soybeans and wheat.

The sky was expansive—not as big as the big sky of Montana, but big enough to shelter the valley. Overhead, in the expanse of blue, grey clouds hovered; the same grey color of the limestone on which the town and surrounding farms rested.

I grew up in this landscape; I was one with it. And as I grew I discovered something else: I discovered that beneath my peaceful boyhood existence, a honeycomb of inner grey and dark caverns waited to be plumbed and explored.

Years later I would stand atop the high cliffs overlooking the sea where the Bay of Biscay joins the Atlantic Ocean on the northwest coast of Spain. These cliffs were formed by the oldest rocks in Europe. The ancients called this region o fin do mundo—the end of the world. It has a stark beauty all its own. But that day I looked out over the slate grey fluid field of whitecaps dancing in the distance, I couldn’t help but bring to mind the limestone valley of my youth.