In A Moment ~ by Jay

I am a hospice doctor. We deal with death all the time. It is familiar, known, manageable, understood. Sometimes we welcome death as the end of suffering. Sometimes we struggle along with the families for whom death comes, as it always does, too soon. We help people find peace and we do it well - but it's different when it's one of our own.

I go to more than my share of funerals, and I went to a funeral today, but this was the funeral of a colleague, killed in the course of her daily work - of our daily work. There was no life review. There was no warning, no way to adjust to the idea, no chance to have the final conversations. There was only the void - her presence, and then her absence. As if a switch had been thrown and with one click we were thrust into a different world.

There was no peace for me in the service. The minister exhorted us to make this our first day with Jesus as our savior, and seemed to emphasize the bloodiest parts of the Christ story. I left the church more in need of comfort than when I had entered. I know that the service wasn't designed for me; I went to be with my team and to show my respect to Martha's family. It was the right thing to do.

I can find a lesson here, an opportunity to expand my empathy for the families of our patients and for the nurses and social workers and chaplains I will rejoin on Monday. I can find an example in Martha's life and dedication, a model for the work we do and the values we hold. Perhaps, eventually, I can find meaning in her death. Not now. Not yet. Now I am just angry and sad and empty.

If I were to assess my risk of complicated bereavement, as we assess the friends and families of our patients, I would say I am routine, not high-risk. I have good social supports, a strong faith, a healthy sense of self, and plans for the future. But today I am reminded of how much routine hurts. I am reminded that moving forward does not mean moving without pain. I will feel sad and empty and angry for a while longer. I am reminded that this death brings up the other losses, and I will grieve my father again, more intensely than my usual daily awareness of his absence.

This is not the post I expected to write today. This has been a blessed year for me. I have found the work I am meant to do, and I am being paid well to do it and am appreciated by my organization. Sam and I have reached a deeper and more intense level of connection and trust than I thought possible. Eve is old enough to talk about books and ideas and to beat me at Scrabble, and she's happy and healthy and amazingly fun to be with. I have good friends here and scattered around the country, and I have the incredible gift of having John back in my life. I planned to write about all that, about my gratitude for the abundance of my 50th year, about the miraculous experience of simply being happy almost all the time.

All that is true. All that is real. All that will be there tomorrow as we start a new year. And all that could be gone in a moment. There's the challenge: to embrace all that is good in my life, to live fully within it, to appreciate every moment of it, even knowing it could all vanish. That's what will fill the void left by Martha's death. That's what she would want.

Happy New Year. May this year bring us peace.

Spamalot~by MPJ

I know Jay has already mentioned this (complete with classic video clip) by we are getting a lot of spam. We are being inundated with spam, buried alive under spam, served spam with every meal (and without any eggs). In fact, we're getting several times as many comments about where to buy Viagra or win a free iPod as we are real substantive comments on our posts. And that's a little too much virtual processed pork for anyone, let alone two Jews and a vegetarian neo-Buddhist.

So, it is with great regret that we have turned on comment verification. Yep, the few of you who are actually humans, leaving actual comments will now have to prove it by typing in a nonsense word when you comment. Know that each time you type it, you are saving each of us from staying up at night wondering if those comments we're getting in Chinese mean anything other than "buy Viagra here!"

The spammers may have won this battle, but the war is not over yet.

Yet Another Meme ~ by Jay

This one was swiped from Dawn.

1.What did you do in 2009 that you’d never done before?

Asked for what I wanted at work.

2. Did you keep your New Year’s resolutions, and will you make more for next year?

Don't do resolutions, so no.

3. Did anyone close to you give birth?

Define "close to you". No relatives or close friends, but several colleagues.

4. Did anyone close to you die?

A founding member of our congregation, unexpectedly; a colleague, also unexpectedly.

5. What countries did you visit?

Spent the year entirely within the borders of the continental US.

6. What would you like to have in 2010 that you lacked in 2009?

More time with friends. The discipline to complete some projects that have been waiting for a long time.

7. What dates from 2009 will remain etched upon your memory, and why?

July 21st, the day I started my new job; December 23rd, our 25th anniversary.

8. What was your biggest achievement of the year?

Becoming medical director of the hospice.

9. What was your biggest failure?:

I didn't follow through on something I promised to do; felt like a failure to me.

10. Did you suffer illness or injury?:

The dog ran into my knee, and it still bothers me from time to time.

11. What was the best thing you bought?:(was bought for you)

Not a thing, but our new bathroom. Well, maybe a thing. And, specifically, the new showerheads. Wow.

12. Whose behaviour merited celebration?

Sam's. He applied for and didn't get a major promotion at work, and the way he approached it was incredibly sane and balanced and gracious.

13. Whose behaviour made you appalled and depressed?

No one in my personal life. Lots of people in public life, starting with whoever made up that "death panel" nonsense.

14. Where did most of your money go?

Into our house.

15. What did you get really, really, really excited about?

New job and the renovation.

16. What songs will always remind you of 2009?

"Power of Two", by the Indigo Girls. Which is not from this year at all, but this was the year I felt like it perfectly described us. "So we're OK/We're fine/Baby, I'm here to stop your crying/Drive all the ghosts/From your head/I'm stronger than the monsters beneath your bed". Also "Boom Boom Pow", the first song that Eve learned from the radio and decided she loved.

17. Compared to this time last year, are you:
i) …happier or sadder?

Happier. So much happier. Truly, fully, happy - for the first time in more years than I can count.

ii) thinner or fatter?

Don't care.

iii) richer or poorer?

Slightly richer, and grateful.

18. What do you wish you’d done more of?

Actual stuff with Eve - art projects, games, shopping.

19. What do you wish you’d done less of?

Worrying.

20. How did you spend Christmas?:

OK, pretty non-inclusive question....but I spent it working and eating Chinese food, a variation on the traditional Jewish observance.

22. Did you fall in love in 2009?

All over again.

23. How many one night stands?

None.

24. What were your favourite TV programs?

So You Think You Can Dance, which I just discovered this year, because I'm behind like that.

25. Do you hate anyone now that you didn’t hate this time last year?

No.

26. What was the best book you read?

Moloka'i is the one that stays with me; may just be the most recent, but I really did love it.

27. What was your greatest musical discovery?

I know this isn't what they had in mind, but I'd say the Genius playlist in iTunes. Love it.

28. What did you want and get?

My new job.

29. What did you want and not get?

A new MacBook.

30. What was your favourite film of this year?

Star Trek. It annoyed me in many ways, but I really liked it. Then again, I don't see many movies.

31. What did you do on your birthday, and how old were you?

I turned 49 and I celebrated on vacation with Sam and some good friends, including a grown-up night in a hotel while Eve had a special-treat sleepover with her favorite teenager.

32. What one thing would have made your year immeasurably more satisfying?

Real health care reform.

33. How would you describe your personal fashion concept in 2009?

Better fitting clothes. Less black, more colors, especially jewel tones.

34. What kept you sane?

Connections with friends, and with Sam.

35.Which celebrity/public figure did you fancy the most?

Not how my mind works.

36. What political issue stirred you the most?

Health care reform, if by "stirred" you mean "made me grind my teeth to stubs".

37. Who did you miss?

My father.

38. Who was the best new person you met?

A new colleague, for the first time; John, but certainly not for the first time.

39. Tell us a valuable life lesson you learned in 2009

Nothing you love is ever really lost.

40. Quote a song lyric that sums up your year:

I have a friend in a bright and distant town
And she's found a common balance
Where you do you work
And you do your love
And they praise you
And pay you for your talents

41. What was your favorite moment of the year?

Watching Eve in her first orchestra performance.

42. What was your least favourite moment of the year?

Fighting with my mother.

(Like Dawn, I skipped a bunch of questions that were about drugs and alcohol and parties.)

57. If you could go back in time to any moment of 2009 and change what?

I'm afraid if I did, the good stuff wouldn't happen.

58. What are your plans for 2010?

Be open to joy.

Unbelievable Cuteness ~ by Jay

I don't post pictures of my own daughter on the blog, but Cate does, and you need to go look at these. This is quite possibly the cutest baby of current babydom (mine, of course, is well past babydom, and she was cuter. But not by much).

Seems to me that poaching pics of someone else's baby is a bit much, or I'd show you one. Take my word for it. Go look.

This Made Me Smile ~ by Jay

Just 'cause.


Swiped from Isabel.

Twelve Months of Jay ~ by Jay (natch)

Swiped from Dr. Isis. A meme for the end of the year!

If you'd like to play, list the first sentence and a link from your first post of the month from the last twelve months...

January 1st: I pick a word for the year (and looking back, I am pleased with my choice):

Mary's picked her word for the year, and so did R at Discovering Recovering.

February 1st: I report on years of conversations with pharmacists who assume I am not the doctor:

This is Dr. Jay. I'm calling in a prescription for Patient Soandso.

March 5th (I was out of town): I come up for air:

The conference ended at 6:00 PM today, and I'm finishing my packing before heading to the closing party.

April 2nd: I get letters:

Dear Dr. Jay,

You don't know me, but I am Mr. NewPatient's wife.

May 1st: I explain my absence (again. Still):

Sam is out of town for two weeks.

June 1st: I begin to separate from my primary care practice:

Every fifteen minutes I make someone cry.

July 1st: I reveal one of my deep parenting fears:

See this post.

August 1st: Why we changed dentists:

The J-man (no relation) had to go to the dentist recently.

September 3rd: Why I shouldn't watch commercials:

Apparently there's a new cleaning product that can clean Multiple Surfaces. Wow.

October 1st: I am grateful (and I get Blogger confused with Facebook):

Is grateful for happy moments with Eve.

November 1st: I am tired:

The time change really walloped me this year, probably because I've been staying up so late watching baseball (which should be played in the afternoon, really, especially on weekends. Grrr)

December 1st: I am present:

Just a Tuesday afternoon after a busy morning, trying to finish rounds and write notes.

Those last few kind of sum up my year: I am grateful. I am tired. I am present.

Merry Christmas ~ by Jay

An odd sentiment from a blog by two Jews and one neo-Buddhist. Then again, it's odd that three women blog here and call ourselves Two Women Blogging. So what else is new?

We're in good company, though. Robin Abrahams, also known as Miss Conduct, has a lovely post up today about Christmas spirit. I particularly loved this

Christmas isn’t part of my religion. But it’s part of my culture, and part of my past, and this year, I feel ready to own that, with no betrayal at all of who or what I am.

Christmas is sort of part of my past. Not my family-of-origin past, but my early-married-life past. Before Sam decided to convert to Judaism, we had a tree every year. He didn't consider himself a Christian, but he did feel connected to the traditions of his childhood. We played CDs of Christmas music and hosted Christmas dinner for our friends. Sam baked the Swedish cookies and coffeecake he'd grown up with and we took our Chanukah gifts out from under the tree every year.

We haven't had a tree in 10 years, and we've traded Christmas dinner at home for the pancake breakfast at the JCC (well, Sam and Eve go to the JCC; I always work). We gave the CDs away a long time ago. I don't miss the tree - I never did feel entirely comfortable about it - but I do miss the music and the coffeecake. And Eve, of course, feels entirely deprived of Santa. She plays the Christmas-recital music on her violin and feels guilty about it, after years of telling us that as soon as she's 18, she's going to be Christian so she can have Christmas.

This year Eve is getting her Christmas - she's with Sam at his mother's, helping decorate the tree and hanging up a stocking and probably listening to carols on the radio as I write this. We've managed to find our peace with what Miss Conduct calls "the hegemonic holiday". It helps that this year, for the first time in my career, I work in a place that puts a menorah up with the Christmas tree. It helps that we have a week off together and a family New Year's celebration to look forward to. But mostly it helps that we can embrace the values and spirit of the holiday. Who could object to peace on earth?

So have yourself a merry little Christmas. Let your hearts be light. From now on, your troubles will be out of sight.

Silver ~ by Jay

Today is our 25th wedding anniversary.

My wedding day was full of light and music and love, and I was happier than I'd ever been - but not as happy as I am today. I could not have imagined what lay ahead. The last quarter-century has been more complicated and difficult and joyous and rich than I could have comprehended when I was 24.

I can't imagine what lies ahead of us now, either, but I am grateful beyond words that whatever it is, I will be able to share it with this man.

Happy anniversary, sweetheart. I adore you.

Quote For the Day ~ by Jay

Death is nothing at all - I have only slipped away into the next room. I am I, and you are you. Whatever we were to each other, that we still are. Call me by my old familiar name, speak to me in the easy way you always used. Wear no forced air of solemnity or sorrow. Laugh at the little jokes we enjoyed together. Play, smile, think of me, pray for me. Let my name be ever the household word that it always was. Let it be spoken without the ghost of a shadow on it. Life means all that it ever meant....there is absolutely unbroken continuity. I am waiting for you - somewhere near just around the corner.

All is well.

-Henry Scott Holland, quoted by Joan Cobb, In Lieu of Flowers

Well, That Went By Quickly ~ by Jay

Chanukah is over. The last present has been unwrapped, the last decoration packed away for next year, the last chocolate coin has been eaten. Eve will get to extend her holiday when she goes to Grammy's for Christmas (Sam's family is not Jewish) while I work the three-day weekend, and then I have a week off and we have company coming.

We're not entirely done with our shopping, since our nieces both celebrate Christmas and we're a little behind schedule, but we're mostly done. We celebrated this weekend by continuing to sort and organize so we can move more furniture around as the new stuff arrives - the renovation is almost done, but the redecoration project goes on. Two boxes of books ready to go for donation, a huge box of stuff to be shredded, a few old slides scanned in to the computer to use for blackmail when the relatives arrive for New Year's.

A productive, quiet weekend - playdates, dinner with friends, a sense of accomplishment. I am ready to start the week.

Shavua tov. A good week, a week of peace, may troubles wane and joy increase.

Present ~ by Jay

I walk in the room to see the patient lying in a bed under a colorful fleece blanket in a sunlit room, and her daughter holding her hand and listing all the people who love them both. Like the list of God Bless requests from a small child at bedtime: Abby loves you, and Quinn loves you, and Diane loves you, and Mikey loves you, and I love you.

One deep breath, and there is stillness. The patient's daughter draws an echoing deep breath, puts down her mother's hand, and sits back.

And I love you.

There is nothing harder we are asked to do in this lifetime than to let someone go because it is right for them. Even when we know it is the right thing, even when we are grateful for the end of suffering, even when the life that is ending has been rich and full and long, we are not ready.

I can't count the number of dead bodies I've seen in my career, but this is the first time I have ever been present at the moment of death, the first time I have heard that particular stillness. How odd, that I am the one to pronounce the patient dead - what a strange locution that is. The patient has pronounced herself.

And I love you.

The needs of the bureaucracy, the boxes on the death certificate, the official listening with stethoscope, all can wait. For now I simply stand quietly, present for that shift in time, that moment when life changes irrevocably for the woman sitting at the bedside.

And I love you.

Conversations With My Daughter ~ by Jay

Eve: I've had American Girl dolls for two years and I have three dolls.

Daddy: You got Samantha when you were 8, right? And now you have Rebecca.

Eve: And Rebecca's Jewish!

Daddy: Yes, I know. Who's the third one again?

Eve: Julie.

Mommy: You remember Julie, Sam. She's the one who is younger than we are.

Eve: She IS?

Mommy: Yup. Julie is 10 in 1972. Daddy and I were 12 in 1972.

Eve: You're OLDER than an American Girl doll?

Mommy: I guess we're historical figures.

Eve: You're like gods and goddesses from long ago.

Letting Go ~ by Tigermom

So my eldest cub got invited to drive across country with a loving responsible relative over school break.

Whoa.

Bad enough that she is growing up. Bad enough that she has a life. Bad enough that I know she uses those unlimited texts on her phone, but I have little idea about what she texts.

Hey, when I burned up the phone lines talking to my BFFs a thousand years ago, at least my mother knew to whom I was chatting because she could hear me.

So how do you let a little one out of the house to be driven across the country?

As Tigerdad said, "Well, we can't think of a good enough reason to say 'No,', so, 'Yes!' "

Plus I am adding the family-member-tracking-GPS feature to her cell phone.

What We Share ~ by Jay

Bluemilk wrote recently about the secret history of loss. The post and the comments map a territory of invisible grief - miscarriages and abortions, stories untold until someone says, quietly, "this happened to me".

We've been working this territory in our hospice group this past week. A baby we had all watched and waited for, born to a mother we all love, and instead of bringing meals and buying diapers we are struggling for words among the tears. My tears are for my colleague, and for me; the grief of our losses is right at the surface for me now. I've told that story more often in the past ten days than I have in the last two years. And every time I tell it, there are other voices: Our second baby lived for 17 hours. My daughter died during surgery when she three. I had four miscarriages before Kristy was born.

It seems each of us has a story of loss. Perhaps that is what brings us to this work; perhaps it is our way of turning the straw of sorrow into the gold of connection with our patients. Perhaps it is what shapes us as nurses, doctors, social workers, mother and grandmothers.

This is why we pray in community. This is why we require a minyan to say kaddish: because some grief is too great to be borne alone. In the chorus of voices that say this is my story I hear the response to my call. The grief remains, but there is comfort in the sharing.

Apparently I'm Not a Feminist Anymore~by MPJ

Seriously? The National Organization for Women (NOW) is opposing a tax on cosmetic surgery because middle-aged women are discriminated against on the basis of looks? What happened to opposing discrimination on the basis of looks? I think I need cosmetic surgery to remove the look of disgust from my face. Good thing I have someone working to make sure that's not taxed.

Spam, Spam, Spam, Spam ~ by Jay

I'm sure we're not the only ones who have been deluged with spam comments lately. I hate spam comments - they get my hopes up, and then I'm left with strings of characters I can't read or English words I don't want to.

Only one thing to do

Things I Could Do Without, But Will Actually Purchase ~ by Jay

Eve wants a skateboard.

Cool.

We know nothing about skateboards, but we know how to use the internet.

Sam finds this



and we know Eve will love it, and it will appear during Chanukah and help us be the Coolest Parents Evah....

but GirlDecks? And the cute little dog? And it's pink?

Sigh.

Yawn ~ by Jay

Clonk.

That's the sound of the power going off at 3:30 AM. I don't know what makes the clonk, but it wakes me up. No power = no CPAP = no more restful sleep. No heat (we have forced air; doesn't work without electricity) means I don't really want to get out of bed, so I lie there and doze, listening to the precipitation (sleet? ice?) and worrying that the power won't come back on and that means the phone won't work and does my cellphone have enough charge if I get paged and have to call back and should I get up so I don't wake Sam, even though it's cold, and am I supposed to drive north for a home visit and what will the roads be like and will there be school and if there's not can Sam stay home with Eve....

round and round and round.

Power stays off until 5:30 and then clonks back on, just in time for the phone to ring to announce a two-hour school delay. Followed at 6:10 by the JCC call to announce that they will be open for an hour before school starts.

The good news: the snow and sleet turned to rain before I had to leave for work, the home visit north of here was rescheduled for Friday because the patient's daughter had a conflict, and I can probably skip my noon meeting and just stay at work and get things done. Slowly, but completely. Tonight's our drumming night and also the one chance we have to observe Eve's ballet class, so I will try very hard to get out of here at a reasonable hour and be on time. Ballet class, drumming, dinner, bed.

Yawn.

Simple Pleasures ~ by Jay

I've never liked morning showers. I actually like mornings - I'm one of those annoying people who wakes up spontaneously at a fairly early hour, and is wide! awake! right away, ready for conversation and activity. I wake up hungry, too, and I want to put my clothes on and go. I don't want to get wet and, no matter how well I try to dry off, start the day slightly damp. I never had to take morning showers when I was younger. I spent the first 20 years of my life with long hair - really long hair, down to my waist most of the time, and thick. My mother didn't allow me to go outside with wet hair, and it took too long to dry, so I couldn't wash it before school.

In my freshman-dorm hallway, there were six women and one shower. Everyone else wanted to shower in the morning, and I certainly wasn't going to stand on line for the privilege. I got into the habit of showering in the late afternoon, after class and before dinner. I had the shower all to myself, lots of hot water and all evening for my hair to dry before I went to bed. Worked out well in residency, too; the shower before dinner made a nice transition to my day.

The advent of Eve changed everything, of course. I can't go off by myself as soon as I got home from work. There's more to do, and I want to spend time with her. By the time she's in bed, I have paperwork and cleaning and laundry to deal with. My hair is short now, and no one cares if I go outside with it wet. I've gotten used to taking showers in the morning, but I still don't like it.

Tonight I came home chilly - winter has settled in for good - and kind of grimy. Too many home visits with scented candles; the smell was stuck in my hair. After dinner I did the dishes and sang the sh'ma to Eve and headed for our gorgeous new bathroom. I turned on the heat lamp, started both showerheads, and took a long, luxurious, hot shower. I lathered and rinsed and repeated. I checked out all the massage settings on the new fixtures. Then I dried off, put on my coziest, fleeciest pjs and slid my feet into my new slippers.

Mmm. Warm, clean and relaxed. I am grateful for simple pleasures.

Monday, Monday ~ by Jay

I had a very busy weekend on call, and the pace will only increase this week. For some reason, all my monthly and quarterly meetings are scheduled for the second week of the month. Combine that with fellowship interviews and conference calls, and it's a recipe for hectic. Oh, and patients - right, my actual job.

Meanwhile, Eve's left ear continues to swell around the site of her piercing, and great distress results. Dr. Mommy can't figure this one out, so Sam will take her to be seen sometime today. Eve asked to go after school, which pleased me until she explained (between sobs) that she didn't want to have to explain it to her friends. Not so concerned about missing class, it turns out.

The dishwasher needs to be emptied and refilled, and the Sunday papers are sitting here almost entirely unread, and that's the way it will stay until tonight. Eve is dressed and fed and the dogs have been out and we will get to school on time. Priorities.

On Call ~ by Jay

It's my weekend on call. Rounds at inpatient hospice, rounds on the Palliative Care service at the main hospital, keep my fingers crossed that we don't get any new consults at the other hospital. Tomorrow is our Service of Remembrance, so I'll need to manage my schedule to allow for time to get there as well.

Meanwhile, Sam and Eve will be getting out the dreidel lights and polishing the hanukkiah and putting away the last of the Thanksgiving things. I ordered Sam's gift on Thursday (shhh.....don't tell him) and one of Eve's yesterday. Sam went out last night and got Eve's other "big" gift, and wrapped the small ones. Suddenly we've gone from being completely unprepared to almost ready. Phew.

I am grateful for the partnership of my husband, and the support of my colleagues, and for the coming of the light in the dark of winter.

Call to Cancel, Anyone?

So this is a busy time of year for a psychiatrist.

Why? The holidays, the family issues reignited during visits home, the expectations, the financial stresses, on top of whatever challenges were ongoing anyway. Add in the current economy and my phone should be ringing off the hook.

And it has been. The phones of my colleagues too. And we do not even take insurance. That's how challenging a time of year it is for many people. And typical for the week after Thanksgiving.

I do not have that many open intake hours in the day however. And while not everyone ends up wanting to come in who calls (some decide they will try in network first, others are concerned relatives whose relatives do not actually want to come in, and so on), some really do want to come in. And some really need to come in, like yesterday.

So when I make arrangements with a new patient for their first appointment, I ask them to give me 24 hours advance notice if they will decide to cancel or change their appointment. Can you see where I am going with this?

I have pages of phone calls to return to patients who want to come in and one of the new patients I had scheduled this week no showed. No call before the appointment. No call after the appointment. Nothing.

You would think I would get a lot of work done with that free chunk of time, but how can I? I spend the first 20 minutes checking the waiting room, checking my answering machine, wondering if I can grab lunch, wondering if I still have time to do an adequate intake if they show up right now. Then I think of the people I turned down for a new appointment, and how I might have worked out that morning if I had known I would have had that chunk of time free.

Then I go and eat some of our waiting room candy and move on.

Ordinary Time ~ by Jay

Just a Tuesday afternoon after a busy morning, trying to finish rounds and write notes. My mind is on the paperwork and the new admission due later today, not on the patient in room 7. I don't expect a conversation; yesterday she turned her face to the wall and resolutely refused to look at me.

Today she's sitting quietly, looking at the balloon that's been tied to the foot of her bed. She can't tell me who brought it, but when I ask, she looks over my shoulder - not in my eyes - and says "Can you sit withe me?". So I sit down in the rocking chair, trying not to show my impatience (I have four more people to see and two death certificates and I don't have time for this). Silence.

"I came to see how you're feeling today".

Silence.

"The nurse was telling me you've been coughing. Is that bothering you?"

Silence. And then, quietly "I think I'm going to die".

She can't say more than that. Can't tell me why. Can't tell me how that feels. But she says, twice more, "I think I'm going to die".

And she holds her hand up just a little bit above the bed. I know a cue when I see one, and I put mine underneath her. She curls her fingers around my palm, leans her head back, and closes her eyes.

Just a Tuesday afternoon in ordinary time.