This Is (Not) Grass

Posted on January 27, 2012 by stephenarcher

Scarcity brings out the fun­da­men­tals in a per­son­al­ity. I will use myself as an exam­ple, although I could refer to oth­ers in my life as well, “ex” peo­ple of sev­eral vari­eties, wives and busi­ness part­ners come to mind – these darker sides come out as peo­ple are leav­ing my life, I guess, or I maybe bring it out in them. Even if I do bring it out, I didn’t make them that way. Maybe no one did. A per­son who I thought I knew is com­pletely dif­fer­ent when things get tight. I bring it out in me too. I usu­ally find that I am short on space or time. I con­tract, retreat. In the past when this went on long enough my depres­sion or frus­tra­tion would leak out as destruc­tion – self, rela­tion­ships, what­ever. Now I try to ask for time or space to recharge. I do this blog, write or take pho­tos. I fill the scarcity with the bet­ter side of me. Then I feel. Better.

I have said many times here that I have trou­ble with feel­ing things. I can lit­er­ally feel noth­ing at times. Is that pos­si­ble? Can I be blank? It is not unpleas­ant, but it is odd. We are emo­tional beings. I see it in my son. Feel­ings, like a river, flow through him. Thoughts how­ever, do not. As thoughts come, the feel­ings have a hard time get­ting space. I mis­place my feel­ings and I think my thoughts are feel­ings. I watch you all very care­fully and I can tell you what I should be feel­ing. What should be feel­ings can be obser­va­tions. It is hard to have thoughts and feel­ings at the same time. Since my brain thinks all the time, I have to ask it to quiet itself so I can have a feel­ing. These crazy con­ver­sa­tions in me. How does this hap­pen? Who is hav­ing these dis­cus­sions. The me look­ing at me think­ing of you, feel­ing for whom, liv­ing this life. As my boy finds his brain, which is really beau­ti­ful to see, his abil­ity to have the flows of emo­tions will dimin­ish. I know now that a human who does not feel his feel­ings will end up with dis­torted bub­bles of emo­tions stuck inside him, but the brain does not give a shit. It thinks and thinks and it is good at it and it is very inter­est­ing too, in a way. I have to talk myself in to hav­ing feel­ings some­times. If I don’t I miss out on love from my wife and love for my wife, joy with my son, sat­is­fac­tion with work, with beauty. I rail against this ten­dency to see the world as a puz­zle con­stantly. I do this because I can’t do any­thing else. I have to have my heart in order to have yours. My brain can’t be two things, like this crazy blue plas­tic grass some­one planted can’t be real green grass. I look at my son at mar­vel at his open heart but I know his brain, his mind, is doing push ups, get­ting strong and wait­ing for him, with all its power and it down­falls. His work, like mine, is to know him­self, head and heart. My job is to teach him gen­eros­ity and hon­esty with both.

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Burnout

Posted on January 19, 2012 by stephenarcher

My patient had lit­er­ally burned a hole in his tiny, new stom­ach with a com­bi­na­tion of cig­a­rettes and alco­hol. I don’t have a moral posi­tion on this except that life is prob­a­bly worth pre­serv­ing until one can make an informed deci­sion. Destroy­ing it uncon­sciously feels arro­gant, but again, who am I to judge?
Most peo­ple can smoke and drink a whole lot with­out any prob­lems to the stom­ach, but after hav­ing weight loss surgery, a gas­tric bypass, it is really risky. The lit­tle pouch is rel­a­tively unpro­tected and the com­bi­na­tion of impaired blood flow (smokes) and caus­tic liq­uids, is a set up for prob­lems.
He was out hunt­ing. Actu­ally he was out mostly drink­ing and smok­ing and reflect­ing (dimly, I think) on why his wife wanted to end the mar­riage. He woke up with a hole in his stom­ach that felt exactly like that. He tried to drink water and the it ran out of the hole like rain through a drain pipe. He devel­oped peri­toni­tis. He made his way to a local hos­pi­tal in remote Ore­gon. The sur­geon there saved his life by sewing a patch of fat over the hole, lit­er­ally.
He then moved to Cen­tral Ore­gon where I have met him. He is a really nice guy. He can’t fig­ure out the drink­ing. He used to eat, but then after the oper­a­tion, he drank. He sits bewil­dered at night won­der­ing why he still does that, even now, after he almost died. As I talk to him I can see him there with his lit­tle glass of vodka, one then two. He is sad, misses his wife, knows it has some­thing to do with this oper­a­tion he had and how he switched to the vodka from the sugar, but it is fuzzy to him. He is relieved when I tell him there is a way to stop drink­ing that involves, well, stop­ping drink­ing. It is as dif­fi­cult and as easy as that. The miss­ing ingre­di­ent for him is other peo­ple. He needs their help. I could tell that made sense to him. I told him where those peo­ple were.
My patient has expe­ri­enced addic­tion trans­fer, a bor­ing term for what is really sim­ply addic­tion, which is the process of fill­ing our empty human-ness with any­thing other than our­selves. When we aban­don our emo­tions, numb them, the anes­thet­ics become the sub­sti­tute and they feel like home and heaven and hell at the same time. He started with his foods of choice, elim­i­nated those by hav­ing surgery but with­out under­stand­ing the empti­ness and started refill­ing the empti­ness with the next thing. He came to me from Reno. It could have been the craps table, but it wasn’t. It was this.
It is any­thing and every­thing. We are built, I think, with an empti­ness. We are forced to con­nect to some­one out­side our­selves in order to fill this empti­ness or we instinc­tively, it seems, fill it with some thing. This doesn’t work, and only when the pain of this gets very appar­ent do we change course.
Here is what I know from what I have lived and what I see in my work (and I don’t know why this is true, but I think it is): we need love and con­nec­tion (con­nec­tion also known as spir­i­tu­al­ity). We get sick alone and we get bet­ter in groups. Heal­ing lit­er­ally lives in the connection.

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Enough

Posted on January 16, 2012 by stephenarcher

I work with peo­ple who are chang­ing their rela­tion­ship to food. Mostly they are obese and don’t want to be. Most have had surgery under my hand to give them a tool to help them relearn two sen­sa­tions that their bod­ies have lit­er­ally for­got­ten. The two sen­sa­tions are full and hun­gry. Because of the dis­ease process of obe­sity, the body lit­er­ally expe­ri­ences hungry/full in a faulty way, much like some­one with dia­betes expe­ri­ences sugar in a faulty way. Mak­ing the stom­ach in to a small pouch changes the expe­ri­ence of hun­gry (reduces hunger dra­mat­i­cally) and full (increases sati­ety). The effects are dra­matic most of the time.

What does not change is the emo­tional com­po­nent of the rela­tion­ship to food. If food has become the person’s expe­ri­ence of love or con­nec­tion, that does not mirac­u­lously change. When I say some­thing like this to a room full of physi­cians, some of them do what I imag­ine you are doing (only they lit­er­ally do it right in front of me); they shake their heads. These physi­cians believe that the prob­lem of obe­sity is eat­ing, and they are wrong. The endgame is eat­ing, like the endgame of alco­holism is drink­ing, but the prob­lem is one of empti­ness. My patients are not hun­gry. They are empty, like we all are empty. They fill up with food the same way an alco­holic slakes his thirst with a drink: not at all.

If a child is abused (over half of mor­bidly obese peo­ple were sex­u­ally abused as kids) and finds warmth when it’s cold from food, that mes­sage gets deeply imprinted. Relearn­ing hunger then also means under­stand­ing that what the body needs and wants from food is not what the heart will ever get from food. Love is not there, in the end. The truth is that love hap­pens within a per­son, and it is for that per­son and it is received and given between peo­ple (ok, and dogs). When the part of us that needs love and con­nec­tion gets filled with the right stuff, even small amounts of food are enough. This is what my coura­geous patients are learn­ing every day. As cool as it is to see a per­son lose a hun­dred pounds and watch the dia­betes go into remis­sion, the high blood pres­sure nor­mal­ize, and to see them walk in a 5K for the first time, it is even bet­ter to watch them do this deeper work and find the real gold: themselves.

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Boing!

Posted on January 10, 2012 by stephenarcher

Do pho­tographs con­vey the truth? Pho­to­jour­nal­ism schools have whole courses that make up answers to this ques­tion. It is impor­tant for jour­nal­ists who are writ­ing to tell the truth, I think we would agree. It is impos­si­ble, “true”, but striv­ing for an objec­tive story allows me as the reader to think that I am mak­ing up my own con­clu­sions. Ques­tions arise: what did the writer leave out here? How were the quotes edited? The same ques­tions arise for pho­tog­ra­phy. Pho­to­jour­nal­ists ago­nize over retouch­ing, crop­ping, con­text.
I do not do this ago­niz­ing, at least not in ser­vice of the truth. I am mak­ing some level of fic­tion with my pho­tographs. My writ­ing is cre­ative and while I am telling you some­thing about me, and, I am not (usu­ally) (know­ingly) lying, I am for­mu­lat­ing an openly sub­jec­tive per­spec­tive. The pho­to­graph in this post was recorded dig­i­tally and the cloud had that shape and that is what led me to stop the car and record the scene. It’s a funny cloud, like a spring, right? After I get the raw image I believe my job is to make art and to lead you to feel some­thing. To that end, I devel­oped the pic­ture. I cropped it mer­ci­lessly, increased con­trast, dark­ened the edges of the road­side, added a bicolor fil­ter, increased the struc­ture and sharp­ness of the moun­tain. I reduced the dig­i­tal noise and I elim­i­nated some tiny clouds in the top right and left cor­ners. That was my per­spec­tive and every pho­to­graph and pho­tog­ra­pher has a per­spec­tive, even the most hard-boiled jour­nal­ist who holds the cam­era a foot from his eye and shoots, which is the prob­lem with truth telling and pho­tog­ra­phy. My act of see­ing some­thing with a cam­era changes the truth about what I am record­ing. I have changed it to reflect my per­spec­tive on the truth. Pho­tog­ra­phers who own that real­ity have my respect. With respect to pho­tog­ra­phers try­ing to be objec­tive I would also assert this:

Pho­to­graphic truth is inversely pro­por­tional to the effort exerted to make a pho­to­graph tell the truth.

The harder a jour­nal­ist tries to make just a straight shot with­out influ­enc­ing me and the harder she asserts that what she is doing is objec­tive, the more I have ques­tions about what wasn’t pho­tographed, how the con­trast manip­u­lated to con­vey a point of view, what the angle of light is doing to change my mind. The less a pho­tog­ra­pher makes a play for the truth, the less I doubt them and the more believ­able the pho­to­graph is. Purely fan­ci­ful and con­trived pho­tographs are com­pletely believ­able for what they are and they do not hide any­thing. This pho­tog­ra­pher may have whimsy but she has no guile. Purely jour­nal­is­tic pho­tos raise my sus­pi­cions and are, inher­ently I think, prone to lies.

Dis­cuss.

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Eddy

Posted on January 8, 2012 by stephenarcher

What is a truth and a lie?
A pho­to­graph is the lie sit­ting, like a spi­der in the web of the truth.

What stays and what moves?
A river does both and stops doing both at the same time.

What is valu­able and use­less?
Love makes no sense and is all there is.
 Poetry, good poetry like in The New Yorker,
 Should not men­tion love.
 It (good poetry) should dance around the empti­ness
 of the lack of it ‚or dance
 around
 the poignant reach of hope­less rubes
 liv­ing as if in square comic por­tray­als of them­selves.
 Leave love out, yo. (But yes, valu­able and use­less and all
 sense­less, yes.)

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Dog’s View

Posted on January 5, 2012 by stephenarcher

Decem­ber was super busy. I took my national boards (passed..!), the kiddo had a minor oper­a­tion (wait­ing in wait­ing rooms is exhaust­ing – I’ll remem­ber that), and my patients, for one month, finally had real insur­ance. Deductibles take 11 months to pay and then peo­ple finally can have the her­nia repaired or some other elec­tive oper­a­tion – our insane med­ical sys­tem at work. It may sound crass, but I feel like a farmer at har­vest when Decem­ber rolls around. And it’s done and that is good.

I have more time to be loved by my fam­ily which helps me love them back bet­ter. I have time to think about what a dog sees on a walk and make the pic­ture. Both the love and the dog make me happy. I feel happy, and I am not going to talk myself out of it.

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Hard at Work

Posted on January 2, 2012 by stephenarcher

Ever feel like you are watch­ing over things that don’t mat­ter? Who is it that does that watch­ing? The thin line between per­sonal may­hem, utter apa­thy or extreme vio­lence is that we don’t know the time of our dying. If we did, of course, we, or I will speak for me since you prob­a­bly would have loftier ideals – I would light up a cig­a­rette, rob a bank (non­vi­o­lently – it’s a per­sonal pref­er­ence) and give the money back or away or just light in on fire right there in the bank, run until my knees finally did give out as opposed to the not run­ning I do now in fear of the knees and because of lazi­ness. Just that one piece of info keeps us look­ing over use­less chores and keeps us tidy­ing up cor­ners. Even though we all know it’s com­ing, we do things we would never do if we knew when it’s coming.

Mak­ing din­ner does its lit­tle part to keep body and soul together so I can see doing that. Plus eat­ing feels good which is a good thing to be doing (feel­ing, good) while we wait around to meet the inevitable dead­line, the one we won’t be late for. In the mean­time, I, like mil­lions now and before me, am curi­ous about the thin line of (un)knowing that keeps me doing use­less things, shack­led to some­one else’s beliefs (which they would dis­avow the sec­ond they knew the moment of their own demise, by the way), keeps my head down and my neck bowed star­ing at my fin­gers work­ing to the bone.

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Shiny

Posted on December 29, 2011 by stephenarcher

It was an acci­dent and let’s just leave it at that, she said.
My patient was feel­ing sheep­ish and guarded. It was Christ­mas Eve, 9pm. She had shot her­self in the chest, but she didn’t mean to. It was maybe a dare or a rash indis­cre­tion. Guns are tricky, as are rela­tion­ships. Her boyfriend was pro­vok­ing her, maybe. She wouldn’t say much. It doesn’t mat­ter. After the trig­ger does its thing, the rea­sons seem, well, remote. When some­one says let’s just leave it at that, we all know that there is more to the story. Also when some­one says “just” they mean the oppo­site. I was just try­ing to help means that I was also try­ing to change who you are. I was just leav­ing means I was stay­ing a lit­tle longer. Etc.

She was right handed. There were no pow­der burns on her left chest so I fig­ured she was wear­ing clothes when she just pulled the trig­ger. She was try­ing to die when she came in. We put a tube in her chest to drain the blood and re-expand the lung. Her diaphragm was injured and that needed repair. She missed her stom­ach (5mm) spleen (5mm) and colon (10mm). The bul­let left her under the left shoul­der blade after tear­ing through her lung like a sponge, lit­er­ally. Nor­mally the blood trav­els in the walls of the lit­tle cells of the sponge of our lungs, but when the cells get bro­ken, it is pre­dictably messy.

This is not an anatomy les­son. It is not a les­son at all. I am see­ing what is in front of me. I am a sur­geon, I am see­ing lit­tle bub­bles of air gur­gling. The dif­fer­ence between res­pi­rat­ing and drown­ing is the dif­fer­ence between air and paper. The sur­face area of the lit­tle spongey bub­bles our lungs is that of a ten­nis court. Mas­sive, and con­tained. She was strug­gling for air, breath. Most peo­ple who fail at sui­cide, even those who start out want­ing to do them­selves in, are happy with the sec­ond chance. My patient was happy to be get­ting to the next breath, to the next
(happy)
new
year.

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Hydra

Posted on December 27, 2011 by stephenarcher

At var­i­ous times, most of the time, now maybe, I have liked fash­ion. I sub­scribe to GQ. I know, but I do. I sub­scribe to weird French fash­ion mag­a­zines some­times where the mod­els are nude and waifs, and unhappy and look like gazelles. I have two minds. I have five or six. I like hip­pies and Upper East Side hope­lessly self-important mod­els and real amaz­ing spir­i­tual peo­ple and MMA fight­ing (mixed mar­tial arts – don’t even get me started) and artists and bad-ass punks, and almost any­one who is on the outswing of their pen­du­lum and any­one who is drink­ing the cup of pas­sion in their life. I like Lind­sey Lohan, and I“m not kid­ding. I am see­ing that this life is the trip I have in this body. This one and that’s it…unless this isn’t it, but can I really be held account­able for mate­r­ial that was not in the syllabus?

I am not avoid­ing the topic. I do like fash­ion. I like think­ing about and know­ing some­thing about the peo­ple who place impor­tance on draped beauty, who define for us what length of pant to wear, or what print works for the cruise col­lec­tion. I like that they are out there mak­ing it mat­ter. What? Are we going to spend all day every­day on the sad­ness of the world? Even Jesus said the poor will always be with us. He fol­lowed it up with an admo­ni­tion to keep our eye on the heav­enly ball, but at this moment I am focus­ing on the friv­o­lous Gucci ball. It does not mat­ter and it mat­ters a lot…to me. I want there to always be peo­ple car­ing about fash­ion. I do. I want it to be about clothes and why they mat­ter. Some­times those clothes are amaz­ing. I’ll stop…after this. Let your­self care a lit­tle about the cut of the dress you see wink­ing above the pumps, about the way the tie rebounds off the suit. It’s fun. The mis­ery is always and every­where; allow­ing beauty in the midst of it is like hav­ing dessert first. Life’s uncer­tain any­way, so dessert first, as they say, is prob­a­bly a good idea.

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Three

Posted on December 22, 2011 by stephenarcher

6/100 Strangers Project

Today, my three, my son, my wife and me, were sit­ting in a preop hold­ing room in Port­land at the uni­ver­sity hos­pi­tal. We walked in to the Mult­nomah pavil­lion– the word evokes pres­ence and his­tory at the same time – prob­a­bly built in the 30’s. Finials and foli­ates gar­nished solid beige and green brick walls and beyond them and hang­ing in the clear­est blue sky was Mount Hood, the most deca­dent header for the city itself. We were look­ing down on the city and the moun­tains beyond. It was beau­ti­ful, truly. Even the inkling of fear that wound round our ankles as we waited for our son to be taken back for elec­tive surgery did not keep us from notic­ing. Even­tu­ally, and as always so far in his short life, he did great and was an inspi­ra­tion to us about trust and about imme­di­ately and with­out guile, let­ting us know his needs are as best he can, even though we don’t yet speak the same language.

The beauty of the pavil­ion has stayed with me. I have been in oper­at­ing the­aters and old sur­gi­cal haunts. When I was a res­i­dent in Cincin­nati, we had our weekly grand rounds – the lec­ture that includes and every­one and has a very long and won­der­ful his­tory in med­i­cine – in a refit­ted sur­gi­cal amphithe­ater. You have prob­a­bly seen one in a pic­ture some­where. They are tiled white, built in the round and very steep to allow the stu­dents to look over white tubu­lar rails at oper­a­tions they hoped to do some day. The patient would be brought in to a the­ater lit­er­ally and the seats were full. The ether flowed and the stu­dents watched her­nias repaired, can­cers excised, femurs set.

Old things take me to an idea of things solid and safe and good. If they spent this much time on this build­ing, the surgery must be good. This is not true, but it is, I think, what we want to think, and some­times, it actu­ally is true. When I saw Adam’s car, the car in this photo, it’s fins split­ting Green­wood Ave. in Bend, I had to have it – on film. Not only the car though – the whole crew. We were fol­low­ing from behind and saw the girl and dog, who we now know are Ariah, the girl and Myah, the boxer. I asked Rose to wave him over at a stop light and we ended up in a park­ing lot tak­ing sev­eral pho­tos, the last of which you see here. This car means a lot to Adam as it has passed through many peo­ple to him and most recently many peo­ple he has known. His words:

“It is a 1960 Chevy Belair. I bought it about a year ago from a friend of mine, who bought it from another friend of ours and he got it from yet another friend of ours. so I am the 4th owner of it in a group of friends. I has the uphol­stery done in it. some motor work low­ered it and did a few cos­metic things such as pin­strip­ing, paint, and fender skirts. There is lots more on the list to do for the car. The car is a daily dri­ver and will always be one, no trailer queen here!”

Loved tak­ing his pic­ture, look­ing over the car and watch­ing lit­tle Ariah watch­ing me take her dad’s pic­ture. The antique Has­sel­blad felt really right for this shot and even though my expo­sures were off, I am very happy with the series after they have been developed.

Old places, old build­ing, new sons and daugh­ters. Even though they come out per­fect in one sense, the sons and daugh­ers, they aren’t. We never are. My kiddo had a lit­tle mechan­i­cal issue that is prob­a­bly fixed for good. Our human expe­ri­ence in these amaz­ing bod­ies involves check ups, bang ups, breaks and fixes. It is about break­ing and heal­ing and repeating.

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