12.16.2016

If You Don't Ask, They Won't Tell

The Mamas and the Papas think we can’t trust Mondays. I'm not sure what's so shady about them but they definitely have an air of superiority.... as if they have the monopoly on dread. There is something I can trust about them though. I know they'll be swamped. There is always a Monday morning line-up of patients outside the clinic, anxiously awaiting 8:00 am. We can almost hear the customers chanting “open, open, open” like the old Mervyn’s commercial. After spending the weekend coughing or vomiting or hurting, they can hardly wait for the doors to open, heralding hopes of a quick fix or a definitive diagnosis.

This busy Monday morning was no exception. Except that my first patient wasn’t there for illness. Belinda was there to go over lab results from our initial visit. They were mostly normal, which [usually] lends itself to a cut-and-dried appointment, something my next three sick visits, already waiting, would be thankful for.
Your Vitamin D level is low….” I said, “so I would like you to……”
I stopped mid-sentence and took a good long look at the hollow, deadpan eyes staring back at me. The person I was talking to was not the same person I met two weeks ago. Something was off. Really off.
Is everything ok?” I asked, sincerely and softly, abandoning the topic of Vitamin D, which suddenly seemed banal.
Today is the one year anniversary of my son’s death….he needs me to be with him.”
What do you mean?” I implored, aware of the instant chill down my spine.
I mean that I don’t want to be here any more…I can’t do it anymore….I want to be with my son.”
What about your other children and husband, who live with you? Do you want to be with them?"
They will be just fine without me….” she said flatly.
As we talked, I learned she had been stockpiling sleeping pills, which she was planning to swallow after going home and cleaning her house. “I want it to be spotless when I go.” She reached for her purse and pulled out a tattered wallet-sized picture of her angel son along with a two-page goodbye letter to her family. She assured me of being at peace with taking her life. "God knows my pain. He will forgive me."
I told her she needed to go to the hospital and get some help. She obstinately refused. “I am NOT going. I hate hospitals. I hate psychiatrists. I do not need help. Please, don’t make me go.”
We have a counselor here today," I volunteered. “Would you at least be willing to talk to him for a little while?”
Thankfully, she agreed, which allowed me an excuse to leave the exam room. I immediately summoned Rafael, a LCSW, who luckily didn’t have a patient in his office. He introduced himself to Belinda and settled in for a crucial conversation. Meanwhile, I called 911, knowing confidently this was what I had to do. And yet, a little part of me felt a sting of angst, knowing I had just betrayed her confidence, and she would forever swear my name.
I was sad and hopeful for her, and now very behind. Monday, Monday.
Later in the day, Rafael stopped by my office.
He explained that Belinda was very upset when the police officer walked into the roomShe just kept saying ‘I trusted Dr. Fisher…how could she do this to me?!’
But you know what?” Rafael continued. “You really did something good today….I am convinced she was serious and ready to kill herself. In fact, I think she had already taken some pills….she was starting to slur her speech and couldn’t tell me the day or date.”
Six weeks later, I was surprised to see Belinda back in my exam room. The empty gray haze in her affect was gone. She smiled. She twinkled. And she said this:
I want to thank you…. I got some medicine and am seeing a therapist. I am doing so much better. I can't thank you enough from the bottom of my heart. I was so mad at you at first, but I’m so glad you sent me to the hospital. I know that you really care about me.”
What if I had not asked her if everything was ok that gloomy Monday?
What if….
If you don’t ask, patients won’t tell.

8.01.2016

My Philosophy on Aging the Day I Begin the Back Nine



Moving to New Mexico has changed me in a lot of ways (right around 50 or so ways 2B exact).  

I think the biggest influencer has been my job, and the wonderful patients I am privileged to take care of: people of all ages in all stages of health and illness. One of the things I have learned is that there is a lot of heartburn here.  #longlivegreenchili #buystockinOmeprazole

The other resounding lesson I've learned is that "our past and present habits will become evident with aging ailments and medical conditions" (Anita Joy). Our bodies are a reflection of our thoughts and lifestyle (and genetics). The care you give now can spare so much pain later. Sure uncontrollable stuff happens. But we can stack the odds. 

I'm no different than others, who in the middle of middle-age has a mid-life crisis. It's sobering to wake-up one day and realize that trampolines are torture. And right around the corner is arthritis and down the street, cataracts. Aging is tough. It ain't for sissies. I see the challenges daily. It could be very easy to be depressed today, my birthday, knowing the potential horizon. 

Instead it's motivated me to step up my game, do what I can to be more mentally and physically healthy and focus on what is good about this back nine of my life. And I wanted to share that!! If I could help one person make a healthy change, all my time, effort and embarrassment will have been worth it! (See #50changes on my Instagram: jennifisher66)



You see....from my vantage point, "middle-age" seems to be a real sweet spot. (Although every age has benefits with things to learn.) The 20s are spent convincing others to love us. The 30s learning to love others, the 40s learning to love ourselves. The 50s and 60s+ are golden, when all that comes together: less proving, more giving and living. Not yet challenged with hearing loss, incontinence, daily arthritis pain, impaired mobility, or other struggles of aging, but with more freedoms that come with established careers, empty nests, and self-acceptance.


Cameron Diaz has a book called "LONGEVITY-- the science of aging, the biology of strength, the privilege of time."  I love her tagline and way to think about aging. I don't like the negative tone of the ubiquitous phrase "anti-aging" as if growing older is an enemy to fight against. You can't hold back a sunset. And those who want to let it happen naturally, without dying the gray or Botoxing the wrinkles, shouldn't be made to feel they are anti anti-aging. I also don't love the term pro-aging as if we are promoting tickets to a carnival ride. 

Years tick by like a moving train. It's pointless to be for (pro) or against (anti) that. Whether we slow down the train, or promote it along the way, the train, unless derailed, WILL get to the station. Being anti or pro-aging assigns value to something that just is. It is what it is. 

Plus, let's be honest, my pro or anti stance varies with the low back pain of the day. Some days I holler, "bring it on" loving the wealth of wisdom birthdays bring. Other days (usually after seeing an infirm 85 yr old), I adamantly want to stop the train. I want to get off and picnic forever in the nearby field of paintbrush and poppies, never ever re-boarding the age train headed to Dementia Town. 

Forget pro or anti-aging. How about choosing to simply find joy in aging, however that resonates in the moment. Your soul is rooting for this.

Joy in aging. Joyaging. Joyaging!! (I can make up my own words... it's my birthday). 

I'm grateful for the perspective and charisma that comes with 49 years of experience + 1 yr of sleeping (=50). Aging is a doomed privilege. Maybe I'm not lucky enough for forever. But I am lucky enough for now. For now, I'm basking in this golden time, that soft magic hour before the sun sets. 




We'll see what I say about all this when I turn 80. I'll probably need a new word, like constipatience!

7.24.2016

SKINCARE Part C


.......... 43/50 SKINCARE Part C ..........

Here is my PM routine:

1. Cleanse: If I am wearing make-up, I use Clinique Take the Day Off Cleansing Balm. Easily handles face/eye make-up. Or Tata Harper Regenerating Cleanser.  Followed by 2nd cleanse with micellar water. If I'm not wearing make-up, I just use the micellar water with a cotton pad. Trendy product...it's all the rage. Attracts/traps dirt due to micelles, tiny oil molecules suspended in water. Was using Garnier Micellar Water (much cheaper dupe for the holy grail Bioderma) but it has ingredients I didn't love so switched to Caudalie.



2. Serums: again the serums are what do the work. I pick products with actives such as niacinamides, peptides, and fruit acids (glycolic or lactic acid). On half of my face (the half with Retin-A), I'm using Drunk Elephant Framboos Glycolic Night Serum (great name, cool packaging, cult following) It has both AHA and BHA (two types of acids). Listed as 12% glycolic.

On the drug-store half of my face, the best comparable I could find is the ProX Olay Nightly Purifying Night Peel, which may be about 10% glycolic acid.

I'm able to use both an acid (night) and a retinoid (day) because my skin is used to it. May be too much exfoliation for sensitive or virgin skin.



3. Moisturizer: the expensive half of the face gets Dermalogica (won't re-use when this runs out) or Mad Hippie (delightful natural cream with safer ingred). Drugstore half gets Olay Regenerist Micro-Sculpting Cream. A great product, pleasure to use. One of the industry's and Olay's best seller of all time. For a reason.



Skin Treats: once or twice a month I use Dead Sea Mud Mask by Pure Body Naturals. 4.5 stars with over 8,000 reviews on Amazon 😱!! This is especially good for acne, rosacea or irritated skin. I just like using it....it makes me feel all spa-ish and fancy.




I use the PMD Personal Micro-Derm tool 1-2x /month.

Glycolic peel (30%) after the PMD. * Do NOT use with active cold sores. Caution with dormant HSV.

Obviously you can see, I employ both chemical and physical exfoliation.

Finally: love, love the luxurious Mahalo line: the company, philosophy, branding, packaging, name, everything about it. And opening a package from them is pure awesomeness! Check out their beautiful IG feed! I'm not a big fan of oils...but if I'm especially dry and feeling indulgent... this is the oil I reach for.

My two-sided experiment isn't perfect. There are lots of influencing variables....but I can definitely see a difference between the two sides of my face. Which side do you think is looking better?

Thanks for stopping by.... let me know if you have any questions, comments or suggestions!

xoXo,
Ms Fish

SKINCARE Part B

....... 43/50 SKINCARE Part B .......

Here is my current AM Skincare Routine:

1. Cleanse with Kirkland wipes from Costco. They are soft, gentle, and a good price. I've tried several others (Yes to Cucumbers, Neutrogena, etc.) but these are hands down my favorite.

2. Tone with either Thayer's Rose Petal Witch Hazel (Natural Grocer or Amazon) or Pixi Glow Tonic (Target) with 5% glycolic.

3. Vitamin C serum. This is the backbone of a complete skincare routine. Proven in clinical trials. This is an antioxidant which treats and prevents photo damage, the biggest precursor to aging and cancer. It is unstable in heat and light, so needs to be from a reliable source that mixes the product fresh. I use this. There is a LOT to learn and know about Vit C. There are lots of different types and the formulas and secondary ingredients used depend on the type of Vit C. Not all C serums are equal!! Despite what you can find on the web, do not try making your own serum.

4. As mentioned in Part A, I am experimenting with drugstore versus higher-end products on my face, hoping really there isn't too much of a drastic difference or I'm going to look might funny. hahaha.

 So on one half of my face, I use Tretinoin Cream (Retin-A*). It comes in different strengths. Right now I'm using mid-potency of 0.05%. This is the worker bee, prescription only. Lots of good long-term data with good efficacy. It thins the top layer of skin promoting rapid cell turnover. Thickens the deeper layer of skin, to boost collagen, improving wrinkles. Reduces age spots and evens skin texture. May reverse pre-cancerous cells.




On the flip side of my face: Neutrogena Anti-Wrinkle serum.  This has retinol, a weaker cousin of the prescription Retin-A with the potential for more irregular absorption, depending on face conditions (pH, dryness, inflammation, etc).
*avoid retinols if pregnant


5. Moisturize: don't do this daily in the am unless looking dry. If I wear foundation, I use Embryolisse, a light delicious moisturizer as a base.




6. Sunscreen: Every single soul, regardless of age, should wear BROAD SPECTRUM daily but imperative if using Retinoids. This can be in the form of a moisturizer with SPF (love Cerave AM), in a tinted CC or BB cream, or as a stand-alone. Currently using Neutrogena Ultra-sheer with Helioplex in SPF 30. (Anything more than 50 is wasting your $$).  This chemical screen is ok if driving to and from work. If outside for awhile, I prefer a physical block. Like Badger-an organic and natural zinc oxide.

7. Don't believe in eye creams.

8. We can talk about lips on request..... comment here if interested....

Continue on to Part C for my nightime routine.

xoXo,
Ms Fish

SKINCARE Part A



****Hi there!
I've been doing a countdown on IG (jennifher66) until my 50th birthday of 50 changes I have made over the last couple of years to feel healthier and happier than ever. It's been fun, but I recognize that my posts are a little lengthy for the quick scroll-through format / mentality of IG. Plus IG is so annoying it wont let me put in page breaks, making it hard to read longer passages.  So I'm putting some of my posts here*****

.......... 43/50 SKIN CARE Part A.......

This will be a 3-part series. I could talk about skin for D.A.Y.S....but I'll reign it into to a couple of hours 😂jk. #maybe Plus check out my IG feed to see mad picture grid skills #justusedanapp #nbd

So here's the SKINny.

Two years ago I looked older: wrinkled, tired, dull complexion, under eye puffiness and darkness, and lentigos (age spots). What??? You mean the people who talk about the importance of skin care were actually right?? Dang it!!! I never, literally ever, washed my face (outside of the shower) or used ANY kind of product on it...except for Sea Breeze a few times during HS. Oh how we loved that astringent burning feeling.

Enter operation skin care. I've been studying and experimenting for two years. Here's what I know: it can be overwhelming with so many products and claims and opinions and conflicting data such as the right order to apply products (has to do with pH), etc. But there are certain products that do have evidence to show efficacy. It's also simply a matter of finding what works for you and your skin type

I'm in the middle of a 6-month clinical trial (n=1).  On 1/2 of my face, I'm using drugstore products, and on the other half, higher-end products of comparable ingredients (not crazy high-end like LaMer, SKII or medical grade like Neocutis, Obagi or SkinCeuticals) I want to know if you really have to spend more. I may start looking lopsided.... 😂😂😂

In the next two posts, I'll explain my am and pm skincare routine. I have researched and deliberately chosen each product. #triedlots! I think my skin is looking better and younger than 2 years ago!! Although I still have hollow blue eye bags.  There are many causes of this, mine is genetic, so there isn't a cream that will magically improve that. It requires a filler like Juvederm. Also, no cream will remove my deep set wrinkles. Those require needles or knives.

If you are interested in how your skin products measure up (safety, efficacy) Beautypedia, thedermreview, or EWG Skin Deep database are good resources. BeautyCounter is a great place to explore safer options.

Continue to Part B for my AM routine.



1.03.2016

Angels on the Roof

Heart Full of Wonder by Megan Leong


"I know you are busy..... but can I tell you a story?"

I was behind. As usual. It was time to go home, and I had (out-of-town) family waiting to start our New Years' Eve festivities.  I still had to call a newlywed and break the news that her culture confirmed genital herpes; change a toddler's antibiotic to one his insurance would cover; call Marcus and tell him the MRI showed 2 fractures in his left hand, one in his right knee and a torn right lateral collateral ligament from his motorcycle accident; and re-fill several medications before the long holiday weekend.

I didn't have time for anything more, but she seemed especially anxious to share something. So, hiding my impatience, I sat down, closed my computer and agreed to hear her story.

She always has one.

Vivian's chronological age is 64, but she is 88 by appearances and 97 if we calculate life-years based on accumulated hardship.  Over the last 2 1/2 years of overseeing her healthcare, she has frequently weighed heavily on my mind. Single, and abandoned by her children, she shares her small home with a grandson, who eats what little food she can afford, forcing her to often starve, but feels no compulsion to clean up his messes or help Vivian in any way. In factual tones, never dripping with sorrow or pity, Vivian often tells me about her challenges, especially ones involving her home's decrepit state of disrepair. Weighing less than 100 pounds and packing around a portable oxygen tank, she is tough and hard-working and does what she can to keep up on things such as trimming bushes, cutting down an overgrown tree with a handsaw, scraping chipped paint, and patching holes in the wall.

Which brings me to her story. I will relay it in first person, just the way I heard it.

My roof has leaked for a long time. In my living room, there is green mold where water drips down the wall. I couldn't afford a new roof, but I have been saving for many months to get some supplies to repair the leak. Two weeks ago, I had enough to purchase a bucket of tar. The cheapest one was $54.53 and I had finally saved $59 dollars. 

I was just about to buy the tar, when another customer standing next to me said, "I wouldn't buy that....it's not going to do a good enough job." He pointed to another bucket. "That's the one you should get." 

I asked the salesman the cost of the other bucket. It was $90. 

"I can't afford that one," I told the stranger.

"Who is going to be putting this tar on your roof?" he asked me. I said I planned on climbing up and doing it myself. 

"I'll tell you what...." he said. "I'd like to buy that other bucket of tar for you. And in fact, I'll come on over and put it on myself." 

He bought the $90 bucket, and carried it out to my car. I gave him my address and drove away feeling appreciative. But I didn't think I would ever see him again.

Three days later, on Saturday at noon, he showed up at my door. He went up on my roof, then came down and said, "it's kind of cloudy right now. I'll be back in a few hours to take care of your leak."

Two hours later, a beautiful pick-up pulling a large white trailer parked outside my house. Out of the trailer came six big guys who immediately climbed up on my roof and started going to work. I soon realized, they weren't there to just put down a bucket of tar. Six hours later, I had an entire new roof.  

The next Saturday, the man showed up again, this time with three guys. They said they were back to put on another layer and seal the roof.  They gave me what I could never, ever afford to do in my lifetime.

While they were working, I made them some of my homemade tortillas and really good beans. It was the best I could do to show my thanks. 

And you know what? I still don't even know his name. 

But I know he's an angel.

As she finished her story, we both wiped tears from our eyes. How grateful I was in that moment that I didn't hurry her out of the exam room. I felt gratitude that Vivian wanted to share this story with me. I was thankful for a profession that allowed intimate exchanges like this. I was thankful Vivian wouldn't have to worry about her roof anymore, and that---maybe--- her health and lungs would improve. I was thankful for miracles and kindness and character. And I was thankful to cap off the year 2015 believing in angels.




3.31.2015

Rhonda and the Aluminum Cans

It was the same story I hear at least once every single day.

Rhonda stopped taking her blood pressure and diabetes medicine 6 months ago because she couldn't afford them.

She shared her story... which sounded similar to so many others.

Rhonda is...
married
without education
without skills or training
can't get a job
in poor health
but not poor enough to be on disability

And then her story began to differ from the others.

Rhonda's husband is on disability and collects monthly disability payments. He makes it very clear to Rhonda that because HE is the one suffering from disability, HE is the one that gets all the money. She is not privvy to one cent of it, since she is 'healthy' and all....

The day I saw Rhonda in clinic, she told me her situation in a factual tone, without begging for pity. Then she got to her reason for the visit: she wanted a prescription refill.

"I have been saving aluminum cans for several months. I just turned them in at the recycle place and got $7.00 to pay for my blood pressure medicine this month."

"What will you do next month?" I asked.

"Oh honey, I don't have the luxury of thinking about next month, or even tomorrow. I just take my days one aluminum can at a time."












3.24.2015

The Fireman



There were three rock-solid hints right away that this was going to be a tough one.

First of all, there was a vague chief complaint. Whenever a patient tells the medical assistant they came for an appointment to "discuss an issue," it's a guarantee the patient isn't there for a sore throat or to check their blood sugar. This generalization usually means one of three things: either the patient wants to be tested for a STI (sexually transmitted infection), wants a narcotic, or is on probation and split their head open while intoxicated.

But it's mostly just the first two.

The second clue was that the patient, in this case a male, refused to allow the female student nurses to sit in on the visit. "That narrows things down a bit," I thought, pointing to a likely problem somewhere in the vicinity between the thighs and umbilicus.

But I was wrong.

The third and final clue was when the patient, someone I had never seen before, greeted me with "are you sure you want to see this?"

Now for me, especially since I chose a medical profession with all its grisly details, this kind of disclaimer is like dangling a penguin in front of a leopard seal. It's an open invitation to escape the mundane of hypertension and hyperlipidemia and feast on something atypical or cool or bizarre or shocking or grotesque or better yet----maybe even fixable.

So when the patient looked at me with apprehension and asked "are you sure you want to see this" I answered assuredly, hoping not to let the undertones of excitement jump the gun like an anxious girlfriend blurting out "yes I'll marry you" before he even pops the question.

"Yes, I am sure," I replied trying to sound safe and confident, and even though I was intrigued and excited, I was also nervous.

There is always that. Always.

Walking into an exam room, I am accompanied by my sidekicks: Inexperience & Anxiety. An undercurrent of worry weaves in and out of my day, popping up here and there like a silver thread woven among a tapestry of wool. Will I know the right diagnosis or the proper treatment? Will I recognize whether the problem is a danger or a diversion? Will I be able to make the best decision for the patient?

I remembered the last time a patient said those words to me --- "are you sure you want to see this?" A 30 year old man, who was lying (clue: not sitting) down on the exam table, proceeded to pull down his pants, and directed my attention toward "something" in his butt that had been causing him excruciating pain for 2 WEEKS.  This is an important point to remember --- two weeks, fourteen days, three hundred and thirty six hours!

I took one look at his backside, and instantly judged this guy as either a Herculean hero or a doltish Cronus. Perhaps he was a little bit of both. I assessed the situation stared and totally played it cool, swallowed hard, and calmly stated, "you need to go immediately to the hospital... you have about 8 inches of colon hanging out of your rectum..."

But I digress. (Like his colon.....)

So back to my story.....there I was in the exam room, ready to see what the patient wanted to hide from the student nurses. It was just me and him and his secret which filled the room like a hot air balloon. I was keenly aware of his vulnerability, and though I have realized this before, I was suddenly filled with marvel at the trust and privilege that patient's extend to health care providers. It is a curious phenomenon, that mere strangers, who within minutes of meeting one another, are exchanging one-sided, intimate details about a person's life and body. This is a precious right and responsibility that I hold sacred and hope never to take for granted.

Slowly, the patient rolled up his sleeves, revealing several scattered nodules the size of shelled walnuts up and down the front and back of his arms. Some were abscessed, others just nondescriptly sitting there, like a gopher in a hole---only the pest which had burrowed down in his skin was not a varmint, but misplaced heroin instead.

His story carved a deep inroad into my soul.

He had been a fireman for 29 years busting his butt and breaking his back, literally, for society. His aches and pains led him to prescription narcotics, which led him to street drugs, which led him to a stomach eroded and raw from the years and years of pain meds. Now at the age of 71, in a desperate attempt to control his pain, he started shooting the heroin to bypass his gut and give it a rest.

It wasn't for the high. It wasn't for the kicks.

He was a newbie to this brave rough world not usually inhabited by those with a pension and grandchildren, and he was scared and ashamed at what the drugs were doing to his toned and rescuing arms.

He had tried every conceivable way to quit drugs and manage his pain in productive ways. He looked straight into my eyes and pleaded, like a sinner asking God, "what else can I do?"

Oh Mr Firefighter..... I pray this is one rescue you will be able to make.



3.03.2014

The Front Porch


my brothers and parents in grafton, utah

Have you ever noticed that the kitchen is a bit of a glory hog?

In magazines like Better Homes & Gardens or real-life living, the kitchen often gets a lot of attention. And rightly so. Often described as the "heart" of the home, the kitchen is the hub of sustenance. It is the place where our senses are fed, and where emotions and pounds are born and bred (and often shed).

I love being in the kitchen: scouring recipes, making (or ruining) a batch of homemade caramels, cooking up a batch of Meyer lemon curd, or kneading rolls.  I love doing dishes and feeling the warm sudsy comfort on my hands, made even better when my daughter sits across the bar from me spilling snippets about her day.

So when it came time to sell our home in Utah, it didn't surprise me that the kitchen was one of the places I would miss the most. What did surprise me is how nostalgic I would get about the porch.



But, then again, this epiphany made perfect sense.

I have always had a passion for front (and back) porches. Maybe it's because our front porch growing up was the place of my first kiss. Or maybe because it was the place where I sat for hours as a teenager pretending to read The Outsiders or Lord of the Flies while hoping to catch a glimpse of the hot boy across the street.

photo by Justin Hackworth

Or maybe it was because of my grandparent's front porch in Idaho. It was enclosed with small windows and lacy curtains. It smelled faintly of lilacs and antiques, had a few plants drinking up the sun, a chair inviting you to also drink up the sun, and a bookshelf of novels to sweeten the pot. It was a like getting a sneak peak into their lives before actually entering their home, and there was always a sense of mystery and excitement crossing through it to get to the real front door.

grandpa in his st. anthony home. photo by Justin Hackworth

As I grew older, I found myself drawn again and again to homes with front porches. It didn't matter whether simple or elaborate, I loved (and still do) the concept of a veranda which speaks the language of slow and simple times.

our front porch in Bountiful, Utah

A porch is to a house what clothing is to people, shedding light (literally, haha) on the style and personality of the people inside. For this reason, I especially love the southern porches that wrap around the house like an extra small apron on a plus-sized girl. I would like to think that only the friendliest of people live in houses with porches so inviting. And if someone is lucky enough to have a porch swing? Well then it seems they have the world by the tail and a downhill pull.

source unknown
source unknown



After I had a family of my own, the front porch became even more meaningful. It became so much more than a spy stoop, a preview, a welcome invitation, or a place to relax and enjoy a lemonade in slow motion.  The front porch took on a life of its own, becoming a stage where so many wonderful and surprising events played out.

photo credit: Nest of Posies


Like the time we got our youngest son. He was dropped off by a stranger on our porch in an old wicker basket. I found him one morning when I left to go to work.

Just kidding.

We didn't ever have a baby delivered  there but we did find a little piece of Mr. Fish's finger (another story for another time).

Which brings me to to the whole point of this writing.


home on Coronado Island, California


PASSING THE TORCH PORCH

On a balmy August Sunday in 2013, our family and friends gathered to say goodbye to my two sons who were leaving for South America.  They would leave in two days for their mission, and six days later we would move out of our home forever. It was a double-decker good-bye that put me on an emotional merry-go-round.

So naturally I wanted a family picture.

This isn't an easy proposition. Unfortunately, or fortunately depending on your point of view, my family has developed an aversion to taking pictures because of my.... say....how do I put this.... previous patterns of neurosis.... which included taking about three million tries to get the perfect pic.

When I got brave enough to share my hopes and plans for a picture, I was met with the expected groans, but I promised that this time it would be quick and simple. All we had to do was walk outside and stand on the front porch. There was beauty all around and joy to the world that we wouldn't have to travel to an exotic red rock locale, or search for the perfect background with the perfect lighting and the perfect colored grass and the perfectly coordinating, but not matching outfits, that looked eclectic but not random or like we tried too hard. On the other hand, my family questioned my choice of location because we definitely didn't have the prettiest porch in the perch.

But this picture wasn't for the aesthetics.

on the front porch for one last photo in our Hurricane, Utah home

It was about freezing a thousand tiny moments.....

....a thousand tiny moments that hit me like a wrecking ball on the night before this photo was taken, jamming together twenty two year's worth of porch memories into one word that I kept thinking about over and over.... GIVING.

Over the previous several weeks, I had been filled with sunshine in my soul thinking about all the things that happened on our front and back porch, with a unifying theme of generous imparting, endowing, supplying. I was amazed at the power of a simple space and overcome with gratitude for all who had ventured onto it. Our final photograph in that house was the chance for our little plain porch to give back one final memory as we parted forever.

Now here I must warn you that if you are bored with minutia or need to go pluck your eyebrows, this would be a good place to stop. Because all that follows is reminiscing about everyday porch miscellanea. Once seemingly inconsequential in their ordinariness, the following stories now feel extraordinarily valuable through the metamorphosis of retrospection.

photo by Justin Hackworth



THE PORCH IS A PLACE OF PRANKS

There was the time my husband was studying and I was (supposedly) getting some sleep before going in to work at the night shift. It was Halloween and by 9:00 pm most of the trick-or-treaters had petered out. I channeled my inner Sherlock Holmes and snuck out of the house to our car where I put on a [previously planted] trench coat and mask. ONLY a trench coat and mask. I tiptoed up to the front door like a bobcat praying noboby else would come by and rang the doorbell. When Mr. Fish answered, I flashed open my trench coat nice and wide, shouted Trick-or-Treat in my best Marilyn Monroe impersonation, then turned and ran away. Well, I use the term 'ran' rather loosely. It was really more like a stiff walk because it was October and about 120 degrees below zero. And my body wasn't used to that kind of exposure cold.


THE PORCH IS A PLACE OF KINDNESS

There was the time my husband was out of work, and we heard the doorbell ring a week before Christmas. No one was at the door when I opened it, but instead there was an envelope with $200 cash and a simple unsigned note which read, "Merry Christmas." It was manna dropped from heaven onto our cement wilderness. Our front porch was visited by the neighborly Halloween phantom, and was the depository for delicious homemade bread, casseroles, fresh garden produce, goodies, and packages from UPS. When my children were young, they couldn't wait each night to see what secret Santa had left on the porch, counting down the 12 Days of Christmas. (Thank you so much to whoever you were!!)

There were the times our porch turned into an amphitheater with performances from the Nielsons, or the Beattys or the Wilcock families caroling at Christmas. Or the Wilcock-Johnson quartet serenading us with Stand By Me or The Lion Sleeps Tonight.

There was the time I opened the door to see a skinny pair of 5-year old legs scampering across the yard and looked down to see a small sloppy pile of freshly picked flowers [out of our yard].


THE PORCH IS A PLACE FOR ART

There was the time we spent hours making spin art with the home-spun spinning contraption that Mr. Fish built. It became our workshop for painting, drawing with sidewalk chalk, or planting flowers. Our porch saw its fair share of unplanned 'designs' made by melting Creamies or spilled fingernail polish.


THE PORCH IS A PLACE HUMOR and SCARES

There was the time Jennifer and Jack dropped off Valentine heart-shaped sugar cookies at Christmas. Or the time the policeman sat there with Sean to interview him, or the time I tripped off the front porch and broke my toe. There was the time Brent sat completely disguised and lifeless on the front porch at Halloween, roaring to life and scaring little kids to death when they walked up to the front door.


THE PORCH IS A PLACE OF TRADITION

There were the times each fall when our kids stood with bouquets of freshly sharpened pencils and carefully chosen stiff new backpacks for the iconic first-day-of-school picture. My good parents started this tradition.....





and we kept it going, year after year.......




first there were four
then three
and then there were two... (Junior Year)


THE PORCH IS A PLACE OF CRUSHES AND CLUES

There was the time when the doorbell rang and we walked out of the house into a porch-turned-cemetery, complete with several headstones and strobe lights and a sidewalk chalk message which read "I'm dying to go with you to Preference." Our porch was a veritable gallery for all kinds of creativity with high school dance "asks" and "answers." It was the beginning and ending place for many a dance date.


sadie hawkin's dance

THE PORCH IS A PLACE OF GOOD CONVERSATION AND FAMILY TIME

There were Saturday or Sunday evenings when we would sit out and watch a lightning storm. Or watch the neighborhood kids play basketball or whiz on their bikes up and down the street. Neighbors strolling by would stop for a visit, discussing anything from presidential elections to managing bee hives.

There were the times when my birthday request was to sit on our porch as a family with an ice cream sandwich and (gasp) just visit. Kindly, my teenagers would acquiesce, and these moments are some of my very favorite times. My kids have a way of making me laugh--- that genuine, deep belly laugh that feels as good as a massage. They would impersonate lines from movies or we would solve world problems like how not to cut off your finger (see above). Of course, there was payback for their time. They always managed to devolve the conversation by bringing up the {completely fictional} story about the time I got angry and threw a frozen burrito.


my mom, nieces and I in Virginia



THE PORCH IS AN ESCAPE

The front porch stories are not all roses and rainbows and soft cuddly bunnies. There were times I would go there to pout or ponder after a fight with my husband or a rough day with my children. There was the time I cried there for hours when I thought our marriage wasn't going to last and hoped that the fresh air would absorb my grief.

There was the incredibly lonely time when my mother drove away after coming to help when our twins were born. I sat on the porch sobbing enough tears to flood irrigate, completely paralyzed and unable (or unwilling) to go back into the house, and face what awaited. For one thing, I missed my mom already so much my teeth ached. And for another, I felt so overwhelmed, scared and anxious at the thought of caring for TWO babies, plus my two-year old AND three-year old......which, if you've been keeping track, was four kids under the age of four. I was tempted to set up a tent right there on the porch. It was far enough away to escape responsibility, yet not so far that I couldn't sneak in for a brownie now and then, and go in at night and watch them sleep, which is the kind of mothering I felt qualified to do. From then on, I would return to the porch many times when I needed some big sky perspective and cloud therapy. Turns out I was the one that usually needed to rock. Not the baby.


THE PORCH IS A PLACE OF CELEBRATION

The front door was often a billboard to announce exciting events, or give congratulations, or leave a welcome note for company. It was a place to hang decorations and show our holiday spirit (or lack thereof, more often!)





The back porch had some stories too. It was the place of lots and lots of parties, where there was often homemade vanilla-bean ice cream churning, steaks grilling or Hires Big H root beer bubbling. The amount of embarrassing and funny stories, laughter, and confessions spilled here could fill a swimming pool.







THE PORCH IS A PLACE OF LONG-AWAITED GREETINGS AND DREADED GOOD-BYES

There were the school days when I would sit on the porch and watch my kids round the corner and come jaunting down the street from school with their backpacks bobbing. I could always tell what kind of day it was by the height of the bob and speed of the walk. If it was a rough day, there was little energy in the gait and the backpack barely moved. Then I knew an extra hug or snack or mommy time was in order.

my grandmother comes to town
first day of new job at movie theater




MY FINAL THOUGHTS.  FINALLY.

If the kitchen represents the heart of the home, the porch is the ante-heart: the place one must traverse to get to the heart. It's like the space between the arms when giving a hug, where love is often wrapped and trapped.

The front porch is a sacred bridge, worthy of its own Pinterest board.

In each of our homes, the porch became the backdrop for old traditions and new surprises, goodwill and goodness, hellos and goodbyes, parties (and party poopers). It was a showcase for seasonal door wreaths and my struggling green thumb.  It was a place where celebrations were shouted and love of holidays were displayed. It was a place where friendships were strengthened, world problems were solved, and teen-age dreams came true. It was a meeting place and a gathering place. It was a place where cares were cast aside and the world passed by. It was a place where friends and families reminisced and sunsets stole away our breath.

oh the stories each of those bricks could tell...

I hope that many of my birthdays will be spent on a front porch somewhere in a rocking chair with a homemade bowl of ice cream in hand and my family gathered around telling stories about the good ole' days of 2014. That is, after we have spent the day river rafting or hiking. I mean, how old do you think I am?

Family and friends...I'll always leave the porch light on for you.

Rock on,
Ms Fish
xoxo





PS: My front porch experiences are not any more special or unique than yours! If you love the porch as much as I do, please share this with others. Wouldn't it be nice for all of us to do more rocking on the front porch, unhurried, sipping lemonade and taking time to smell the roses. Or in my case, or my garden,...smell the struggling roses.

Disclaimer - This blog post is not promotional or sponsored by anyone. All these views and my love for front porches and rocking chairs is simply acquired from personal life experience and was not written under pressure from the Amish, the people of Tennessee or any rocking chair company. I simply want to remember and renew the laid-back front porch lifestyle. However, in full disclosure, if given a chance, I could totally be bought to sample and promote someone's chair. 


source unknown


12.12.2013

Hopper and the Trains


photo credit

Lionel Hopper is famous.

According to him anyway.

-----------------

When I first entered the exam room, I was greeted by the musty, unmistakable smell of abandoned hygiene. On the exam table sat a new patient named Hopper. He was the doppelganger of Doc on Back to the Future, except Hopper's carefree hair wasn't white, but the color of a faded tangerine and he had thick sideburns flanking a face that looked like it housed a lot of stories.

Hopper got straight to the point. He wanted Dilaudid, a narcotic pain medicine for his back pain of 30 years.

Our conversation went a little something like this:

Me: It is our policy that we do not prescribe narcotics for long-term pain.

Hopper: So what am I supposed to do?

Me: What have you been doing?

Hopper: Drinking beer.

Me: How much beer you drinking?

Hopper: Sometimes 1 or 2 beers a day, or sometimes 20-30 cases of beer a day.

Me: 20 or 30 CASES?? (placing huge emphasis on the word cases)

Hopper: You bet....whatever it takes. I've been all over and can't get a doctor to give me some of that medicine.

Me: You've been all over this city?

Hopper: All over this country. I'm FAMOUS!

Me: Really...what are you famous for?

Hopper: Hoppin' trains. I'm a train hopper!!

He said this with a mix of disgust (that I didn't recognize his fame) and pride (as if train hopping were the equivalent of winning the Nobel Prize).

Hopper: I've been surviving on the streets for 30 years.

Me: I could prescribe you some Naproxen.

Hopper: I can't afford that.

Me: But you can afford Dilaudid?

Hopper: Yep. It's the only thing I can afford.

(Along with 20 cases of beer, I thought....)

Me: Would you like a Toradol shot right now to help with the pain?

Hopper: No way. I'm allergic to needles.

Me: You are allergic to needles? (placing emphasis on needles....)

Hopper: Yep, one time they gave me a TB shot and my arm swelled up to here (spreading his fingers about 5" high from his arm).

Me: That means you were having a reaction to the medicine, which means you could have tuberculosis.

Hopper: Nope. It's those damn needles.

After we finished the visit, the nurse walked by as Hopper was walking down the hallway toward the exit. She heard him muffle under his breath,

"I'm never coming to this clinic again...."

--------------------

You win some. You lose some.





12.10.2013

RIPPLES

I love lakes. And the beach--- the smell, endless sky, birds, soft sand. And mostly, I love the hypnotic waves that ripple on and on and on and on.

And yet... here I am living in a desert.

But I realized the other day, that there are waves (of sorts) to appreciate right here in my arid inland life.

My story begins with R, a 50 year female who tripped and landed on her elbow. She didn't show any visible trauma initially, but then large purplish bruises arrived to the party several days late, which caused R to worry and so she came to see me for the first time. With a normal x-ray and exam to back me up, I gave her reassurance that the bruising was a normal response and, "no, you are not crazy to be so worried."

One week later, R  brought in her best friend, I, who had not seen a doctor in several years. The two ladies giggled and carried on in the exam room, like a pair of teenage cheerleaders talking about the football team. I had a boatload of concerns, her health spiraling downward from years of neglect. Over time, we have tackled the problems one by one.

One day, I came in with her husband P, a diabetic who stopped taking his medication several years ago. His diabetes was out of control, bringing with it several other problems along for the ride. Among the first things I did was give him some cream for a bothersome rash. After getting almost immediate relief, he told his daughter to come see me for a rash that she was fighting. The 24 year old daughter, P2, bopped into the office with miserable sores and bobbed out with a prescription for relief.

So..R brought I. And I brought P. And P brought little P up the coconut tree. (Haha...10 points if you can name that book....).

Then there is L. She is an 82 year old firecracker, tough as leather, who was recently diagnosed with breast cancer and underwent a mastectomy. Her two daughters brought her in to see me as a new patient because she was having a reaction to the antibiotic given after surgery.

A week later, I walked into the exam room and saw a familiar face. "Well hello," I said. "Welcome back." One of L's daughters, E, had a few problems of her own she wanted to discuss.. Since then, E has returned several times, and I look forward to her visits.

A couple of weeks ago, as I was taking a history on a new patient named S, she blurted out, "my mother told me to come see you." Turns out, S is just as delightful as her mother and 82 year old grandmother (E and L).

And wouldn't you know it? S has a teenage daughter. And yes, now I have seen her also. Four generations. L+E+S.

Throughout my schooling I heard various providers boast about this sort of thing. "That's what I love about family medicine," they would taunt, "being able to care for the whole family."  Honestly, I didn't understand that appeal.

Until now.

I see they  were right. This privilege brings a certain pleasantness, a kind of soothing rhythm, as I move in and out of their days and observe the ebb and flow of their lives.

Waves.

Oh sure, it isn't a substitute for the beach. But this RIPPLE effect (of seeing friends, families, generations, one bringing another and another) echoes a tiny hint of the ocean and brings a small wave of joy, right here in the desert.

And I don't even have to clean sand from my car.  





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