>On my reading list

Posted on December 30, 2008 by Risa Denenberg

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I’ve been reading The Magic Mountain, written in 1924 by Thomas Mann. In brief, it is the story of a privileged young man who goes to a tuberculosis sanitarium to visit his stricken cousin, and ends up spending years there–finding it impossible to leave a world where illness is center stage. He shuns the banal world of family and work and instead spends his time having lofty thoughts and conversations about the meaning of …. everything. I’ve wanted to read it for some years, but I finally bought it after I came across the just published first volume of Susan Sontag’s journals, Reborn: Journals and Notebooks, 1927-1963 issued by her son, David Rieff.

Sontag wrote about many things–essays, stories, novels, extended conversations–but so often the tie-in was the body and medicine. She wrote Regarding the Pain of Others; Illness as Metaphor; AIDS and its Metaphors; Death Kit, a Novel. Apparently she was very affected by The Magic Mountain, reading it and arranging for herself a private meeting with Thomas Mann when she was quite young. I read Illness as Metaphor and AIDS and its Metaphors during the years I was immersed in AIDS, but I’m not sure that I understood her ideas until some years later. Reading her son’s memoir of his mother’s last illness and death–and now reading The Magic Mountain–deepens my understanding. Or gives me more to think about, another layer. For starters, the issues I think about every day, issues dealt with in medicine–and particularly in palliative care–are nothing new. The arguments, the conundrums, the hard choices and painful decisions–all of these just come with the territory of the body.

Here, Mann has his protagonist share thoughts about the origins of disease and its inevitable association with the body:

So much for pathology, the study of disease, with an emphasis on bodily pain, which at the same time was an emphasis on the body, an emphasis on its pleasures—disease was life’s lascivious form. And for its part, what was life? Was it perhaps only an infectious disease of matter—just as the so-called spontaneous generation of matter was perhaps only an illness, a cancerous stimulation of the immaterial? … The second spontaneous generation, the birth of the organic from the inorganic, was only the sad progression of corporeality into consciousness, just as disease in an organism was the intoxicating enhancement and crude accentuation of its own corporeality. Life was only the next step along the reckless path of spirit turned disreputable, matter blushing in reflex, both sensitive and receptive to whatever had awakened it.

This is a brilliant meditation on the origin of life itself. But it also suggests that the illness dilemma derives from the problem of having physical bodies; the flaw of not being simply spirits.

Mann goes on to have his protagonist (Hans) and his cousin (Joachim) consider the costs of medicine, and the use of medical resources. Hans has taken to visiting the shut-ins at the sanitarium, those who stay closed off in their rooms at the end to die. Hans hates that death is so shrouded in this place where people go to die.

Hans Castorp made a personal inspection of the deceased. He did so in open defiance of the institutional practice of concealment; he despised the egotism of all the others, who did not want to know, hear, or see anything, and hoped to reproach them with this act. . . . . [I]n fact, there were complicated motives behind this wish. His protest against the egotism prevalent here was only one of them. Likewise playing a role was his own spiritual need to take suffering and death seriously, to pay attention to them, a need he hoped would be nourished and satisfied by his getting closer to the seriously ill and dying.

A wonderful meditation for those of us who choose to work with the dying.

Here, “the horseman” has just died after a long stay. His caregiver offers her thoughts, to which Joachim expresses the idea that resources were wasted keeping this man alive for so long.

It was a miracle, she said, that the horseman had lived to see the holiday. He had long since proved what a tough cavalier he was—it was hard to know what he had used to breathe with toward the end. True, for days he had kept himself going only with the help of massive amounts of oxygen; had used forty demijohns yesterday alone, at six francs a bottle. That must have run into some money, as the gentlemen could well imagine, especially since his wife, in whose arms he had passed away, had been left quite penniless. Joachim expressed disapproval of such expense. What was the point of these tortures, of clinging to life in such an expensive, artificial way, when the case was hopeless? One could not blame the man for blindly consuming expensive gas keeping him alive, when they had forced it on him. But those treating him ought to have acted more reasonably and have let him walk the inevitable path, for God’s sake—regardless of the question of resources, or better, with considerable regard to them.

Point for point, this is exactly what we face in the ICU. How often do we feel this way? How often do we keep such thoughts to ourselves?
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>Still Life and Non-Sense

Posted on December 18, 2008 by Risa Denenberg

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It’s snowing in Seattle and after risking frostbite, waiting for the never-appearing bus, listening to the traffic report, or falling on icy asphalt, everyone is now sitting at home watching the snow. Seattle closes down when it snows. Schools were closed yesterday and again today. Even worse, Seattle uses some kind of ecology-minded salting mix for the roads, where they bother to salt, which has not stood up well to the below freezing temperatures, causing ice-on-ice . I had my snow tires placed on my all-wheel drive Subaru yesterday, but I’m sitting it out too. Too many people here have no idea how to drive in snow, much less on ice. If you recall, I’ve had my share of sliding and falling on ice. I’m happy for an unexpected day at home in a warm house, with a silly cat, good music, snow drifting down and kids outside having a ball.

In this lovely free time, I’m making corn chowder and trying to learn about vent weaning and dialysis. Our service is now doing consults for a kidney dialysis center and a vent-weaning facility. My understanding of ventilator settings and prognosis for weaning is kind of sketchy. Good excuse to hang out on Amazon.com and buy more expensive medical books. I also finished reading Death Foretold: Prophecy and Prognosis in Medical Care by Nicholas Christakis, which I highly recommend whether you work in the field of medicine or not. Christakis is, by the way, one of the authors on the recent BMJ paper about happiness. <http://www.bmj.com/cgi/reprint/337/dec04_2/a2338> The funny thing about this study (which basically found that if your friends, or your friends’ friends are happy, you are more likely to be happy) is that these effects did not show up in co-workers. I wonder what that means for those of us that spend so much of our daily lives immersed in work?

I know that I was unhappy in my last job and I’m pretty darn happy so far in the new one. Of course, true to my melancholic personality, I don’t expect happiness to last. I used to say, when I somehow landed on a small island of pleasure, that I was “between depressions.” But in terms of my work-life, the greater contentedness seems to me to be entirely related to differences in the two systems. I’m thinking about levels of systems: the teams’ practices and processes, the hospitals’ climate and culture, the regulations governing nurse-practitioner autonomy (or lack thereof), the communities we serve.

So not to get too personal, here’s a thought. I was reading Supportive Care for the Renal Patient (Chambers, Germain, Brown, eds., 2004, Oxford Press) when I came across this sentence: “In the U.S. there can be barriers to hospice care particularly for the patient who chooses to continue dialysis.” So this means, in contrast to in the U.K., where apparently being on dialysis is not a barrier to hospice care. And of course, the difference isn’t in the cost of dialysis, or the philosophy of palliative care, it’s in the structure of payment. In the US, the renal patient who wants both hospice care and to continue dialysis (the nerve!!) puts hospice in the position of having to pay for dialysis out of the hospice pot of funding. After all, it’s all Medicare funds, but just in different pots. This is the essence of fragmentation. Hospices get blamed for this, or worse, hospice comes to accept an artificial divide between disease management and comfort care. Now keep in mind, for the unacquainted, that the dialysis patient who stops dialysis will die in an average of 7-10 days. That’s 7-10 days of hospice, in the US book. Now I ask with honest incredulity, does this make sense to you?

Closer to home: In Pennsylvania, a nurse practitioner has to have a supervising physician in order to practice and prescribe medications, in Washington state, there are no such requirements, NPs can practice and prescribe without any relationship to a physician. In both states (all states, because it is a Medicare policy) an NP get 80% of the reimbursement that a doctor gets for providing the same service. In the former job, the palliative care service was embedded in Home Care. Speaking Medicare regulations again. What a mess. In the current job, we are a medical service. Like any other medical service, say Cardiology or Infectious Diseases. So there are minimal barriers to providing care in multiple settings, home, hospice, nursing home, hospital, dialysis center, vent-weaning hospital. But in both places, decision algorithms are designed for billing, not for providers. Providers spend a enormous amount of time just learning the rules.

Does any of this make sense? I can’t make enough sense of it to even begin to know how to criticize the system or how to make it better. Although I guess all of us (patients, parents, partners, doctors, nurses, etc.) should let Mr. Obama know how we feel about it.

Now, I’m going to sit on the couch with a blanket, cat in lap, cup of coffee in hand and read another book, this one just for pleasure, Magic Mountain, by Thomas Mann. Thinking about Susan Sontag last week reminded me that this is one of the classics that I’ve somehow missed.

Posted in palliative care, Seattle | 1 Comment

>Susan Sontag and my grandsons

Posted on December 10, 2008 by Risa Denenberg

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You know, when I wrote my last blog about wanting to be a BON girl (thanks for the concept, Bob, a girl can hope, right?) I was being lazy. I wanted/needed to blog, but I just couldn’t get to the internal place where I needed to be. In a way, I was just faking it, getting something out there without much effort, but then of course, in the other way, I want nothing more than to be read, I want to be read in the same way that us humans long to be seen. And the response was very gratifying: keep writing, post more often, keep on keepin’ on, as we said in the sixties. Very much, thank you. So, if I have just one reader (and I have more than one) I should shoulder the responsibility of doing this thing. Blogging. In fact, not so long ago, I said I was blogging to save my life. And here I am, living. Still. So far, anyway.

So I will promise myself that I will write. And not crumple and toss if it’s not prissy-perfect-prose.

So I’ve been thinking about self-consciousness. This arose when I read a review in the New York Review of Books about the forthcoming journals of Susan Sontag, edited by her son, David Reiff. I blogged about David Reiff, after reading about his book, and then reading his book, Swimming in a Sea of Death, about the last years of his mom’s illness and dying. The forthcoming book is the first of three volumes, it’s titled: Reborn-Journals and Notebooks, 1947-1963. (Reborn … hmm … have to think about that, she was an atheist after all.) Apparently Sontag journaled constantly, often daily, from age 15. (Grrr … jealous!) So, the reviewer (Deborah Eisenberg) teases us with portions of these early journals. The fascinating thing to me is Sontag’s enormous self-consciousness. She calls it “x”. She says: “X” is when you feel yourself an object, not a subject. When you want to please and impress people, either by saying what they want to hear, or by shocking them, or by boasting and name-dropping, or by being very cool. She also says, America is a very X-y country…

So she doesn’t call this “x” self-consciousness, that’s what I’m calling it. These few lines of hers tell me so much about myself, but also made me think of my two grandsons, now 6 and 9. One, the older one, Yann, is self-conscious, the younger, Dilan, not at all. Dilan makes the most amazing funny faces and expressions, but is never looking to see if you notice, he really doesn’t care. It’s amazing. Yann does think about who is watching and what they think of him. He is surprised by compliments and anxious to do well, perform well.

How does this happen? What does it do to a person? What does it mean? I have no idea. Sontag was brilliant, driven, successful, wildly noticed. But there are many unselfconscious people who are brilliant and successful, maybe less driven and wildly noticed.
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I visited one of my nursing home patients today who longs for company. It’s not the loneliness of dying, it’s just loneliness. Most people don’t know how to be alone even in the best of circumstances–how to be ok alone. But from Sontag’s words in her youthfulness, I see that the need to be alone, to hold sacred the space for solitude may derive from wild self-consciousness, that only stops berating and accusing the self when the self is alone. But again, I don’t know. This is what happens when I just think on paper (er, on computer). I wonder if I will find myself lonely when I am dying. I’m more likely to be the one who will wait until everyone leaves the room, or more so, kick every one out. But maybe not. I have no idea how it will go really.

We talked a bit among our team about Washington’s Prop 1000, the so-called assisted suicide bill that Washington voters approved by a large margin. I sense that my lack of reservation, that is, my positive feelings about this measure, are a bit of an anomaly among my kind. Indeed the palliative and hospice groups came out against it. The AMA came out against it. Have I “over-normalized” death? Does this have anything to do with my self-consciousness? I doubt it. But I’ll think about it.

Meanwhile I have to learn how to tag. Tag, you’re it. And practice at not being perfect. As if.

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>Blogs of Note

Posted on December 7, 2008 by Risa Denenberg

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I’m looking through Blogger and noticing the ‘blogs of note’. Interesting blogs, certainly eye-catching, some profound. But I can’t help wondering, why isn’t my blog a “blog of note”? Like everyone else who writes a blog, I want everyone to read mine. I aspire to be a BON.

Is it because:

  • I have no idea how to create a fabulous background and instead am using a template?
  • I don’t have a camera and rely on google images for pictures?
  • I haven’t imbedded any video from YouTube?
  • I’m not interested in pop culture?
  • Instead I’m interested in: dependency, depression, death, data?
  • I don’t demonstrate external consistency?
  • I appear to lack a sense of humor?
  • I haven’t transcended the divide between what I need to say, and what can be heard?
  • Few want to hear what I have to say?
  • I’ve inflated the importance of what I have to say?
  • I’ve inflated the importance of being noticed?
  • I’m too depressing?
  • I’m just full of shit?

So what do you have to do around these parts, to get the old BON nod? Anyone know?

Posted in Uncategorized | 5 Comments

>When she tells you she is tired, listen.

Posted on November 25, 2008 by Risa Denenberg

> Every time I wash my hair, I think about my mother. Again and again, as I squeeze a dollop of shampoo into my hands and begin to rub lather into my scalp, I remember.

In her last months she was so tired, a fatigue that taught me everything I needed to know about fatigue. In truth, my early responses, when she said “I’m so tired, all I want to do is sleep” were terribly unhelpful. I thought I knew what it was like to be tired all the time, actually in the throes of recurrent depressions, I did know. But Ede had never before experienced fatigue as a symptom. For her entire life, nearly 80 years, she woke early and never napped. Indeed, as she grew older, she seemed to need less sleep. Until the cancer, her energy seemed legend. Until the cancer. So I really didn’t get it. Would tell her it was ok to be tired, ok to lie down, ok to rest. As if I knew.

Then one day, getting out of the shower, as I was helping to dry her hair, she said, in a uncharacteristically quiet, almost offhand voice: You don’t really have to shampoo twice, do you? I knew exactly what she meant. Although in reality, instructions have changed. Decades ago, old directions on glass shampoo bottles read: shampoo. rinse. shampoo again. rinse again.

There was a lost feeling, a sadness. All these years, I thought, she was following old directions, but now that she is so tired, she must question what is truly necessary. I thought about the history of hair washing, although I certainly don’t claim expertise. But I do remember perching on the tall yellow step-stool with a towel around my neck, being tipped backwards, head lowered, my mom or my aunt washing my hair in the kitchen sink. As much as I hated it, once a week, I couldn’t get out of it. And I had lots of hair. And she shampooed twice, rinsed twice. There was a time before showers, when bathing, shampooing, hygiene, the whole shebang, was just a different set of rules. There was a time, during my lifetime, that you didn’t wash your hair if you had a cold, or were on your period. Ede told me that in her teenage years, they called having your period, falling off the roof. I can only guess that the phrase was so obscure so that it would forever remain obscure. A life in which one could not imagine seeing ads for tampons on television. A time when there weren’t televisions, tampons or showers.

These thoughts, as I shampoo my inch-long wash-and-wear hair pretty much every day (shampoo once, rinse once), converge: my mom dying a bit each day; me at six getting my hair washed in the kitchen sink; images of my mom and her sisters as teenagers whispering about their periods; me drying her hair when she was too tired to do it herself. I am grateful for the images, the memories, the shuffled meanings. I am grateful for the lesson.

If someone, a patient, a family member, anyone, tells you that she is tired, very tired, listen. It is a symptom. Like pain. For some, it’s the most horrible symptom of all. Life is fleeing, and here you are, unable to stay awake to watch. And all the rules suddenly must change.

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>Occasional Notes from Seattle

Posted on November 20, 2008 by Risa Denenberg

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For the past two months, I have been sending occasional notes to my “palliative pals” at the Lehigh Valley Health Network where I worked with the palliative care team for 2 years, before moving to Seattle to join the palliative care team at Harborview Medical Center. Partly to stay in touch with folks I miss, partly to decipher why I left one palliative care team to join another. I am publishing my most recent note here, as a personal incentive to blog more often about the world of palliative care. A world I inadvertently fused with in the late 80’s when I was involved in AIDS activism and AIDS medicine. During the years when palliative care was really all we had to offer, when palliative care meant watching my best friend die in his 30’s. When I discovered that no other part of the life cycle interested me more, engaged me more, or compelled me more than death.

For this intention, I am grateful to Pallimed, A Hospice and Palliative Medicine Blog (Visit at http://www.pallimed.org/) and to Christian Sinclair in particular, who writes for Pallimed. Christian is a palliative care doc whom I’ve never met, but have come to appreciate (love? is love too strong a word? I don’t think so, this is strong stuff, don’t you think?) through following his tireless review of palliative care literature along with chock-full-of-smarts-compassion-&-humor writings. Amazing isn’t it? When worlds converge. Palliative care and blogs. Who knew?
So (as everyone in Seattle starts sentences with …),
As we head towards Thanksgiving, I am feeling thankful. The whole world changed with the election of Barak Obama, and I survived my first week attending for the palliative care service at Harborview! It was a wild week, there were 4-5 new consults each day, and on Wednesday we had 20 on the census. I had a resident and a wonderful medical student, so I did have help. But I had never worn the attending hat before, and I was grateful to get through it without screwing anything up. In fact there have been a lot of firsts this month for me–a lowly (in most states) nurse-practitioner. The first day I was covering the outpatient service, I signed not just one, but two death certificates. I am carrying 3 pagers. I facilitated death rounds for the MICU residents. The youngest patient I’ve followed was 9, and about half of our consults are under 60, there is more trauma here than chronic illness. It’s hard, but I love this job, I guess just wasn’t fully walking in my own shoes in a job with less responsibility, less challenge.

It’s taken me these two months to begin to understand a tiny bit about how things happen at Harborview, but there is an incredible cooperative spirit and collaborative attitude. I believe there is something quite special about this hospital, in addition to it being in Seattle, which is certainly a liberal-green-friendly leaning city. Pretty much everyone working here says that is the case. The idea is that if you like working in this environment (fast-paced, very high acuity, state of the art, safety-net mission) you stay forever, if you don’t, you leave at 30 days. I love going on ICU rounds and seeing the nurses being very much a part of the team, giving report, asking for what they think the patient needs, very respected, and of course, very competent and caring. The trauma ICU probably does 3 or 4 withdrawals of life support each week, using a protocol developed by palliative care, so everyone is extraordinarily competent when it is time to withdraw life support and and provide comfort measures with family present. We don’t even get called, unless there are complex family dynamics.

The current plan is for me to build the outpatient program. I almost regret agreeing to that plan, as it means I will only attend in the inpatient service about once a quarter (now that I’ve done it once, I realize how exhilarating it can be). But the outpatient opportunities are wide open. Why things are so open here for the palliative care program, and less so in other communities is something that I am really trying to grasp. I will be seeing patients at a dialysis center and an acute care vent-weaning facility. I have 1/2 day of clinic once a week in adult medicine, Darrell has a 1/2 day clinic in oncology, but that could grow. This week we were the primary providers for 5 hospice patients, 2 at home, and 3 in nursing homes. The hospice folks really love us because we make house calls, I don’t have to tell you how amazing that feels to me, to be having a collaborative relationship with hospice!

The justification for hiring another NP for the service was based in part on growing this program, so I will have to make it grow. But then, pretty much everything grows here, bathed softly in water, not so much rain as drizzle, almost every day. Seattle is breathtakingly beautiful. Did I mention I have a spare bedroom, and that you are all welcome to visit anytime?
Posted in palliative care | 2 Comments

>A most difficult conversation

Posted on October 4, 2008 by Risa Denenberg

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How can I tell what he is thinking? His front teeth missing, his voice so weak. I struggle to hear, to make words of his soft garble. I say lightly,‘You’re making this hard for us, you know.‘ He smiles, a smile laced with sweetened regret. But what can he do? He doesn’t have an answer. I sit beside him, he is crumpled in his bed, his nurse comes in and out of the room; she pulls his Foley out in the midst of this most difficult conversation. One less tube.

No one has visited. He has no family to make decisions for him, at least none that he is in touch with. There is a brother, many miles away, who has his own problems, has little to say about what we should or should not do for this frail, very ill old man in the hospital bed. He has a sister, but he doesn’t want us to call her. He is estranged from his children. It seems there is no one but his caregivers to help figure this out. The first time I spoke to him, more than a week ago, he just wanted to be allowed to eat. He was sitting up then, a bit more alert, a bit more aware that he had options about his care. All he wanted was a cup of coffee and a sweet bun.

But his nurse objected. He had in fact failed his swallow test and would likely aspirate–bring food into his lungs and develop pneumonia–the same event that brought him to the hospital in the first place. To me, at that time, he seemed to be saying: OK then, it’s worth it, I’ll take my chances. Let me eat. He was clear that he didn’t want a feeding tube. His caregiving team was divided on the issue. Even those of us who wanted to let him eat knew that he would choke and develop the pneumonia that was likely to be his last illness, the old man’s friend. There was a standstill for almost two weeks, he was slowly starving, becoming weaker and more confused. Then finally he agreed to have a naso-gastric tube inserted to bring nutrients from a bag hanging above him into his stomach. Because he tried to pull out the tube, for several days his hands were tied with soft restraints to the bed sides, but eventually he was freed to pull it out or not, as he would. We were trying out best to keep him comfortable. Today he gently played with the tape holding the tube in place along his nose while we conversed. But not surprisingly, he seemed to have aspirated again. Medical care simply wasn’t helping, he was struggling to breathe and clear his lungs, hanging on for something, but what? Wistful, he talked about food and getting out of the bed into the chair again.

Now he says when I ask him what we should do, what we should stop doing, where he hopes to go from here, is this: Just help me.

At the end, there were no tubes, and although we gave him morphine, his breathing remained labored. He died. Alone in that bed.

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>Random thoughts: first week in Seattle

Posted on September 6, 2008 by Risa Denenberg

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9/01/08
My first day in Seattle: The house is so small, the outside so big. There are 3 coffee shops within walking distance.

9/02/08
This is life on a whole different scale than I have known.

9/03/08
Unfamiliar foliage. I want to have names. I need Hildy to tell me what these trees, these shrubs are called.

9/04/08
Unfamiliar music. Bands that I have never heard of: Fucked up; Mogwai, Built to Spill; Silver Jews; Mission of Burma; Dengue Fever; The Dead Science. Morning edition starts at 4 AM. The radio call letters start with K instead of W. Instead of the Village Voice, there is The Stranger.

9/05/08
There are parks everywhere and water everywhere. People walk, ride bikes, smile and drive without rancor. In my quiet little neighborhood, the mail is delivered for the whole block on one corner of mailboxes, like in the country. There are no stop signs in either direction, small traffic circles, friendly greetings, no sidewalks. Further out, there is suburban blight, K-Mart, and Lowes. No Wegmans. You can get most anything at Fred Myers.

9/06/09
Now all of my stuff is here crowding me, reminding me why I am here, what my life is about. When the house was empty, I felt so free. I used the computers at the library, wandered about, mostly staying outdoors. Oh how I wish I had another week to get to know this place before starting to work again.

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>Seasons of Corn

Posted on July 27, 2008 by Risa Denenberg

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People do change, although we don’t change because others want us to, and we can’t force others to change even when we think it would be good for them or because we wish they would. Even I can change. Do change. We change when it makes sense, when we are ready, when the benefits outweigh the hazards, when longing overcomes grief and intransigence. When we are blessed and offered a gift. When we have no other choices for survival. When we learn that it’s not sinful to be happy. When we are confronted with the need to care for our own self, so that we can continue to work , continue to love, continue to care for others. When we notice things we have always ignored; suddenly see that which has been hidden or denied.

I have always had difficulty with attachment. I like living alone. I will not miss you when I don’t see you for months. I don’t call. You have to call me and pursue me to hold on to me. There is a history to this, it is unimportant. In some ways it’s a simple fear of abandonment. In some ways I have a transcendent sense of attachment. I don’t need to be in your presence to hold on to the connection. I accept that things are not lost, sometimes we just don’t know where they are, what they have become. Because I am leaving, again changing my life completely (seemingly), I am having to answer to what it is I will miss here. In this place. At this job. During this epoch of my living.

Here is where I drive to work everyday along country roads where farmland is abutted by tracts of enormous new homes, many burdened with the effects of over-financing. There are these fields that have homes scattered on them with no trees in sight. Stupid for homes, right? But then there are fields and fields of corn. Mostly corn, some soybeans. It is hilly land and corn grows well on it. Sweet corn and field corn. Corn for fresh-picked, salt-buttery summer eating and corn for fuel. Corn meal, maize, mush, polenta, corn syrup. Corn.

I will miss the seasons of corn. The land tilled and reddish and ready. The short green stalks. Watching, almost day by day how high the corn grows, the ears now visible, stalks as tall as I am. That’s where we are now in late July. Corn stalks shimmering in streams of hot sunlight, bending with torrential rains. Corn, corn, corn. Later–which I will miss this year–the ears will all be harvested, some yellow, some white, stalks slowly turning brown. Dying. Some farmers will plow them under in the fall, others let them stand til spring, letting snow fall over them. Finally plowed under, tiny stalks rise again. Generations of corn, parent, daughter, granddaughter, again, again, again. Seasons of corn.

I will miss these seasons of corn. As a metaphor for missing everything else that is here and won’t be in Seattle, where I am heading. But of course it will be here still. As will everything else. Be here still. Be still. Watching seasons of corn. Taking nothing, taking everything, with me.
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>my new-news

Posted on July 4, 2008 by Risa Denenberg

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Wondering why I have been so unsatisfied with my “good life” became a daily activity for the past many months. Something about the constraints of my job (love the work, hate the job) but even more, the limits of the community where I am working, have locked me in a block of ice, so to speak, a place where my deepest creativity has been stifled, even villianized. I didn’t think to ask: where are the Jews, the blacks, the ethnic flavors? where are the artists, the poets? where are the old hippies? where is the STD clinic, the musicians, the drug addicts? where are the lesbians for Christ sake? I acted out the part of a loner, needing no one. I love my little cabin on the mountain, but a cabin on the mountain is just a cabin on the mountain, really. A permanent retreat, really.

Eventually I accepted that I should simply take responsibility for my own bliss/happiness/whatever. And after that, a series of events fell into my lap and have catapulted me into a new job/new city/new story. I don’t actually know how these things happen, but I know that they do happen.

What happened is … I have been offered job as manager of the palliative care program at Harborview Medical Center in Seattle. I have accepted the offer, and plan to move to Seattle in September. The job will be challenging and the idea of living in Seattle is totally exciting. I’ve always wanted to try bicoastiality.

Of course, I can’t tell you how the story will unfold. Yet.

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