In Sickness and In Health

I was hit by a truck this week.  I could barely make out the license plate as it sped away: H1N1.

I had spent the last six weeks dodging germ traffic in my clinic, having diagnosed several dozen patients with the much hyped Swine Flu.  But my luck could only hold out so long.

My symptoms were mild at first, causing me to believe I may have contracted some lesser virus.  But, being a much better doctor than patient, I pushed it too hard through the weekend, and then crashed on Sunday night.  Still in denial on Monday morning, I loaded myself up with ibuprofen and tried to make it into work, only to have my nurse make an executive decision and send me right back home. 

And then I truly crashed.  Through the floor.  Plummetting towards the dark ugly bowels of the earth.

Being several days into the illness at that point--too late for tamiflu--I decided that as long as I was home, I wasn't going to mask my symptoms with ibuprofen.  If this illness was telling me to lay prostrate in bed, then that's what I was going to do.

My lungs were on fire.  My sputum was the color of pond scum.  My sinuses were turgid with pressure; I thought if I could stick a needle in them, they would pop.  My head throbbed.  My skin bristled at the slightest pressure of even my clothes.  I had no appetite. But mostly, my entire body was overpowered by a profound malaise, the likes of which I have never before known.   I lacked the strength to read, to even hold up my head.  I lay in bed and moaned for hours and hours, like a cow crazy with disease who stumbles in a winter pasture, thrashes, and then lies still, the only sound the mournful, wheezing bellows of its lungs as snow begins to slowly cover it like a white sheet in the morgue, like the blizzard that dropped two feet of snow in Denver that night.

I thought, so this must be what it is like to die.  This is what happens when an insult utterly saps my body of vitality, and I succumb finally to the malignant entropy of the universe, wave upon wave of disease and pain crashing over me as I flounder, thrash, and then relent.

Forty eight hours passed in unmitigated misery.  My lovely wife was an angel, Florence Nightingale bringing me soup, covering me up with blankets, and holding down the rest of the fort.

Just past the point where I thought my body had lost the fight, I began to heal.  My sinuses cleared.  My cough lessened.  My brain fog lifted.  But mostly, I felt energy returning to my bones.  I felt a rush of exhilaration.  "I have taken your worst shot, you dreadful Pig Flu, but I'm still standing."

Today, I went and played basketball, wary of whether or not my convalescing body could handle vigorous exercise yet--if ever.  As I drained three pointer after glorious three pointer, I knew that I was back.  Me.  My body.  My soul.  My deadly long range jump shot.

I deal with suffering people everyday of my life.  I sympathize with them as I try and coax them back to health.  Lucky for me, I don't often personally experience pain or physical suffering.

But I have renewed empathy now.  An illness such as this is a reminder of how miserable it is to lose our precious health, how our physical suffering threatens our emotional strength, and of how amazingly frail, yet marvelously resilient, our bodies are.

The sky is blue today. The snow is melting.  Life is beautiful again.  Hallelujah.

The Power in Sean's Palm: A Short Story

     Evening blows across the sky, early stars stretching out like cotton, soft and deep. This is August in Colorado, just past dusk: cool, dry, and violet. I make my way up the trail from the culvert, across the field and towards the car, with Sean at my heels. He pants and shuffles along, struggling to keep up. He's a foot shorter than me, and as is his custom, he keeps on talking. 

     ". . . and then the ghost waved his arms and because the Indian was afraid of ghosts he jumped on his horse. . . "

     Sean talks, but we rarely converse. These excursions of ours across the expansive suburban meadows are exercises of his legs, tongue, and imagination--and my ears. I take him on these hikes by choice, but not for the conversation. I feel some sense of obligation towards Sean, though I’m not sure why. Maybe it's my inner nice guy. Or maybe it’s just fatigue that makes me relent to his constant requests, because I have a hard time saying no. But something tells me the real reason has little to do with Sean. These trips are for me, an imperfect antidote for loneliness. On a otherwise perfect Friday night, it’s either Sean, or no one.

     Sean has a syndromic appearance: short stature, misshapen face, mild retardation. But either through denial or bravado, his parents don’t acknowledge that he is different, determined that he be treated as absolutely normal. Since they moved onto our cul-de-sac two years ago, they've never made mention of him being different—playing catch in the front yard, inviting me over to watch movies, going to football games. Or encouraging him to go with me on these evening hikes. Sean is eighteen years old, a year older than me, on track to graduate from high school next year in the special ed program. He is nearly "normal" enough so that at times I've wondered if he has any true handicap other than being slow. He is nice, harmless, not unpleasant in any way. But his small size, compact facial features, and thick gaze mark him physically. I take the cue from his parent's and act as a friend, treating him as normally as possible. But what does normal mean to Sean? He’s still talking,  

     “. . . then the chief shot the arrow straight through the heart and then the Indian . . .”

     I’m ready to change the narrative. “Hey, Sean,” I interrupt, and we stop walking. I point upward. “Look at the stars tonight.” Sean continues to blithely tell his story for a few more steps until he collides with my leg.

     “What?” he asks, stumbling backwards through the weeds. He sees that I'm pointing and looks up. “What?”

     “See that really faint cloud up there?” I feel like a museum guide. My elaboration of facts is a standard feature of these treks. I continue, “That's really a billion stars or more that are so far away that to us they look like a cloud of light. It's called--”

     “--that's the Milky Way,” he finishes for me, matter-of-factly, staring at me rather than at the stars he’s just named. I cross my arms and look back at the sky.

     “Yeah,” I say, “you're right.” Sometimes he surprises me by knowing more than I expect. I breathe deep and feel the cool, dusty air in my nose, and for a moment I feel like I'm breathing in stars--so bright, so far away. The breeze glides open and vast across my face.

     “Mark,” Sean calls, “do you know what stars are?” He has yet to lift his eyes off of me, continuing with that thick gaze. I smile down at him, waiting for his answer, preparing a gentle correction. He concludes emphatically, “They’re burning planets.”

     A thin smile escapes my lips, and after a second, I respond smoothly, “Well, kind of, Sean. They're actually huge balls of gas that burn super hot. They're like the sun, just farther away.” His gaze remains unbroken. In the starlight, I can't tell what he's focusing on—my nose, my cheeks—but it’s not my eyes. He stays silent, and I wonder if he is thinking or if his brain is just on pause. We're only few feet apart, but suddenly it seems there is a great distance between us. I glance towards my car a hundred yards away and turn towards it to walk.

     “Mark . . ." I turn my head back around and see Sean holding up his palm. He whispers, “Wait.”

     I stop walking and turn to face him, wondering what he's going to do. He is breathing deeply and closes his eyes, bending dramatically forward. He squats and brings his palm down among the weeds, passing his stubby hand back and forth a few inches off the ground. He whispers, “I can feel them.” I say nothing. A moment passes, and he tries again. “I can feel them,” he repeats, adding, “They were here.” He grabs a handful of dust and pebbles and lets them sift slowly out of his thick fingers. He soulfully turns his gaze back to me and begins to speak.

     But I beat him to it.  “Who?” I ask. The line between reality and imagination is thin for Sean, and I have run out of patience for tonight. “Who was here?”

     Sean theatrically sweeps his gaze across the fields, to the mountains and back, fingering the dust. With his eyes on me again, he intones, “The Indians.” Tension mounts in his voice. I wonder what movie gave him this idea. “Six of them. They died on this ground, because of. . .” Once again, his eyes sweep to the ground, back to me. "Because of . . . the white man."

     He says "the white man" with a well-imitated, introspective guilt, as emotionally raw as an 80’s TV Western. When he pauses again, I blink and turn away, walking briskly towards the car. Sean churns his legs and stumbles through the weeds, struggling to keep up. The drama intensifies in his voice. “Mark, I can FEEL them.” He waits for me to say something, but I don't. He grabs my arm, but I don’t stop. “You don't believe me, do you?” I have little desire to respond and can’t think of what to say. We have reached the car. I walk over to the driver's side door. Sean follows me around, watches as I slip into the driver's seat, and then walks back around to the other side. I turn the ignition as he opens the door and plops down. The radio comes on loudly, and I turn it down to a murmur. Sean stares forward and asks again, “You don't believe me, do you?”

     I roll down the window and put the car into drive. I glance at Sean, then back to the road. What should I say? “Sure,” I shrug, “there used to be lots of Indians around here. Utes, Arapahoe, some Cheyenne, I think . . .” Then I stop, realizing I don’t really know any more beyond that. The lights from the suburbs shine across the fields. In the daylight, I can pick out my house from the crowd, but at night they all melt into a wash of lights and empty spaces. The cool Colorado air flutters through the open window, drowning out the radio.  I reach over to turn up the volume. I look at Sean. His head is bent over like he might be asleep, but I catch a wet glint of the distant lights reflecting off of his onion-skin eyes. He's awake, staring at his open palm like a Bible.

(If you liked this story and would like to read more, please check out my website at http://www.authormarkfoster.com/)

After Apple Picking

We're up to our ears in apples.

We have two apple trees, and our neighbor has three, and he said that if we picked his apples, we could have them. Well, I'm a sucker for anything free, so I have--rather recklessly-- risked life and limb in climbing to the flimsy upper boughs of the trees to pluck from them the last tantalizing, crimson-blushed green apples. (Where's Waldo in the above photo?)

The kids have been great helpers. Joy is a skinny little tree monkey who can slither onto branches I can't reach, and Grant is my right hand man on the ground. We've all come away scratched and scarred, but we're now enjoying the fruits of our labors. The apples are small and tart, but perfect for baking, and Elizabeth has made apples pies, apple sauce, even apple pizza.

It all reminds me of a favorite Robert Frost poem, After Apple Picking. Like all of his best work, it's full of rustic imagery, subtle symbolism, and whimsical melancholy. It evokes thoughts of hot apple cider, autumn frost, and the irrepressible encroachments of time that fatigue our best intentions.

Enjoy!

After Apple Picking
by Robert Frost

My long two-pointed ladder's sticking through a tree
Toward heaven still,
And there's a barrel that I didn't fill
Beside it, and there may be two or three
Apples I didn't pick upon some bough.
But I am done with apple-picking now.
Essence of winter sleep is on the night,
The scent of apples: I am drowsing off.
I cannot rub the strangeness from my sight
I got from looking through a pane of glass
I skimmed this morning from the drinking trough
And held against the world of hoary grass.
It melted, and I let it fall and break.
But I was well
Upon my way to sleep before it fell,
And I could tell
What form my dreaming was about to take.
Magnified apples appear and disappear,
Stem end and blossom end,
And every fleck of russet showing clear.
My instep arch not only keeps the ache,
It keeps the pressure of a ladder-round.
I feel the ladder sway as the boughs bend.
And I keep hearing from the cellar bin
The rumbling sound
Of load on load of apples coming in.
For I have had too much
Of apple-picking: I am overtired
Of the great harvest I myself desired.
There were ten thousand thousand fruit to touch,
Cherish in hand, lift down, and not let fall.
For all
That struck the earth,
No matter if not bruised or spiked with stubble,
Went surely to the cider-apple heap
As of no worth.
One can see what will trouble
This sleep of mine, whatever sleep it is.
Were he not gone,
The woodchuck could say whether it's like his
Long sleep, as I describe its coming on,
Or just some human sleep.

The Best They Can

I work with a great nurse, an RN with many years of ER and OR experience on her resume. She maintains a healthily cynical, darkly humorous view of needy patients, exhibiting the hardened exterior that most of us health care workers eventually develop out of experience and necessity. But beneath the tough veneer, she has a gigantic heart and displays gentle acceptance of our most difficult patients, and face to face, she always gives them the best of her compassion and kindness.

Several months ago, on the very first day we worked together, she came out of a room with a patient who was, to put it mildly, a train wreck, a sorry, pathetic person at the end of their rope whose health and social situation was as depressing as it was precarious. She came into my office, put the chart in front of me, and said with a sigh, "Dr. Foster, they're a mess. But you know what? They're doing the best they can."

I looked at her for an explanation, and she continued, "You know, they didn't wake up this morning and say, 'I want to fail at life today, so I'm going to ruin my health and my relationships and do bad things that hurt other people.'"

The best they can. Over the succeeding eight months, we have repeated this phrase like a mantra when dealing with our challenging patients. (However, we have decided that there are exceptions, and that some of our patients are indeed not doing the best they can, and in fact are intentionally failing out of the school of life. But these are rare exceptions.)

By and large, it holds true. At the least, this mantra forces me to perceive needy patients in a more compassionate light. Isn't it true, I tell myself? Don't most people try, within their capacity and experience, to succeed at life? The narcotic addicts, the hypochondriacs, the borderline personalities, the depressed and defeated: isn't the fact that they're breathing, sitting in the doctor's office and seeking help--doesn't that mean they're trying to get better, to do better, to be better people, taking the detritus of their lives and attempting to refashion something usable, even beautiful?

We all have survival instincts, and a very many of us are stuck permanently on survival mode. The frantic, abrasive mother who slaps at her children as she begs for pain meds may be tough to deal with, but after all, she's a single mom, abused herself as a child, and she is trying in some dysfunctional way to carve something better out of her life for her and her children. She's seeking love, safety, acceptance, and peace on very basic levels, and when these appear too elusive she turns desperately to unhealthy avenues to fulfill her needs, like stoning herself with vicodin and sedatives every day and living with an abusive man who at least pays her some attention. But this probably represents the best way that she can figure out how to cope. She's doing the best she can. And sadly, so is he.

The best they can. I keep repeating it to myself as she slaps at her two year old again and becomes more insistent of her absolute necessity for narcotics. She needs them like she needs air. She might die without them. On a scale of one to ten, her pain is, like, a bazillion.

I'm not sure I believe it, but luckily I've got a nurse who reminds me to look at her with compassion, even if I refuse to enable her addictions. Maybe with time I'll learn to be more naturally accepting and kind.

So forgive me if I'm not there yet. I'm doing the best I can.

Lincoln

Greatness takes many forms. It is typically easy to recognize and quantify, and we celebrate those who achieve such heights. Roger Federer's fifteen grand slam titles, for instance. Neal Armstrong walking on the moon. Warren Buffett's wealth and sagacity. Dealin' Doug's hairpiece.

But rarely do we find greatness in a place that matters most, embodied in a person whose values, vitality, and vision become intertwined indistinguishably with our own identity, our own survival. These most rare people represent a near perfect incarnation of our highest ideals. There are probably only a handful of them in the history of the world--great men and women who perform their greatest acts on the grandest, most critical stages--and unfortunately, they tend to be assassinated. But their greatness doesn't fade with time, but rather grows, and we justly carve their faces onto mountains, build monuments to them in the nation's Capital, or write them into scripture.

At the very top of my list of great ones, second only to Jesus Christ, is Abraham Lincoln. I just finished Team of Rivals by Doris Kearns Goodwin, and my mind is overflowing with gratitude and admiration for the backwoods prairie lawyer who freed the slaves and saved the Union.

The book is tirelessly researched, referenced, and comprehensive in its scope, nearly eight hundred pages long, and honestly I have so many thoughts floating in my mind about Lincoln that I don't even know where to begin. I think I'll just start by naming, in no particular order, attributes that Lincoln evinced and why they are so resonant with me.

• Magnanimity: this is, to me, his overarching and most remarkable character trait. He had such a generosity of spirit about him that he was able, nearly always, to set aside petty, selfish concerns and do what was best for the greater good. Time and time again, he promoted talented men who had personally insulted, slandered, betrayed, and undermined him to positions of responsibility and trust. In kind, these men proved their worth, and eventually became trusted, diligent advisors, indispensible to the Union's war effort. This is most evident in Lincoln's relationship with Henry Seward, the man he defeated for the Republican nomination in 1860. Initially embittered and aghast that he had been defeated by a non-deserving hick, Seward went on to become Lincoln's most trusted advisor, most able stateseman, and his closest friend. Likewise was Lincoln's relationship with Edwin Stanton, the lawyer who humiliated Lincoln at a trial in 1858 but went on to become his irascible, indefatigable, and ingenious Secretary of War, his second closest advisor and friend. There are dozens of other examples, not least of which was Lincoln's liberal and forgiving attitude towards the South and Reconstruction, which he was never able to implement due to his assassination.

• Strength of purpose / Confidence tempered with humility: Lincoln's magnaninity sprung from his rock-solid, healthy self-confidence, a powerful ego tempered to perfection with humility. Where his confidence sprung from is anybody's guess. His mother died when he was young, and he had virtually no formal education. He was tall and physically powerful , but awkward and not good-looking. He endeared people to himself with humor and meekness, but was not in any way socially dynamic. No person had any reason to believe that someone of his background and education could become President, rid the nation of its original sin of slaverly, or save the Union. But somewhere inside Lincoln's mind and heart, he was aware of his own powerful mental and moral faculties, and came to believe in his own essential goodness and importance. That accurate self-awareness and internal fortitude propelled him into election after election, through defeat after defeat, and eventually self-actualized during his presidency and within the crucible of the Civil War, when he put all his skills to the maximum test and maximum utility.

• Courage: doing the right thing for the right reasons in the face of tremendous adversity and personal (or political) danger was Lincoln's hallmark.

• Wisdom: he possessed a folksy wisdom. Similar to Christ and his parables, he had an intrinsic gift to relate anecdotes--usually humorous--that would lucidly define a principle or succinctly illustrate a complicated argument. It's probably hard for us to completely understand the social and political environment in which his reasoning was required. How do you reason with a society that has been attempting to justify enslavement of other human beings for hundreds of years, and that is correctly wary of the extinction of their way of life should slavery be abolished? Lincoln did it--if not successfully--then at least convincingly.

• Humor: he was a funny man, consistently conjuring humor to rouse the spirits of those around him, and even more so to lighten the impossible sorrows that burdened his own shoulders. He was always self-deprecating, in great contrast to most of the preening politicians of his time. Here's a favorite Lincoln anecdote that he once relayed:
  

  A man encountered Lincoln in the woods. Lincoln saw that the man was carrying a rifle, and tried to charm him. "How do you, sir" he asked.

  The man gave a half smile but said, "Friend, I have no quarrel with you, but you must now prepare to die, for I must shoot you, for I have vowed if I ever encountered a man who is uglier than myself, I would kill him."

  Lincoln ripped open his shirt and exclaimed, "Sir then fire away directly for my heart, for if I am uglier than you, I do not want to live!"

• Eloquence: derided by the self-important bloviators of his time as too plainspoken and simple-minded, he nevertheless wrote and uttered some of the most articulate, logical, poetic, and essential words in national and world history. At Gettysburg in November of 1863, following a three hour speech by the preceding verbose speaker, Lincoln arose and gave an address that was shocking in its brevity--less than three minutes. The gathered crowd could scarcely believe it as he folded his paper and sat down. Some didn't even know he had started yet, much less finished. Pundits of the time ridiculed him or professed offense at the breach of proper etiquette. But as we all know, the words he spoke are among the most important, concise, and resonant words of all time. He would go on to top that speech (in my opinion) with his second inaugural address 18 months later as the war drew to a close.

And if I didn't have anything better to do with my time, I could go on and on: Determination, Ambition, Resilience, Honesty, Social Intelligence. Lincoln possessed all of these qualities in more abundance than most any other human ever has.

Weeks before his assassination, he had a portentous dream foreshadowing his own death. But he was at peace with that. He had said many times that should he die but the Union be saved, he would die a happy man. Around that same time, he was on a ship sailing toward Virginia when a terrible squall rattled the rest of the passengers and crew. Lincoln emerged hours later from the hull of the ship, stretching his arms after having slept peacefully through the storm. Just five days after Robert E. Lee's surrender at Appomatox, John Wilkes Booth put a bullet in Lincoln's head. It was the night of April 14th, 1865, Good Friday.

The parallels to Christ are eery and unmistakable. Forgive me if my praise of Lincoln borders on being reverential. Certainly, he was only a man, in full possession of human flaws. But it is not hard to see the hand of divinity working in his life. raising him up from obscurity, placing him in position to be savior of our fledgling republic.

Not everyone we call great deserves the honor. But Abraham Lincoln does, a reminder of the greatness of our nation, the greatness of the human spirit, and the greatness we each harbor within ourselves.

The Back Nine

"Golf is a good walk spoiled." --Mark Twain

I think I'd have to disagree with Mr. Twain on this one.

Maybe that's because I usually play golf with my Dad, and we always get carts. Can't spoil a walk when you're riding.

But even when we do walk, and in spite of the fact that I'm a pretty lousy golfer, in spite of the fact that I routinely lose, and in spite of the fact that it costs a lot of money and takes an exorbitant amount of time, I've learned to love golf.

Especially on a day like today, when we had the back nine at Foothills pretty much to ourselves, and the morning sky was flawless blue and the green grass was still dewy wet. Even the fact that I collapsed on the final hole and lost to both my brother and my Dad barely even phased me. I still came home relaxed and smiling.

I owe my love of golf primarily to two men. First, Dr. Dave Smith, a mentor and golfer from my residency in Greeley. "Dr. Foster," he persuasively told me, "Part of becoming a doctor is learning how to play golf, and I'm going to teach you how." Thus, he dragged me to Greeley's handful of courses on many occasions, and under his tutelage, I finally overcame the threshhold of total humiliation that had always precluded me from improving my skills. I've learned that once you get past the point where you can hit at least half of your shots decently and a few shots well, golf starts to get fun.

The other man is my aforementioned Dad. We never golfed until I was done with medical school, but we've golfed a ton over the past six years. I'll admit, he's paid more than his fair share of green fees on my behalf, and my old excuses of "I'm a poor starving resident with young and hungry children," or "I forgot my wallet. Again," no longer apply. (My latest in the age of cell phones is, "I'm running late. Would you pay for me and I'll meet you at the teebox?" This still works pretty well on occasion.) We're both at points in our careers where we can take Friday mornings off, and it doesn't take much persuasion for either of us to meet up at the links. Dad's better than me, but not by too much, and so we always have pretty competitive rounds, with neither of us having a clear advantage.

But as I mellow with age, the competition is no longer the thing for me, at least on the golf course. I enjoy the scenery, the air, the quiet. I enjoy the momentary concentration prior to each shot, the precision required of all my muscles, limbs and breathing acting in unison, and the glory of striking the ball perfectly--as smoothly as slicing soft butter--and watching it sail through the shadows and sky and land within feet of exactly where you were aiming.

Okay, so that doesn't happen very often for me, but when it does, I'm telling you, it's sweet.

The momentary glories of golf don't always obscure its myriad frustrations. Sometimes I still feel like pulverizing some bystanding goose when I skull a chip shot into the lake, or twisting my putter into a knot and chucking it into the bushes when I rim out a five foot gimmee.

But for the most part, I refrain from demonstrative frustrations now. I take a deep breath, look at the surrounding lush foliage, and remind myself that "Hey, this is a game, and it's better than working."

It's a great game, and one I hope to grow old with. I've put my kids in golf lessons early with the semi-selfish hopes that, for at least the next forty years, even when I'm an old, crooked man, we'll be able to play golf together.

I see myself chuckling softly as I sink a putt to ice the round against my middle-aged son, and not minding a bit that he unaccountably forgot his wallet. Again.

(Here's another favorite poem, this one a sonnet by Timothy Steele describing the exquisite serenity of a languid summer afternoon. Enjoy.)

Summer

by Timothy Steele

Voluptuous in plenty, summer is

Neglectful of the earnest ones who’ve sought her.

She best resides with what she images:

Lakes windless with profound sun-shafted water;

Dense orchards in which high-grassed heat grows thick;

The one-lane country road where, on his knees,

A boy initials soft tar with a stick;

Slow creeks which bear flecked light through depths of trees.

And he alone is summer’s who relents

In his poor enterprisings; who can sense,

In alleys petal-blown, the wealth of chance;

Or can, supine in a deep meadow, pass

Warm hours beneath a moving sky’s expanse,

Chewing the sweetness from long stalks of grass.