a bad case of the monday's.

for most people, you might say that they "get monday"--you know, in other words, it is the person who doesn't like monday & goes about his or her day with a bad case of the monday's. BUT, apparently i'm special...because mondays "get me". i swear it--they are out against me.

remember two weeks ago? that monday turned out fine after an incredibly frustrating start. and then there was last week, which in the book of my history tops all other monday's ever lived by me...

as all monday's do, it started out innocently enough. i had decided the night before that my pants were getting a bit too tight this early on in the holiday season, which warrented a good workout the following morning. and since i had to report for my first day in the ER @ 7am, it made for a very early morning. with my lunch box, purse, book bag, & gym bag in hand i made my way down the slightly-snowy steps @ 5:40 am. i brushed the snow off my car window (with my bare hand because i'd forgotten gloves) and was headed to the gym in a relatively short period of time after i threw my pluthera of bags in the backseat.

once i walked through the fitness center doors, i ran to the locker room to deposit my bag in the toilet, set up my station for Body Pump in the fitness room...and waited. And i waited....and waited...and waited....and 3 other people walked into class and then we waited....and waited...and waited. we all waited until someone from the front desk called and said that the teacher forgot he had to teach that morning & wouldn't be joining us. WHAT?!??! you mean i got my butt out of my freezing cold apartment at freaking 5:40 this morning to sit on my butt in the freezing cold gym waiting for the teacher to show up??!!!?!?!?!?!?!

after a quick workout upstairs i figured i would just show up early for my ER shift so i might leave a little earlier that evening...which is when i walked out to my car & realized that my soy milk that was so lovingly self-packed in my lunch box had tipped over when i'd thrown my bags haphazardly in the backseat. And that lovingly self-packed soy milk now decorated the floor, seat, white coat, and purse of one very frustrated girl. i squatted in the semi-dark parking lot wiping out the lunch box, wiping off the seat, and sorting through the baggies of soggy food that was supposed to have been my lunch. oh, and did i mention the fact that i was almost run over by a crazy west virginian trying to find a parking spot?

i showed up in the ER with a large yellow stain down the front of my coat--caused by drying soy milk but slightly resembling wiped-off bird poop. fast forward a few hours & the ER was bustling. people were filling the rooms with ridiculous complaints...but the most exciting part was that there were a few legitimately sick patients.

one woman had a chest tube put in after developing subcutaneous emphysema--and subsequently the voice of a smurf. it really wasn't funny, but as i stood in the corner listening to someone who sounded like they'd sucked helium, i couldn't help but chuckle at the irony of the actaully grave-situation. humor gets you through everything, right?

an overdose was wheeled through the door. and after his respirations started to drop, they decided that they had to intubate. they'd given him charcoal to drink while he was still conscious (it helps absorb drugs/substances in the stomach so it doesn't get into systemic circulation) but the drugs took affect too quickly for the charcoal to work.

the P.A. handed me the suction & i immediately took a white-knuckled grip on the handle--probably from subconscious excitement at what was about to happen. and what did happen next got a little...ummm...messy. as the P.A. tried to guide the tube down her throat & into her lungs, we all realized that she wasn't sedated enough for her gag reflex to be gone--and so he was struggling with the positioning of the tube (there are certain landmarks you have to look for). as we rejoiced that he'd finally gotten it in, a huge spray of black charcoal poured out of the tube & shot at least 2 feet in the air...covering the nurse who was holding the man down, covering the P.A.'s lab coat, and soaking my pant leg. the humor of the situation peaked when i continued to stand there with a white-knuckled grip on the suction, completely oblivious to the shrieks & pokes of the nurses to put the suction on the shooting charcoal-mixed-with-stomach-acid fluid that was coming from the tubed man on the table. and perhaps even more hilarious is that it wasn't until at least 25 seconds later (which, of course, seemed like 10 minutes) when the P.A. physically yanked the suction out of my hand that I finally surveyed the black-stained nurses now soaked with charcoal colored liquid and realized what had happened.

when we all recovered--& dried off--i realized that the lunch i had eaten was not agreeing with my stomach (perhaps it was the charcoal stained pant-leg that upset my stomach so??) and so, aware that there was a gas bubble slowly making its way down to you-know-where, i positioned myself in the corner of the nurses station that is empty most hours of the day. i stood there, probably looking quite the opposite of inconspicuous, and let that gas bubble go--and the sound that came out was, quite possibly, one of the loudest i've ever signed off on. which is when i turned the corner & realized that a case worker was sitting at the desk on the other side of the wall i just farted against.

after 8-or-so more patients it was almost time to leave, & i gathered that i'd better stop in the bathroom before my bladder exploded. i walked in, turned the light on, & paused in the mirror. before me stood a frazzled, thoroughly exhausted girl....and one pant zipper that was gaping WIDE open for the world to see.

the world which included the last who-knows-how-many patients....

"...and for everything else..."

1 pack of cigarettes: $4.75

cost per week of smoking 4 packs per day: $133

money spent in 1 year on smoking: $6916

cost of smoking over 25 years of smoking 4 packs per day: $172,900

sum of annual bills for once-yearly doctor's visits in 25 years of smoking: $7500

x-rays at age 63 because of shortness of breath: $450

cost per month of Spiriva inhaler to help with shortness of breath: $85

repeat x-rays at age 63 years 8 months because of shortness of breath & pneumonia: $450

Nebulizer + Albuterol for continuous trouble breathing: $200

oxygen tank & tubing: $250 per month

cost of ambulance trip to the hospital because of trouble breathing & nasty cough: $2500

eight hour ER visit for worsened shortness of breath: $800

total cost of cigarette smoking in a 63 year old: $187,885

a real-life lesson about the consequences of smoking for the 18 year old on the other side of the curtain: PRICELESS

She came in for a toothache…because she “just couldn’t stand the pain.” The light that came from my penlight reflected against black teeth & weeks (maybe months) of plaque buildup. So she sat on a bed in room #1, because she didn’t brush her teeth.

He came in with a scratch on his face—mom said his dog did it. And under his eye was a ½ inch scab, not bleeding. He played & laughed when I asked him if he was in pain. His parents seemed more concerned about the tiny scar that would sit on his face that they did about the possibility of him losing his eye to infection. So he sat on a bed in room #2 because he was playing with his dog.

He told me he had a stuffy nose, and then got nervous & wanted medication when he discovered his stay would be more than three hours. We had to finish his lab tests (legal precautions, we said). So he sat on a bed in room #3 because his nose was runny.

Her throat hurt “so bad that [she] couldn’t swallow”. She told me she thought she’d just “pop in” to the ER to “get some medicine” because her doctor’s office was busy. It had only been hurting for a few hours. And so she sat on a chair in the corner of room #3 for five hours because it was “convenient.”

She didn’t have a fever, no infection, no change in attitude or appetite…just a runny nose. Her parents called the ambulance—maybe because they were scared at the clear fluid coming out of her 3-week-old-nose. And those paramedics drove through two inches of snow to pick up that 3-week-old baby…who sat in room #5 with a simple runny nose with two overly-naïve parents.

She had diarrhea in room #6.
He had a belly ache in room #7.
A sore leg occupied the bed in room #8.
Her constipation bottom dirtied the sheets in room #9.
A fussy baby in room #10.

Her blood pressure was dropping. Oxygen saturation was too low. Heart rate was sky high. She’d eaten dinner…then slumped over in her chair. They wheeled her in on a yellow stretcher. She came in because she was DYING….and her stretcher paused in the hallway because all the beds were taken.

conversation.

from where i stood, he looked like an old man. which, in fact, he was. slumped over in his wheelchair, his bright green hat with "Lucky Dad" written across the front was a stark contrast to solemn whispers surrounding his presence at the nurses desk. they had found him in his room--his O2 sat's 86% & quickly dropping, despite increased oxygen through his nasal cannula.

Dr. W: We'd like to send you to the hospital, Mr. Smith

Mr. Smith: I ain't going. If I'm going to die, I'm gonna die right here!! [raising his shaky hand & pointing his finger downward on "here", as if enunciating his point]

Dr. W: Mr. Smith, I think you are sick & we need to get a picture of your chest.

Mr. Smith: Then you bring in the xray...we'll take the picture right here.

Dr. W: Mr. Smith, how to you think James would feel if I just let you die here? If it were James in this position, what would you want us to do for him?

Mr. Smith: Everything you can...

Dr. W: Then how do you think he feels about you?

Mr. Smith: I am 88 years old. I 'dun & lived my life. He still has to live his.

Dr. W: Mr. Smith, I am okay with you dying. But I don't want you to be miserable for a couple of days while your lungs fill up with fluid...and then die.

Mr. Smith: No, doc. I'm ready. I'm waiting. If you have to send me, take me to Dr. Taylor. He'll know what to do.

Dr. W: Well I can't make you go.

Mr. Smith: No you can't...& I'm going to die righ t here.

Dr. W: Okay we'll do what we can.

Tell me, how am I supposed to handle that conversation? How am I supposed to be an innocent bystander & maintain my composure (which I did not--I pretended an eyelash fell in my eye when the waterworks came on)? How am I supposed to be part of medicine, respect patients wishes, learn about the amazing interventions...and then let them ignore something that could save their life??!

And then again, at 88 years, how can I blame him for being ready to go?

tiny.

Why is it?

Why is it…

…That when old people die in their sleep, we take a deep breath, find a memory, say that “they had a good, long life”…and move on with our lives?

…That when old people die from a horrible disease we wish they would have died sooner, more peacefully; the justification of the disease often not even questioned.

…That when old people lose their spouses we attend the funeral, marvel at their 50 years of marriage and go about our days as if they have nothing to offer.

Why is it…

…That when young people die we are struck with grief for months, even years on end; we forget to breathe, proclaim that they didn’t live long enough for us to find a memory, and sulk in the fact that they were shortchanged on life.

…That when young people die from a horrible disease we wish they would have lived longer, disease free; the justification of the disease questioned daily because it just “isn’t fair”.

…That when young people die and leave spouses behind we attend the funeral, shed more tears than we have in the last three years combined, build a monument of sympathy for their widow and proclaim how much they would have had to offer, had they lived just a little bit longer.

Why is it that we feel the death of someone older is justified, but death of someone younger is always unfair?

Why is it that our hearts break for the young widow but barely skip a beat for the elderly widower of a Golden Marriage filled with fifty years of memories?

Why is it that people flock to the funerals of the young, clearing out schedules & missing appointments, while the memorials of the old are filled only with their remaining friends and a few acquaintances because we had a hair appointment that day at 1pm?

Why is it that regardless of the age, regardless of the life, regardless of the spouse or profession or contribution, we forget to remember that they LIVED.

And that LIVING is a feat in itself….

take a moment to read a few posts on this blog: http://marisavanderveen.wordpress.com/
(this man's wife passed away last year at age 33 from cancer, leaving him behind with three young children...this blog is about his grieving process...i was moved to tears)

Today.

There was a point, sometime in the past two years, where I seemed to have stopped living. The vibrancy that once infected my days, the joy in rain & snow & hot chocolate seemed to fade away. I might venture to say that at some point, I was depressed. And actually, depression, in some form or another, is so common in medical school that they specifically warn us about it during our orientation week. Throughout our first two years it becomes somewhat of a joke, our professors lightly referring us to the psychologist on staff should we need any “mental help”. And quite frankly, it isn’t taken seriously enough.

Those of us who struggled to get out of bed some mornings, either from real depression or the mountain of textbooks that needed to be read & material that needed to be memorized found ourselves in make-shift counseling sessions with our peers. Mine were each Thursday morning at 10am over coffee with five other women. We titled the time “study sessions”, but every week they inevitably turned into what some might consider a support group. And I have every ounce of faith that those five women saw me through what might have been real live depression.

And although I am doing much better (I still don’t want to get out of bed in the morning, but I’m thinking that now its just because I’m not a morning person), I still struggle with finding the JOY in each day that I once abundantly noticed. When I drive, the vibrant orange trees are just trees, the cute old man is just old, and the annoying pain patient is well, just annoying. It seems that somewhere in the midst of my textbooks and sky-high stress levels I’ve not only lost the ability to find joy…but also the patience to look for it.

I’m kind of understanding now what it means when people say that physicians had a class in medical school on how to be arrogant, rude, and a bit lifeless at times. I’m understanding now what it means to lose the tolerance for mediocrity—I’m expected to perform perfectly at my highest cylinder, and in turn I now unrealistically expect it from others. And I’m understanding now what it means to be so overwhelmed by the humanity that you encounter each day that you eventually lose sight of your own [humanity].

And in the midst of this struggle, I’m faced with the challenges of understanding where God fits into medicine, how medicine melds with faith, what my role is in mediating the two; answering the tough questions God’s way…questions about the sanctity of human life & at what gestational stage I personally believe human life begins, questions about the science (if any) behind homosexuality, pain, and neuromuscular disorders, questions about compassion & how much I’m supposed to shell out to my difficult (not to mention draining) patients, questions about how this insane thing called the practice of medicine is going to fit into my life as a mommy someday…

All this thinking has me distracted…so distracted, in fact, that I’ve stopped looking forward to the days’ experiences & started dreading the new ethical, moral, and heartbreaking cases I’ll have to mentally sift through before I can fall asleep at night. Something which very well may have contributed to my almost entire lack of sound sleep for the past 2+ weeks.

But like every change that needs to be made, it is easiest to start simply. I’m not entirely sure what “simple” is like these days…and I certainly feel like I have a long journey of “recovery” (can I even call it that?) ahead of me…in addition to more questions with answers that need to be sought out through prayer & experience.

"I have always, essentially, been waiting. Waiting to become something else, waiting to be that person I always thought I was on the verge of becoming, waiting for that life I thought I would have. In my head, I was always one step away.

...[But] life's made up of more than that one moment. Life is a collection of a million, billion moments, tiny little moments and choices, like a handful of luminous, glowing pearls. And strung together, built upon one another, lined up through the days and the years, they make a life, a person. It takes so much time, and so much work, and those beads and moments are so small...

This pedestrian life is the most precious thing any of us will ever experience...

You have stories worth telling, memories worth remembering, dreams worth working toward, a body worth feeding, a soul worth tending, and beyond that, the God of the universe dwells within you, the true culmination of super and natural.

You are more than dust and bones.
You are spirit and power and image of God.
And you have been given Today."

~Shauna Niequist, Cold Tangerines

And so my goal is to remember that…just that as a simple first step.

I have been given Today. For a purpose. For a reason.

And if I do not find success in anything else today, I will find success in Today and its purpose.

brave.

I realized something as I dodged the reclining chairs on wheels & haphazardly places wheel chairs that clogged the hallways this morning: you have to be brave to get old.

You have to be brave to watch your once youthful skin wrinkle & thin.
You have to be brave to watch your spouse struggle to take the steps he once ran, struggle to button the shirt he once easily pulled over his head.
You have to be brave to read your best friends’ obituaries in the Sunday paper.
You have to be brave to wake up to an empty bed, a quiet house, and a half-empty pot of cold coffee because no one was there to drink it with you.
You have to be brave to stand at the grave of your love of 50 years and face the rest of your life alone.
You have to be brave to watch the sunset and trust that it will rise again, to want it to rise again in the morning.
You have to be brave to see the world change around you, to see computers and iPhones and earbuds and portable DVD players and electric cars that run on popcorn oil; you have to be brave to face the technological giant that is beyond your understanding.
You have to be brave to face your second, maybe third war…and hear the stories about the bombs and explosions and loss of life…for the third decade of your life.
You have to be brave to love the friend across the hall, knowing that she may not be there tomorrow.
You have to be brave to not get jealous when people pass in peace around you…while you struggle in pain strapped to a wheelchair, stuck in a sanitized home. You have to be brave to not yearn for freedom…
You have to be brave to gain the humility it takes to allow a 21 year old glowing skinned female wash your privates and change your diapers.
You have to be brave to put a smile on your face when your days consist of darkened hallways and pureed foods because you can’t swallow anymore.
You have to be brave to see visitors that treat you like you are a child, forgetting that the decades of life you possess are well beyond their own childish understanding.
You have to be brave to look forward to the days and nights that will be filled with utter lonliness because all those close to you have died.
You have to be brave to look back at the memories of a vibrant life once lived, once full of love and activity.
You have to be brave to get old.

I don’t think I’m that brave.

existence.

He sat. Probably where he’d stayed for the last two hours—since the last body-turn by the nurses to prevent pressure ulcers. Blue curtains covered the window he faced. The heating unit blasted warm air toward his slightly reclined chair. Where he sat.

When I greeted him with a friendly “Good Morning, Sir”, I was quickly corrected by my preceptor that this person was, in fact, a female.

At first glance, I couldn’t tell. And actually, the second & third glances didn’t decipher much either. Her white hair had thinned in a male-balding pattern, leaving the peak of her forehead & top of her head entirely hairless. Since menopause, the estrogen in her body had slowly dwindled, causing growth of whiskers & stray hairs on her upper lip & chin. The protuberant stomach that overtook her lap masked any sign of breast tissue that was still present at age 97.

Only mumbles greeted me as a reply to my friendly “Good Morning”. My preceptor informed me that she had SDAT, or “Senile Dementia, Alzheimer’s Type” and was unable to communicate at all. In simple terms: over the years her brain had formed toxic plaques within the cerebral material that caused her to first forget her keys & doctors appointments, then her friends birthdays…eventually her friends, too. And one day she couldn’t recognize the very children she had borne. Not too long after, her own image in the mirror was that of a stranger. And now, at this advanced end-stage of the disease, she had forgotten how to talk. Literature tells us that her automatic response to lack of oxygen would go next…and some day soon she will forget how to breathe.

It’s a difficult disease to comprehend. Much of our bafflement about the disease likely stems from our cultures emphasis on “contribution”. We, as a society, value those who are able to contribute…to our society, to our educational experiences, to our health, our future, our everyday vanities, even to our conversations. And Alzheimer’s challenges us in difficult ways because the very people, often our parents, brothers, sisters, and friends, that have contributed so much to our lives suddenly stop contributing and start existing. And for our feeble brains to understand that existence is quite enough is often too difficult to wrap our neurons around…

This woman’s son visited her twice each day. I think he realized that her existence was enough, regardless of her contribution to his daily life. Remnants of his grade-school-looking handwriting plastered the walls with signs reminding nurses to “Only check pressures in right arm” and that “Family will do laundry” and to “Turn patient every two hours”, the latter of which was accompanied by a hand drawn guide on the direction of each turn at specific times of the day so as not to forget an angle that might give his dying mother a bit more relief.

The mystery of Alzheimer’s Disease has gripped the families of this nation, with over 147 patients being diagnosed each day. That is 147 people who will forget their keys and their doctor’s appointments. Who will forget their friends’ birthdays…and eventually their friends too. And who will one day wake up and find their own family complete strangers. That is 147 families who will be struck with the tragedy of loving a new, constantly changing, horribly difficult person that once loved them back….each and every day.

And this disease, this plague of forgetfulness that overtakes people’s brains is another intersection in my own life where personal experience, faith, and medicine collide in a brilliantly colorless display of questioning.

My grandpa had Alzheimer’s. Jon’s grandma had a form of it, too. And although we were more detached because of college & our move across the country, the toll it took on both our families was horrendous. If any consolation exists, it is that of innocence: most Alzheimer’s patients don’t realize that their memory is failing them. They, like this patient, have seemingly lost the ability to compute at all…giving slight relief (if any at all is possible) to grieved & exhausted care takers. And perhaps it’s the innocence of these patients that allows us to cope with the grief, fear, anger, and changes they face.

The brain is a black box—a mystery to even the most advanced scientists…and Alzheimer’s disease is no different. And while my own faith tells me to appreciate the mere existence of these patients, I can’t help but wonder whether or not God really intended us to live long enough for our own body to start producing toxic plaques that cause us to forget all the people & things He placed in our lives. And if He did intend for some people to eventually forget how to breathe, I can’t help but wonder what kind of lesson he is trying to teach those closest to them—in my opinion, there are plenty of other ways, much less tormenting & exhausting ways, to get the message across that this Earth is not our home. But then again, I am far from being in God's position of Divine Wisdom.

And so I’m left at this point again. The point where answers and questions don’t meet. The point where I’m questioning and experiencing and searching for reasons. Reasons why this woman didn’t slip into peace ten years ago when her children would be left with memories of hugs from their mother--a mother who recognized them. Reasons why this disease of old age is so prevalent—and reasons why people live lives with the end purpose of mere existence, anyways.

And still, reasons why God put this woman in my path in the first place…

Monday Morning.

It started out innocently enough…at least I thought it did. I had a new preceptor to find—presumably on the back roads of West Virginia. I planned my morning well in advance, which likely contributed to my disrupted sleep Sunday night…leaving me feeling groggy & not entirely prepared to face a new week at 6:05 on Monday morning.

Actually, my alarm went off at 5:15am. I had hopes of going to the gym…but after a night of restless tossing & turning, I decided against it when the music started blasting my ears only a few hours after I had shut off my light.

My preparations went smoothly enough, and aside from spilling soup all over the counter, watching my bottle of hair gel slide into the toilet and dropping my socks in the sink, I was ready to walk out the door in about 20 minutes. With car keys, purse, Nalgene, lunch box, gym bag, and books in hand, I reached for the door knob & realized that I had to pee one last time before my who-knows-how-long drive into the boonies.

As I stood washing my hands, basking in the glorious feeling of warm water in a freezing cold apartment, I realized that my almost-white-khaki pants were quite thin. And I thought about how cold I might be in the office. …which is when it dawned on me that my polka dotted turquoise underwear were completely visible on the rump view of my rather thin pants.

An extra few minutes to change my underwear.

And then I was off. Not entirely sure where I was headed, I drove along a two-lane road that curved & twisted around rock formations & cow pastures like switch-backs on a hiking trail. One thing was for certain: I WAS in the middle of no where.

About 15 minutes into my who-knows-how-long drive, I slowed down from 55mph to about 30 mph…you know, to enjoy the scenery....which in all honesty, was actually quite breathtaking. The river was foggy & I imagined Pocahontas canoeing down the river with her raccoon & birdy friends…oh wait, that was a Disney movie.

In truth, though, the trees were firey orange, the rolling hills were a faint blue color, and I passed red barns whose paint had chipped & roof slats had worn…I passed tilting shanty’s that, once loved, had been neglected for years. And I passed a slew of trailors & makeshift remodeling projects with little smoke trails sneaking out the chimney’s—a sure fire (haha) indication of the warmth that was burning inside (again…haha).

I noticed a field of horses on my left…and at the corner of the lot an avacado green trailer. And although I was driving, I slowed down enough to watch the horses for just a few seconds. Afterall, I was the only one on the road at o-dark-thirty in the morning.

Their coats were shiny, their manes were…flow-y…and really, they were so pretty enjoying their morning meal of West Virginia grasses with the Blue Ridge mountains as God’s painted backdrop. And just when I made a mental comment about just how awesome it must be to run free in a field like that, the brown horse took the liberty to give me a bit of a show by jumping on the black horses back and…….well, I’ll let you fill in the details. Lets just say they might have made more pretty horses yesterday!

And so the drive continued. After about 25 minutes of fields and cows and…ehheemmm…pretty horses, I found myself driving through a “town”. My directions told me I was supposed to turn….and turn I did….which is when I found myself face to face with a market on the corner, aptly named “The Corner Market”. I passed “Nance’s Diner” & “Matt’s Furniture” & “Trudy’s Flowers”, all reminders of small town America at its best.

I realized soon after my turn that my only further directions were to “drive” & look for the “Health Center on the left”. GREAT, I thought. At this point, it was well before 8 o’clock…and already I’d seen hills and trailer and cows and mating horses and turquoise underwear and in-the-middle-of-nowhere stores…

And so, since the office didn’t open until 8, I drove back & forth between two “towns”, looking for the “Health Center”. At one point I was driving alongside a little deer who had found himself a nice path along the white line alongside the two lane road.

It took me another 25 minutes, 1/4 tank of gas & 3 phone calls to the nurses at the clinic to find this infamous “Health Center”, which was actually another 5 miles down this road-to-nowhere…

When I walked in the door I was greeted with smiles and the announcement that no, in fact my preceptor was NOT in the Health Center he had given me directions to; the same Health Center I had just spent over 45 minutes driving to find….

He was at the “Senior Center” just a “few miles” down the road…

conversation.

i've spent the last two days with a PM&R (Pain Management & Rehabilitation) doctor--which has proved to be quite an experience. Yesterday I listened to people in "pain" (in quotes because i don't believe all of them to be legit) complain about how miserable their lives were (can you tell i'm short on sympathy?)...and today i spent the day in an in-patient rehab clinic working with speech, physical, & occupational therapy.

it was quite an eye opening experience, as i've never had any reason to visit any of the above fields' offices...and one patient in particular made me chuckle more than any other...

bits of her conversation with the speech therapist:

{first of all, let me set the stage for you: patients visit speech therapy for 30 minutes at least once per day. located in a small office at a corner table, the therapist takes patients through a series of exercises that, depending on the patient's ability & reason for admission involves anything from "repeat after me" phrases to complex math questions...it also needs to be said that apparently this patient was admitted & barely spoke during the first week of her stay--needless to say the times have changed in her world...}

therapist: (referring to my presence in the room) She's just observing, is that okay Mrs. Ringer*?

Mrs. Ringer: I'm observing my hind end right now...is that okay with YOU??!!?

therapist: Repeat after me..."rose...sweater...hamburger"

Mrs. Ringer: rose...sweating...booger

therapist: Okay...repeat these numbers "9...2...1...8...4...7...2"

Mrs. Ringer: OH LORD JESUS HAVE ooooooooooooo MERCY where in be-Jesus are you gettin' those numbers?

therapist: From this test, m'aam--off the paper in front of me. Can you repeat this sentence?

Mrs. Ringer: OH LORD JESUS HAVE ooooooeeeeeeeoooooo MERCY my hind end is burning like yesterday's coleslaw

therapist: oh wow. i'm sorry...m'aam can you repeat this sentence?..."I drove down Mercy Street & took a right at Stockton Avenue"

Mrs. Ringer: Gah!!! Well be-Jesus...I am NOT from this town...

therapist: Well m'aam, this question isn't about this town...its just a sentence off this test in front of me...can you repeat the sentence i just told you??

Mrs. Ringer: silence

therapist: Okay, well...then what did you do yesterday?

Mrs. Ringer: I do believe i was sitting on my tail a-hollerin' like crazy...

therapist: umm...okay...How long have you been here?

Mrs. Ringer: Long enough to have a STROKE!!!!

therapist: What did you do before you came to see me today?

Mrs. Ringer: Oh I don't know...OH WAIT...I was hollerin' with my tail...and OOOEEEEEEOOOOOOEEEEE I am STILL hollerin' with my tail....can you help my tail??




*patient's name has been changed

waiting.

I remembered him on the drive back to WV yesterday. I was on my third sermon of the drive, a talk on the Song of Solomon from Mars Hill Church by Pastor Mark Driscoll. Something inside me snapped…and as I reached back for the quickly-emptying box of Kleenex, I remembered him from my visit to the nursing home last week.

My attending grabbed my arm and pulled me into the doorway of one room in the third wing on the first floor. We were making rounds & had just finished with a lovely 92 year old Italian woman when I was yanked into a quiet room in the middle of the bustling hallway.

The residents, as I wrote before, were a bit unruly because of the Halloween party that was to follow dinner. The staff was busy in the dining room, stringing orange & black streamers across the ceilings and stationing CMA’s at the cookie tables to ensure their Diabetic residents didn’t indulge themselves into a sugar coma.

From inside the room, though, the squeak of wheelchairs & big-tongued babble of denture-clad residents seemed miles away. And aside from the low hum of oxygen tubes, I might have guessed I was in an entirely different building. I was captivated. By the quiet. By the tubes. By the white net crib the body before me rested in…

The attending told me he was only 59. The patient had been under his care for at least two years—and hadn’t changed a bit since then.

My mind raced. FIFTY NINE??!?! TWO YEARS IN THIS BED??? NO CHANGE??

His skin was smooth, almost glowing. Women would pay money for that natural glow. A thin white tube hung above the netting slowly dripping liquid protein into his deteriorating stomach.

And there he lay. Silent. Still. Unaware of the chaos that ensued around him, just feet from where his sunken face rested.

Apparently he had suffered an unexpected stroke…and just never recovered. I asked about family & the attending shook his head slowly—no one had come to visit this man in the white netted-crib. And when I was updated on his medical condition, it was quite clear there was no chance of improvement.

I thought about the tears running down my cheeks. And then I cried for him. Because the truth is that the brave staff who bathe him, who change his liquid-protein, who rotate his bony body to avoid pressure sores; the brave staff who walk by his room countless times each day, they won’t notice when he is gone. And the truth is that I won’t either. We all, sadly enough, are waiting for him to die.

And then I cried some more. Because at this point in his life, he is alive…but he isn’t living. He doesn’t cry. Doesn’t grimace. Doesn’t laugh. He doesn’t converse. And in every way is playing a non-contributory part in this society.

I’m reminded of the lyrics of the song “Somebody’s Baby” by Jon Foreman:

She yells, "if you were homeless

Sure as hell you'd be drunk

Or high or trying to get there

Or begging for junk

When people dont want you

They just throw you money for beer."

Her name was November

She went by Autumn or Fall

It was seven long years

Since the Autumn when all

Of her nightmares grew fingers

And all of her dreams grew a tear

She's somebody's baby

Somebody's baby girl

She's somebody's baby

Somebody's baby girl

And she's somebody's baby still

She screams, "Well if you've never

Gone at it alone, well then go ahead

You better throw the first stone

You got one lonely stoner

Waiting to bring to her knees"

She dreams about heaven

Remembering hell

As a nightmare she visits

And knows all too well

Every now and again

When she's sober she brushes her teeth

She's somebody's baby...

Today was her birthday

Strangely enough

When the cops found her body

At the foot of the bluff

The anonymous caller this morning

Tipped off the police

They got her I.D

From her dental remains

The same fillings still intact

The same nicotine stains

The birth and the death were both over

With no one to grieve

She's somebody's baby...

And that is just it. HE was somebody’s baby. And when I walked into that room, my faith & the limitations of this miraculous field we call medicine engaged in a head-to-head battle. My faith telling me that he should be loved, that every human being has the *right* to live…and medicine telling me that with no chance of recovery, this man that once was is no longer…

So where do we define life? And furthermore, what do we define it by? The ability to cry? To engage in conversation? To respond to questioning or small pokes or painful pinches we call stimuli? The ability to eat independently? Or blink? The ability to move at all? And where do we draw the line? Two years? No improvement? No response? No chance of a hopeful recovery?

I’m still left pondering. When I get around to writing my own Advanced Directive, I know I don’t want to be stuck in a white netted crib for the rest of my life…I know I don’t want to be pushed into a side room and rotated every two hours to avoid pressure sores…I know that I’ll just want to go home.

My instinct is to think the same for all of my patients as I do for myself…to think that this man in the white netted crib would also just want to *go home*. But such is the conundrum of medicine: each person is autonomous…and as a physician, I have to respect that, no matter how difficult, tainted, or burdensome their care may be.

And so fell my tears. Tears for the life that is frozen in time—for the man in that white netted crib that no one is missing. Tears for the life that seems wasted…the years that have passed without so much as a moan. And tears for the mind of this man…because those fancy beeping machines can’t tell us what he is thinking, or wanting.

And so lays this man. Surrounded by tubes and beeping machines that give us no hint as to whether or not he will ever wake up, much less his awareness of the Halloween party down the hall. Surrounded by the echoing sounds of squeaking wheelchairs and the big-tongued babbles of denture-clad residents. Surrounded by a white netted crib and freshly sterilized sheets.

…and perhaps, too, surrounded by angels...waiting patiently for the commencement of his journey home…

I've been tagged!

(1) I have a hair fetish—and perhaps a slight bit of OCD-esque tendency when it comes to stray hairs on furniture, clothing, or things. So beware…I WILL come after you with a lint-roller (one of which I carry in my purse) if I find stray hairs on you!!

(2) Chai tea is my favorite J Only three types of chai have topped my “best ever” list: “MyChai” made organically from local ingredients around Mt. Bachelor in Bend, Oregon, some magical mix @ the Service Station in Spokane, WA, and what I’m kindly referring to as “hick chai”, found at the only coffee shop in Lewisburg, WV. My morning consumption has been known to exceed two cups—after which I leave for work with a roaring headache from the sugar rush…normally though I still with ½ cup & splurge on the weekends ;)

(3) I love office supplies. My favorite stores include Staples & Office Depot (although I am partial to Staples) and drool over any stationary stores’ pen aisle. Buy me a new pack of highlighters and I am one happy clam :)

(4) My dream job as a child was to be a neonatolgist (i.e., preemie doctor) with a side job working at Sea World, riding Free Willy into the wild blue abyss. (And I’m not kidding). So far, the former isn’t out of reach…but since Free Willy died a few years ago I’ve let the latter slip through my grip

(5) I want to charter a sailboat in New Zealand and sail into the sunset with my husband :) I grew up sailing my Grandpa’s boats…and have dreams of a New Zealand sailing trip someday.

(6) I have never eaten liver (although Jon is a fan of it)….but I have consumed the likes of: shark, crocodile, frog legs, sashimi, boiled bananas, raw seaweed (straight from the ocean!), salmon smoked by a real Indian chief!, head cheese (a man made me eat some in the commissary one day), cow tongue, pigs feet, spanish chocolate made from real cacao & chili powder and many more delicacies :) YUM! (okay not really…I almost gagged with all of them!)

(7) I never thought I’d get married. Seriously, I didn’t! I imagined myself as an old lady with lots of cats (even though I don’t like cats), practicing medicine & coming home to a house of purring critters…God changed those plans real fast, yes?

extra credit (8) I have a slight obsession with list-making. I finally found glorious [insert angels singing] iGoogle where you can customize YOUR OWN ONLINE LISTS and was instantly in list-making-heaven. If there is ever any suspect of my saneness, just ask me if I have a list in my purse...if I don't, you'll know I really am crazy!!!

{okay, I know I'm supposed to tag other people...but I'll make this voluntary :) }

dessert stealer.

i was in the nursing home in the afternoon, shortly after lunchtime. it didn't smell like a nursing home; the rarely-bathed-chemically-tries-to-be-clean smell didn't linger in the air like it usually does in the try-to-be-clean hallways of other nursing homes i've stepped into. no, this nursing home smelled different...older, maybe.

the halls were white. the walls were white. black scuff marks streaked the side rails of the hallways, evidence that wheelchairs frequently wheeled astray & into the plastic barriers guarding the peeling wallpaper. the nurses station was the center of the second floor, with each wing of rooms branching from a mecca of files, folders, phones, & frenzied nurses bustling to & fro in an attempt to take care of the somewhat unruly patients.

there were odd sounds that echoed down the hallways. yelps. moans. the background noise of TV's turned up for hearing-aided ears. and even the hiss of the oxygen pumps could be heard if you listened close enough. it was obvious there was a bit of excitement in the air--residents were milling about, weaving in & out of their rooms, down the hallways...some trying to make an escape on the elevator. they had their annual halloween party tonight...and the chaos in the hallway was partly due to the blocked-off dining room where staff was decorating. one seventy-something year old woman pranced down the hallway in a neon green fuzzy scarf & purple spandex. another man flew past the elevator in his wheelchair pretending to shoot everyone who walked by with his imaginary gun. i was even informed by the large woman in room 108 that johnny successfully escaped over the weekend & was found walking down the street outside in little more than his pajamas.

i was about three patients into our visit when i noticed an inconspicuous man wearing a red zip-up sport jacket walking the hallways. in the middle of charting my patients physical exam, the man stopped walking & perched himself at the center of chaos in the most inconvenient place possible near the counter of the nurses station. his head was covered in reddish brown hair that was growing more sparse each day. and although easy on his feet, it was obvious from his habitus that he had known some other handicap. he large tongue protruded much more than normal as he licked his lips every few seconds and his thin fingered hands rubbed his protuberant belly much like Santa Clause might.

he was thinking something--that much i could tell. but between charting & my own thinking, i hardly noticed what he was doing just a few feet away from my stack of patient files. a few moments passed and i looked up to find the back of the red jacket facing me and the man standing with his face shoved in a corner in the hallway about 6 feet from the nurses station where he had just been standing.

why in the world would this man put himself in the corner voluntarily??

and then, without warning, red-jacket-man turned around and bee-lined for the nurses station counter again. holding a small round plate with streaks of brown mousse on it in his left hand, i finally noticed the large tray of desserts that had been set for later delivery to other residents on the counter right where he was standing.

which is about the time i glanced up toward his balding head of hair. and what i saw was a 60-something year old man with chocolate mousse all over his face, not to mention the globs of whipped cream & choclate that had escaped his mouth & landed on the front of his red jacket.

he did it. he STOLE another residents dessert right from the nurses station and devoured it in the corner of the hallway.

that large tongue of his went in-and-out and in-and-out faster than before--probably in an attempt to hide the evidence of what he'd just done. but the damage was done, evidenced not by the globs of leftovers he didn't notice on the front of his jacket but mostly by the 6 other desserts he had ruined when he "set" his emptied dessert plate right on top of them.

the nurses aid in black scrubs came running down the hallway after she saw him meandering around the dessert tray. he made a run for it, hobbling down the hallway as fast as his skinny little legs would carry him.

but not without a GIANT smile on his face. he was darn proud of himself for his steal...

lessons from the weekend.

i headed to atlanta this past weekend to visit family who was (were??) celebrating their 60th birthdays & 40th wedding anniversary. after a last-minute change of plans, i changed my plane ticket to an earlier time flying out of NC instead of WV....and in the meantime i learned a few things.

(1) no matter how fast you think you are, it is impossible to run across 3 concourses in the Charlotte airport & still make your flight in 8 minutes.

(2) the man at the gate will NOT let you on the plane after the door has closed, even if you offer to ride on the wing.

(3) Starbucks will inevitably mess up your $4.75 self-sympathy-coffee: Grande Soy Decaf No Whip No foam Pumpkin Spice Latte.

(4) you know you need to go to the gym more when you shins are sore from your 3 concourse run in the airport.

(5) 5 year-old soccer games are just about the funniest thing on the planet.

(6) coffee is good.

(7) after a 1 hour flight time took over 6 hours, sometimes it is just better to drive.

(8) people you love are always worth it.

holding on.

i'm sad today. sad because i'm in west virginia again. sad because this week isn't starting out optimistically, because of the state of affairs in this world; sad because of the lack of personal responsibility of the citizens of this country. sad because my love is in another state 4 hours away and sad because my heart doesn't know how to embrace God's plans.

i should have seen it coming, the sadness. it comes each month. seven days. lots of tissues. emotional lability (or instability, depending on who you talk to). usually it manifests itself in feelings of being totally & completely overwhelmed. then there are months where frustration takes the lead & still others where my world is just knocked off its axis.

but this month, it is just sadness.

i'm emotionally empty. which makes me wonder where these tears are coming from...and why they bothered to show up in the first place. and i'm emotionally overwhelmed with the present & the future.

i've been trying, really, i have. i've been trying to let go & let God. but gosh it is hard sometimes. i've been trying to take things in stride, to let life unfold and not worry about who will iron out the wrinkles. and i've been trying to soak up each moment without even a fleeting thought about my independence one year from now. looking in the mirror, i can't help but wonder where the faithful person is who once wrote this, who totally trusted God with her future & feelings & failures. who wanted to be emptied more than wanting answers; who wanted to be faithful more than wanting favor; and who wanted God's will above her own....i can't seem to find her today.

i'm just sad about all of it.

i suppose it is because i don't want to let go. i cherish closed fists, holding so tightly to the functionality of my life as it stands that on days like this CHANGE is the worst thing that could happen to me. but the trouble comes when i try to convince myself for the four hundreth time that change is good.

change is good. change is good. change is good.

nope, still not working.

i think i'm overwhelmed by the sheer amount of change that seems to dominate the landscape of our future. i'm overwhelmed by the number of seemingly uncontrollable factors that could send our pendulum of hope swinging into a giant black hole. and too, i'm overwhelmed by my own (annoying) propensity for "what if's" that seem to invade the spaces of each thought about the future.

the way i approach life during weeks like this (& probably more, if i'm willing to admit it) is probably much like someone approaches losing a loved one. because the truth is that many aspects of my life i am totally in love with right now; i've grown overly attached to them and like a heela monster, just can't let them go.

"A natural response to the possibility of losing someone is to hold in tighter or to try to gain more control. Ironically, this does not lead to a life of freedom & joy, the very things we were pursuing. Most of us do learn to let go. We let go of our childhood & accept adult responsibilities. We let go of our teenage children & our attempts to control them. We let go of finding happiness in possessions or careers. We even learn that we have to let go of other people & not be dependent on them for happiness. To learn these lessons, we have to accept the fact that these things or people were gifts in the first place." --Hank Dunn, Hard Choices for Loving People

apparently i classify as "one of those people" who never has learned to let go--and my seeking has left me with a white-knuckled grip on the things in my life that don't belong to me in the first place. which leaves me totally bewildered by families like this, who seem to so easily keep thier heads above raging rapids when the tides of life change too quickly (check out more updates here).

i've got lots to learn....an huge pile of kleenex to throw in the garbage....and an entire book to guide me through the process of really letting go and holding on, both at the same time.

choices.

Our bodies begin to shut down after 72 hours without food. The molecules we use for energy are filtered & rationed. Muscle begins to breakdown to provide the energy we need to stay alive. And after just 96 hours without food, our body creates new molecules that, left for days, can become toxic to the brain. In other words, we need to eat.

She hadn’t eaten in at least 48 hours. A myriad of tubes & beeping machines stood at her bedside, weaving under & over her seemingly lifeless body. The florescent light that flickered above gave her skin a yellow, jaundiced tint. If you watched long enough, she’d open her eyes every few minutes—her iris’ jumped back & forth, up & down, as if she was trying to focus on something none of us could see. Then, eyelids would close again silently leaving us with only the faint memory that they opened at all.

When I saw her for the first time, I was surprised to find out she had already lived over eight decades. I guess it’s the printed blue hospital gowns & tangled mess of sheets that skews a bystanders perception of age, and maybe of human life altogether.

I found out she had been married twice, her second husband stood faithfully at her bedside. No tears were shed—he knew she had to leave him at some point, probably much sooner than he’d hoped for. Between the two of them, they had 17 children—all of them from their previous marriages. But they had been married for a long 33 years and at the moment, it just seemed too soon to say goodbye to their “new” marriage.

Only two of the seventeen children were in the room. They informed me that a nasogastric tube (NG tube) had been placed the night before. I barely noticed the thin tube filled with white liquid among the octopus of clear tubes & blue tubes, smooth tubes & corrugated tubes, that emerged from her sheet-covered body. They said it was a hard decision—but that “Dad just wasn’t ready yet”.

She wasn’t breathing on her own—a BiPAP (Bilevel Positive Airway Pressure) covered her mouth & nose, sending air into her lungs & sucking it back out again. I’m not sure how long she’d been on the machine, but once a patient is on BiPAP it becomes increasingly difficult to take them off as hours & days progress. Similar to intubation, a BiPAP causes airway & lung damage—damage that, in the elderly, is often irreversible.

But despite the BiPAP this patient’s lungs were already damaged. She had small cell carcinoma, an extrememly aggressive form of lung cancer that can infamously spread to any & all parts of the body in a matter of weeks. She was a survivor though—she’s lasted at least a few months. She’d fought. Chemo. Radiation. Surgery.

And now her fight was nearing its end. Her body was starving. Her lungs had stopped working. Her cancer had spread to the liver. And her body was, quite literally, giving up on her.

Was she ready? Was she ready to die? Is anyone really ready?

As I stood there I couldn’t help but think of all the pain she went through. Chemo drugs take a toll on the body—nausea, vomiting, cell damage, kidney damage. Radiation is supposedly very painful. Hypoxia had surely taken over as well, altering her lucidity, speech, & even brain function. What HAD the last few months of her life been like?

They were probably painful, emotionally & physically. Overwhelming. A bit discouraging, perhaps, due to the nature of her cancer if nothing else. And yet, she was still here.

Would I make the same choice? Would I choose to live my last days & weeks, maybe months, strapped to an IV pole sending toxic chemical throughout my body? Would I choose to shoot radioactive rays through my body in an effort to kill a cancer that would certainly eventually kill me? Would I make the same choice? Would I want my childrens last memory of me to be a body, covered in sterilized sheets with tubes & machines at the head of the bed? Would I make the same choice?

...would you make the same choice?

hot topics.

I didn’t understand what it was for the longest time. I think I first heard the term in 7th grade. We were required to write “topic reports” on some current event in the world, something every seventh grade sociology class makes students crank out. On this particular day, I was waiting in line to talk with the teacher & get the “stamp of approval” on my chosen topic (of which I can’t seem to remember). The girl in front of me got a stern look from the teacher and was asked “Are you SURE you want to cover that topic?” She shot back with a confident answer about how the youth in Asia were so important to her & she’d had exposure to them. She just seemed really passionate about her chosen topic.

Hmm. Weird, I remember thinking. Why is she *so* interested in kids in Asia? I mean, I hear they have dirty water & stuff but so do kids in Africa…why Asia?

It wasn’t until a few YEARS later when I reflected on my witnessed conversation that I realized she wasn’t talking about youth in Asia, her chosen topic was EUTHANASIA. Chalk up one blonde moment for me.

And today I remembered that same seventh grade conversation again. I just started my geriatrics rotation—which is actually much different than I envisioned. I’m a bit of a guinea pig for a “newly established” rotation curriculum (if you can call it that) through the hopsital I'm working with. And because of some scheduling conflicts, I’m working with a case manager at the hospital this week instead of an attending physician.

I was pleased to find out that she is a lovely woman who is quite passionate about her job—not to mention fantastically good at it. And it is actually a breath of fresh air to witness the goings-on behind the scenes of physician orders & patient medical management. A bit of a reassurance, I guess, knowing that I wouldn’t want her job—not to mention the fact that I desperately missed using my stethoscope today (although my back thanked me for the relief from my 10 pound white coat stuffed with instruments & books).

So back to Youth in Asia—err, Euthanasia. Also known as Physician Assisted Suicide, I noticed on my last absentee ballot that it was on the table for passing in Washington State. It is legalized in Oregon & an up-and-coming “hot topic” in many other state legislatures.

To be honest, I’ve tried to avoid the topic altogether thus far in my life, having only vague opinions about the subject—most of which are driven by my faith & the set of morals I’ve established based on that faith. But like many other “hot topics”, my personal opinion is constantly in flux, constantly being molded by the patients I meet, the stories I hear, and the suffering I witness in medicine. And truly, Euthanasia is just a jumping-off-point…there are so many other topics that center around death & dying, palliative care medicine, hospice houses, and other end-of-life issues.

Our culture shies away from death, as if it is some disease to be caught, some preventable & entirely undesirable end effect that the magic of medicine can save us from. But the miracles of modern medicine simply prolong the inevitable—sometimes improving the quality of life, sometimes giving many more decades of memories to families who would have otherwise missed out, and sometimes turning a quickly fatal disease into a process of protracted suffering. What most people don’t realize is that our approach to death is actually a direct reflection of our approach to life.

We discovered that most people meet death as they met life:

some head on, some with denial, & some with passivity.

There is a “death style” as well as a “life style”.

How we die will be an expression of how we have wanted to live,

& the meaning we find in our dying is likely to be

at one with the meaning we have found in our living…

[A] person who has learned how to let life go

may have not only a richer & more flexible life,

but also one that better prepared him for his decline.

–David Callahan

Although I’ve personally been exposed to what I would consider a fair amount of death, some accompanied by irretractable pain & suffering, I’ll be honest in admitting that I’ve shied away from accepting my own death. My faith tells me to embrace it, but I’ve become rather complacent about the whole ‘experience’—perhaps not willing to let go of my life as it stands right now.

And so, I think this rotation will be especially good for me. I’ll share the stories of the patients I come into contact with, those suffering, those hopeful, & those who are excited to meet Jesus. And in the meantime, I’m hoping to get a better grasp on issues that will be important for my future in medicine, issues like euthanasia, advanced directives, DNR’s, & palliative medicine….

And I’m hoping you’ll think a little more about them too...

goodbye's are the hardest.

goodbye's are always the hardest. i used to be good at them. i used to hold in my tears, mask my sadness, and move on. perhaps it was because of the constant transition i experienced in childhood, travelling from one home to another at least twice each month; transitioning from one extreme to the other, mom's house to dad's house, the city to the country.

i used to joke about how "some day" we just knew it would make me stronger. because as a young teen, there were so many times i just cried. cried that no one else could understand how i felt. cried because i felt so alone, so prematurely independent. and cried, because i couldn't fathom stability in my constantly changing environment.

but that "someday" is here. and i can't help but smile looking back at God's provision. i don't think that today's transitions would be nearly as easy, as smooth, and as hope-filled had i not been in that valley so many years ago. it is so clear now that hindsight is always 20/20--that God really is in control of all things, no matter how dark the night may seem. and often times, He provides little "treats" , of unexpected time together, an extra $20 for a date, unexpected gas money, or an injection of grace that make my heart flutter with gratitude.

i've been thinking a lot lately about the past two years. i told my mom on friday that i couldn't fathom doing it all over again...and i am so grateful that i don't have to. life right now seems crazy and i'm longing for the days when jon & i won't have to be on the lookout for yet another separation...but in the meantime, God is filling my gratitude cup...

*gas prices have gone down here, making my weekend drives of 4 hours one-way much more affordable :)
*i've found myself happily occupying my time with what we have already instead of wishing for things to jump into my shopping cart
*my geriatrics rotation scheduling was messed up by my school, giving me a 3-day-weekend this weekend!! (which equates to one extra day with jon!)
*God is slowly but surely calming my heart about the upcoming year...and each day i'm reminded that this life is less about me & more about His Glory
*our friendship with one another is the strongest it has ever been :)
*i'm looking forward to the next year & am setting goals for myself for when jon is away...

there are so many more things to be grateful for :) i bought the book i mentioned last week--and it really is a great reminder that this country was founded on humility & faith. i'm hoping our thanksgiving season is full of the same.

sugar cookies.

i don't like crunchy cookies. not at all. my grandpa did, & i'd bring him batches of cookies that i had burned--err, purposely made crispy for him. but not me. and so you can imagine my joy when we came upon this oh-so-soft sugar cookie recipe. a recipe so yummy i honestly couldn't believe that they came from our kitchen & not one of those little pre-made-pop-in-the-oven packages.

Soft Sugar Cookies

1/3 cup butter or margarine

1/3 cup shortening

3/4 cup sugar

1 teaspoon baking powder

1 egg

1 teaspoon vanilla extract

2 cups all-purpose flour

preheat oven to 375. Beat butter & shortening on medium-high for 30 seconds. Add sugar, baking powder, & dash of salt. Beat until combined, scraping bowl. Beat in egg & vanilla. Beat in as much of the flour as you can with the mixer. Sir in remaining flour. Divide dough in half. If necessary, cover & chill dough for 3 hours or until easy to handle (we didn't...they turned out fine).

roll 'em out on floured surface.

bake for 7-10 minutes or until edges are firm & bottoms lightly browned.