Prophetic Work

In a dream the angel said to me: “Lift up

O Man, prophetic voice to ask the world

‘Are you happy?’ Noting with compassion

The desperate dullness, unspoken in their eyes

Behind vehement affirmation.”

                                                            Why so shrill,

The gray voices of the elderly choir ladies,

Cracked, wavering, unmatched?

                                                        “You hear matter

Only, which has been only partially ruled

Since its Lord and Lady long ago

Abdicated their authority in rebellion

Surrendering to a spirit the world of things.

Atoms have not obeyed so well since then,

Atoms and the movements in between

In ear and air and throat.”

                                                Alas, I said,

Unruly matter! Such a clumsy tool

For so sublime a task.

                                       “Unruly matter?

Matter is innocent, docile to its law,

Perfect as ever it was. It is the spirit,

Unruly and therefore most unfit to rule,

Which bears the blame for this. The blame for all

Disharmony which plagues the life of man:

Unworship of molecular machines in cancerous cells, and

Of worms inside intestines, drinking blood, and

The preying of man upon his fellow man, and

The withering fear of being preyed upon, which

Shrinks the soul, bitters the tongue, pinches pennies.

The ownership of the poor by the middle class, who

Flatter themselves that they are not the rich, so

Not to blame.”

                        Complicit up to my eyeballs

I stood ashamed.

                              “Prophesy, O man,

And ask the world, ‘Are you happy?’ For all these crimes

Those curly heads and balding heads and gray

Trembling hands, enforce imperfect obedience

From dry larynx, arthritic knees, kyphotic spines,

Offering the very best of all their so,

So imperfect work. This we call “the Liturgy.”

Old People Are More...

My two favorite patient populations to work with have always been old people and children. Of course I have always loved interacting with kids, even when I was one myself. In some respects I still am one. It keeps me sane.

I was surprised when I started working with old people in my medical rotations to find that I really liked them. Perhaps they appeal to me because of their extreme vulnerability, which in America is often pretty great and is getting worse. Children are almost never left unprotected in the healthcare system. Old people very often are. If I can interact with an old person who feels abandoned, unvalued and unloved, and just for a few minutes or an hour or so I can listen to their story and let them know that they are still worth my time and patience, I like to think that I am fighting back against the hatred that society has for the ones who no longer make money.

But vulnerability is not the only reason they appeal to me. Underneath the vulnerability I see something else, which I am not sure how to describe. The only word I can think of is "rootedness." They are not less than the young patients, they are more. Old people have already become. I am explaining this very badly.

My fiancee and I agree that in general there are two kinds of old patients. There are terrible old patients and there are awesome old patients. There are no average old patients. (This is not including patients with dementia or Alzheimers or some other primary mind altering condition. They are a different story altogether.)

Once in the ER, on the exact same day on opposite sides of the hall I had two patients, both older gentleman, one in his late 60's the other in his early 80's. One had come in for a fall in his garage, and spent his whole visit complaining about how much pain he was in, and how terrible the service was, and how he had to tell his story so many times, all the while explaining how tough he was and what a high pain tolerance he had. I was examining him and he winced and screamed like I was stabbing him every time he saw me come near where the injuries were.

The other gentleman, the older one, had cut his leg with a chain saw a week prior and had calmly driven in to the hospital and gotten it stitched up (bad call on the part of whoever stitched it). Now it was closed, but there was a huge, angry, red abscess cooking in the wound pocket which had not been allowed to heal from the bottom up as it should. His whole front thigh was in pain, but he was sitting upright, quiet, patient, chatting and telling stories of his exploits and the strange things he saw back in the War. We squeezed every drop of pus out of that wound by force and then mashed on it until there was not one little pocket left undisturbed. He turned a few shades paler (he was a black gentleman) but then he looked at the huge glob of pus and clot we had expressed and jokingly asked whether he should give it a name.

Old patients are not less of anything than their younger counterparts. They are always more. They are either courageous beyond belief, or whiny beyond belief. They are either interesting in ways that no younger person could ever be, or incredibly dull. They are either utterly loving and self-giving, or they are exasperatingly selfish. The elderly gentleman with no teeth, rheumy eyes and unsteady feet is still more courteous and gentlemanly (and charming, my fiancee would say) than any suave, cultured man of the world. The dirty old man is more lecherous than any horny teenager would ever dare to be. That peaceful old lady with the curly white perm is more completely unselfish in her every thought than I have ever been at my most heroic. That other lady in room three is more vocally and rudely inconsiderate than I have been since I was a baby.

Perhaps my fiancee and I have this perspective because we see them under stress. The stress may reveal traits that do not show in day-to-day life. However, I think there is another reason. I think that old people live in extremes like that because they have spent their whole lives becoming that thing or the other. They have either been practicing strength and courage and courtesy and become very good at it, or they have been practicing weakness, manipulation and whining their whole lives and have gotten very good at that.

Whichever the case, it does not change how I treat them. If anything, I have to put more effort into the whiny patients. I don't know their whole life story (although I probably will if I don't watch out) and I don't know what they have been through. I don't know what they are afraid of. They probably don't know what they are afraid of, and if they have not faced up to it in the last 70 years or so, odds are they won't do it in the time they have left. I pray that they do, though. Even at the end of our lives, all of us are still becoming. Right up until the very end, change is still possible.

At any rate, it makes me take a good hard look at my life. I ask myself, what kind of old person am I becoming? Am I becoming a holy terror? Or am I becoming that awesome old dude who can crack jokes while getting an abscess drained without anesthetic? It is worth thinking about.

Getting Old

When I am deployed I always have time to work out. Whereas in the states I always have more important things to do, and physical fitness is relegated to whenever I can make the time, on deployment there are long periods of time where there is literally nothing to do except work out. Then of course there are the deployments where there is no time at all, but that is a different story.

So thursday morning I did a solid sprint workout, trying to get my run time back down to the sub 6:30 mile range. I was feeling pretty good, but I had deadlifted the night before. Not necessarily the wisest thing ever, to jump straight into two-a-days and to sprint the morning after a deadlift routine. Sure enough, I pulled a muscle.

Not a large muscle, like a hamstring or a quad or anything like that. No, I pulled a very small, almost inconsequential muscle in my lower abdomen, right in the flex of my hip. It doesn't hurt very bad except when I do one very specific movement, which is try to bring my left leg from behind me underneath my body to in front of me. Given that I am a biped who gets around by walking, however, I do this with an astonishing degree of regularity, i.e. every step. As long as I am just walking it is fine, because I don't let my leg go that far behind me, but even a single step of running hurts like the proverbial Dickens.

So there you have it, just one tiny little pulled muscle. No big deal, right? When I was 19 I would have taken a weekend off, come at it hard on monday and been fine. Now, at a few months shy of 29, I am having to be wise, unfortunately. I have to cut back not just the intensity of my workouts, but even the style. It is only a small muscle, a small injury, but you use that muscle for virtually every exercise that involves tensing up your core (which is pretty much every exercise worth doing). More importantly, a weakening of that muscle leads to an increased risk of hernia, which I do not need right now.

So there I was tonight, in the gym, spending an hour working just biceps, triceps and forearms. I have not done an arm workout in years. I despise isolation exercises, ones that only use a single joint, or pair of joints. I eschew the body building notion that every muscle needs to be trained independently and sculpted to the max. That is vanity and a waste of time. I don't have time for that. When I go to work out I am focused on one thing, and one thing only, and that is increasing my work capacity. Sometimes that means I practice martial arts, sometimes I practice moving my own body, sometimes I practice moving other heavy things, but I despise workouts that are focused on cosmetics. My goal is function, healthy body mechanics, and the ability to do useful things.

Unfortunately, all of those heavy, multi joint lifts or dynamic body movements or martial arts techniques involve the core, which means they stress that particular muscle, which means they retard healing, so there I was, curling.

Then, to make matters worse a buddy that I sometimes lift with came in. He is a big guy. Huge. He proceeds to start a leg series, squatting and leg pressing. I really wanted to get rid of the curl bar and the cables and all that girly stuff and throw a bar across my back, but I refrained. I did not jump into the squat workout.

It seems I have invested my pride in the kind of workout I do. Every bit as foolish as the "beach muscle" lifters that I presume to despise, I have taken pride in not being a "beach muscle" lifter. So when beach muscle lifts are all I can safely do, it irks me. It stings my pride. Therefore, it is probably good for me. I need the humility of realizing that even functional fitness is not my goal, and therefore needs to be surrendered. God had other plans, and therefore I must cease my grumbling, my superiority complexing and my feeling sorry for myself. It is an opportunity to remind myself that I am mortal, strength is fleeting, and I will grow weak and die someday. This is my first acute sports injury, at 28 years old. I am doing really well so far, but it is all down hill from here, and I need to be detached from my physical abilities, because God is going to take all of them away eventually, once they have served their purpose. Let them go. He is the only strength that matters.



His pleasure is not in the strength of the horse,
    nor his delight in the legs of the warrior;
the Lord delights in those who fear him,
    who put their hope in his unfailing love. Psalm 147:10-11

Thanatophobia

Oh, you poor thing! You poor, poor hideous

Ancient crippled thing! Once you were the prettiest

Maid, the handsomest youth! The slow insidious

March of death has brought you here. How piteous!

My heart bleeds for you, after a fashion.

I hate death and sickness! With fierce passion

I denounce this slow wasting, this crashing

Crushing, cresting wave of disability,

And in my deepest, most heartfelt compassion

I offer you escape from your senility.

Go on, I say. It is quite all right. Utility

Outlived, it is quite right to embrace the finality

Of the morphine drip.

                                      (But do you know how much I

Hate you for the crime of being fat?

Of not being perfect? I hate the disgusting flab

That flips and flops and slides across your lap

When you try to sit up in bed. I hate the gasps

Of weakening breath, of death. I want to slap

Your wrinkled, flabby face for blocking my path

With your hobbling. I hate you at meal and bath

And checkout line. You stand condemned by the math

Of usefulness. Keep up or else incur the wrath

Of my generation.)

          You shall not waste in futility

But railing against it you shall dare to die

And cease to remind me of my own creeping mortality.

Thus shall I cure you of death. When once you lie

In convenient, forgotten darkness, on the slab

In the morgue, (or in the assisted living facility

Dying by slow degrees of useless drab

Aloneness,) then I will forget at last that I

Too must die. 

Rather a dark poem, so here is a little lightness to wash it away. Enjoy!

 

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