Not-Not Disease

I just read a poem over at the med lit magazine Pulse: Voices from the Heart of Medicine, that brought to mind that elusive state of not-not. Family physician Barry Shaver wrote a beautiful poem dealing with indeterminacy. I cut and paste below.

Schroedinger’s CT.


To be
And not to be…
May not be
So bad

Without this scan
We won’t know
If you’re living
Like the rest of us
Or dying
On a more compressed schedule

Once it’s done
You’ll be a zero or a one

Are you sure you want to know?





Dr Shaver could have renamed that moment after concern and before confirmation: not-not disease.

It may be disease. It may not be. 

It is neither and both at once.

Sickness and health. Doom and delight. 

Opposite states of being–being AND not being–compressed into one.


On the Craziness of Clinic

Oh! The craziness of clinic,

really what more can I say? 

Eight patients scheduled by ten o’clock

They never go away!

Double booking, triple booking, and a slow MA to boot

And no one’s sick of anything, except for life–I’m moot!

The real need for all the sick and tired in this mess

Is love and walks and happiness

and broccoli and rest.

To heal the sick and wounded souls who land within my care

I really need a yoga class, and gardens everywhere.

 This medicine thing is paining me

and is it helping them?

Give up the meds, the labs the tests

and heal all from within.



Gratitude Journal

Gratitude is good for you. Science tells us so.

Gratefulness boosts health!

And my health needs boosting.

“Be selfless for selfish reasons.”

Be grateful to be healthy.

Today I was grateful for:

Sick leave, that allowed me to stay home and hawk loogies into paper towels instead of exhausting myself at work coughing on patients

Sunshine, that poured in through the front window in the morning and lit up the lavendar topiary

The Lavendar Topiary–newly added to the plant collection last week, to replace the one I sadly overwatered over the winter. The nursery had two shipments sell out before I could buy them earlier this summer. I asked them to call me when the next shipment arrived. And they did!

The Nursery Worker Who Called–thank you to the diligent and caring garden nursery person who shepherded the lavendar topiary to my home!

Ovaries that continue to produce eggs. Now all we have to do is get them fertilized and grow them into a healthy baby!

The lake and the horizon, with a sailboat sailing by.

Gratitude for green grass, warm sun, and blue waters with cloud shadows.

Daemons, Genies and Our Creative Muse

How do I continue to write after the freakish success of Eat, Pray Love?

So asks novelist Elizabeth Gilbert in this amazing 2009 TED Talk, as she confronts society’s anticipation on her behalf for a mental health breakdown when confronted with the potential to become a creative has-been.

What she was really asking is: what is the creator’s relationship to creativity?

Was she herself the source of the creative work that spoke to so many souls?

Or was she the conduit for the expression of ideas that came from a source outside herself?

She leads listeners on a tour of society’s expression of artists’ relationship to creativity. She begins with the ancient Greeks and Romans who envisioned genius outside of the craftsman, a deamon (Greek) or genius (Romans) who lurked like ghosts in the walls, entering the craftsman to find their expression in the world. Moorish dancers twirling in the night, sometimes elevated by a transcendant energy, a glimpse of God that led viewers to shout “Allah! Allah!” turned to “Ole, ole!” for bullfighters and flamenco dancers in Spain.

Back then, it was said: this creator “has” a genius.

In the Renaissance, when man became the center of the universe, it was said: this creator “is” a genius.

The pressure to be a genius, the pressure to continually be God’s transcendant expression of the divine on earth, is a bit much for a mere mortal. And so, she posits, you see the increasing link between creativity and the expression of mental illness, leading to the modern day conception of great artists as alcoholics and manic depressives, and the fear of a lifetime of instability associated with a commitment to a creative life.

When we remain simple humans, and genius is a companion that comes and goes, we are able to maintain our sense of self as ourselves.  This divine expression no longer is something we must express at every moment, but something that will come to visit us when it does. We make ourselves available to the daemons that visit us. And when we do, our daily labors provide the craft through which genius may be expressed to other mortals.

Beautiful. She takes the pressure off the writer to be anything other than a writer. We are no longer solely responsible for producing a work of genius. We just need to produce material, through which genius may choose to find its expression.

As someone who was paralyzed in writing after winning a college essay prize accompanied by a public prediction of “she will become a Pulitzker Prize winner in ten years!” this gives me the permission to return to writing, with no expectations for myself other than to write.

What I talk about when I talk about clinic…to myself

Every time I get ready to actually go practice medicine in my community health clinic, it is a struggle to get myself to go out the door.

“I hate clinic,” my mind tells me in the morning as I take a shower.  “I don’t want to go to clinic today.”


Much of my mind’s complaints are centered around how slow it is, how much I dislike all the charting.

“I hate our electronic medical record.”

I actually surprised myself by growing to like doctoring back in the days of the paper charts, when I would be done at the end of the day, and my mind was at peace. EMRs take me about twice or more as long to complete for each note.  They’re designed for billing, not patient care. My charting work never ends.

“I like my patients,” I try reminding myself. “Today I have the privilege of supporting people in being healthier.” This helps me get out the door.  Because this is true too.  I enjoy talking with patients, and believe that our encounters are healing.

A decade’s worth of experience working with a socio-economically stressed patient population has taught me to recognize patterns of illness. A gazillion medical complaints? Screen for depression.  Pain everywhere? Screen for sexual abuse. An otherwise healthy 27 year old male who shows up for “a checkup”? Screen for STDs.

I have my good days and my bad days. My good patient encounters and my not so good.

“It will be okay,” I tell myself, as I pull on my shoes and sip my coffee out of the travel mug that a homeless patient gave to me–from the hospital I had to send him to for jaw surgery after he got jumped on his way to clinic.

My patients come to me with diabetes, hypertension, obesity. They come to me with foreclosure, and abuse, and sons killed by senseless gun violence.

They come to me with the pain and sequelae of life. And I do what I can, and advise them to exercise, drink water and eat their vegetables.


The Not-Not Me

In the second year of my college depression, I made a poster for my dorm room wall out of yellow construction paper, black permanent marker, and glittery nail polish.

“Not-Not,” it said in bold black letters, that sparkled in the light.

There was a definition underneath, that I’m not remembering.

Not-not was a term I stumbled across in my class “The History of Modern China.” As an ancient culture shifted and shook, and struggled to invent characters to fit ideas imported pell mell across the nineteenth century — justice, democracy, Marxism–the old world shattered and a new China was born.

Not-not. The opposite of nothingness. Not necessarily somethingness, but not nothing.

For someone struggling to adjust to a world marred with a new found void, I found the concept of not-not reassuring. I was not myself, as I struggled through my second episode of prolonged and deep depression, shocked by the loss of the me I had grown throughout life to know.  I was not not myself, for this was still me. But it was a different me–a slower, sadder me, who struggled to concentrate and express my ideas, who gained twenty pounds and inhabited a body that did not move like the one I had grown up in.

I was not me. Life was not worth living.

And I was not-not me. Life was not-not worth living.

Reading Francesca Milliken’s blog “The Not Me” that chronicles her devastating depression, makes me remember the college me who needed to know that not-not existed, who saw the sparkly writing on the wall and was reminded that there was a space between being and nothingness that could be inhabited and claimed by a word and life could go on.

I just google searched “not-not China” in an attempt to find the definition, and instead found a recent movie by Chinese modern artist Zhou Chen. In 2013, he made the film “I’m not not not Chen Zhou,” exploring China’s modern art world.

Zhou Chen proudly inhabits the space of not-not.  I first saw his work a few years back in the National Art Gallery in Washington D.C.  On the ground were ancient Ming vases. Next to them were ancient Ming vases covered in cheap modern house paints. Nail polish bright colors with McDonald’s logos, and a video and picture series of himself smashing the vases to the ground, and shards of the broken vases.  The ancient Ming vases that are treasures of modern China, now desecrated by Warhol-esque neon paint, become neither treasures of ancient China nor not-treasures of ancient China. They are not-not treasures of ancient China, and in the affirmative statement of opposite forms of being at the same time, express the not-not me who thinks these thoughts today.


Imaginary conversations

The voices in my head– 

she said-

Tell me to hurt myself

To flip the furniture

to yell and scream.

The voices in my head–

she said–

stay in my head

i know they are me.

You are in charge–

I said–

they are visiting you

not directing you.

Insight supported by medication

not psychosis.

The voices in my head–

I said–

are my own voice



filtered into words

Screaming to be heard.

The Hard Knock Life of a Community Physician