Blog

I sat on the exam table waiting under the bright lights of the room. I felt overly warm, even though I was only covered by the customary thin gown, the kind that opens in the back leaving the rear on display. My bare legs hung over the edge of the table. My feet dangled.

Menopause had broken my personal rheostat. I felt moisture creeping out of my pores in the usual creases, my armpits, the back of my neck, the backs of my knees, my groin. The frayed gown was now absorbing the perspiration below my breasts like an ratty wornout sponge. I could feel the paper sticking to my skin as I shifted on my hips. The mask made matters worse. I pulled it down under my chin and blew out a hot puff of my stale rebreathed air to mix with the sterile smells of antiseptic lingering in the room.

I was waiting for the doctor to see me for a preop exam, to determine if I was healthy enough for surgery. I stared at my toes. The orange nail polish had chipped on some. I rubbed one foot on top of the other to cover the most unglamourous of them. I examined my legs and discovered a few rogue hairs that apparently ducked and dodged my razor that morning. They glistened in the bright light now. I knew he would not notice. As a physician myself, I never noticed except to attend to patterns of hair growth or skin issues behind the hair. Still, I felt vulnerable. Exposed.

The doctor arrived presently. After minimal small talk, he established the reason for my visit. He quickly reviewed my supplements, allergies and prior surgeries. He started in on a perfunctory examination of neck, heart and lungs while he went on asking questions. “Any night sweats, chills, fevers?” He clicked off the usual list, moving his stethoscope from over my chest to my back.

I could see him checking imaginary boxes and making notes in his head like a quality assurance inspector as he performed the exam robotically. Then he came to immunizations.

The red flag tab on the electronic medical record indicated I was due for two. I smiled and nodded agreeably to one, and calmly shook my head no thank you to the other.

This was a record scratch for him. He asked me why, genuinely shocked that I had any other response than complete compliance. I explained that I had reviewed the literature, weighed the evidence, and because I lived a healthy lifestyle and had a healthy immune system, I decided that for me, the risk outweighed the benefit.  

He shook his head in disbelief as if I had checked my brain, medical training, and years of experience at the door. “You’re a doctor and you’re refusing an immunization.” Clearly, we were not having a shared decision-making dialogue like the one I had previously with the surgeon discussing the risks and benefits of surgery and whether it was the next right step for me.

His tone was condescending. “What side effects are you talking about!? You know you are putting yourself and others at risk,” he continued as if the science was settled. There was only one way to interpret the data. In these last short months, the vaccine had proven itself safe and effective for everyone everywhere in every situation no matter what no questions allowed. I could not tell if he was truly concerned about me or if he was annoyed that I was not taking his advice. Maybe he was in the running for most vaccinations handed out that day, and I just broke his streak.

The doctor asked me to lie down and proceeded with the abdominal exam. We both remained silent. My mind wandered as he pressed, probed, and listened with his stethoscope, feeling more like an object than a person. After what felt like an eternity, he finally finished.

I sat up pulling the gown tighter around myself, like a child clutching a blanket, desperate for a sense of safety that the flimsy fabric failed to provide. I felt his burning disdain creep over me making a mockery of my earlier hot flash.

“Dr. Smith was healthy as a horse, and he died last just last Tuesday.” He paused for effect, his hand now on the doorknob ready to rush off to the next room. “Get. The shot,” he commanded with all the authority the MD embroidered on his starched white coat carried.  When I declined a second time, he scoffed, “Good luck, you’re going to need it,” and closed the door behind him.

I felt my flushed face, retrieved my sense of self, and wondered why I was so surprised. It wasn’t as if other colleagues hadn’t chided me spitting the science in my face and talking about me behind my back. The medical school where I had been an esteemed clinical preceptor for their lifestyle medicine track let me go.  The hospital where I was on associate staff for twenty-five years practically made me sign in blood that I would not darken their doorstep; but interestingly, they were quick to schedule surgery for me as an unprotected patient. It made sense, and it didn’t make sense.

Driving home I wondered if I had ever humiliated a patient in this way. It did not take long for conversations to flash across my memory banks, like lightning bolts across a stormy sky.  I winced as I recalled a few of my least favorite moments as a doctor.

The day after Obamacare passed, I declared with exasperation, “Maybe Obama can help you,” to a patient who had come back a fourth time for the same problem which my treatment had not cured.    

“Today is the day. Put a stake in the ground. You have diabetes.” I said that to a person who was battling breast cancer and was not registering the reality of this new diagnosis and the impact on her health.

To a woman who chose not to vaccinate her baby according to my regimen, I replied, “Your children are well because my children are immunized.”

Yes, I know it is hard to believe. I said those things. To my patients. And those are the ones I remember. And no, I’m not proud of it. I wish I could take those words back. The first part of the Hippocratic oath is “do no harm.” That included do no harm with my words. I still felt the sting of conviction even though I had long ago apologized.

Let me ask you a question. What horrible thing has a doctor said to you?

I have heard some doozies from patients.

“No surgeon would ever touch you with a 10-foot pole at your weight.”

“Did they take you to the back to weigh you on the industrial scale?”

“If you would only try to lose weight, your condition would get better.”

“Your cervix must be the smallest part of your body.”

“And then what did you do”? I asked my patient after she related her story to me.

“I went out to my car and cried.”  Tears rose behind my eyelids for so many reasons, acknowledgement of her pain and resentment, the doctor’s shortcomings, my own failings, our collective humanity.

The providers who say those things don’t understand obesity or their patients who have obesity. They don’t know how hard the person in front of them has tried to move the needle on the scale. They don’t know how to help. And they don’t know that their words are doing harm. Truly, they don’t know what they do.

So, here’s the next question? What are you going to do with it?

Ok, I get it, fire the doctor if you are able. We deserve it. And yes, write us a letter. We need to hear what you have to say. But what is your ultimate power move, even when we don’t apologize?

I am going to ask you to do the very hardest thing: forgive. Not for the doctor’s sake, not because he or she deserves it, but for your sake, because you deserve it. You deserve to be free from the bondage of those words. Forgive because it is a way to reclaim your power. In releasing the grip of negativity and pain the provider caused, their words can no longer dictate your emotional state or sense of well-being. You get to oversee how you act and feel. And you deserve to be at peace. It is not easy. It takes time. That’s ok. Break the curse and forgive.

Knowing what it is like to have a hard day, knowing that that doctor just did not understand me and where I was coming from, and wanting those patients to whom I said those horrible things to forgive me, I forgave that doctor.

Someone somewhere once said “Forgiveness is unlocking the door to set someone free and realizing that you were the prisoner. And like Jesus taught his disciples to pray, “Forgive us our trespasses as we forgive those who trespass against us,” I am endeavoring to adopt his posture of forgiveness, for others as well as myself. I am accepting my inability and the impossibility to do no harm one hundred percent of the time, but maybe I can be part of the remedy for peace.

It wasn’t a day off. It was an “off” day.

I was at my Reach Out Weight and had been there for at least the last week. I didn’t know exactly how long because I stopped weighing myself the previous month since the scale reflected my Refocus Weight. I chose to start this day with curiosity, however, considering the consistency of my rhythms in the last month. What had changed?

I decided to fast. Not as punishment to be sure. But I had not fasted since January. Maybe my system just needed a break from food.

I shrugged my shoulders shaking off the frustration and determined to make it a good day.

For the next eight hours, I carried on as usual, listening to my patients talk about their areas of confidence and motivation. Together we identified specific barriers that come up again and again. I supported them as they shifted their thinking, uncovered new approaches, hung on to hope, and chose not to give up.

In between appointments, I struggled to fight voices in my head crying,  “You Charlatan, who do you think you are?!?!” I could feel the curiosity melting into criticism. Why did the scale still hold so much power? It’s only one data point and an incomplete one at best.

Memories of weight recurrence throbbed in my brain like a debilitating migraine. I had worked hard for several years to gain and lose the same thirty or forty pounds. I tried all sorts of fad diets. WW, Zone, Southbeach. The calorie restriction worked, but only for a while. I could not bear the weight of the unforgiving dietary laws.

I spent 2014 learning a different way: lifestyle change. Lifestyle change brought a freedom from the oppressive focus on calories to the guidance of practices, not only around nutrition, but around sleep, movement and stress management as well. This was effective for me, and I lost the forty pounds one more time, and I thought, for the last time. It was so effective, I was compelled to make a major shift in the way I practiced medicine.

But in the first three months of starting a lifestyle and weight management practice, I regained ten pounds. Ten pounds! I had learned from an esteemed mentor that an increase of five percent from realistic nadir weight seemed to trigger exponential regain.  Adipose cells have memory, and they will fight for the higher set point. Who is going to go to a lifestyle medicine doctor who is gaining weight? That’s like going to a cardiologist who smokes and needs a heart transplant!

Despite implementing every tool I had learned about leveraging weight without dieting, I stayed stuck for two years. I was running circles around the scale and getting nowhere.   

As I recalled the battle, I fretted. Was weight recurrence threatening once again?

My “off” day brought other discouragements as well: news of a beloved one’s cancer, disagreements among family members, and bills. It was always the bills that reminded me that even if I wanted to throw in the towel and give up, I couldn’t.

My husband tried to console me. “You look fine,” he said with real sincerity, “you are beautiful.”

It didn’t help. When I get to this state, there is no encouraging word, no mound of ice cream, no vat of wine that drives out despair. There is only sleep; and I could not get to bed soon enough to put an end to this “off” day.

My dream world took me to a courtroom setting where I played all the roles: relentless prosecuting attorney eager to expose the crime, smug judge eager to enforce the law, biased jury eager to convict the criminal, and indifferent executioner eager to carry out the obvious guilty verdict. I was on trial again, and it was not looking good for me. There I stood in the witness box, swearing an oath to tell the truth, the whole truth, and nothing but the truth, so help me God.

The prosecution directed my attention to Exhibit A. “Describe to the jury, Doctor,” she began, emphasizing the word “doctor” in the most mocking voice, “what you see in this picture?”

He directed the jury’s attention to an image of an empty yellow box ten times its Costco size projected on to a screen. Incriminating crumbs appeared defenseless around the box’s perimeter.

“Wheat thins,” I replied meekly, my head hung in shame as the salty words left my parched lips.

“A little louder please, so the jury can hear you,” the self-righteous judge scolded me.

“Wheat thins,” I said again, pleading with and leaning toward the jury, “but, please, I can explain. You see, it was my anniversary and…” A lone cracker flew out of a fold in my sweater, landed on one of its corners on the white marble floor, and spun like a top until it fell flat on its face. Damning evidence for all to see.

The jurors sucked in gasps deep enough to create a vacuum and strong enough to draw the next breath from my lungs leaving me speechless. They jerked their necks side to side eyeballing their neighbors. Like a tempest wind, indignant whispers rippled, then surged among them. “Everyone knows wheat thins don’t make you thin! Everyone knows wheat thins don’t make you thin!”

“Order in the court!” the judge cried banging his gavel all the while glaring at me as if the ensuing commotion was my fault too.

The prosecutor cut me off, not interested in my explanations. “No more excuses, Doctor! This picture clearly shows a lack of restraint. And isn’t that what got us here in the first place!?” Even my defense attorney had no objections.

My heart sank. This courtroom, this trial, it was all too familiar. I knew the routine well—the self-accusation, the guilt, the endless cycle of blame. I imagined, even in my dream state, my defendant’s assistant bursting into the courtroom, her right arm lifted high, waving new evidence to sway the jury’s verdict: a faulty bathroom scale, a better body composition, there must be some rational explanation.

But then I took a moment. A deep breath. I reminded myself that this was a dream, a manifestation of ancient fears, not my new reality. Life happens. Weight happens.

I looked again around the courtroom and saw the people in the dream soften as they morphed into my family members, my friends, mentors, and even my patients—each one representing a piece of the puzzle that was my life. They weren’t judging me; they were symbols of support and understanding.

As I faced the jury, I began to shift my perspective. Yes, there were moments of weakness, and still would be, but there were more moments of strength, perseverance, growth and reasons for celebration. Even celebrations with food. I remembered the countless times I had overcome obstacles, how I had guided others through their own struggles, and how much I had learned along the way.

The prosecutor’s voice faded, replaced by a sense of clarity. This wasn’t about punishment. It was about acknowledgment. Acknowledging the journey, the ups and downs, and the progress I had made despite the challenges. Acknowledging that data is information, not ammunition. And the scale is never the only measurement of health.

With renewed resolve, I rose from the witness box, no longer the defendant, but the advocate for my own journey.

Yes, weight happens, and it’s going to be ok. Progress, after all, is not always linear. And every step, whether small or large, contributes to a healthier, more integrated life.

P.S. My sincerest gratitude to Donna and Melissa, who spoke words of encouragement over me and chased my fears away:

This is the original text from the book where Desiderata was first published.

Go placidly amid the noise and the haste, and remember what peace there may be in silence. As far as possible, without surrender, be on good terms with all persons.

Speak your truth quietly and clearly; and listen to others, even to the dull and the ignorant; they too have their story.

Avoid loud and aggressive persons; they are vexatious to the spirit. If you compare yourself with others, you may become vain or bitter, for always there will be greater and lesser persons than yourself.

Enjoy your achievements as well as your plans. Keep interested in your own career, however humble; it is a real possession in the changing fortunes of time.

Exercise caution in your business affairs, for the world is full of trickery. But let this not blind you to what virtue there is; many persons strive for high ideals, and everywhere life is full of heroism.

Be yourself. Especially do not feign affection. Neither be cynical about love; for in the face of all aridity and disenchantment, it is as perennial as the grass.

Take kindly the counsel of the years, gracefully surrendering the things of youth.

Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with dark imaginings. Many fears are born of fatigue and loneliness.

Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe no less than the trees and the stars; you have a right to be here.

And whether or not it is clear to you, no doubt the universe is unfolding as it should. Therefore be at peace with God, whatever you conceive Him to be. And whatever your labors and aspirations, in the noisy confusion of life, keep peace in your soul. With all its sham, drudgery and broken dreams, it is still a beautiful world. Be cheerful. Strive to be happy.

by Max Ehrmann ©1927

It was a lazy Sunday afternoon. That morning, Kenny and I had enjoyed a beautiful worship service at a church in Portland we recently started attending, and then a leisurely lunch discussing the challenging sermon we just heard, and then, a luxurious nap.

It was now 4:30pm and the sun hung low in the sky patiently awaiting its disappearance below the horizon. Kenny was across the street finishing up a few chores.  I relaxed in our living room in the brown leather chair with a glass of pinot in one hand, a book in the other, my feet up on the hearth in front of a warm fire, endeavoring to practice the ancient rhythm of Sabbath. I found my thoughts shifting from God to my patients and the upcoming work week as I read my book, Practicing the Presence of People, by Mike Mason.

The author explained how he was inspired to write this book after studying Practicing the Presence of God written by the seventeenth century Catholic monk Brother Lawrence. I had been drawn to the book desiring to do a better job at my job. Having recently overcome a few financial hurdles, I was wondering about slowing down a little, to spend more time with people, namely my patients, and to make that time more quality time, staying fully present, really listening and reflecting, rather than thinking about what was coming next. I had even commented to a friend a few weeks earlier that I felt the Holy Spirit was leading me to “practice the presence of people over profit.” I was not sure what that meant or what it looked like exactly, but I was curious to find out.  

The blaring ring of my cell phone jolted me from my thoughts and brought my Sabbath to an abrupt end, even preempting the setting sun. I heard Kenny’s weakened voice on the other end of the line. He was gasping for breath. “Call 911- I drove – the tractor – over the bank – call 911 – you won’t- be able – to get – me out – of here.”

I ran as fast as adrenaline enabled, yelling into the phone, “I’m coming! Where are you!  I’m coming!” I sprinted the half mile across the street, down the hill, and over the gravel road, first spotting the upside down, mangled tractor and then arriving upon my mangled husband.

Old training kicked in. There was no blood. He had an intact airway, was breathing, all be it shallowly, and he had a pulse. He was moving all four extremities as he flailed in pain.  I could feel the fractured clavicle but was unsure of internal injuries.

I spoke calmly to the 911 operator who suggested I put a blanket over Kenny while we awaited EMS. Our friend and neighbor, Terry, appeared, seemingly out of nowhere, and laid his coat over Kenny.

The ambulance arrived presently, and five paramedics went to work. They quickly placed a C-spine collar on him, assessed his vitals, lifted him onto a backboard and then onto a gurney. Each bump over the gravel elicited wails of increasingly excruciating pain from Kenny and jerked anguished  tears from me. Clearly this was more than just a broken collar bone.

I drove behind the ambulance but could not keep up. I made a few phone calls and asked for prayer. “It’s 5:15pm now,” I calculated, “With CT scans and all, we’ll get back home before midnight.” I remained naively hopeful, “I’ll still be able to get enough sleep and see my patients tomorrow.”  

I realized we had experienced a miracle. The injuries were not as bad as they could have been, not by a long shot. He was not dead or maimed. He had no head or neck injury and no major internal hemorrhaging that would require surgery. Even so, the injuries were worse than I expected: fractures of the clavicle, eleven ribs in several places, and three vertebrae, as well as a small pneumothorax, a hemothorax, multiple contusions, and skin lacerations.

He needed to be admitted to the hospital. I needed to cancel my Monday patients. Yet I chose to keep family and friends up to date. That in itself was a full-time job.

Kenny finally made it to a room and fell asleep, exhausted from the trauma and drugged by the pain medications.

I went home to take care of the dogs and sleep in my own bed. I wrestled with myself but still did not reschedule my patients. Instead, I woke up the next morning and after my ritual water and black coffee, planned to race to the hospital to make sure Kenny was ok. I would be able to exercise, rush to the hospital, check in with Kenny’s attending physician, and rush back in time to start seeing patients by 9:30am. I felt almost prescient having reworked my schedule with late start Mondays about three months ago.  I can do this. I can do this. I coached myself.

I walked down the dark hallway into the waiting room of my home office where my treadmill beckoned. Before I could even turn on the light, I was slapped in the face by a horrible stench. One of my dogs aberrantly left a pile right in front of the entry door. No, there was no way I would be able to get rid of that awful smell in time to see patients. I finally gave in.  I guess I am canceling patients for today. Practicing the presence of people over profit apparently started with Kenny.

Rachelle conveniently texted a random question. I informed her what had happened. She wanted to help. I conceded and she cleared my day.  

At Kenny’s bedside, I had lots of time to ponder. I realized it seemed ridiculous that I would even contemplate going about my normal day when my husband lie broken in a hospital bed with multiple fractures and internal injuries. It’s a no brainer that as his wife, this is where I needed to be. Why was this such a difficult decision for me? Just as I observed myself running to Kenny, was I now seeing myself running away?

Instead of judging myself for even considering working, however, I stayed curious. What was I afraid of? What story was I telling myself? I talked with my sister, Amy, and she stayed curious with me.

Practicing the presence of people, as I was to find out, reading further in the book, actually started with me.  I first had to be open and honest with all my thoughts and feelings.

“I do not judge myself,” states Paul in 1 Corinthians 4:3. As I explored my various emotions, “taking every thought captive” took on new meaning.  There was space at the table for all of them: fear, worry, anger, uncertainty, as well as faith, hope, love, and trust.

I recognized that some of my own past traumas were resurfacing, particularly when my son, Sammy, became ill and was hospitalized twenty-seven years ago. This was not that; but it sure smelled like it.

I observed that the memories were not threatening to take me down; they were asking for help. I allowed them to resurface and invited the Holy Spirit to shine His compassionate light, to sort out truth from fiction, and start a deep, healing work.

Practicing the presence of people. If I am not able to truly come to grips with my own thoughts and feelings, positive and negative, especially in the face of curve balls, withholding judgment and leaving space for compassion and curiousity, how would I be able to do this well with others.

Kenny’s injuries are well on their way to recovery. And so are mine.

I feel very fortunate that my husband and I are on the same page about so many things. And I am not talking religion or politics, though we agree on most issues in those areas too.

We share similar interests in recreation. We enjoy hiking, kayaking, gardening, walking on sandy beaches in Hawaii, and most recently, pickleball. We have similar tastes in décor, furniture, art, shows, etc. We like gathering around the table with family and friends, making and sharing a meal. We love spending time with our children and  grandchildren.

One of the most important values we both share is ageing well which means we both enjoy eating healthfully.

It was not always this way. Early in our marriage, neither of us paid much attention to food quality. And we were not necessarily in agreement with what constituted healthy food.  We both had bad habits, nostalgic tastes, and wrong thinking.

Kenny held fruit juice as an excellent source of vitamin c and served our kids orange juice or mixed fruit juice every day for breakfast and then packed capri suns in their lunches. My version of healthy Kraft mac and cheese included adding tuna and broccoli to the powdery chemicals.

He threw away my diet coke and I hid his karo corn syrup (which he poured on top of the inch coating of jam and butter that he slathered on the Krusteez pancake made with egg and vegetable oil) in the trash.

As we both dove deeper into the big wide world of nutrition, we picked up the good with the fads, eventually getting away from the promise of finding the fountain of youth in any one supplement or diet and embracing the fact that food – high quality food – has to be our main source of nutrition. After all, our bodies are constantly turning over cells. That is, we are getting rid of old dead cells, and making new ones. We make the new cells out of the food we put into our bodies. The better the food quality, the better the cell quality. And the better the cell quality, the better the health.

Over the last ten years, we have moved from packaged foods, convenient meals, and fast food, to being very picky about restaurants, spending more time in the kitchen, more money on groceries, experimenting with new recipes, making our own mayo, dressings, even crackers. We have gone from grocery store produce to organic to growing our own or foraging from local farmers.

We are not perfect. We are still in process. And we trip each other up at times. I buy the occasional “healthy” cereal. Kenny buys Haagen Daz bars or tortilla chips or processed cheese. Or beef jerky. Or licorice.

Most of the time when I open the cupboard or refrigerator and see foods that don’t serve me, I see them with imaginary labels stuck on them reading “Not My Food” or “Kenny’s food.” I tell myself that Kenny has different nutritional needs than I do He is physically active on the job from sun-up to sun -down. He is a guy. Etc.

Most of the time, I can overlook his culinary temptations. But sometimes, when he brings his bowl full of yummy goodness to our den where we kick back and unwind before bed, when he is reclined in his lazy boy, chomping away on whatever delicacy he has cooked up, way after the kitchen was closed, it’s hard not to want to share that with him. So. Sometimes. I do.

I feel for my patients who are not on the same page as their significant other or family members about a healthy lifestyle. They end up making two different meals a lot of the time, or choosing the best they can, which is so hard. I have so much respect for them as we work together to help them stick to their new habits with or without family support.  

I have also seen time and time again how healthy living can have a ripple effect.  I love to hear patients report their spouses are losing weight too, or are seeing improvements in their blood sugar or blood pressure or sleep.

The process of making changes can be a kind of wellness evangelism. Not by judging or proselytizing like a reformed smoker, but by patiently inviting friends and family to come along for the wellness ride, by modeling new ways of experiencing life and health.

It must be Spring I mused, examining the crop of weeping vesicles on my right posterior thigh. I tried not to scratch. Spring is when my beloved husband, Kenny, moves from spending most of his waking hours inside the shop to outside in the dirt. He is not as sensitive to the oils from poison oak as I am. Even doing his laundry leaves me vulnerable. Where did I put the Technu?

When that rash was finally drying up and starting to scab over, I noticed three smaller red dots forming a linear pattern on my left thorax. Breakfast, lunch, dinner. The saying I had learned at the clinic where I completed a dermatology rotation as a fourth-year med student echoed in my mind, followed by the working diagnosis of… bed bugs. I stared at the new rash again.  Bed bugs?!? My skin started to crawl. I bristled. Not because I was above bed bugs. Ok, there is that. But the last time I had an encounter with bed bugs, I ended up with a reprimand from HR. I was only trying to defend the dignity of the bed bug victim. It’s a long story. I shook my head and moved on to the second diagnosis in my differential of localized, pruritic rashes: contact dermatitis.

The new laundry detergent my husband had bought may have been too harsh for my delicate skin. I was having an allergic reaction to it. I stripped the bed, washed the sheets in hot water and vinegar, and shoved the ridiculous notion of bed bugs way down on my list of differential diagnoses. The huge hassle that would ensue to get rid of them was too much to think about just now.

I slept fitfully that night, uncomfortable in my own skin. I itched everywhere. My husband was skeptical and underwhelmed watching me strip the bed again the next morning. “I don’t have a rash,” he reasoned.

“Well, you did not get poison oak either,” I said curtly as I shoved the sheets in the washing machine and poured in the hypoallergenic detergent I made him buy.  In any case, we were headed to Texas for a week to help my mom’s big move. Whatever was causing my new rash would be gone by the time we got back.

The work of packing and moving and an unexpected night in the ER with Mom completely eliminated all physical – and mental – traces of  skin irritation .

Home again Tuesday, we were in bed by midnight. I was exhausted from flight delays and thinking about working the next day and fell fast asleep. The alarm went off way too soon, but I was determined to jump right back into my exercise routine. I hit the showers by 7 streaking past the bathroom mirror. What did I see out of the corner of my eye? Was I imagining things now? A new rash very similar to the last one, on the other side of my rib cage.

I freaked.  The bed bug hypothesis marched back into full view and sent my hysteria into full throttle. This time everything was put in bags, and I begged my husband to call the exterminator. He easily capitulated and then made no fuss when I suggested we sleep upstairs, in a different bed, with sheets that had never been washed in the alleged offending detergent. The exterminator came and went without finding a trace of anything malevolent. Still, I fed the dryer like it was a voracious cookie monster, but instead of cookies, I fed it loads and loads of bedding which it spit out after churning them through the highest heat possible.

That Saturday morning, as per usual, I met with my accountability partner. When I hesitantly showed her my rash and recounted my story, she matter-of-factly remarked, “Looks like spider bites to me.”

Instantly, my dread, fear, and shame disappeared. “Oh…right…spider bites…of course.”

She chimed in again. “By the way, why are you afraid of bedbugs?”

Good question. And we started exploring. It was an eye-opening conversation and a healing opportunity.

The mind can be a funny thing. Our thoughts can get the best of us. I am glad for the safe people in my life who are not afraid to tell me what they see, especially when I get stuck in one point of view.

Those safe friends and family help me process thoughts and feelings, discover their source, differentiate them from reality, so I can deal with them in a healthy way.

My sessions with patients at OWW enter this kind of gentle, grace-giving exploration. And I am so glad to offer patients coaching with our Certified Health and Wellness coaches, Rachelle Mathios and Meghan Hess. They are both highly skilled in this self-discovery approach to lifestyle change. With genuine curiosity, they ask honest, probing questions which help people know themselves better. Why don’t you like to cook? When did you start believing you did not have time for yourself? Why is it selfish to take care of your needs? What does it mean that you gained weight this month? They reflect what they see and give positive, nonjudgement feedback.

Sometimes the questions get to the place where we feel uncomfortable in our own skin. But if we delve into the discomfort, staying honest and vulnerable, this kind of adventure frees us from old patterns of thinking and doing to discover new ones that change our health and our lives.

It’s funny how bad news hits you in different ways. The news of our beloved neighbor Larry’s death three years ago set me in flight, quickly running from my back door across our backyards to his side for a final goodbye and then to his wife Linda’s side in hopes of offering some comfort. Last Sunday, the news of Linda’s death left me paralyzed, unable to move.

She was the third friend and mentor who had died in a seemingly short period of time. I felt a rock in my foundation shift underneath me.

I don’t remember the first time I met Linda Geck, whether it was at one of her famous neighborhood barbecues or a more informal gathering. She was our backyard neighbor for twenty-two years and her door was always open to us. “Come in!” she would sing cheerfully from her chair when she heard our familiar knock at her back door. She’d scurry to greet us with a loving hug, at times using a cane, and lately with the aid of a walker. Her face lit up with an appreciative smile and twinkling eyes, happy to see friends who dropped in even for a few minutes. We’d come over mostly in the evenings, after she had put in a day’s work.

In the Spring you could find Linda in her greenhouse carefully planting and nurturing the seeds she had chosen that winter. She’d pour over catalogs, carefully reading about each variety and deciding which annuals would perfectly complement the other, or figuring out when each vegetable would come on, in order to time her canning. In the summer, she was in her gardens. Her flowers were stunning, something out of Better Homes and Gardens. Perennials decorated the path along the driveway. Annuals spilled out of pots upon pots in her back yard with glorious displays of color. She spent hours in late summer and early fall preserving her bountiful vegetable harvest.  And in winter, she’d be in her chair knitting or crocheting or at the sewing machine, working on her latest project. In every season, rain or shine, Linda had work to do and she did it with pleasure, proficiency, and pride.

Linda knew how to make beautiful things. She was expert at every kind of needle craft, tatting, Brazilian embroidery, needlepoint, cross stitch.  You name it, she knew how to do it. She quilted quilts, knitted sweaters, crocheted Afghans. She would find a certain item she liked at a bizarre or in a magazine, like a scarf or a placemat or doll or something, improve the design, make a ton of them and then give them all away.  I was often getting her expert advice on my projects. She always had an accessory to add to take it to it the next level.  She helped me make napkins for our son’s wedding. After the wedding was over, we sewed some of the napkins into a quilt. She helped me embroider it and tie it off.  I once crocheted an angel for her. Linda embellished the wings with sparkly yarn. I made a dress for my granddaughter’s babydoll. She added rick rack and made a matching blanket to go with it. Linda worked every day of her life adding sparkle to her surroundings.

With over ninety years filled with truly living, Linda enjoyed sharing some of the pages of her past. Something in our current conversation would remind her of a lesson she had learned or a friend she met or an event in her life and she recounted a lively anecdote as if it had just happened. She’d squeeze her eyes shut, forcing her brain to eek out vivid details from her huge memory bank, the name of the friend’s friend, or the make and model of the car, or the pattern of an article of clothing. We came to love Linda’s stories. Stories of joy and sorrow, of exploits and adventures, of hard times and hard work, of new friends and old. And she told them over and over, embellishing a different detail each time. Visiting with Linda and listening to her stories was like watching reruns of your favorite Waltons or Andy Griffith or Little Rascal episode.  Funny. Poignant. Sometimes with a moral or a lesson. Through laughter and occasionally tears, Linda was a great storyteller.

Linda looked back on her life often but mostly found joy in looking ahead. To the next season, the next barbecue, the next celebration, the next gathering of friends and family. With great anticipation she would plan, combing through her cookbooks, to find old favorite recipes and to try new ones to please the crowd that would gather. Her faithful son, Paul, drove her all over town to buy items for the party and to invite her many friends .For months she would talk about it, the decorations, the guest list, the menu. And for months after she would muse about the good time had by all.

What Linda looked forward to the most, though, was the hope of being reunited with her whole family. She knew she would have to wait for heaven. Yes, she was heartbroken when her husband of sixty-seven years died; but she also carried the pain of losing two of her sons. One to cancer. Another to conflict. She talked about their expected reunion often and with loving, forgiving tears. “Maybe not in this life,” she would say, “but in the next, we will all be together again.” She coveted our times of prayer together for reconciliation.

The Apostle Paul exhorts us to remain “joyful in hope, patient in affliction, and faithful in prayer.” I saw Linda live this way, appreciating everything from her past, working hard in the present moment, and looking forward to eternity. I am so very grateful for her influence in my life.

I felt relief when hearing the news of Margaret’s passing. Margaret was my very good friend Lisa’s mother and eventually, my friend. Kenny and I did not know Margaret very well prior to Lisa’s sudden and untimely death September 17, 2022.  We came to know her, at least in part, in the year and a half that followed. We visited her weekly at her home where she lived alone, hanging onto independence with all her might. Struggling to make new memories, Margaret clung to memories from her past and enjoyed telling stories to her friends who frequently visited. Stories of raising her six children, her tenure with BSF, biking across the country with her husband, and traveling to Paris for their 50^th wedding anniversary. We’d bring her a meal or flowers or something I crocheted. Lisa had told me gifts were her love language.

And she was always trying to give us something. “Take it,” she’d say, pushing a towel or cook book or small trinket into my hand. I enjoyed paging through her collection of The Barefoot Contessa cookbooks, reading her hand-written notes in the margins, which recipes were hits with her family, which ones were duds and why, how she altered favorites for potlucks or parties. Is that what Lisa meant was ephemera?

Of course, we couldn’t take anything, not from someone who probably did not know what exactly she was doing. With one exception.  We did take her up on her offer of a Christmas tree from her property.

Margaret’s failing memory made it necessary for her to move to a memory care facility. We kept up weekly visits as best we could. We watched Margaret’s health and memory slowly decline. I often wondered why God allowed the kind of suffering dementia brings. But even in her decline, she never forgot her Albert or her Lulu. And she never questioned her faith. In tender moments and hushed tones, she would sing a hymn or quote scripture verses. Those memories were solid.

In time, I realized Margaret’s end of life was one of God’s great gifts to me. Despite the dementia and not always remembering my name, Margaret’s warm smile was proof she knew me and welcomed my company. Her pace was slow and her presence calming. At times during moments of clarity, she shared simple wisdom. Forgive. Laugh. Trust in God. She may have understood that our visits were what I needed and that they helped me more than they helped her.

Margaret passed away quietly in her sleep in December, one month before her 90th birthday. I felt relief for her. And release for me. Our time together over those fourteen months replaced the shock and sorrow of Lisa’s death with comfort and healing.

Human life, in any shape or form or disease state, has value and meaning and purpose.

One of the first questions patients ask me during our first session together is how long I am going to make them track their food or their steps or their sleep.

First of all, I explain to them, I can’t make them do anything. I do want to show them the value in tracking, however, because as we all know, you can’t change what you don’t track. We have to know exactly where we are before we can figure out how to get where we want to go.

If we are honest, we eat more than we think we do. Our food recall at the end of the day often forgets the handful of chips here, or the few bites of a cookie there. We don’t move as much as we think we do. We go to bed later than we think we do. Real time tracking is the best way to clarify the reality of our situation.

There are countless apps that we can use, My Fitness Pal, Carb Counter, Cronometer, to name a few. They all require an onboarding of usual meals and have various levels of granularity for counting calories, macros, and micronutrients. They come with suggestions about goal setting for weight loss and projections for when to expect to get to the desired weight.

Friends of ours wanted to optimize their health so the husband created a spreadsheet specifically to count omega 3s and and 6s in addition to macros. With an engineering background, he had it down to a science. And as one who understands the utility of spreadsheets but lacks the ability to put one together, I was quite impressed looking over the detailed and accurate results of his system. He could probably sell it.

Most of us tire quickly of tracking though. I know I do. I will download an app and at first it is new and exciting. I get into trying to be better than the day before, gamifying the process in some way. Then after awhile, I get bored with it. Or I go out to dinner or to a friend’s house and can’t input what I ate or forget and then it is not accurate and I give up.

I did the same thing with my Apple watch and step counting. Again, it was fun at first. I embraced the reality of how few steps I truly get in a day, then challenged myself to get more. But I would forget to wear it during my morning walk. Or it would run out of juice because I forgot to charge it overnight. So I knew it was not 100% accurate which created a source of frustration for me. So why bother.

But the truth is, any time I stop paying attention to my behaviors or anything that is important to me or my health, I don’t do as well and even backslide. If I lose track, I get off track.

I think it has to do with law of entropy. Things go from order to disorder left on their own. My body, my health is no exception. But with positive energy like paying attention to better inputs, I can improve or at least slow that aging process. And how will I know if there is improvement unless I measure it.

I have found that tracking behavior often trumps tracking things like calories. Figuring out why I do what I do or don’t do what I want to do is eye opening and that leads to lasting change.

We practice all kinds of ways to keep track at OWW and not just with apps and rarely calories. We offer support and accountability in a safe and nonjudgmental environment. If you want to learn more about your health and how to improve it, give us a call and we will help get you on track.