Family

Lighting For Literacy, Colonet, Baja California, 2017

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“Do all the good you can, by all the means you can, in all the ways you can, in all the places you can, at all the times you can, to all the people you can, as long as ever you can.

“The greatest Christian virtue is doing, the least is talking.

“Beware you be not swallowed up in books!

“An ounce of love is worth a pound of knowledge.

                                      John Wesley

I have seldom been so rewarded for being a Methodist as on my fourth trip to Colonet, Baja California, where I was privileged to interpret for Doug McNeil and Kevin Kinsella while they worked on a Lighting For Literacy (LFL)  project guiding middle school students in lighting up the lives of eight families living in  Ejido Punta Colonet. In doing so they also lighted up middle school STEM projects (Science, Technology, Engineering, and Math) in the minds of students who put together the lighting systems and went to Colonet to install them.

The cats at Los Gatos Methodist Church (LGMC) and Rotary International (RI) know (LFL) well, having witnessed it’s lightening fast 60 day gestation and assisted its birth in 2012. Their very first solar lighting installation was actually in Colonet, Baja Ca. Within the next two years LFL projects reached 8- and counting-  continents, and introduced STEM and LFL to 1200 and counting middle school students at that age where inner spaces and lives can be lighted up in the process of lighting up remote places. AT Colonet this April I felt enlightened as well. I would go anywhere with these dudes and these children. 

Without burdening the reader more heavily with words, a browser  will lead to many links, here are a few that can tell about LFL better than I. 

LGRI Rotary

  LFL

 LFL Ivory Coast

The photographs below tell  of the experience more clearly than words, and may lead the reader to consider the possibility of LFL:

 

 

 

 

 

Doug McNeil

 Kevin Kinsella

First job of every morning  putting together two  units  for two houses. I couldn’t see how it was done, but these people did.

The plastic bag holds mounting brackets and connectors. Note  all the wires, and the name of the student on the lid.

The rechargeable battery goes in the box too. Simple, no? Yeah, Right!

Jessica

 

Tom in a moment of silent and serious concentration. I believe he is a monk in a grizzly bear skin disguise.

 

A fence perfectly representing the environment. The stakes are dried up spikes of cactus plant shoots. They are placed on  barbed wire, then tied on with rolled up salvaged black plastic bags.

 

 

 

 

 

 

 

Below are dried roots of the same cactus- Maguey- dug up from the sullen and reticent gravelly soil with considerable effort, to serve for cooking fires.

 

Dogs, dogs, dogs, everywhere.  We saw no house without doggy  gangs of 5 or more. They alert arrival of strangers and fend off coyotes,  if they are lucky; but numbers help.

The little Pichons must take care of their own hygiene.

 

 

 

 

 

 

Alejandro cleaning the spines from Prickly Pear cactus  …new growth leaves, or  nopales are used for a very common vegetable dish. He gave us a one week old dried rattlesnake which he advised us to let dry more, then grind up, and use with any food…like re fried beans and ground rattlesnake.  Cascabel con frijoles refritos.

 

 

 

 

I fell under the spell of this admirable woman.  She was a migrant farm worker from Chiapas, not speaking any Spanish; met  and married. Their 15 year old son works for a builder and did much of the block  construction;  15 years is adult at times. (During WWII my dad worked at a copper mine in Chihuahua. When I was 10 he took me to El Paso and put me on a troop train with $5. I got to  Northern CA  with some help from the soldiers. Like children in Colonet, we were older when younger then.  From this distance that doesn’t seem a bad thing.

 

I can’t  pronounce or recall  her name but will never forget her.  In this photo Antonio, the pastor of the Christian church in Colonet is helping her dig a footing for a table in her wash house.

 

 

 

 

 

 

 

 

Another home when the light was turned on in this dark  windowless room. It is only the equivalent of a 60 watt incandescent bulb, but What a difference! I like this photo also for the high heeled shoes over the door. There were 3 pairs but I didn’t want to be too intrusive with my photos.

Little silent things like those shoes have much to say if we listen.

Another wash-house with a dog in its shade,   and a fenced garden in back overlooking open countrywide. Unseen are 10,000 ft

peaks to the East.  –The Sierra de San Pedro Mártir.  But here the only vegetation remaining is thorny scrub brush and

maguey  cactus; nonetheless it is a beautiful green Spring after heavy Winter rains, and there are stubborn tiny flowers everywhere.

The lights installed, instructions given;  the switch is turned on by one of the children; and LFL makes the final point by giving each child a set of  age appropriate books; we take a last  group photograph. Adios is the perfect word.

Observations about Family

I would have never gone to Colonet without following my children, Amy and John and their Los Gatos family. The April 2017 buildings would not have been successful without my son Fred,  who drove 1800 miles to be here; or 3600 if he gets home; or his Colonet counterpart, Ivan. Or pastor Antonio.  Or, need it even be said, the  VIMers who were the glue that put it together. It strikes me that this  LFL  project post    tells of the nature of family. Families who keep animals in, and  desert varmints and coyotes out with  close spaced brittle dead stalks of cactus plants,  wire and plastic waste;  who carve out  a place in the desert to imagine a  house  into existence– no, a home– largely made of trash. That’s what only families can do, like those pictured  above.

I acknowledge that fat, happy,  flawed, or failing,  all I am is family. My parents and grandparents, and my Methodists;  even my intolerant or rude fellow citizens; and not least,  my children who refuse to let me go through my own rosy second childhood quietly, but take me to places like Colonet, to be nourished or frightened  by the life forces of VIM and LFL.; I blame you all for disturbing my golden years; but especially Amy, Fred and John; if they aren’t a blessing disguised as family, who is?

Here you are,  in the photos below, my babes,  late  on that Sunday afternoon, after a long trip and a long drive, framing the first wall. Like, Wow! What Energy! What discipline! What Organization!  What Execution! But unfortunately  the very next morning I had to go pal around with Doug/ Kevin et al.

So thank you, I suppose, for disturbing my personal quiet, reflective peace!

 

 

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Letter Six- To Santiago, Chile

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Feb 6 – Mar 25 2015 Brazil and Chile

 Note: These letters are Creative Nonfiction, but accurately coincide with real events.

I was afraid of getting to Guarulhos airport late because of São Paulo flooding or the trucker strikes, so took a cab just after mid-day even though my flight was to leave 8 hours later. Yet the roads were clear of flooding and of striking truckers; traffic was light. Not only is the terminal a comfortable place, but there are a quiet recesses where one can lie down and take a nap on three seats. I did. My flight- on Gol Airlines- as in Goooooooool! was easy, in a very new big Boeing.

Can foreign airlines be safe, new, and competitive–like foreign made cars or off-shore medical care? My daughter’s flight was on Air Canada: San Francisco, Toronto, São Paulo, then a 10 day layover, then Santiago, another 10 day layover, and back to Toronto and San Francisco. Cost: About $1200. She found her journey, by comparison, superior. I found the same thing with Gol. My fare on Delta, not including an extra flight, and change, was $1700.

Thinking Santiago airport transportation would be difficult arriving at 0155, I had checked with a world-class  transport provider; the most reasonable transportation was US$ 85. When I arrived, not only were immigration and customs a breeze at that hour, but a local ‘Transfer’ van cost less than 10 U$D, taking me right to my Rent-A-Home door in the Las Condes sector of Santiago. So much for fear of flood, strikes and 1 AM arrivals in Santiago.

The most striking thing about Santiago, and Chile in general, is its total transformation.  40 years ago the country was among the poorest and stagnant in the Americas; it is now the most successful by any standard measure. Because of the explosive economic and civic growth, the whole North and Western half of Santiago is an awesome expanse of tree-lined streets and parks, with elegant high-rise apartment, residence, and business buildings, surrounded by glitzy suburbs in the Andean foothills

If São Paulo is an earthy, wealthy and crusty old lady, Santiago is the great great granddaughter of a dead magnate who lost everything after WW I –when the nitrate mining industry collapsed  (fertilizer and gunpowder); this decendent rebuilt the family fortune and transformed the family business, taking it to a new level and direction.

As one result Chile became relatively expensive for US travelers during the last few decades. But for Dollar holders 2015 is a relatively favorable time to visit, like much of the world; the Chilean Peso has fallen about 1/5 against the $US.

Even though this is a small country—less than 18 Million people—it has not escaped the world-wide changes addressed in Moises Naim’s book The End Of Power. He claims that historically powerful entities, people, governments, industries, and institutions can neither exercise nor hold on to power, which now belongs to obscure individuals, small business, small countries, informal coalitions, and upstart of all sorts.

As I write, local TV channels are doing live broadcasts of a huge investigation of tax fraud here called Pentagate: the exchange of political advantage (money!)  by holding companies in order to evade taxes. The case has been building for months and is being adjudicated by the Supreme Court: One sees politicians and wealthy fraudsters in handcuffs, being denied bail, and led off to prison.The supreme court proceedings are in the hands of an eloquent elderly judge, who speaks clearly and deliberately, reminding me of our Watergate or McCarthy hearings. The electronic and print worlds are on fire.  See http://santiagotimes.cl/pentagate-scandal-continues-heats/ and this blog: http://blog.panampost.com/editor/2014/12/11/want-responsive-elections-in-chile-fund-them-yourself/

The blogger, in particular, speaks not only to Chile but to the USA, and arguably, the world.

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office building and shopping center
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It is common in Santiago for high rise apartments and buildings to feature balcony gardens, often with hanging decorative vines.

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Ahumada pedestrian walkway in old downtown center of Santiago
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Plaza de Armas, Downtown, Central Santiago
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Small farmer’s and food market, central Santiago

For almost a month we’ve lived in a nicely located Apart-Hotel, in Las Condes. It is on the metro line, and at the crossroads of upscale NW Santiago, the home of fine restaurants, dress shirts, ties, and business suits—-in the young, suits and backpacks–, glitzy shopping, and spiffed high-heeled women with ironed hair who roam this high-rise glass and steel world. These folk lunch in hundreds of sidewalk restaurants, and supper in style. New and expensive hotels are the rule. The picturesque old downtown financial district, a bohemian sector, and the student dominated barrio of small universities in between… are all a short metro or cab ride away.

As in much of the developed world, everyone here complains: approval of government is at less than 30%, of the president less than 20%. No one trusts corrupt and ineffective institutions, abusive businesses, failed efforts to control pollution and degradation of the planet; or our world in chaos: Sound familiar?

But objectively the fast growing middle class here lives well; and the poor live poor, but far less than half a century ago though complaints are almost universal.   Over those decades, by every standard measure Chile is a better and better place for more and more people. Santiago restaurants and hotels are full. The skyline sprouts construction cranes. Roads and freeways are generally new. A tunnel running 15 miles E and W under the main river is a toll road which, when exited, makes automatic charges based on distance; no toll booth, but cameras. How can things be so bad all over the world and look so good?  Yet that is the same all over our planet, if one simply compares life today with 50 , 100, or 500 years ago.There is another great metropolis built almost every month, and that is where most people apparently want to be. Maybe we need to stop listening to the News, and tend our own garden, as Voltaire suggested.

The normal generational change continues but moves faster than ever.Older Chileans are often rather formal,and intense,  preferring never to seem different from one another, reserved, focused, not easily given to unrestrained  pleasures  like dance or song by contrast to the same generations of Peruvians Panamanians, Argentines, Colombians, or Brazilians. Perhaps older Chileans remember the political crises of the 50’s 60’s 70’s, and more easily find solace in the oldest and finest wine industry in South America, and the birth of their new country.

The young educated middle class of  millennials here more closely reflect a developing worldwide norm: active, outward looking, rejecting and objecting to borders, and limits of other kinds. While there is a drug culture  found in millennials here it is, like alcohol, most damaging to the poor and uneducated, or those who lose hope for one reason or another. This crowd of new world young is worth listening to; more accurately, they will speak up whether we listen or not.

Chileans are miners, master builders and engineers of necessity. They work on and under a thin wedge of the earth’s unstable crust between the Andes and the sea. A well-built high-rise building may suffer earthquake cracks, but they are only skin deep. The structures can bend, like willows rather than Oaks; so the best place to be in a major quake is inside a well built building. Outside, deadly stuff can fall on you, you can be swallowed up by a big crack, or swept away by a river whose course is altered… that happened in a small town during the most violent earthquake ever recorded en vivo, near Valdivia, a southern coastal city. http://en.wikipedia.org/wiki/1960_Valdivia_earthquake

Volcanic eruptions, like small quakes,  can  often occur without significant earth movement. They can  be very spectacular with huge plumes of smoke,  ash, and volcanic lightning.  Pictures below are from  three eruptions in places I have visited often: (ongoing!) near Ensenada, a friend’s house, and a unique old hotel full of antiques;   Villarica, earlier this year, near one of the  most elegant  and unique international resorts in the world; and Chaitén near Pumalín, a famous 2.5 million acre eco-park founded by Douglas Tompkins. As spectacular as  eruptions are, they are seldom deadly. They can cause much disruption of life however. This site offers a good idea of how ash affected the small town of Chaitén  .  http://www.boston.com/bigpicture/2008/06/chaiten_volcano_still_active.html

calbuco 2015
Calbuco erutption 2015, is dumping much ash onto nearby towns. Much of the ash falls from the volcanic plume across the border in Argentina.
villarica 2015
Villarica erutpion 2015, beautiful but brief.
chaiten5a
At night the electrical storms associated with eruptions are spectacular. This photo is from the 2009 eruption of Chaiten.  The town of that name was, covered in several feet of ash, and is just now only beginning to recover.
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Lake Puyehue, near two of the volcanic eruptions pictured.But for us, and many expatriates,  Chile is about extended family: We have 27 cousins for example. Most live in the Metropolitan area between Valparaiso and Santiago. When there we have little rest with visits book-ended between s (welcome celebrations) and (goodbye celebrations); in between are daily get-togethers. We eat, and talk, gossip, and eat. There is rarely a lunch or evening free. We begin to yearn for home, for rest, for our Sacramento humdrum existence!

But for us, and many expatriates,  Chile is about extended family: We have 27 cousins for example. Most live in the Metropolitan area between Valparaiso and Santiago. When there we have little rest with visits book-ended between bienvenidas (welcome celebrations) and despedidas (goodbye celebrations); in between are daily get-togethers. We eat, and talk, gossip, and eat. There is rarely a lunch or evening free. We begin to yearn for home, for rest, for our Sacramento humdrum existence!

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In much of South America, restaurants offer a Menu each day, a low cost full meal. Here are main choices in blue, side dishes yellow, desert and drink below. This is lunch Menu in a business district restaurant. Just over 7 U$D
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Oceanfront apartment in Vina Del Mar. Beaches are generally public, with no building between roads and ocean.
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Chile stock exchange. Anyone who invested  in the 80’s – and never sold-  would be very pleased with the market and the peso.
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Pedestrian mall, central Santiago

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2015-03-03 22.03.13

Being There

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A primary care physician,–or generalist by whatever name–can best prepare and accompany a patient in that transcendental experience that is dying and death.
Family Medicine physicians, in particular, are ipso facto, concerned with the health of Family. Therefore, provided the patient agrees, the physician should encourage the participation of family and friends whenever possible; the life-long advantage of Being There for death is highly significant for both survivors and physician.

The doctor personally attending a dying patient was routine, 100 years ago. Perhaps that was in part because nothing else could be done; remember the Luke Fildes painting of a doctor sitting resignedly at the bed of a patient?

The_Doctor_Luke_Fildes

While it may be overly dramatic, the details stand a closer look: The physician’s demeanor; the neglected cup and potion; the disarray; the child’s parents; the darkened humble room. This doc is not attending nobility, but a family that lives at the edge of life. The doctor can do little except Be There. Isn’t that precisely the nature of death, that physicians can offer nothing except comfort, advice and –- most important under the circumstances–our presence?

We seem to have forgotten–or become fearful of– just being there for family and friends of the dying patient. Maybe we are afraid of being found out to be just… human; to have failed in our pretentions of scientific omnipotence. Because omnipotence implies guilt and deception when it becomes impotent. Yet the nature of life’s end is too critical a moment for a physician to give over exclusively to well meaning hospice teams, hospitals, nursing homes, or institutional types.

Clearly, Being There for death is quintessential to medicine. It completes the circle of a life, and  defines what is human, and  what a physician. Why should we abandon our patients and families in their extremis? No one, I believe, can better be there at that time than the physician, if well known to the patient.

In my own experience Being There is eminently doable, even though that was decades ago, in Woodland, when house calls were still common. The practice included something that could be called Home Rounds: regular visits, usually one afternoon each month to those who had difficulty getting to the office due to the limitations of chronic illness. The best features of those home calls were interpersonal, quiet, unspectacular, shared humanity. The visits quite naturally led, occasionally, to the time when death visited as well– as expected. The downside of those home visits was that better diagnostic and treatment options were not in hand. Yet present day micro-technology can largely minimize that problem; how contradictory that as it becomes ever more reasonable, available, effective, and mobile, its use outside institutions seems more limited.

There is no serious barrier to home visits, or to Being There today, even during the current medical perfect storm. (see below) Medicare regulations have been modified to allow primary care physicians to discuss end of life decisions as part of a health assessment. It seems clear the same sort of hocus-pocus will be made available by ACA administrators for younger people. (see below.)

However, the physician who hopes to Be There might best think about the process and plan for it –as we do with any other aspect of medicine. Perhaps the easiest part is already at hand; the material that is available from, for example, CMA, referenced here without further comment:
1) Advance Directives: see, for example:
https://www.cmanet.org/about/patient-resources/end-of-life-issues/
2) POLST. Be able to discuss Physician Orders for Life Sustaining Treatment https://www.cmanet.org/about/patient-resources/end-of-life-issues/physician-
The topic of dying is almost impossible to introduce quickly or easily. Most of the books on the subject are rather tedious or dense. I therefore suggest the physician go through exercise of making up a simple, easily understood one or two page letter to communicate with patients. I have done so, for people themselves to use, but it can be modified for use by a physician. It is found below in a version for use by patients, but should be updated because things change; it can easily be revised by a physician or others to introduce the subject in discussion. a version is viewable on line at https://nwalmanac.wordpress.com/.

###########################

Thoughts on Death and Dying
When it becomes impossible to avoid death and dying, you may want to consider whom you want to Be There, even though no one is able to provide more than comfort. To make that possible, consider setting down information that can make clear your preferences. The purpose is not to replace the physician, pastor, other counselor, or hospice; but to assist them, and you, and your loved ones in this universal life experience that is at least as significant as any other, including birth.
Review your personal belief about death
Consider experiences that seem death-like:
The condition we were in before birth;
Deep Sleep, Dream, Amnesia of drugs.
Consider what you expect your own death will be like:
1) Will your death be permanent or temporary?
The beginning of life everlasting? Yes_____ No_____
A temporary condition before rebirth? Yes_____ No_____
A permanent state of rest, nothingness? Yes_____ No_____

2) Will you be aware or even conscious? Yes_____ No_____
3) Will you- can you- feel pain after death? Yes_____ No_____
4) Will you be rewarded or punished for your life? Yes_____ No_____
5) Do you want religious guidance to die? Yes_____ No_____
If so, who will be with you?_________________________________________
_______________________________________________________________________

6) Will friends or family to be with you when you are dying? Yes_____ No_____
If so, who will contact them?
Name: ___________________________________________Phone_______________________
Name: ___________________________________________Phone_______________________
Name: ___________________________________________Phone_______________________
Name: ___________________________________________Phone_______________________
7) Do you have an Advanced Directive? See, for example:
https://www.cmanet.org/about/patient-resources/end-of-life-issues/
8) Consider POLST, Physician Orders for Life Sustaining Treatment so you can better say what to do when or if you can no longer make decisions: see
https://www.cmanet.org/about/patient-resources/end-of-life-issues/physician-orders-for-life-sustaining-treatment

—You may want to take this completed form to your physician, friend, pastor or family. The physician can most readily provide comfort care personally.

—Speak up if your ideas change. That can happen!
—If you want your doctor to be with you when you die, ask that a copy be
placed –or scanned– into your record. Keep the original.

Date: ___________Signed:________________________________________________________

################
Note:
There is much written on the subject of death and dying. However it is often too detailed, tedious or theoretical to be practical. That is why you, yourself, are the best person to determine your ideas on death and dying. You may think about practicing detachment from the things of your life. The short list below is inspired by Chapter 3 of The Tibetan Book of the Dead by Robert Thurman 1944 Bantam.
1) Begin giving things away. Especially things you care about. Give thoughtfully, carefully.
2) Review your relationships, concentrating on what may make your relations and friends.
3) Let go of your own body concerns; take care of it but be relaxed about it.
4) Meditate; when you do, or when you write, you can better find your inner self.

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See also:
http://www.nytimes.com/2010/12/26/us/politics/26death.html?pagewanted=all&_r=2&
http://voiceofsandiego.org/2013/08/12/second-opinion-how-does-obamacare-address-end-of-life-care/
‘President Obama had wanted end-of-life counseling to stand as a separate, billable service, giving families and doctors a clear route to make decisions about when to forgo treatment. The idea was scrapped because of concern the benefit might pressure families and incentivize doctors to pull the plug.
But there is language in the final law that moves the discussion forward a bit. The Affordable Care Act’s Medicare regulation says “voluntary advance care planning” can be included in covered annual wellness appointments. The planning would involve creating an advance directive, a legal document that dictates how aggressively a patient can be treated once he or she loses the ability to make decisions.’

The Melba Notebooks Published

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The Melba Notebooks, (partially based on material in this blog,) has been published. Anyone who has been close to elderly parents or friends who are in their last years will find these scenes moving; anyone who is living that life experience now will find the Notebooks to be familiar territory, or perhaps, instructive.

Book Description
Publication Date: February 5, 2014

Bob and Melba marry at the dawn of the Great Depression. A mining engineer, Bob finds work outside the US and is later blacklisted by mining companies after supporting a gold miners’ strike in the Philippines. For several years thereafter he can only find work as an underground miner himself. Melba, Bob and their children make a life, often from scratch, in mining towns around the world, including Quebec, Ontario, the Philippines, Mexico, and the Western USA.

They grow old and frail. Having lived on their own terms, they want to die on their own terms too—at home, away from institutional protocols that tend to sanitize, trivialize, and prolong old age and death. They do so with the help of their children and caregivers. Their story was culled from five hand written spiral bound notebooks that make up a five-year conversation among caregivers about Elder care and terminal care told with clarity, sympathy, humor, and power. The print edition is available at Amazon, and CreateSpace. The e.book is at Kindle Direct Publishing.

In Solitary

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This solitary cell is lonely
but far from inmate strife;
in cement walled stillness
I call up a wistful memory
of a long gone former life.

It’s early morning when we wake
from dreams of a rustic cabin
at one end of an endless road.
Does anyone know how long?
Who cares? Whatever it takes!

The rising mountain fills our senses
with scent of pine, and mossy damp.
Cries of angry gravel as we pass
frighten tiny meadow flowers
corralled by wind-bent grass.

Our excited little Geo,
fretful, and fearfully aware,
creeps past feral rocks
by a swirling singing stream
where birdsong colors the air.

I imagine a woman like this river,
beautiful, strong, soft and constant.
But a steep stretch of rutted road
makes the Geo stall and stop
unable to carry its peopled load.

Cramped legs and minds unbend
To unburden the grateful car;
Whining mosquito gangs attack
like a teasing older brother;
and I fondly bite them back.

We reach that fearful place
between a clutching abyss
and leaning cruel black cliffs.
I close my eyes up tight
to keep death out of sight.

My Uncle laughs and claims
“The mountain’s coming down.”
We pass a remembered spring
that weeps and sings of rain
and snow and lightening,

Where clear stone washed water
bred in stoney darkness,
born of a granite womb
becomes the newborn river
that leads us all to the sea.

Then I see it! The green gate!
I can hardly wait to know
of grandma’s secret things;
what wonderments she’ll show
like Scrabble and music she sings.

The Geo finds a place to hide
between dark woods on either side
and spits us out upon the road
like giddy human pack mules
fretting about their load.

I stagger under the weight
but stubbornly add more,
to shorten my anxious wait
for auntie’s fresh baked pies,
campfire songs and remembered lies.

The old cabin rises to greet us
dressed in hand made shingles
my father split and nailed there
sweating beer and singing curses
at the wild mountain air.

When his bright light died
we placed his lonely ashes
there by his favorite tree,
by the tomb of my childhood
and the cradle of juvenile rage.

Through this silent six side cell
runs a road by a singing river
that leads to the soulful sea.
And I hope whatever was lost
Still lives and thrives in me.

Uncle

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Tío

Yo le digo tío-,

I call him uncle

Lo digo pa’ joder.

Just to piss him off.

Yo era forastero, solitario,

I was a stranger, alone,

Un poco amargado, resentido-

Quite bitter, resentful.

Pero me trató con sencillez,

But he treated me with openness,

Con cariño como si fuera digno de respeto,

And affection as if I merited respect.

Como si no hubiera cagado mi vida.

As if I hadn’t fucked up my life.

Cuando no soñaba, él me alimentó con sueños suyos.

When I couldn’t dream he fed me his own

Sueños Gonzalez, raros, bellos,

Gonzalez dreams, strange, and beautiful,

Con vitaminas de locura.

With vitamins of insanity.

Todavía  sueño con la vida más que la muerte,

I still dream of life more than death.

Puedo dar y recibir, soy sano, fuerte.

Can give, receive, am whole, strong.

Y todavía le digo tío,

And still I call him Uncle,

Porque no tengo nombre suficientemente grande,

For there’s no word great enough,

Ni profundo, ni ancho,

Or deep enough or wide,

Para este hombre que le digo tío,

For this man I call Uncle,

Aunque no es tío mío.

Who is no uncle of mine.

A few years later Tío got prostate cancer and I advised no aggressive treatment. Eight years after a dense stroke, he is  alert, diapered, and walks with difficulty, preferring to be wheeled about; he loves his bed. He still radiates good cheer, but sometimes in a moment of weakness confesses an ineffable  sadness.  After the dreaded  cancer diagnosis,  I had promised to interfere personally if he ever requested it. He has never asked.  Neither have I;  and the dreaded cancer has never spoken a word.  

Reflections

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Body and mind raced as he responded to the code blue call. There is no day or night in a busy emergency room, no Time, no season. “An emergency room is light” he thought.“We are hens tricked into accelerated laying by the light. It comes on and BAM there’s another one, you’re welcome, thank you very much!”

 

An ER staff moves constantly in cool restless filtered air, and it’s kept that way because they are almost always very active; so blankets must be handed out regularly to patients.  He spent the first ‘overnights’ in a small ‘ER’ as a junior medical student.  The $8 pay was a bargain since he could sleep intermittently, and miss only the early lecture or clerkship round, slipping into the back layers of students, avoiding the eye of the professor.  Forty years in ERs followed. At first the harsh cold fluorescent light, an electric wind of sorts, used to leave his eyes  light- burned after a long shift. Black wrap around sunglasses would have helped but they were too hostile, too military. The noise, lights, crush of duty were conditions that soon seemed as natural as never waking up feeling totally rested due to constant change in work-sleep patterns.  He learned to eat, or inhale, a full meal in three minutes, to sleep any time, anywhere, instantly; and awaken as quickly, fully functional. Or usually so;  he chuckled, remembering when, as an intern after delivering twins, his first, alone, he immediately fell into a dark deep sleep of relief and exhaustion; a nurse called and asked something about the infants, and he responded;

“Give them each 100 mg of Demerol!”  Should have left the lights on!

 

As supervising attending physician he would observe closely while the resident physician ran the code.  Slipping quietly into the room like a late med student, but now  was an experienced physician prepared to offer occasional constructive question or a suggestion, if needed.

 

The old man was handsome; a golden black face and slender habitus made him seem young.  But it is always the eyes and the backs of the hands that  confess a person’s true age.  And they said, “ Well over 80.”  The man seemed vaguely familiar, yet he couldn’t place him among the accumulated codes and years of people threatening to die. Ventricular Asystole. No heart activity. He reflected;

“Not very likely we we’ll be able to send him upstairs to the ICU; and if we do they’ll probably send him way upstairs. Or downstairs if he’s Greek or somesuch.” But that thought was cynical and he quickly brushed it aside.

 

The new resident did not disappoint. Nor did anyone else. Resuscitation is always a team effort. Compressions, oxygen, intubation, confirmed, IV access, and  Drugs IV, labs.  All at the same time.   As he watched an attractive nurse do chest compressions, an unwelcome recollection of the first chapter of The House of God invaded his mind, and again he thrust it aside thinking,

“Some books should have warning labels: ‘ Said to be brilliant, insightful, but the Surgeon General has determined that the reader may be infested with mental garbage.’

 

After the initial chaos, the action became more ordered, deliberate, thoughtful. Team members commented and suggested.  And suddenly the monitor revealed Ventricular Fibrillation!  There was hope.  Electricity, three shocks, and the faint smell of burned gray chest hair. No change, more of the same, and once again, Asystole. Algorithms or recipes for resuscitation were followed.

 

The chart appeared.  The patient was almost 90. He  rather uncharitably thought,

“There must be a new person in records. Someone is awake”.  The charge nurse stepped in to say the patient’s wife and son were in the quiet room, so he stepped out to speak briefly with them, and review the history provided by the ambulance crew. The man, always very physically active, had been mowing the lawn with his push mower when he collapsed. Outside it was 112 degrees F.  His only surgery had been for cataracts, and his sole medication was estrogen for prostate cancer. There were no risk factors for heart disease except age and male sex.  The patient had been retired since age 65.  He had no special  activities or interests. “ My God!” he mused, “How has he survived 25 good years without the most addictive of all drugs: work.” In one of those recurring coincidences of life, his father had been a miner, and worked in the same mine at about the same time as the patient¸ Noranda, Quebec, where he had been born.  He wanted to ask more detail but had to return to the code. “Back to the henhouse.”

 

Relaying the information to the resident, he found that the patient’s situation was grim; a pulseless wide slow complex.  The labs were back, the x-ray studied.   He watched the resident methodically repeat the algorithm, consider and actually attempt to treat the only other possible treatable conditions. Yet she seemed to unable to make the obvious conclusion.

 

The resident was a single mother. She and her two children lived at a distance where rents were reasonable, in tiny apartment,  paid for child care, paid taxes, social security, drove back and forth to on street parking.  Her son had had a recent serious injury, and he had treated the younger child for severe asthma.  “We weren’t paid, but had free housing for me and my family, and free food.  We were really residents, working 36 on and 12 off. Why are they still called residents? But perhaps she will not beccome a robo-doc. The young docs don’t tend to abandon their spouses and children in the name of Hippocrates, like I did. I hope so.”

 

The seconds became minutes. The code team awaited orders. The inviolate code atmosphere was pierced from outside the room by voices, sounds of pain or retching, paging , buzzers,  bells and smells. The regular electric convulsion of the big code wall clock second hand soundlessly shredded the air.

 

Abandoning his role as observer, he called the resident aside and spoke in a whisper.  “ Good job. Very well done. But, unless you want to crack an 90 year old chest for practice, don’t you think you can ‘call’ the code?”  And in that moment he knew he had been negligent. He had not remembered that the resident was just returned from her own father’s funeral the week before.  He had forgotten that a resident is family. Like the family that he had so often neglected to value to nurture, to simply share his time with.   “What do the architects say”, he thought,“ ‘Function follows form?’  But in living it is the other way round. We become what we do. I hope she will do better than I have. ”

 

After the usual and always painful talk of informing the family, he asked as usual if they would like to visit with the patient. As usual, yes, but briefly. They left.  Returning to the bedside with the resident to review documentation of the code, nothing, however was as usual.   He felt as if he could see beyond the veil of Time. He had the sensation of gazing into a three thousand year old mirror from the side rather that front on. He could see, or sense, centuries of reflected images bouncing back and forth between the silvered and face surfaces of glass. It was clear that he and the dead man and the resident and Hippocrates are the same person, each a reflection of the others.

Fearing some sort of revealed truth or understanding would dominate him, he hurried away, out of the blinding eternal light, into the clean and translucid blackness of rain washed night air.