Wednesday, September 29, 2010

Fall's Reflections

The straw-like grasses sloping to the creek beyond my fence are burnt and brittle. Water stagnates, piddling and puddling through the creek’s trough, seeping round small stones with nary a trickle. The oppressive heat of summer has been nudged by cooler nights and honking geese overhead. Still, dawn breaks open sunny-side-up with all the fixin’s of an Indian summer.

My heart too is perennial in its heartbreak, rent with sorrow for another summer past, that season of unyielding sunshine and my desire to bathe in it. I’ll clean house during autumnal rains, do dishes after dark, and run or cycle to beat nightfall home. During summer, my life is lived out loud, outside.

As the distractions of summer ceased, something else arose in me. Niggling thoughts sliced deep, filleting my pericardium wide, forcing me to silent introspection.

How will I occupy my remaining years? What good will I do? Where shall I contribute? With and to – whom?

Some would label this mid-life crisis. Crisis it is not, though inferring my life half over, a time for evaluation and assessment is neither unwarranted nor untimely. Most, by virtue of a common pathway – love, marriage, children, grandchildren, great-grandchildren – face a well-trod path. My trajectory is not that; the trail through my jungle as yet unhewed. Work at Kaiser and homeownership lend a certain predictability. After that, it’s up for grabs and mine to create.

Such was my frame of mind departing into the wilds of both Yellowstone and the Grand Tetons. The region’s bears are unusually hungry for a paucity of their natural food sources. Some Ursidae have turned to predation upon Homo sapiens… an encounter heavily favoring brute and brawn. Two have been fatally mauled and three maimed by hungry grizzlies near park boundaries just this year.

Hungry grizzlies had me contemplative, reflective, and introspective, nose-to-nose with mortality. I have no real unfinished business, only unpaid bills. My relationships are rich, my work compelling. I have loved and been loved. I once experienced love at first sight – for my cat Keo – such a heart tumble as it was. I have been blessed with body and mind that work – my vehicle through this life has served me well.

I called and emailed a short list to hold conversations for completion. My close friends have some experience with this though one became agitated and annoyed. “Why would you go?” he emailed.

“There is inherent risk to many of my excursions into the wilds. While I do not intend to perish in the mountains, it is as good a place as any and far better than most. Know that out there – I play passionately and thrive. You?”

I returned unscathed if only less a few pounds. During that first week back, my tenth patient was weaned from insulin and I received that fateful call: That cardiovascular job for Kaiser at Mercy? Ain’t happening. I mourned its loss, my perceived opportunity to practice unfettered. I felt deflated and forlorn. I told few of the tenth patient – the few that seemed to care – and headed to San Francisco for Kaiser’s Cardiovascular Medicine and Surgery (COAST) Conference.

“Around me,” I’ve declared, “People get healthy and fit.” It’s true enough though the mechanics – the why and how of it – escapes me. My masseuse recently lost fourteen pounds with fifty to go. “I am getting back to my tri-athlete weight,” he said, “Because no one will listen to me if I don’t practice what I preach.” Amen Brother! It is a lesson much needed for us in healthcare and into which Kaiser’s new Live Well, Be Well campaign promoting a healthy workforce, points.

At 0750 on Sunday morning, COAST featured Dr. Esselstyn, a retired Cleveland Clinic (can you say: Mecca for cardiovascular care?) heart surgeon outlined his nationally-renown program for reversing heart disease, diabetes, and erectile dysfunction; conditions of gargantuan healthcare dollar proportion and import. I waited to speak with him and sidled up at an opportune time.

“I just weaned my tenth patient from insulin.” The jaw of a nearby cardiologist dropped. “I have another handful of patients who were never on insulin and I’ve pulled away all their glycemic agents excepting Metformin. Some are living in the zone, with hemoglobin A1c’s in the fives (like people without diabetes, having successfully driven their disease into remission). I have a few that have fallen off the wagon but I think my success rate is better than 70%. But I feel like I’m recreating the wheel and I don’t want to do that.” I said nothing of the myriad of friends and colleagues who have altered their eating, lost weight, begun exercising, and corralled their diabetes.

“That’s incredible,” he said, “And it’s a lot of work when it’s done as only one facet of your practice.” We talked a bit; he asked, I answered.

“Let’s do this,” he said abruptly, “You come to Cleveland and stay at my home with my wife and I. You come to the clinic for several days and apprentice with me. If I don’t hire you away from Kaiser, I’ll send you home with everything you need to create a program.”

We exchanged email addresses and I thanked him for his incredibly generous offer. I felt expansive, excited, exploding within my skin. I could hardly wait to get home and email friends including the beeeg kahuna Jack. Instead, I wrote at the Metreon beneath a warm and bright San Francisco sky released from its customary geometry shaped and framed by concrete and fog. Arriving home, I mounted my bicycle and pedaled twenty just to sort myself out.

I’ve spent the week in communication with like-minded practitioners: two cardiologists from Kaiser-Santa Rosa, an internist at Kaiser-Stockton, and an endocrinologist at Kaiser-Sacramento. I’ve been outside daily, my favorite locale for audience with God.

Swirling, sailing, softly crunching, large and leathery Sycamore leaves overwhelm my green waste bin. Fall is a thoughtful season of reflection. I am called to it with every twisting and twirling photosynthetic colony in it’s Newtonian plunge, with every quaking aspen, with every clattering leaf herded before blustering winds, with every reflective headlight off wet streets.

Here’s what I know: I have little interest in a life of mere survival and existence. I am intensely interested in living life inspired. If it is also inspiring? All the better.

“Will you go to Cleveland?” friends ask.

“Absolutely! When the student is ready, the master appears.”

“Will you move to Cleveland?”

“Abso-NOT-ly! Too far from Hawaii.”

I wonder what my life is for? It is for something like this that comes so easily and contributes so much.