Three Times

Posted on February 12, 2012 by stephenarcher

Three times. I have been mar­ried three times. Third time is charm­ing. Prob­lems in surgery seem to come in threes, at least that is what we always say: two bowel obstruc­tions and it is mid­night. I have one more to go before I am off at 7. etc.
Mar­riage. It is not them. It is me. Yawn. The uni­verse has been wait­ing for me for this time, and even this time I have not han­dled it at all per­fectly. I am mar­ried but I am still walk­ing and stum­bling up the steps. What does this mean? Mrried, yo. We are together and mak­ing this life together and I am here and in it and the time I spend with you is valu­able like (way more than) money or more (but what is the vocab­u­lary for what I value that is not not related to $, but seri­ously?) , but still, in that, is me. I am still here. Does any­one relate to this, that what is here for work is the reality/fact/idea/ that I am part of this equa­tion. She is gen­er­ous and lov­ing and con­tent and then there is me who is also truly lov­ing and con­tent and also rest­less and won­der­ing and and I think we all have these thoughts like what am I to this and what am I to the world and why do I have dreams about Morocco and why do I have thoughts of Miami and thoughts of Brus­sels and places I have not been and you know, I may not now go you, my love, my love may not either and this is your one life and I know you won­der – I know because we all do and I do, and I admit it, I do, I won­der about the night in Tunisia you did not have and that i did not have and that we did not have, we didn’t. Think of this equals that and I am this or that and the strug­gle with unde­fined num­bers (we are at three now) and poly­no­mi­als are mak­ing their way in to this sys­tem, by default and I am the denom­i­na­tor that is com­mon and yet math seem to have grace, unex­pect­edly, which is dif­fer­ent than finance (which is num­bers) but which has no grace and noth­ing really interesting:the math of three in my life is where I find grace in the storm of always think­ing mind so I can mean it when I say… This is my life and I am in love with my wife and my child and this time in my life. I am where I am meant to be.

Step up. There is this woman in the life of a wan­der­ing man who is like a weather vane in the wind – the wind moves and the vane turns noth­ing changes with respect to the place of the vane or the wind: she is solid while the life of the man is like Laugh­ing Gulls dip­ping and curl­ing around the lazy bread crumbs fly­ing up from the 83 Ford Thun­der­bird on the beach, my dads that i am dri­ving and I don’t have to explain this to you, it is just this moment I remem­ber that I ren­der, like the chef ren­ders the fat off the meat, like the mem­ory is ren­dered off of time, like tragic, deli­cious all at once, like a Sun­day night and you are twenty-five and a bot­tle of wine and in love and watch­ing a film, a movie, and the pasta is warm and you are in love and awe of love and it is the first time you feel adult and it is a lit­tle sad and a lit­tle beau­ti­ful all at once, like that, all the memories…

Like that and like my shifty crazy rest­less soul look­ing for cool and relief and won­der here on this Sun­day night, the best night for lovers, right? Right. Here. Now. I am here now and that is good.

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Shorebreak

Posted on February 10, 2012 by stephenarcher

I feel the wave gath­er­ing under me, my feet ris­ing and the giddy feel­ing of it mov­ing beyond me, as if a horse just ran through me and then the falling, the falling and my feet back on sand and then a lit­tle reverb from the wave that broke, most of its energy mov­ing away from me, but a lit­tle find­ing its way against the tide and it feels good mov­ing around me back to front, return­ing to say thank you it seems, and I lean back until I feel my hair, like the fronds of a jel­ly­fish mov­ing in cir­cles and I stand up and I know the water com­ing off my face makes it sheen like it never can except here, like it is smoothed with sil­i­cone and my eyes slowly open hands open, feel­ing this all with my body, yes, and the slow, gath­er­ing again, draw­ing my arms out and I’m smil­ing and my feet are ris­ing and I am being lifted.

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Line Up

Posted on February 4, 2012 by stephenarcher

You might not know that doc­tors’ busi­nesses in the US are going bank­rupt. Mine did. Not me per­son­ally, but the busi­ness. Med­i­cine is a cog in the econ­omy like every­thing else. Lots of cogs are blow­ing out. I have a story, like every­one who goes bankrupt.

When I went to med­ical school I learned that doc­tors are pretty well respected. I think that most peo­ple live with a level of dis­trust for doctors…except their own. The other thing I learned was that if I lined up and kept my nose rel­a­tively clean (which I have not nearly always done) I would have job secu­rity in addi­tion to respect and I could buy a nice house with a man­i­cured yard and super lin­ear shrub­bery. I learned that I would work my ass off and I could expect to not make a nickel if I didn’t show up to work. No pas­sive income to speak of.

Some of those lessons have changed. I have touched on the respect part above. Job secu­rity is not a given, although it is much bet­ter than many fields (but see below and above), and I still believe that there is always room at the top and I make my plan to be the best sur­geon I can. I do indeed work hard and pas­sive income is still hard to come by.

So my bank­ruptcy story has to do with a part­ner play­ing Jenga with our prac­tice. He sud­denly quit (not a typ­i­cal part­ner move), defaulted on finan­cial respon­si­bil­i­ties, and those remain­ing got to watch the rather remark­able tum­bling and destruc­tion of a decade of work. I recently went to traf­fic school for a ticket (I got a warn­ing one early morn­ing from a really nice cop and the next day at the same time, place and chan­nel we did a rerun. We both (kind of) had a laugh about it) and dur­ing the 6 hours of “class” we saw many slow-mo traffic-signal traffic-cam videos of car wrecks caused by dri­vers who were either a)inattentive or b)angry, I learned. Even though they are dis­turb­ing there is an irre­sistible mod­ern dance feel to a car wreck that draws me to it. I catch my breath as the cars, which are usu­ally stub­bornly solo, find one another, finally. There is some­thing beau­ti­ful in it. Any­way, I kept think­ing that I was being reminded of some­thing. Now I know that it is the demise of my busi­ness caused by inat­ten­tion, resent­ments, assump­tions. As I have lived through the process, I will indulge myself in another metaphor: it’s like when the charges go on a build­ing being razed and the cen­ter gen­tly drops to its knees and the arms of the build­ing appear to rise in praise or supplication.

Even though I am mak­ing (up) some­thing beau­ti­ful about this betrayal and embar­rass­ment (I will take the lib­erty of claim­ing this blog as my attempt at beauty), I am here writ­ing to get it out of me that I do feel exactly betrayed, pissed, and embar­rassed. I am not look­ing for com­fort, to hear its going to be ok (I know for sure it is more than ok, no mat­ter what – for instance we have already been bought by a medium-sized (Ross not Macy’s) box store of a medical-practice-buying group and we didn’t miss a day of work – lots to be grate­ful for). I am let­ting myself have the feel­ings and I since I tell you about things like that, I am telling you about this. My (X)-partner? He knows his motives. I don’t. Don’t want to. I don’t think Karma is too wor­ried about a lit­tle med­ical prac­tice in Cen­tral Ore­gon, but who knows? I do. It’s not. At a min­i­mum I will rec­om­mend that he not come here for a ref­er­ence. His behav­ior is his prob­lem (or reward depend­ing on if you are me or him, I guess) and I am sure he will have an inter­est­ing and reward­ing story about all this. My job, today, is to come to terms with rebuild­ing, remem­ber­ing who I am instead of look­ing at what I do, and pay­ing atten­tion to these dif­fi­cult feel­ings. Like with my lit­tle kiddo, if I pay atten­tion and stay present when he is uncork­ing, he gets dif­fer­ent in a bit. If he goes through uncork­ing alone or he sees me ignore it, it is actu­ally dam­ag­ing to him and he saves it as one of those mil­lions of unfelt feel­ings that we store and even­tu­ally have to find an anes­thetic for. It’s ironic that anes­the­sia means to have no feel­ing and in the world of our emo­tional selves it is feel­ings not felt that look for anes­the­sia, not the ones that we strug­gle through, feel fully and move on from. Those ones bounce away from us as harm­less as the tire thrown bounc­ing down the road after a wreck.

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Little Of Me

Posted on January 30, 2012 by stephenarcher

I have gained weight in the last year. I work with peo­ple all day every day on this issue and here I am hav­ing gained enough weight that I know that other peo­ple notice, won­der, ques­tion. Enough that it is get­ting in the way of rela­tion­ships, most notably on my side. I feel less of me even though there is more of me. The less of me is what I am notic­ing the most, iron­i­cally. The part of me I have hold of is dimin­ish­ing. I am falling out of focus.
When I exer­cise I feel good. I don’t exer­cise much. When I exer­cise I lose weight, for­tu­nately. I am not exer­cis­ing. I am not able to give myself exer­cise as a gift, a chore or any­thing else. The rea­son is that I under­value me. There is not a mys­tery at work. I don’t have enough of me to have enough of me. I am writ­ing this to change this and to hold the inten­tion in these words to look for me in the move­ment of my well made and good enough body. I spend so much time in my head, but I live in this body. I want it back. I can’t really give it to any­one else or be all there while I have so lit­tle of so much of me.

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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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