I am not the world’s best gardener. I’ve tried growing tomatoes but they invariably end up with rot; sweet peppers provide homes for insects more than nourishment for my family; I seem always to be out of town the week that peas are ready to be picked; pumpkins spring up in random places and run wild along the back fence, dying back to reveal pumpkins grown into the wire mesh. So I stick to flowers.

Most of my gardens are grown in raised beds in an attempt to escape the hard clay soil of my yard. In one such bed, four feet by 24, a clump of oriental lilies towers. In the spring frilly irises shoot up and flop over in their top heavy glory. By midsummer, these plants are joined by annuals that managed to seed themselves. There are tall coxcomb in pink and hot red, white and yellow statice, blue bachelors buttons, all jumbled up with the asters, glads, and dahlias I intentionally planted. I tell myself it is all a cutting garden. To the eye, it is a mess.

I discovered several years ago that my dahlias grow best when my beds are raised to a full foot in depth. One long bed is devoted entirely to dahlias that grow up through vertical lengths of netting secured to fence posts. In another long bed I erected posts and cross bars to support the heavy flowers. In another bed I neglected to supply the dahlias with any support this year. The thick stems have flopped over, the flowers blooming on stalks turned upward to the sun. I try to avoid them with the lawn mower, but don’t always succeed.

I am proud of the flowers growing under our towering black walnuts. So many plants are unable to grow under these trees, I like to gloat about my day lilies and cone flowers, phlox and irises that thrive there. Those beds aren’t the most showy, the most glamorous of my yard, and often my gloating falls on deaf ears when my audience isn’t familiar with the challenges of black walnuts, but I revel in my success nonetheless.

A few years ago I took a job that required long hours working out of town. Beginning that August, and for the following year I neglected my garden completely. The weeds I never pulled grew tall and went to seed. I dug the dahlias in early November, dumping the mostly unlabeled tubers in big buckets and leaving them to shrivel in our too-warm basement. By the time I quit my job the next summer, the weeds had taken over.

So often gardening is a solitary business, by both desire and necessity. I know which plants are intentional and which are not; which are weeds and which are coddled hybrids from a specialty catalogue. And weeding can be therapeutic. Not only can you see immediate results, you can sublimate your frustrations as you cuss each evil plant you pull. Still, having weeds is an embarrassment for a proud gardener. They are signs of ineptitude, of a lack of attention and care.

When a large garden club called me to say that they wanted to tour my garden and give me an award, I agreed without thinking. But when I hung up the phone and looked out the window, I could see that the weeds had grown taller than the flowers. I had to get to business. And I had to be systematic, starting at one side of the yard and making my way all the way around, even though I risked not finishing in time. Deadlines are a marvelous motivation.

Every day for several weeks I sat in the garden, rubber trugs at the ready, as I pulled weeds. I cursed every bad boss I’d ever had, every frustration, every disappointment, as I worked. The compost pile grew, then grew some more, finally towering high in the back corner of my yard. My arms grew tan, my back ached, the mulch pile I’d had delivered to the driveway slowly shrank as I topped off each bed once the weeds were gone.

I don’t know how I did it, but when the twenty-five members of the garden club arrived for their tour the garden looked great, and I pretended it was effortless to keep it that way. The day lilies showed off their tetraploid colors; the phlox was starting to bloom; the dahlias were happy though only a few blossoms had yet emerged. The glossy greens and whites of my hostas hadn’t yet scalded from summer drought, and the black walnut garden was in good form. I stumbled through my presentation, not sure what might interest the garden club the most. They handed me a plaque and headed off to their next site on the tour. I hung the plaque on my front porch.

I should have taken photos that day, to show that there was a moment in time when my garden looked almost perfect. I wish it had halted in that perfect phase, had become a place of solace and calm where I could escape all demands. But it didn’t. A garden is nothing if not dynamic. Almost as soon as the garden club left the weeds started to take over again. I can’t look at them without seeing the failure that they represent. Every year I vow to do better. I’ll keep at the weeding, I’ll stake up all the dahlias, water more regularly, remember to actually spread the fertilizer I buy. And I hope again, as I do every year, that if I can just keep up with it all, I will be rewarded with an effusion of flowers, spilling over the beds, lighting up the neighborhood. I will have flower bouquets for every one of my friends, blue ribbons in the county fair, and lots of recognition and praise.

None of those rewards would matter, of course, if I could stop seeing my garden as a chore or a burden, or as something to be battled with and overcome. This garden doesn’t need to be perfect, no one is counting the weeds and issuing grades except myself. I need to see my garden for what it is, a source of beauty and life to be tended and nurtured. Along with the flowers, the healthy plants, the beauty, the work itself – that process of nurturing – can provide solace, too. I just have to let it.

I signed on to pursue an MFA in creative writing at Spalding University three years ago after leaving my last medical job. I had written a first draft of a novel and wanted to make it better but didn’t know how. I thought the MFA might be a good way to do that. I also thought it would help me validate my desire to be a writer, would spur me to write a lot, would provide feedback, help me improve, help me write. Now that I am heading toward graduation, and am yet again procrastinating getting my writing done, it seems like a reasonable enough time to reflect on the experience.

As far as the novel goes, I worked on parts of it with my mentor during the first semester, and, at his encouraging, wrote some new stories unrelated to the novel, part of a possible new project of interrelated short stories. A year later, before a book length manuscript workshop, I rewrote the entire novel, changing some things that needed to be changed, reorganizing the scenes, rethinking the relationships between characters. In the workshop I was given incredibly helpful feedback from five readers. I need to rewrite the book again, need to deepen the characters, need to better define the conflicts. It feels overwhelming. The linked short story project has fallen by the wayside as well. Perhaps that is something I will revisit. Some day.

For my second semester at Spalding I decided to try nonfiction, as I was interested in writing essays about medicine, and figured this would be a good opportunity. To my surprise, I started a memoir about my experiences as a patient which I’ve added to over the next two semesters. I talk about my medical training and practice, family struggles, the death of my mother.

I had expected to have the memoir done by now, but it turned out to be more difficult than I had expected. It was a challenge to find themes, to organize topics instead of just writing a timeline of my life experiences. Before the MFA program, I used to ponder for hours, days, about my writing, thinking and thinking about a subject, or fretting that I couldn’t seem to focus down on a subject. Eventually, the ideas would coalesce, I would sit down at the computer, and an essay or chapter would pour out. I had hoped that the MFA would transform my process into a daily writing official job, but that has not happened. I fret about pieces, panic about deadlines, struggle to focus on ideas, and sometimes a chapter or essay gels. More often it does not. I write because it is expected, but I really hate having my writing come out bad, rambling. I understand, and agree, with the notion that the  best writing comes in revision, yet I seem to be struggling with that, too. The issue seems to be one of focus. Why can’t I focus?

When I was practicing medicine, the pressure to focus came from outside. My focus was on my patients – connecting, trying to understand them, trying to figure out what was wrong and what to do about it, discussing my thoughts with them, and recording the encounter in the medical record. The work was intense. At the end of the day, my patients’ stories rang in my head. The images of their terrible experiences in life – childhood abuse, bad decisions, regrets, loss, grief, sickness – all haunted me. There was no room for the stories I wanted to write. Even when characters popped up in my head and tried to tell me their stories, I had no time or energy for them.

When I was teaching family practice residents in training, their stories – their traumas, struggles, desires, difficulties – along with their patients’ issues, occupied my time. I was embroiled in the struggles of the clinic, the residency program, the politics. My writing was limited to brief chart notes or presentations for the residents’ teaching sessions and grand rounds. I was tired and stressed every minute and the writing impulse faded.

So now that I have had time, now that I am not so stressed, not so fatigued, now that I have opportunity, why haven’t I burned up the computer keys with my words, my tomes? Here’s a writing opportunity on a silver platter but I haven’t finished a book, haven’t published anything except a small short story and a small essay each buried in their respective, small, online journals.

All the while I sit at the computer I am aware of the garden outside filling in with weeds, the lawn that needs to be mowed, the house that needs to be cleaned, the food that needs to be cooked, the bills that need to be paid, the husband who thinks I’m a slacker and wants me to go back to a paying job. I want to be a person who compartmentalizes her life, who is driven to write, who writes. Instead I am distracted and disorganized. Some days I get a lot of gardening done. Other days I cook or clean. Most days I fret about the writing I’m not doing. Occasionally some ideas percolate enough to become an essay, filling in some of the vacant spots of my memoir project, helping me believe I am a good writer after all. Encouraged and newly confident I sit back down at the computer, try again to force myself to write, and again I fail. I tell myself to go with the flow, relax and just think and ponder. As my anxieties rise, I wonder, again, if writing makes sense as a career. I wonder again if I am just fooling myself.

 

Last night the temperature got down to 29 degrees here in Michigan.  My peonies are all in bud, as are my tall allium.  My oriental lilies, while not budded, are tall and growing.  I was concerned about the plants freezing, but because I have so many, it seemed impossible to cover them all.  This morning at 6 am, with the thermometer at a dreaded 29 degrees, I got the bright idea to run the sprinkler over part of the garden. I’d read how farmers in Florida do the same to protect their citrus crops from freezing during unseasonable cold.  The water should be around 50 degrees, right?  What could go wrong?

Well, after two hours of an oscillating sprinkler running over the garden, I discovered that now instead of a little frost on my plants they were completely shrouded in ice.  Ice dripped from the plant supports, from the leaves, and had formed casings around each peony bud.  Yikes.  I turned off the water and cracked and removed the ice as best as I could.  The outside temperature is now hovering around 34.

The lilies were similarly cased in ice.  I closed my hand around the top of each plant to crack the ice which fell to the ground clacking like winter.  The lily leaves look bruised and dark; I can’t tell how the peonies will fare.  I’m hoping that since the allium are so close to blooming that they will be OK.  Maybe they are more cold hardy.  Those buds didn’t seem to have any ice on them.  Darn it, what have I done?

Of course after this debacle, I looked up frost and peonies, and read that it is the freezing of the dew on the plants that causes the damage more than the temperature alone.  That is why most peonies do Ok with some cold, and why covering the plants is important; that prevents the dew from landing on the plants.  So I guess I marched right in and created a problem that hadn’t existed on its own.  There didn’t seem to be all that much dew last night; the cars in the driveway had ice on the roofs, but none on the windshields; the roof of the house across the street had only a dusting of frost; the lawn had frost patches only.  So my watering served to provide the water that would freeze and cause the damage I was trying to avoid.  Looks like I really mucked up the situation.

On the other hand, the Michigan State University extension service website describes using sprinklers to protect crops like blueberries and strawberries, and states that this method is effective down to 23 degrees.  Huh.  They don’t seem to worry about the formation of ice, as the ice stays at 32 degrees and supposedly prevents the plants from getting even colder.  They run the sprinklers until the air temperature is above freezing and rising.

So did I cause the problem, solve it, or make no difference in outcomes?  No idea.  I guess time will tell.

Life is such a learning experience.  I did cover one flower bed that had a number of oriental lilies, irises starting to bud, and newly seeded sections where the seeds may or may not be germinating.  The rest of my garden I left alone; just not enough old bed linens to make a dent.  So there is my controlled experiment: intervention by covering, intervention by sprinkling, and no intervention.  The lilies will be the test plants, as they were in all the test groups.  I have peonies that I sprinkled and those that I left alone, so those results can be compared as well.

Until today I’ve been restraining myself from going to the garden center to buy plants.  I have five flats of annuals under grow lights, and I never did start my dahlias in pots this spring.  After one more possible frost tonight I can start setting them all outside.  Time will tell whether my peonies, lilies, allium, and sundry other plants in my back yard perennial garden will bloom or not after this cold weather and after my failed attempt to prevent damage.  I’ll let you know how it all turns out.

Hello out there to anyone reading.  I am a writer who focuses on Vermont, medicine, physicians, farming, gardening, and the lives and thoughts of women.  I am working on a novel, Family Medicine, as well as  a memoir, In the Country of Medicine.  Even though I am a family physician myself, I know that there is a difference between medical treatment and healing, and that healing is a much more complicated process.  I know, too, that medicine can cause harm, though it isn’t always clear to physicians that harm has occurred, how to recognize it, how to prevent harm from happening, or what to do about it when it does.

Many years ago when teaching a newly designed course in the Doctor Patient Relationship for first year medical students, I mentioned to them that doctors have as much power to cause harm as they have to do good.  Immediately the room turned on me; these idealistic, hopeful students who believed that the very fact that they were going to be doctors must mean that they were good people, could not process the idea that they might  do harm.  Surely only bad people would injure someone.  Surely all the hours of their lives they spent studying at the sacrifice of fun, friends, and family, must mean they were altruistic, well meaning, noble.  Who was I to tell them differently?

In fact, I was a person who had felt the harm of medicine personally, not just through errors of commission, but through errors of omission, neglect, obliviousness.  Of course, by medicine, I don’t limit my judgement to physicians alone, but to all medical personnel.  Surely, as my husband sat writhing in pain recently at the local Emergency Room as he experienced his first kidney stone, the intake nurse could have advocated for him to be seen more quickly; the doctor who saw him could have ordered an IV and pain medication; the nurse in the ER could have arranged for him to be monitored in the hallway even if a room wasn’t available, rather than send him back to the waiting room to suffer without treatment or attention.   I had presented my concerns to these people, mentioning that he might have a kidney stone, or he might have an acute abdomen (a term that signifies a true emergency) caused, perhaps, by an inflamed appendix or diverticulum.  I thought that my input would encourage them to listen, to attend, to take his case more seriously.  It did not work.  As a wife, should I have behaved differently? Should I have yelled at the nurses? Demanded treatment?  Even while knowing that behavior would get us both labelled as trouble makers and drug seekers?  In the end he did receive fluids and morphine, which he accepted even though by that point his pain was changing and the stone had nearly passed.  The final two or three hours of the ordeal were almost blissful for him, as the pain, nausea, agony, all went away.  He came home later that day symptom free, the diagnosis of kidney stone all but certain.

What is the price to an individual of medical indifference?  My husband brushes off that ordeal, reminding me it is over, as we make our own plans for dealing with a possible recurrence (maybe getting his doctor to write a couple of prescriptions for us to keep at home just in case.  I wonder if she would even do that?)  All the while, the memories of that ordeal have nagged me.  I am reminded of other instance in my life when medical care has been less than caring.  When my mother developed seizures as a teenager in the early 1930’s, a neurologist decided the best option would be to irradiate her ovaries; if she didn’t have menstruation, she wouldn’t have seizures.  I came close to never existing until my grandmother cancelled the procedure the day before it was scheduled.  Or when my father was in the hospital after a total knee replacement; he was bored and antsy, as a farmer unable to be outdoors is apt to be, so wheeled himself around the hospital in a wheelchair, his newly operated leg outstretched.  As he returned to the wing where his room was located, the chair malfunctioned, his outstretched foot slammed to the floor, his new knee suddenly locked straight from hyper extension.  As bad as the initial pain from the surgery had been, this pain was even worse.  Yes, he was given pain medication before and after the second surgery to repair the malfunctioning joint.  But no one apologized for the crappy wheelchair that collapsed on him or reassured us that the wheelchairs would be examined and repaired so it wouldn’t happen to another patient like him.  No one apologized for his requiring a second surgery, or the increased bill and operative risk that resulted.  In fact, the staff was hesitant to explain anything that had happened, perhaps afraid of a lawsuit.  Yet how comforting it would be to have someone, anyone, acknowledge my father’s suffering.

Many years later, as that knee replacement started to fail, as his other knee became nonfunctional, my father refused to even consider undergoing another knee surgery.  The outcome of that first experience was so bad in his mind he would never take the risk of going through it again, no matter the degree of disability and discomfort he experienced.  Technically no one did anything wrong from a strictly medical standpoint.  Yet everyone was complicit in worsening his suffering.

So I guess my point here is that medical care doesn’t always seem to have a lot of caring associated with it.  I don’t know that this is a new thing.  And maybe the myth of the caring family doctor of old was just that, a myth.  Maybe the few doctors who were humane, attentive, caring, as well as medically knowledgeable, set a standard no one else can reasonably reach.  I don’t want to believe that, of course.  Instead, I believe that a medical education system that cares about its trainees is more likely to produce doctors and nurses that care about their patients.  Currently, our medical education system is generally cold, inhumane, often abusive.  The products of that system likely haven’t the capacity to care about others, their own needs being so neglected.

Hospitals care about causing harm in that they risk losing funding if data about patient outcomes is unfavorable.  They launch initiatives to encourage hand washing and sterile technique, which have some effectiveness.  In hospitals where staff and physicians voluntarily participate in literature reading and discussion, there is improved camaraderie and respect among the professions, and, interestingly, improved outcomes for the patients.  Sadly, though, efforts to improve hospital culture including improving mutual respect among staff and physicians is not universally attempted or even recognized as important.  Instead, hospitals worry about profit margins, staff worry about cutbacks, doctors worry about productivity, and patients – well, they should worry about all of it.  But in the end, patients are just numbers, bodies to fill beds, insurance numbers to be billed, data points on a spreadsheet.

No, I don’t have any glib answers to all of this; as we Americans struggle to understand our current government, as we struggle to figure out how our health care system might improve and how or why political forces seem determined to make it get even worse, the last thing that seems possible is to make health care more humane and caring.  Still, by talking and writing, perhaps I can be a tiny reminder of what medicine is supposed to be about – not just treatment and cures, but also healing and caring.  Instead of pretending our scars don’t exist, I tend to look at them to see how they happened and how they might be avoided next time.  I want to hope that there can be a side to medicine that cares about doctors and patients alike, and that caring physicians and other health care providers can survive in this hostile climate.

And when I can’t take thinking about medicine any more, then I’ll write about my garden, my writing, flowers, and whatever else comes to mind.  Thank you for joining me on this journey.