D Day + 1+ 51

My father died on D Day +1 + 51 years.

It was only fifty three days until he would have celebrated his sixty third birthday.

As many of you know, I have been thinking and writing about his death on and off for years, here and elsewhere. The thought that I might one day outlive my father has never been far from the front of my mind.

Well, tomorrow is the day. Today, September 2nd, is fifty three days from my sixty third birthday.

If I wake up tomorrow, as I certainly plan to do, I will have seen one more sunrise in my life than my father. I will have one more day to live, to love, to work, to play and to think about what is and what might have been, than he had.

What if today had been the last day of my life? I worked at home today seeing patients, as I have been doing for the last half year. I chatted with people by cell phone and on video calls, listening to them and trying to be helpful in the midst of the worst public heath crisis in a hundred years. I electronically prescribed medications that I sincerely hope will help alleviate suffering. I asked after one of my new employees to see how she was doing. At lunchtime I listened to a book about politics, as one does during a presidential election year. After work I took an intense forty five minute bike ride in my neighborhood and along the river with the heat index 106 degrees. I was hot, winded, and soaked at the end of it. It felt good. I felt alive. I missed my wife today, as I always do when she is away on work flights. She sent me a beautiful picture of Germany today, where the temperature and the pandemic are cooler than here in the US. I took delivery of a wonderful set of pastels that she wanted to order for her birthday, which is this Friday. (No, it is not a surprise. One of the pleasures of getting older and having most everything you need is that you can special order your gifts with no shame at all!) I smiled when I saw the box, anticipating the pure joy that these little sticks of color will give her when she holds them in her hand and applies the pigment to the special papers she will use in her art room upstairs.

Did I do enough today? Did I care enough today? Did I get outside my own head, lay aside my own anxieties and worries and needs enough to give of myself to others in a way that would have made my father proud today? Did I learn something new? Did I grow emotionally, spiritually? Did I question my own motives today, vowing to have purer ones if I am given one more tomorrow? Did I care for my physical health? Did I take care of myself in the same way that I am always asking my patients to take care of themselves?  Did I have a good day today, a day that could have been, that could be,  my last?

My wife is convinced and has ordained that I will live until I am  ninety six years old. The odds, not to mention my family genetics, do not support that wish I’m afraid, but I do love to hear her say it. I would love to live ten, twenty, even thirty more years if God grants me that special privilege. There is a lot I want to do. There is a lot I want to experience. There is a lot I want to learn.

Tomorrow, I will have lived one day longer than my father. An accomplishment? No, not at all. A gift. A true gift. A pleasure. A reminder that we are not promised one more day, but that we are allowed over and over again to take possession of that most precious of commodities and choose to use it in any way we wish. We are given the gift of time.

I will wake up tomorrow morning and rejoice in every small muscle twinge, every sleepy yawn, every hunger pang, every emotional surge, every cognitive challenge and every warm sunbeam that graces my aging face. I will rejoice in another day and the simple fact that it has been gifted to me.

Besides, what is my other option? If I die tonight and make it to heaven by morning, I would be greeted by my father, a man who preceded me in death by decades but who would be exactly my age. Somehow, I don’t think even God would find that amusing.

 

Death is nothing at all,
I have only slipped into the next room
I am I and you are you
Whatever we were to each other, that we are still.
Call me by my old familiar name,
Speak to me in the easy way which you always used
Put no difference in your tone,
Wear no forced air of solemnity or sorrow
Laugh as we always laughed at the little jokes we enjoyed together.
Play, smile, think of me, pray for me.
Let my name be ever the household world that it always was,
Let it be spoken without effect, without the trace of shadow on it.
Life means all that it ever meant.
It it the same as it ever was, there is unbroken continuity.
Why should I be out of mind because I am out of sight?
I am waiting for you, for an interval, somewhere very near,
Just around the corner.
All is well. ”

Henry Scott Holland

When It’s My Turn to Die

To every thing, turn, turn, turn,

There is a season, turn, turn, turn,

And a time for every purpose under heaven.          The Byrds

When it’s my turn to die, come see me.

For you see, there was a good friend of mine, a teacher, a mentor, who taught me much about people and mental health. He was a hearty type, a man who walked up and down the hill to work for years. He walked and worked and worked and walked and did this summer and winter and year in and year out. He diagnosed and read and learned and treated and taught and did this for many years. We laughed and waxed poetic and drank beer and discussed the meaning of life, as young people are want to do with their mentors, and I learned much at his feet, that man. He was around. I was around. We aged. I became a teacher and healer and mentor in my own right, and he still walked the hill up and down and up and down, until the time he didn’t. He became a case study himself, one with an illness, a terrible, awful, progressive debilitating illness that took away his walking and his standing and sitting and leaning and finally his talking too. Stripped it all away. I heard about him, though he was but a few miles away from me. I wanted to go see him, I really did. Those times that we talked about theory and motivation and symptomatology and drank beer and cracked jokes and laughed came to the surface of my brain like a great whale coming up for a glorious gulp of briny air, way out to sea. I did not go see him. I could not. I was afraid. Of what? His mortality. My mortality. Death in its second most personal form, when it takes someone you know or love. Knowing that when they go and you stay, you become them. You move up the ladder toward your own demise, closer to death than birth, rolling the dice every day. No excuses. There are none that hold water. I am ashamed. But, truth. I was afraid. I will feel guilty for letting my mentor down for the rest of my life.

So, when it’s my turn to die, come see me.

 

When it’s my turn to die, tell stories.

I love stories. You know that if you know me at all. I love to read them, I love to hear them, I love to write them and I love to tell them. Stories are life. If anything is worth anything, there is a story about it that deserves to be heard. Come into the room where I am, even if it is hard for you, come into the room on Sandburg’s little cat feet if you must, find a chair, sit knee to knee with the person there with you and tell stories. I will hear you, and I will be happier as I face death. You may not know that I hear you, I may not be able to physically show you that I hear you, but trust me, I will hear you. Tell stories of naughty things done, things left undone (yes, I am likely to still be an Episcopalian at the time of my demise) triumphs, tragedies, conquests and even failures that taught you a lesson (see paragraph one, above). Let my home-going be the homecoming for your focused thoughts about your own life and times, the things that make your story yours. It would make me so happy to know that the last things I heard, even if I was too far away from this physical world that I was not entirely aware of it, were the stories that were told by my friends and family in the room where they came to see me at the last.

When it’s my turn to die, tell stories.

 

When it’s my turn to die, be pragmatic.

Look, this is it, okay? This is what’s going to take me out of this world and allow me to discover the next. I may have seen it coming, I may not have. Either way, it’s time. I’m good with that and you should be too! I have had a fabulous life. I have had wonderful relationships, I have great children and grandchildren to leave in charge of things here, I have worked at jobs and vocations that I loved, I have traveled the world, I have climbed mountains and I have cheated death. (Just not this time.) Look at me over there, across the room. I am breathing hard, but after all, if I have been lucky, I  have taken more than seven hundred million breaths in my lifetime. What are sixteen more, a hundred more, five hundred more? My poor tired heart has beaten almost three billion times. It has loved fiercely, but it is ready to rest. Mourn for me, yes, please. Shed a few tears. Tell those stories. Reminisce. Celebrate my life and how it intersected with yours. But then, please, please be kind, and let me go. It’s time.

When it’s my turn to die, be pragmatic.

 

A time to be born, a time to die
A time to plant, a time to reap
A time to kill, a time to heal
A time to laugh, a time to weep
To everything (turn, turn, turn)
There is a season (turn, turn, turn)
And a time to every purpose, under heaven.

 

 

 

 

 

 

Covidisms: Thoughts on Death

I did something last evening that I have never done before. I wrote a serious and heartfelt email to the New York Times and those who make the podcast The Daily, one of my favorite ways to start each day. This podcast has a way of finding and telling stories that get to the heart of what we are all experiencing in the midst of our lives, especially in these days of pandemic and racial strife and economic crisis. There have been many episodes of The Daily that have been poignant, thought provoking and moving, but two of the most recent ones from this past week hit me hard. I would like to share the end of the email that I wrote before I go further with this post:

The episode revisiting the situation in Bergamo, Italy, through the wise, thoughtful and emotional perspective of Dr. Fabiano Di Marco hit home. I lived in Italy for two years as a teen and my wife and I had planned a trip back to Rome and Florence in April, my first trip back to the country in fifty years. Of course, it did not happen. I felt a deep sense of sadness for the Italian people and the medical staff members who are trying to serve in the face of this pandemic.

Today’s episode about the grief felt by little Tilly for her grandfather hit me even harder. I am a grandfather of six kids, five in Chattanooga and one in Denver. I have not been able to see them for what feels like years, except by FaceTime calls. We are planning a driving trip out to Denver and back in late September, because I am not excited about getting back on planes, but we need to reconnect with our family and friends in other parts of the country. Hearing Tilly talk about her grandfather, coupled with the recent losses of one of our long time mental health center employees and another counselor whose clinic I used to consult with, made me very much aware that I could be that grandfather or that employee who contracts this virus and does not make it through the ordeal.

Your stories are powerful. For someone like me, who tries very hard to deal with the emotions by blogging, journaling, taking long hard bike rides or keeping up with the political craziness all around us, they force us to stop, to listen, and most of all, to feel. Ironic, isn’t it, that a psychiatrist would have a hard time feeling. Of course, the feelings are there, and when they are released by storytelling  and powerful emotions that you bring to life, the intensity of it all is almost too much to bear. It is so necessary though, and I know that full well.

Thank you, thank you, thank you, for getting the information out there, for telling the stories in such compelling ways, and for making us think, process, and feel. Yours is one of the first podcasts I listen to every day, and the ideas that come from it are some of the last ones I think about when I go to sleep at night. I appreciate what each one of you do. Please keep up the excellent work, knowing that we hear it, and we need it.

I wanted to express my thanks to the makers of this show because they provide a way for me to stay in touch with some very profound feelings during this time that I had simply rather not have. I feel frustration, I feel anger, I feel loss and grief, I feel elation, I feel dullness and boredom, I feel indignation, I feel sorrow, I feel pity, and I feel fear.

As I have mentioned in blog posts earlier this year and in followups afterwards, I will be sixty three years old on October 24th this year, God willing. At that point, I will have lived longer than my father, who died suddenly at age sixty two of a devastating brain aneurysm and cranial bleed. I never had much doubt that I would easily reach that point and that age, given the fact that I try to eat right, I exercise, I am trying to keep my weight and blood sugar and cholesterol and blood pressure down. All the right things that one must do to live a long life, barring catastrophe. I have been holding my figurative breath all the same, knowing that when I reach that milestone I will have a good cry, say a few words of thanks to my dad that I hope he can hear and go about the task of living productively until my sixty fourth birthday.

All of that held true until March of this year. Until the coronavirus upended all our lives, changed our daily routines, changed how and where we work, who we see, how we eat, how we travel, how we worship and how we connect with others. I have done what you have done, tried my best to make good decisions, protect myself and my wife from harm, continued my work to care for my patients the best I can given the circumstances, and kept my cool, for the most part. We have personally been so very blessedly insulated from the ravages of this plague. As far as I know, no one in my family has contracted this virus, no one I work with has had it, and only a few of my patients have, most of them doing well in spite of having the illness.

In the last couple of months, one of our long term mental health center employees, someone who was there when I started working in the center almost twenty nine years ago, contracted the virus and died. He left behind a wife and young son. A pharmacist friend of mine, who visited our offices every month to inspect our medication areas before her retirement, has just been released after a ten day stay with COVID-19. A counselor who once had a family clinic that I did medical consultation with in the early nineties recently contracted the virus, got very ill very fast, refused to be placed on a ventilator, and died quickly of COVID-19. The disease is starting to hit home.

I grieve these losses and setbacks for various reasons. I feel so badly for the families and loved ones of those who pass on. I rejoice over the victories of those who get infected but make it, all the while fretting over what long term consequences they may have to endure. I am sad that when someone like my counselor friend dies, not only because her life was most likely cut significantly short due to this illness, but because her death reminds me starkly that mine is coming too. She and I shared a slice of time, a set of circumstances, a place to talk and work, and a shared cause of promoting good mental health for the people we treated almost three decades ago. I sincerely hope that the work we have done together and that I continue to do goes on, but I am made painfully aware that we will not. We will end.

I do not fear death so much as I am not ready for it. Like everyone else, I am sure in my own feeble mind that this illness, this worst illness of its kind in the last hundred years, is not going to be the way that I will leave this life. It is not aiming for me. I will live a long life and become a grump old man who still likes to read and write and fish and take pictures and take walks by the river. Or will I? The uncertainty of these times is the biggest stress of all.

In watching this pandemic and how it is affecting all of us, I am reminded of a few basic things that we must attend to each and every day, as if it was going to be our last. Things that tend to shine through and demand our attention when someone dies and passes on, leaving their legacies.

  1. Relationships are important. Make them. Enjoy them. Nurture them. Attend to them. Water them like flowers in your summer garden and watch them bloom and dazzle with bright color.
  2. Find something that you are passionate about, and throw yourself at it with fury. Write. Paint. Play music. Heal. Preach. Teach. Mentor. Parent.
  3. Put others above yourself. Whether this viral illness is your ticket off this planet or something else gets you down the road, you will inevitably leave others behind. They, like little Tilly on The Daily podcast, will remember you. They will remember what you said, what you did, what you taught them, but most importantly, how you made them feel.
  4. As the recently departed John Lewis of Georgia said, get into trouble. Get into good trouble. Do the right thing because it IS the right thing. Do not waiver in your resolve to do this, because it is important.
  5. Know above all else that your reason for being here on this earth is not to glorify yourself, embellish yourself, surround yourself with riches and accolades and awards, and make yourself the center of the universe. (You are most assuredly not.) Your mission, your assignment, your reason for being is to do all you can, everything you can, in every way you can, with everything you have at your disposal, to make the lives of those around you, those less fortunate, those who are downtrodden and oppressed and neglected and forgotten, those who the world despises, BETTER. You have the power and the obligation to do that. If you do, if you truly do, then at the appointed hour you can meet death, smile, close your eyes and know that your time here has been well spent.

Stay safe, do the right thing, and live long, friends.

What the Funeral (Re)taught Me

In the liturgical tradition of the Episcopal church, a funeral is an Easter service. It finds all its meaning in the resurrection. It is characterized by joy. This joy does not make the human grief we feel unChristian or wrong.

None of us lives to himself, and no man dies to himself.

“For everything there is a season, and a time for every matter under heaven: a time to be born, and a time to die; a time to plant, and a time to pluck up what is planted; a time to kill, and a time to heal; a time to break down, and a time to build up; a time to weep, and a time to laugh; a time to mourn, and a time to dance.” Ecclesiastes 3: 1-4

“Help us, we pray, in the midst of things we cannot understand, to believe and trust in the communion of saints, the forgiveness of sins, and the resurrection to life everlasting.”

“Dust thou art, and unto dust shalt thou return.”

Rest In Peace, Reynolds Gracy Jarvis, M.D.

Death of a Mentor

My friend, teacher and mentor Reynolds Jarvis MD died on May 21, 2019, after a long battle with amyotrophic lateral sclerosis, or Lou Gherig’s Disease.

Reynolds was a man who came into my life in that period of time between 1983 and 1987 when I was learning how to be a doctor, and more specifically, a psychiatrist. Yes, I had earned my MD degree in 1983, and I was licensed as a physician, but I had not clue one what I was doing. We were all struggling back then, all the folks in my small residency class at the Medical College of Georgia in Augusta, Georgia, to find our sea legs on the ocean of pathology that confronted us daily. Reynolds was one of the men and women who was entrusted to teach us how to be knowledgeable, compassionate, competent doctors.

He was one of those rare physicians who was proficient and comfortable with one foot in the world of mental illness and the other in the world of internal medicine. He was at ease when diagnosing cogestive heart failure, pancreatic disease, hypertension, as well as depression, bipolar disorder, and schizophrenia. If a patient had more than one illness, and one of each type, then bring it on. He would help us learn how to tease apart the pieces of history that we needed to make accurate and relevent diagnoses.

He liked to tell stories and especially liked to put things in the context of what real people needed and wanted, and how they went about seeking the goods and services that they needed to make their lives better. These concepts had been formulated and taught by another of our mutual mentors, Dr. E. J McCranie, several years before. We all loved to stand around a keg of beer in those heady days, waxing poetic and scientific about the ins and outs of human need and psychiatric pathology.

Reynolds would rotate as attending physician on both internal medicine services and psychiatric services. Rounding with him, talking over patient presentations with him, was a treat. He had the respect of both departments, and that was not lost on his charges.

Another physician friend of mine made me aware of his illness one day at church. I had not known that Reynolds had been ill, as I had not seen him in many years. He told me about his diagnosis, which room he was in at the hospital, and said that he had been by to visit. I might want to stop by to visit too, he offered. I thought about this, knowing that it would be the right thing to do, and promised myself that I would consider it.

I never went to visit my old friend and mentor.

I feel sad about his death, but now I feel even more guilty that I did not go to tell him thank you before he died. Why did I not make the effort to go to the hospital to say hello?

There are many reasons, some of which are merely excuses. I can tell myself that. It doesn’t help, but I tell myself that anyway. I remember Reynolds being large and in charge, in that soft, confident, smooth talking way that only he could. I remember him being smart, so much smarter than me, and thinking that one day it would be great if I could be half as proficient at my craft as he was at his. I remember him being one of my teachers, only seven years ahead of me in his graduation from medical school, but seemingly light years ahead of me in experience and confidence. I was so angry inside when I heard that ALS was going to cut his life short, in that cruel way that any progressive neurological disease does, robbing one of all dignity at the end, and not respecting race, color, creed, class, or MD after a name as it ruins another life.

I did not want to see him that way, could not see him that way. I did not want to confront his death, for in doing so, in saying goodbye to my teacher, I would now have to realize that I am closer to confronting my own. Each loss we bear brings us closer to our own loss of this life, and I was not in a place to do that. I feel ashamed, but it is the truth as I feel it right now. Diseases like ALS take away all our control, and I could not bear to see my old friend, once so easy going and confident, in that state. Forgive me, Reynolds.

His funeral is on Saturday at our church. I will be able to attend, just before I take the short drive to Aiken to work a long emergency room telepsychiatry shift until midnight that night. I will go to pay my respects, as I should.

Do we really lose people, their ideas, their skills, their emotional imprint on this world when they die? Do we really? Or do we carry part of them with us, always, imbedded in us just as surely and firmly as any of our own DNA?

I choose to believe that when they are gone physically that we keep some of them with us until we are gone, and by that time we have passed some of that wisdom and wit and energy and intelligence and competence along to someone else that we care about very much. As the wonderful animated movie Coco taught us, as long as someone has a picture of us, thinks about us, and holds us dear, we never really die. It’s only when there is not a soul who remembers us that we truly pass away.

Dr. Jarvis, I will go to your funeral on Saturday. I will smile when I think about the things you taught me that I use to this day. I will leave your funeral, go to my office and see people in the emergency rooms of South Carolina who are in need. And I will be very, very glad that our paths crossed as you taught me what it means to be a physician.

Rest in peace and rise in glory, friend.

Amen.

(Image of Dr. Jarvis via Platt’s Funeral Home obituary in the Augusta Chronicle)

Thoughts on Death, Part One

I posted yesterday about a chance meeting with an old acquaintance. With a simple question, he was able to make me think about my own state of affairs today, and to have the wonderful conscious thought that yes, indeed, I am happy.

Today, I turn my thoughts to death, not because I am depressed, but because I recently lost a medical colleague to a sudden heart attack, just days after he had left our employ and started a new job in the upstate area of South Carolina. There are certain thoughts that come up in one’s mind anytime someone dies. When a colleague dies, especially a colleague you have been related to in a supervisory context, these thoughts are varied, multi-layered, and complex.

Dr. B was sixty nine years old, eleven years my senior. It is always hard to supervise an employee who is older than you, but it happens more and more frequently in today’s workforce, where the average age of employees has risen across the board. Specific incidents sometimes arise that must be dealt with directly, and supervisors with their own authority issues may have a difficult time dealing directly with these issues. Also, as one ages, one tends to fall back on “the way things have always been” or “the way we have always done it”, and this may lead to conflict in the workplace when practice trends, productivity expectations, and operational use of new theories and practices are foisted upon all employees, seasoned and new.

In medicine, as in many other fields, we are taught to be lifelong learners, productive professionals, self starters, and industrious workers. We are taught in essence to tow the line, to be like everyone else, and to “close ranks” when adversity strikes us as a group. Like the “Thin Blue Line“, medical professionals look after each other, support each other, and have each others’ back, even as they try to fight illness and foster the health of all members of society.

Now, this does not mean that we as medical professionals always agree or always do things exactly the same way. We are trained in similar ways, some of us at the same programs by the same mentors and professors, but we develop our own practice styles as we age and as we become more senior in the profession. Best practices are guidelines that are generally regarded as the standard of care in most medical circles today, but there is plenty of wiggle room in medicine for the “art of medicine” to still shine through. Personally, I am glad for that.

All this to say, I guess, that we must strive to respect those who disagree with us, or who we disagree with. Especially in a professional group such as mine, it is imperative that we respect each other, have open dialogues when disagreements occur, and that we constantly try to improve the practice of medicine in general and our own take on it in particular. This is paramount in times of stress, such as the current period in medicine when electronic medical records, reimbursement, documentation and maintenance of certification grab more headlines that the latest cures for some obscure disease.

Death, and what it takes away from us, also makes us rethink what could have been. Did I really listen? Did I strive to understand the pressures from the other side, the other perspective? Did I give that situation a fair shake, or did I simply blindly impose my own value system on it and make a decision that was rigid and not completely informed? Hindsight is always 20-20, isn’t it? Death takes away our ability to rethink, reprocess, and correct course. Death is nothing if not final.

I wil be attending the visitation for my colleague on Thursday evening. Somehow, the little things that mattered so much two weeks ago, the scheduling issues and the specific patient problems and the interpersonal stresses and all the rest, do not seem so important now. Whether they were imposed on me from above and I was simply an agent of change, passing down information or rules to my supervisees, or things that came from inside me, doesn’t really matter now.

What does matter is that a colleague has finished his life’s work, albeit much sooner than he anticipated. He has listened, heard, and acted on the things that he could change for his patients, and he has done  his best. His toils are done.

He has taught me, like everyone I have ever worked with has, some important lessons. I will be a wiser man, and a better one, if I heed them and use them in whatever time I have left to live my life.

Rest in peace, friend.

 

Charles “Chuck” Baber III

August 31, 1946-December 13, 2015