Opioids in practice

For some time, I've wanted to write about the opioid epidemic from my point of view--the doc in practice, who doesn't understand what's happening at the time.   Here is that piece.   It is difficult to imagine how doctors trying to do the right thing can ever prevail against  the influence of  the drug companies, who put profits ahead of patients.  The coverage in the mainstream media, which has focused  on the doctors who were paid spokespeople for the pharmaceutical companies, has not emphasized enough how the companies influenced the rest of us through state medical boards, legislation and the FDA.  



What happened?

Those of us who pushed our way into "male" careers forty years ago learned to cope with a workplace that was not welcoming to women--it was the only way to do what we wanted to do. They told us that we had to be tough, and part of being tough for women was not letting men derail us.  As I wrote in The Personal was Political  we were astonished to learn during the Anita Hill hearings that there was a name, sexual harassment, for the abuse of power we took for granted. So I am not shocked by the current revelations, more surprised at the reaction this year when last year it was business as usual.  Years ago, I wrote a short story (fiction) based on one situation I encountered in training, a story which was published in the online magazine Persimmon Tree.  http://www.persimmontree.org/v2/winter-2013/sara-and-us/

Back from vacation

Just returned from a trip to Canada--Calgary, Lake Louise, Banff, Vancouver.   

Moraine Lake in the Canadian Rockies

Moraine Lake in the Canadian Rockies

While I was away, an essay I wrote as part of a symposium on "neighborhood" was published in The Threepenny Review and a short story Fools Gold in a literary magazine Radvocate  Fall is here, with Japanese anemones in bloom and tiny flowers on the lemon verbena that I have never seen before.   With both writing and gardening, there is a long gap between beginning a project and seeing the finished product.   It's always a bit of a surprise to see how it turns out.

Women in fiction

I have been reading Alice Mattison's wonderful book about writing:The Kite and the String.  One passage that has particular resonance for me concerns literary writing about modern women with careers.   "For many centuries a novel about a woman doctor (for example) was so unlikely that when it became possible to write one, it still seemed unlikely.  When we have written such books, because the carrying-out of work by women is still a recent phenomenon, often they are books arguing that it's right for women for work, instead of assuming it and moving on from there."  Or, I would add, books where the career woman fails or sabotages herself.  For example, the midwife character in Michael Chabon's book Telegraph Avenue, is a black woman who fights with the obstetricians.  As any U.S. midwife can tell you, learning to work alongside  obstetricians is an essential skill, one they master in training or pick another career.   And black women have gone along to get along for centuries.  It was painful to read about this character committing what in real life she would have known was professional suicide in an almost casual manner. On the other hand,   Lab Girl  by Hope Jahren, a memoir by a scientist in her forties,  is spectacular because the author never questions her right to be a botanist and doesn't dwell on the inequities, without pretending they don't exist.

Tessa Hadley writes rich prose about present day  women (Clever Girl, The Past, The London Train) whose lives are still regularly derailed by pregnancy and childrearing.   Maybe literary fiction can not embrace women who take control of their reproductive lives with birth control and abortion because pregnancy is such a useful literary device.  I appreciate that Hadley wants us to remember that there are many women who  throw out their youthful ambition, like the character in Married Life who almost chucks her violin.  The descriptions of children are profound and the novels are seductively comfortable.   But I, like Mattison, would also like to see ambitious women on the page. 

Year's end

I open my new (secondhand) yoga book by Judith Lasater and read "Living well is not about being calm; it is about being present."   This has not been a calm year but I have been present for  the   graduations of two children, my husband's third knee replacement on the same side in six years, trips to London and Costa Rica and of course, the election.   I guess there is a reason that I have felt distracted and unsettled.   There have been months when all I have been able to write is my short garden column for The Berkeley Times.  Transitions take energy, even if they turn out well, even more if they are as unpredictable as our new president.  Oddly, I felt some relief, as soon as the storm broke in November.  Now we know, we can move forward, since that's the only direction available.   Happy New Year.

A summer respite

At the beginning of the year, I learned that I had been waitlisted to return to Hedgebrook, the idyllic women's writing residency on Whidbey Island, in Puget Sound.  I forgot all about it until I received the call near the end of July.   

I spent a very happy week in August in my own little cottage, Fir this time instead of Owl, writing, writing.  The other half dozen or so writers and I met at dinner each day, to talk about everything under the sun, always returning to writing and books.   One day we visited the county fair and shared a funnel cake, then explored Langley, WA, lingering at a wine bar.    Another we made a bonfire with genuine s'mores.  Everyday, I picked blackberries and raspberries for my morning yogurt.  I met this little frog when I was reading on the lawn.   

Back to work

    For some months now, I felt that I had nothing to say here.  The political turmoil has left me speechless.   So much hatred on display.  We just returned from a trip to London between two graduations on the east coast. The  Brits are debating whether to leave the EU, with plenty of vitriol leading up to the referendum in June.   Everyone asked us about Trump.  I think it made them feel better about their own problems.

        In February,  I received a letter that it was time for my "annual mammogram". The letter distorted the  American Cancer Society guidelines in order  to drum up business.  I felt ashamed for the hospital where I used to practice.  When I protested to the radiologist in charge, she admitted that the letter was inaccurate ( even the ACS now recommends mammograms every other year for my age group) but said that it didn't matter, because radiologists still recommend yearly tests.  She doesn't want any part of  empowering us to make our own choice if that choice could jeopardize her income.  

      At my daughter's  graduation from medical school, one of the speakers pointed out that we would never have been able to eliminate polio if that vaccine had been priced equal to the cost of caring for someone with polio, the way the pharmaceutical companies claim that hepatitis C drugs are priced.  Of course, internal memoranda suggest that there was no such calculation, just a decision to charge as much as the market could  bear.  Meanwhile, other pharmaceutical companies raise the prices on drugs decades past their patents to outrageous levels, so that even people with insurance can't afford them.   For the first time, the percentage of patients without insurance has dropped to single digits but doctors still have to "explain" to patients why they can't access the treatment they need. 

       When my son received his masters in education a few weeks later, one of the student speakers spoke of how he hoped to bring the benefits of modern medicine to his  home village in China.   Not "precision medicine", the  expensive individualized genetic treatment that has seduced the medical profession with its potential profits (at the expense of public health) just basic health care.  At both graduations, speakers focused on the inequities of the current system, which are strikingly similar, in education and health care.  It was good for me to hear their academic perspective, because it made me realize that whoever is elected, my job remains the same.       


Mindful Flossing

One of my problems as a writer is that I can't confine myself to one genre.  Ideas occur to me and I write them down, with no concept of what to do with them.  One of my resolutions for the new year is to experiment with posting short pieces here, starting today.  Mindful Flossing  is a silly little story that came to me after an encounter with a new dental hygienist.   For some reason, it fits my holiday mood.  Happy New Year!


After my divorce, the only woman in my life who withheld her approval was my dental hygienist.  At a tender age, she had already perfected the slight head tilt and sad eyes that asked the question, “Is this the best you can do?”

            For years, I wanted to scream, “Yes! I have a life! A life I don’t want to waste flossing!”  My wife and I never agreed about my career goals and I despaired of reaching an accord with this freckle-faced hygienist either.  There were days when I didn’t floss at all, refusing to cede authority to someone named Tulip.

            Then I discovered Mindful Flossing™.  The concept is simple: teeth are sentient beings.  Everyone recognizes that teeth feel pain.  It only stands to reason that they can also feel clean.  Not all teeth are equally attractive; they are as variable as people are. But like us, they want to display their best selves to the world.

            The Mindful Flossing™ technique helps me to focus on the needs of my teeth.  I start by holding a generous length of floss at eye level in front of me and give thanks for all the events in my life that have led to this moment, for the opportunity to floss another day.  I take ten deep breaths, in and out, to calm my monkey mind.   Then slowly and deliberately, I pull the floss down one tooth to the gum on the inbreath and up the adjacent tooth on the outbreath.  I visualize a continuous “u” between the teeth, down, across and up.  

            I know that it sounds like it would take forever to floss all my teeth.  And it does take somewhat longer in real time.  But here’s the magic of the technique: the time feels shorter.  My relationship is directly with my teeth, not with a wife/dental hygienist figure.   By flossing, I release the life force in my mouth.   In other words, it is all about the teeth, here and now, rather than the threat of periodontal disease in the future.  It is a way to center myself, a dental meditation.  After flossing, I rinse with pure, cool tap water and rest in total acceptance of my mouth.

 I used to floss in the car to save time, swallowing the food stuck between my teeth.  How vile.  It pains me now, to think how disconnected I was from my teeth, dividing my attention between them and the road. No wonder my gums bled.  Teeth know when we’re distracted, just as children do. 

            Since I began to practice Mindful Flossing ™ five months ago, I have not missed a day.  Typically, I floss morning and evening and sometimes indulge at noon as well.  I find myself longing to floss when my stress level rises. My teeth offer me unconditional love, despite hard use. I can hear a chorus of little voices, “Thank you, thank you” after I rinse.

            Mindful Flossing ™ encourages experimentation with different kinds of floss and other dental stimulants to keep the flossing experience new and vital. Changing from waxed to extra slippery or mint may revitalize your practice. Dental tape, toothpicks, tiny wire brushes, rubber tips, all have their place in a rich dental life. The frank display of edgy products in the dental aisle reflects the new image of flossing, which transcends hygiene: on Breaking Bad, Anna Gunn flossed through a conversation with her psychopath husband.

  As my flossing practice deepened, I gradually understood that it is the process itself, my relationship with my teeth and gums,that is the goal, not the approval of the dental hygienist.   Yet as so often happens, once I was fully present for my teeth and let go of the outcome of my flossing, my gums rebounded to health.

At my next dental visit, when Tulip probed, my deepest gum pocket measured two millimeters, instead of the threes and fours she expected.  I could see her smile at the corners of her eyes, before she pulled down the paper mask and her perfect teeth greeted mine.  At that moment, I knew that I had found my soul mate.  She immediately embraced the precepts of Mindful Flossing™ in her life and work and encouraged me to share my discovery with the world.

            Reader, I married her.

Fall Reading

        In the course of reading Negroland,  a recent memoir by Margo Jefferson,  I followed a trail back through James Baldwin to James Weldon Johnson, who not only wrote  The Autobiography of an Ex-Colored Man, which is fiction, but a true autobiography, Along This Way, which is even more interesting.   Johnson not only trained as a lawyer, founded and served as principal of the first colored high school in his hometown, Jacksonville FL, wrote songs for New York musical theater  with his brother and other friends but was fluent in Spanish and served as a  U.S. Consul in Venezuela and Nicaragua in the early years of the twentieth century after a stint at the fledgling NAACP.  A fascinating life,  written in a conversational style that seems entirely modern. I only knew him as the author of the poem that became the "Negro National Anthem",   "Lift Every Voice and Sing".  His brother set the poem to music.   The autobiography  also gives some context for the recent furor about Woodrow Wilson.  Johnson talks about how Teddy Roosevelt, (before Taft, before Wilson)  appointed many blacks to prominent government posts, so many that they were called his "Negro Cabinet".    The NY Times headline, "Wilson legacy gets complicated" is misleading.   Wilson's legacy has always been complicated.  

Summer's End

Here in California, we have been praying for the end of summer for months.  Even in the city, the drought has been a constant low-level irritation.   I am trying to water my garden just enough so that the plants survive until the promised El Niño.  It feels cruel, to withhold the full measure of water they need to flourish.  My rose bushes are so old, about twenty years now, that they have held up pretty well with the minimum water, even though they are thirsty .  The rhododendrons, on the other hand, are shallow rooted and disease-prone  when water is scarce.  When plants die, I leave bare spots.  The front lawn, about 100 square feet, is mottled brown and green.  We are allowed to use the sprinkler twice a week, which is sufficient  to sustain the grass when we sleep under our fog blanket but last week's heat wave was additional stress.  There's little air conditioning here and none of us do well with more than two ninety degree days in a row.    I make everyone collect a bucket of water while they are waiting for the water in the shower to warm up and I carefully rotate which plants get the bonus water.  Carrying water daily makes me more conscious of its value.  We save water from boiling corn and blanching vegetables, too.   After cooking, I set the pots outside to cool down.   More mulch, less fertilizer...every trick I know.   The water bill in August said that we had used 30% less water than in 2013, so we're on track.  And there have been no major fires near us, although we flinch every time we hear a fire engine.   Could be worse.