Life

Stories from the streets and la clinica

I found this document by accident in a random place on my computer. Reading this over now I am struck by how religious I was when I was writing then. I recall that almost everyone I knew who was involved in refugee health at the street or community level was religious or seriously humanist. We were all doing the best we could.

————————

These are dedicated with gratitude to our volunteers – without whom the clinic and mission could not happen. Some dates are inexact. Last update 5/2005

Waiting for clinic to open

Witness: Every Wednesday at Zaragoza Elementary school we hold parent education classes in the front of the school cafeteria. Every week during those classes the school brings in special needs students to the back of the cafeteria for breakfast. By special needs, I mean those with Down syndrome and other such problems. Week after week, month after month, and now, year after year these children are a witness. What witness?

  • Of the children themselves, setting out on a long and difficult journey, of which they have no knowledge and few resources … the girl in the wheelchair, a beautiful and haunting sight; the boy who struggles with his walker and his limitations; the girl with Down syndrome whose laugh sounds so normal; the tall thin girl, kind of staggering and lost …
  • Of the caregivers and teachers who, with consistent (and unsentimental) kindness, care for children who at times are not easy to care for and in so many ways are disconnected.
  • Of the parents, bringing their tragic children to this school, this place of Hope … last week, a big handsome man, waving and smiling with love at his darling girl with Down syndrome.
  • Of a society that tries to care for the least of these.

So, here’s to you, children, caregivers, parents, and school (and the society it represents and teaches). Thank you for showing me this love and beauty. Last week, right before we left Zaragoza, Cesar Termulo, a fine young doctor who gave the class that week said to me, “Right now, prayer is of utmost importance.”

Trust in Him at all times, O people; pour out your hearts before Him; God is a refuge for us. Psalm 62:8

Blessed are the poor in spirit, for theirs is the kingdom of heaven. Blessed are those who mourn, for they shall be comforted. Blessed are the meek, for they shall inherit the earth. Blessed are those who hunger and thirst for righteousness, for they shall be satisfied. Blessed are the merciful, for they shall obtain mercy. Blessed are the pure in heart, for they shall see God. Matthew 5:3-8

Take heart daughter; your faith has made you well … Matthew 9:22

Waiting room

Amen (10/2004)

Going back to the question of eternal things … this is written by Lindsey, a high school student who is one of the Agape volunteers: Three friends and I stayed at, and worked in, the Long Yan Orphanage with the 17 special needs kids. They ranged in age from 4 to 18, and there were only 2 Chinese nannies per 12 hour shift to watch over them. Most of the kids didn’t have names. We gave them each a name that seemed to fit – Jason, Isaac, Daniel, even Bo. I will tell you about one of the 17 who won our hearts; we named her Annie. She thirteen years old, but was unable speak, sit up, or move from her wooden pallet. She was painfully thin and always restless.

We thought she was severely retarded and unable to understand us, but still we sat with her and talked to her, just to pass time. One afternoon after we’d been there about a week, Jessa, my good friend who lives in China and speaks Chinese fluently, was sitting with Annie just talking to her. As she switched from English to Chinese, she saw Annie become very alert, looking up at her with her brown eyes. She asked, “Annie, can you understand me? If you can understand me, open your mouth.” Slowly, Annie did so.

After that, she and Jessa worked out a system of communication and Jessa could get Annie things she specifically wanted. And every day, Jessa told Annie about Jesus.

The last day we were there, Jessa was sharing the gospel with Annie again. She decided to ask Annie if she wanted to pray and receive Christ. When she asked her if she wanted to, Annie opened her mouth- her way of saying yes. Jessa led her through a simple prayer and when she said, “Please forgive my sins and come into my life.” Annie began crying and crying. After a time, she calmed down and was filled with a peace I had never seen in her before. Jessa told her, “Annie, you’re my sister now. I’ll see you in heaven!” Annie looked up at her and squeezed her hand really hard.

Bobbie Baxter, MD, Agape founder and medical director

After I got home, I learned that Annie died three days after we left the orphanage.

Meeting Annie changed my life. I can’t wait to see her again in heaven. All the orphans taught me more about God’s heart. Since I’ve been home, I’ve found so many verses in Scripture about how He cares for the helpless, for the fatherless. One of my favorites is Psalm 10:17-18, “You hear, O LORD, the desire of the afflicted; you encourage them, and you listen to their cry, defending the fatherless and the oppressed.”

(I know Jessa & Lindsey will take no credit for what happened, but I want to note that however it happened, they heard, encouraged, and defended the afflicted with hope where there was no hope.)

Grace: At la clinica we started this week doing physical exams on children just removed from their family(s) because of abuse. Case workers from the residential facility where the children will live (Jonathan’s Place) bring new children to Agape for their intake physical. There were 13 last week, but I expect fewer next week. It’s strong. Because in Texas, it takes a lot of abuse for a child to be removed from a home, what with all our “family values” – yeah, right. As much as the children, this is for the staff at Jonathan’s Place. What follows is from an email I sent to my son after the first day:

Chris Wynn, our chaplain, now gone to Colorado, fall 2004

“So when I was writing (to someone else) I was thinking I wanted to tell you. But since its you, I’ll say more: The people (caseworkers) that were with the children were all young (of course): Katy has been at it for three years & is very intense & real; Keisha started two months ago – shy, nice; Ashley came in late – she feels really solid. Sometimes I wonder, what did I do to deserve this – to be around people like this. Not to lay religious on you, but it can’t be anything but grace. And isn’t that a beautiful idea. End of email. The second day there were eight more children. This time Chris, a young man, intense, sweet-natured, solid. And Ashley again. High compliment to say, I’d take her on patrol. Reality is they’re taking me on patrol – lucky they’re short patrols. Students & I trying to get up to speed on exams, learning what we don’t want to learn; the students are doing a good job.”

Had lunch at Grace with students and Andy Macha. Was telling him about the situation with Jonathan’s Place – some of the emotion – and he gave me a teaching. From the perspective of his 16 years with Child Protective Services he talked with us about balance & perspective with the goal being to be better able to do a good job. 9/2003

Humbled – again: Last week was humbling. Actually, in this work, most weeks are humbling – if we pay attention to what is happening around us, with whom we are working, and what we are doing. First, there was a family from Chile. The wife was a university-educated midwife in Chile and is now working in a day care center. The husband was an executive financial analyst and is now driving a truck. Then there was a five-year-old boy without parents in the home. He is cared for by his 18 year-old brother who is not doing that bad a job. A woman brought in her feverish four-year-old daughter. Her husband, an engineer, has been out of work for a year and has come to Dallas to go back to school. Several people in the family have been ill, and they spent all their money on the first three people who were sick. We treated a 56-year-old dispossessed farmer from Zimbabwe. After losing his life’s work he is starting over in America. There was a two-year-old child with flaccidity, decreased intelligence and development, and the sweetest nature; and the most beautiful parents seeking, seeking that which cannot be found – hope for recovery. Ah, Valeria, beautiful one. And finally there was a 16 year old who brought her grandmother in. The grandmother is from rural Mexico and is unable to read or write. Her granddaughter works with us as a Saturday volunteer and is planning on going to Baylor or TWU to major in nursing. From generation to generation, country to country, hope to hope – how can we be so fortunate to do this work.

Consuelo and her grandmother

Eternal Things: Awhile ago a former student challenged me to focus more on the eternal. I was not sure how to do this, but my respect for her is such that I’ve kept it in mind, waiting, I suppose, for a sign. I know that we do the work of the Samaritan; and I know there is scriptural basis (in all religions) for such work, but it just seems like what we do. About a month ago we were asked to help care for Mr. S., a man with terminal illness. Mr. S. was a Parkland patient with no insurance or Medicare. The deal we worked out was that the Parkland nurse practitioner would see him several days a week and we would go on Tuesdays and Thursdays so the Parkland NP would have a break.

Mr. S. lived with his son and daughter-in-law, their three children, his wife, and toward the end, his two sisters – all in a two-bedroom apartment in South Dallas. The daughter-in-law did nearly all the care for Mr. S., and the sisters took care of the children, cooking, and so on. What a magnificent job the daughter-in-law did! What a wonderful family.

Last Thursday we were there, changing his dressings and getting him cleaned up. By this point he had gangrene in both feet and pneumonia; and the cardiac insufficiency that brought him to this point was worsening. Clearly he was close to death. As always, when we finished with the physical care, we had a prayer with Mr. S. and his family. Lupe (the Agape promotora) prayed with us and for us and as always, we were touched. Mr. S. died at home that night. I thought about the time we spent with Mr. S., and especially the last day and the last prayer. I think that was an eternal thing. 4/2002

Hands: I helped serve communion at Grace a few days ago. People came up to the front of the church and knelt and I served the wine while the pastor and a Cambodian girl served the bread. All kinds of hands – slender, soft, calloused, children, old – one man had a lot of prison tats and another (Asian) had a cross tattooed on the back of his hand. Later I realized that he was part of the Burmese (Karen tribe) family sponsored by Grace. I talked a little with him after church and learned that he worked with Dr. Cynthia Muang on the Thai-Burma border. Dr. Cynthia is a hero of mine. Small world. 11/2004

Thank you: My friend Chuck was playing poker last week and was dealt a straight flush! He showed up at Bible study with a check for la clinica. Here is my thank you letter to a good man.

Refugee camp where Dr. Cynthia worked

“Thank you very much for your generous donation to the Agape Clinic. I think a lot about what we are trying to do at the clinic and why and whether we are wise in our work and our stewardship. The answers to the questions usually come from our patients. Here is what you are investing in …

Last week a woman came in with a complaint of several months of abdominal pain. She was seen by a nurse practitioner student with translation assistance from a 15 year-old neighborhood girl.

The NP student’s path is not all that different from mine – she is 50 years old and has worked in hospice for many years; and is in the NP program as a means of getting ready for the rest of her life. The neighborhood girl’s path – at least early on – is also not that different from mine. She is in trouble and working out court-ordered community service hours.

They were all in the exam room for a long time. Finally, the NP student came out and told me that the patient had been raped coming across the border some months ago, is having symptoms of pelvic inflammatory disease, and is depressed. She had never told anyone before now and was deeply distressed (meanwhile, the 15 year-old was sitting with the patient). We can treat PID presumptively, but this woman also needs HIV and other testing. So, we helped her get an appointment to a women’s clinic; set up for Lupe, our lay health promoter (salary paid in part by First Presbyterian), to go with her to the appointment; had a pretty intense prayer with her; started her on Paxil and pain medication; arranged for her to see a counselor; and moved on to the next patient.

The point (I think) is that all these strands (volunteers, students, troubled youth, donations, community, prayers, and more) come together in this safe place where mercy is practiced. Every one of the strands is critical. Thank you.” 7/2003

February 2004: It’s been an intense several weeks. It began with a child who had been raped and was dealing with it. Dealing with it! She had two very sad little sisters and was holding and comforting them. I don’t know what to think of that – there is more than one way. The whole thing just very sad.

I went to a party where pretty much everyone from Common Grace Ministries was. I was a lot better off when I left than when I came. I’m really grateful to have been there. The thing about most of the people there was that they live lives seriously dedicated to Christ. Toward the end of the evening we sang songs like …

Let the poor man say I am rich in Him
Let the lost man say I am found in Him
And let the river flow
Let the blind man say I can see again
Let the dead man say I am born again
And let the river flow
Let the river flow

Last week the students on outreach saw a family with a history of several generations of violence and gang life. The focus of the visit was a child with uncontrolled asthma. Last year the mother’s boyfriend put a gun to the child’s head and pulled the trigger. The gun didn’t fire but lives already off-track swerved suddenly way out of control. The boyfriend is in jail, awaiting trial, but the child is having serious problems that are intensifying as the trial date nears. The dangers this family faces are short-term (this deal is not like litigation and some of the players are deadly) and long-term (how can this child stay out of gang life or a psychiatric hospital?). So here is what we did:

  • Started the child on preventive asthma care and taught the Mom how to better care for the asthma and allergic rhinitis.
  • Set the child up with same-day psychiatric care – the sort of care the Mother had sought unsuccessfully for months.
  • Worked to ramp up support from other providers.
  • Started the Mom on antidepressant/antianxiety medication and made psychiatric care available to her through our psychiatrist.
  • Started the Grandmother on hypertension medicine.

Then we prayed together, “Father, Thank you for bringing our lives together in this moment …” We’ll follow-up next week.

Later in the day Esmeralda’s Mom came in. Esmeralda was killed in a fire Christmas 2002. I’ve known her Mom from around for 7 or 8 years. I had not seen her since the funeral.

Estevan Garcia and me

A man came in seeking antibiotics, diabetes, and pain medicines. He had been discharged after 2+ weeks in Parkland with deep diabetic ulcers high up in one leg. He had been given a prescription for Levaquin (30 days worth – very expensive) and several other medicines and was unable to buy them. He had been off the Levaquin for several days – a dangerous thing to happen. We were able to (1) take care of the medicine and (2) accompany him on a six hour visit to East Dallas Health Center and help with registration and obtaining needed supplies and medications. This may save his leg. Leslie, our social worker took the lead on this and one can only stand back in awe at what she was able to do.

Last week we saw 102 sick patients; had 28 women receive mammograms (through UTSWMC); screened 40 people for HTN, DM, BMI, asthma, and so on; started treatment on several of them; held a class on women’s health for about 35 women; taught several classes of children; made 9 home visits; taught 8 nursing students, one seminary student, one FNP student, and one faculty member; participated in several miracles; and more. Thank God

Sadly Ridiculous: Rudy is eight years old. He was sent home from school on a Monday because he had tinea capitis (ringworm). His mother brought him to us Friday of that week because she was unable to register at the East Dallas Health Center (EDHC). That’s five days of school missed for ringworm! We treated him with medications supplied through a grant from the Open Ring Class and he is now fine and back in school. 2000

Community garden. Student on outreach

Frightening: Mrs. T. is 52 years old. She has diabetes, hypertension, and problems related to these, e.g., decreased kidney function, peripheral neuropathy, and other problems. Typically, she goes for days to weeks without medications, thus compounding her problems and hastening her first and inevitably early heart attack or stroke. We supplied her with some of her medications, spent a lot of time teaching her about the illness and self-care, and worked to get her registered at EDHC. She is now registered and receiving quality low-cost care. 1999

A Long Time: Mrs. C was a 58-year-old Cambodian woman who had undetected cervical cancer when we found her in door-to-door outreach. She lived in a one-bedroom apartment with her husband and three children: an eleven-year-old son with Down’s, thirteen-year-old daughter who provided most of Mrs. C’s care, and a fifteen-year-old son who was sent to prison midway through the course of care. Her husband was an alcoholic and not involved in her care. One of her neighbors, Pheng, took care of Mrs. C’s children much of the time. This was not a small thing, as Pheng lived in a two-bedroom apartment with her husband and five children.

Mrs C had a terribly difficult life. She grew up poor and in her middle years survived war, torture, forced labor, and became a refugee several times over. When I met her she was an alcoholic and abusive to her children. Mrs. C spent most of her days and nights lying on a small couch in the apartment living room.

Students and faculty were instrumental in the cancer being diagnosed, played a critical role in getting the patient through two courses of treatment (surgery and radiation), and took responsibility for her home care following crises related to very severe complications of disease, treatment, and her own well-hidden alcoholism (septicemia, stroke, seizures, bowel obstruction, malnutrition, and dehydration). For two years, Mrs. C received at least three home visits each week. She agreed to hospice care about two months before dying.

It was clear to all concerned that Mrs. P was spiritually bereft and without hope. Using both Buddhist and Christian translators, we tried counseling and to address hope and other spiritual issues in several different ways. Although she was nominally Buddhist, she refused offers of transportation to the temple. On several occasions she accepted gifts of objects sacred to Buddhists, but after a few days would put them away. Several Christian missionaries visited on a regular basis and although she did not resist these visits, neither did she respond to them. Everything we tried seemed to fail. She did, however, seem to appreciate our efforts to care for her and her family. The only thing that we saw that affected her was when one day a nursing student knelt unbidden beside Mrs. C’s couch and prayed. Although Mrs. C understood little of the prayer, tears began to run down her cheeks as the young woman prayed. Afterward, Mrs. C whispered, “Thank you.”

Schistosomiasis lesion

The week before she died I went out of town for a conference. I returned late Sunday. On Monday I left for work early so I could see Mrs. C first. I walked into her apartment and at that moment, she died. Two hours after she died, the only people left in the apartment were her daughter, one of Pheng’s daughters, and a gangster friend, Ranny. Ranny suggested that Mrs. C should have “something pretty” on. So we removed her clothes, bathed her poor wasted body, and dressed her in a pink T-shirt and her best sarong. Approximately 1996-98

Waiting room. Leslie on phone

Strange People: In the course of outreach, one of the students made several visits to an apartment where a 60-something year old woman lived with a younger man and woman. The younger woman was very seclusive and every time we were there she had blood in her mouth (but no other evidence of trauma), and would not let us close enough to determine what the problem was. In conversations with the older woman we learned that the man (call him Jimmy) was “helping” a 10 year old girl who lived nearby. Over several weeks the story came out that the girl had a bad home life. Her mother lived with two men and was intimate with both. The girl was afraid of one of the men and so spent as much time as she could with Jimmy. She bathed at his apartment and at least once a week she spent the night with Jimmy, sleeping with him on a fold-out couch. According to the older woman, Jimmy and the girl liked to wrestle. Needless to say, when the story came out we took quick action. I remember the student on this case saying in a very serious way, “Mr. Kemp, I think there may be a problem here.” We talked with a detective of my acquaintance and he went after Jimmy and brought Child Protective Services in on the case. I do not know the final outcome, except that the girl was removed from her mother’s home and Jimmy disappeared. Good work, Dear student. 1995

Connections: Jessica came to the clinic with severe onychomycosis. We had enough itraconazole (a very expensive drug) to give her one pulse, which we did. We then contacted a dermatologist who gave us enough to finish the treatment. The last time we saw Jessica, her fingernails were growing out with no sign of infection. This was a good thing, but Jessica is not really the point of the story. Through the process of treatment, we noticed that Jessica’s mother, Maria, seemed distressed. We asked her what was going on and learned that she had no money, her children were going hungry at school, and her husband had been deported. Lupe, our lay health promoter helped get the children signed up for a lunch program and we were able to give the Mom some money. Here is the point of the story: Because someone noticed that something was wrong and Lupe was helpful, one of the neighbors called Lupe in the second week of December, to tell her that the Mom had been killed. The neighbor, Cecelia, took care of the children for eight days until enough money had been donated to send the Mom’s body back to Mexico.

The point for all of us is that we need to keep paying attention to what else is going on around us besides physical illness. Because someone noticed, we were able to participate in sending Maria home. 2000

A Hard Spring: In the spring of 2000 we (Baylor Community Care) lost significant medical services, had to move the clinic twice, were burgled, and an important working relationship came to an end. In our most difficult times in late spring and early summer, we were down to seeing 10-12 patients in one clinic session/week. Though it was a painful time, what stands out the most to me about this time is the people who stayed with the work: Estevan Garcia, Sharon Lehmann, Leslie Kemp, Alison White, Martin Hironaga, Debbie Schwartz, Lupe Springer, Martha Sanford, Marilyn Hightower, Kathryn Marshall, and Edwin Read. What a team! We are now part of the Agape Clinic, our situation is vastly improved, and the team remains largely intact.

Outreach in the community garden

Pentecostal: I was in an exam room with a patient and a student. The patient was a Mexican woman who worked in a chicken processing plant. Her job was hard and entailed repetitive pulling and twisting (of what, I hate to think). As a result, she had a repetitive motion injury. She was treated with an NSAID and encouraged to talk with her supervisor about changing her task at work. The patient had some personal issues as well.

The student was a Pentecostal. I realized that while our medicine would be helpful to the patient, what would ultimately be most helpful would be the Spirit-filled presence and prayers of a person like the student. I feel something very real and fundamental about the Pentecostals who work with us – and there seems to be more of them as time passes. What a glorious time this is – when Presbyterians, Pentecostals, Catholics, Methodists, Baptists, and others can work together for the Glory of God – somewhere between heaven and earth.

Tattoo: During a clinic session at Midpark Place (an early clinic site in the Kurdish community), I fell into conversation with an elderly man who had brought a Russian Jew to the clinic to pick up medications. I noted the elderly man had a faded series of numbers tattooed on the inside of his arm, horrifying proof he had been in a nazi concentration camp. In that same room at that same time there were Baylor students (mostly Baptist), Catholic volunteers, Kurds (mostly Muslim), an Armenian family (history shows that Kurds participated in the attempts to exterminate the Christian Armenians 1894-1915), and a Buddhist caseworker. Moments like this help me remember the beauty and power of this work. 1997

Reach Clinic: Awhile back a woman brought a 22 month-old girl in to our clinic. The child had two problems: (1) a “rash” that turned out to be genital warts and (2) a prescription for a medication for the warts. The medication cost $140+ and the woman could not afford it. She had been given the Rx at a clinic (the Reach Clinic) that treats children and infants who have been sexually abused. Dr. Garcia called the clinic and was told that the prescription can be filled there and an appointment was made for the woman to bring the child in next week. We followed-up and discovered that the woman did not keep the appointment. After several more contacts back and forth, the child got back to the Reach Clinic and received her medication. Not everything is at it seems initially and sometimes people need a lot of encouragement. 2000

Home Visit (from a student’s clinical log): Thursday, my partner, April and I went to visit a patient with diabetes, lupus, and hypertension. She was noncompliant with her medications she was supposed to be taking; and was taking at least one medica

Window at Grace Church where clinic was

tion (hydrocodone) that was intended for someone else. She said she had been taking the hydrocodone along with her medications when she remembered and she never looked at the name on the bottle to see if it was hers. There were 12 out 24 pills left in the bottle. She said after she took the medication she felt very tired. She told me about something that happened last week that I found very interesting. An Angel appeared to her when she was sick and said, “Come on. It is time for you to go you are very sick”, and Ramona (the sick lady) said, “No I am not ready to go.” Still in Ramona’s dreams she can see the Angel’s beautiful eyes and she feels that she is having an out of the body experience and the Angel is carrying her. I asked Ramona if she had ever asked Jesus Christ to be her personal Savior and to forgive her of her sins. She started crying and said, “Yes I have.” I then asked her if she and her friend would like to pray. They both said yes and we all joined hands and I prayed for them. I referred Ramona’s friend to Parkland, for pain and discharge from her left breast. She called while I was there and made an appointment for that day. 1999?

Split Shift: I was seeing a ~50 year old woman with diabetes and an inf

“Not too tall”

ected toe (Those go together – horribly in some cases.). Somewhere during the exam I realized she worked at a major hospital. I was irritated. We are a small overloaded mission clinic serving people who have nowhere else to turn; and of course this woman had insurance. I told her we would take care of her infected toe and tide her over with oral hypoglycemics. But she should use her insurance and see a private doctor or go to the hospital clinic. While I was getting her medications, she told Lupe (our promotora) that she worked for a temp service and did not have insurance. Lupe told me when I came back into the exam room. I felt small – so much for my cheap irritation. I asked the woman to come back in the following week first thing in the morning, fasting, so we could get a better picture of her blood glucose. She then told us she worked a split shift – 6-10a and 4-8p. Have you ever worked a split shift? It is really hard – you’re never really off. So this is the life our patients lead – very, very hard; out of meds half the time; putting up with irritated clinic people. When she returned three weeks later (no diabetes meds for the last two weeks) she told Lupe she actually did have insurance, but did not know how to use it. This also is the life many lead – paying (top dollar, I might add) for something they cannot use. She is scheduled to return next week for a blood glucose check and help from our social worker to be able to use her insurance. 2001

On Columbia … There are women walking children to school

You are the salt of the earth … you are the light of the world … Matthew 5

Olongapo!

In 1966 I was in a special landing force (SLF) on the USS Vancouver, a “landing platform dock“ ship on the way to Vietnam. The ship had a cavernous bay (the dock) with the entire stern being giant doors that opened out into the water. LVTs (landing vehicles tracked) were parked inside and when ready for a landing could drive down a ramp into the ocean and then to shore. There were around 500 Marines in our unit and I’m guessing there were 30-40 LVTs inside the bay. When the LVTs were starting up it was a huge roar and smoke

USS Vancouver

everywhere inside the bay and we were lining up to climb inside ready to go into the water and to the beachhead. Topside there was a landing platform from which several helicopters could take off or land at the same time.

After an uneventful voyage from San Diego to Pearl Harbor and on to the Philippine Islands we docked at the Navy Base Subic Bay on Luzon. I think we were there for about a week the first time we were there and after a few weeks in Vietnam we went back to Subic for an unexpected 10 days. Most nights we went on liberty from the ship to the base and from there into the town of Olongapo, or at least to Magsaysay Street, the one street in Olongapo that wasn’t off-limits to Marines

LVT. You can see a Marine hanging off the side and a driver up-front

and sailors. The street was 8-10 blocks long and was mostly bars, cafes, hour hotels, and the like.

Somewhere in there we made a practice landing on the island of Mindoro. When we hit the beach there were islanders selling orange sodas and good, heavy knives that were better than machetes for cutting your way through jungle and brush. Some of us traded ammunition for the knives. We practiced tactical movement in the jungle on the mountains in the rain. It was challenging, but not as challenging as combat.

Liberty on a beach in the Philippines or Vietnam. 

At the gangway from the ship there would be a Marine and a sailor who would look you over to be sure you were squared away enough to leave the ship. At the time we were required to wear tropical khaki uniforms ashore instead of utilities (like “fatigues”). We were there during monsoon, so it wasn’t easy to keep clean uniforms. When it was raining we would wear a raincoat with trousers clean and pressed from the knee down; everything else would be wrinkled and even muddy or moldy. But that was good enough to get us off the ship. We would ride from ship to shore in open landing craft, dock at the base, and then head either to the Enlisted Men’s Club for okay food at a good price or go straight on into Olongapo.

The base had an exit gate that opened onto a bridge over a very polluted river where Filipino boys swam and shouted for coins. When you’d toss coins into the water they would dive for them. Just past the bridge the party for doomed youth began. Bars were usually segregated according to service, interests, or race – some were for sailors and some for Marines; some for country music and some for rock and roll; and some were for white guys and some for black guys. Going to the wrong bar could end up in a fight, but that could lead to arrest by the Shore Patrol and a night in the brig and no more liberty so actually everyone was pretty well-behaved for drunken Marines and sailors. Most bars had bar-girls or prostitutes who could be taken out to a hotel after paying the mama-san, the older woman who managed the girls. Payment for sex was separate and between the girl and her customer. Most bars had a sign demanding that guns be checked.

The only time I went off Magsaysay Street was when some of us took a jeepney to a brothel in another part of town. Part way through the party there was a raid by the Shore Patrol and we had to run for it. As we ran through the gate to the brothel one of the guys hit his head on an iron overhead – Bong! – and was staggering around confused and had to be pulled into the escape jeepney for a wild ride back to the legal part of town.

Photo in a bar in Tijuana, but it captures the vibe

I met a sweet-natured woman named Delia. We spent time in the bar where she worked, in cafes, and in a hotel. I remember once she coughed and spit it out on the floor of the bar, but I didn’t care. It was an intense time, especially the second time we were at Subic, since we had already spent a few weeks in VN, had been blooded, and so really knew what the score was. The “score” was that this was very serious business and some of us would be killed.

At the DMZ where we ended up

I ran out of money and had to make some to keep going into Olongapo. One of the guys in my company had already seen enough combat for his taste and was trying to avoid going back in. He and I worked out a deal for him to pay me to break his trigger finger. He laid his finger on a step on a companionway (like a ladder) and I hit it with an iron bar. It didn’t hurt as much as he expected and he said something like, “You didn’t do it!” and I said, “Look at it.” He did and he saw that the finger was going sideways and bleeding. I got my money and he got out of going back to VN. I recall that a few weeks later after we’d taken some serious casualties he pretended to try to get on a helicopter going from the ship to the field and was restrained by someone – phony drama. I’m glad I did it: we got rid of a quitter and I went to town. My guess is when he got out of the Corps he presented himself as a badass combat veteran haunted by the war.

For awhile my ambition was to own a bar in Olongapo or Tijuana or someplace like that. There would be prostitutes working there (but no cribs) and I would have my office on a balcony overlooking the blue-lit bar and I would sit up there drinking gin and tonics with my girlfriend.

———————————-

Writing a book, memories

Worthwhile to click this photo

Sometime around 1988 my mother was diagnosed with small cell carcinoma of the lung, a type of lung cancer with few survivors. At the time she was living in the small house we built for her behind our house in days memorable for their sweetness with David playing at Grandmother Mary’s house standing on a little step stool (the stool is in my utility room 40 years later) at her kitchen sink playing in the water, helping her cook, just being there and all of us having dinner together several times/week, hanging out in the back yard, hanging out at my Mom’s and Leslie’s and my house where in the living room we had taken some of the furniture out to fit in a giant (~7x4x4) heavy cardboard refrigerator box I’d gotten behind Weir’s Furniture store and cut a little door in to fit 2-3-4 year old children and there was a window and a blanket on the floor

Lung cancer, natural history 1 (See multiple potential causes of difficulty breathing in lung cancer, some of which can be alleviated or even eliminated.)

inside and lots of pillows and stuffed animals – altogether a much better entertainment center than a TV! But back to my Mom and the book…

To her situation I brought some solid hospice experience, some good clinical skills and knowledge, some understanding of the end of life, and a commitment to take good care of my Mom. At the onset of all this I thought I would ramp up the care I would give by reaching a greater depth of understanding of lung cancer. My explorations evolved into a kind of chart that explicated what I thought of as the natural history of small cell carcinoma, including the most common sites of metastases, oncologic emergencies, and paraneoplastic syndromes. I consulted and clarified the chart throughout her illness and in at least one instance I was able to instantly identify and intervene in an oncology emergency (cord compression) before it became an emergency.

A few years after my Mom died (https://ckjournal.com/how-my-mom-died) I thought I would expand on what I’d done re the natural history of cancer. To that end I charted the natural histories of the 18 most lethal tumors leading to death in the US. Each tumor type was broken down into:

  • Primary tumor
  • Sites of metastases
  • Problems related to the primary tumor and metastases
  • Assessment parameters

(Later these tables were reproduced and further expanded in a series of articles in the American Journal of Hospice and Palliative Care.)

The tables anchored my book, Terminal Illness: A Guide to Nursing Care, published by J.B. Lippincott (1995, 1999). The book also explored individual and family responses to terminal illness, spiritual and cultural issues at the end of life, pain and other common physical problems, and diseases other than cancer encountered in hospice and palliative care. It took about two years to write.

Lung cancer, natural history 2

The reason for writing the book was to improve the care of people at the end of life. It was intended primarily for hospice nurses and others working in hospice and palliative care, who, in the course of one week might see patients with cancers of the lung, colon, pancreas, head and neck, and someone with end stage myasthenia gravis. And in the next week see patients with cancers of the esophagus, prostate, ovaries, and so on. That’s a challenge to provide quality care to people with so many different problems! The book was a tool for doing quality care at the end of life, a tool for practicing loving kindness.

For Absence

(A blessing for those who have left us and for we who are still here – the author is John O’Donohue) 

May you know that absence is alive with hidden presence, that nothing is ever lost or forgotten.

Not far from our home somebody made this sculpture/memorial for a good old dog who passed away. Good Boy!

May the absences in your life grow full of eternal echo.

May you sense around you the secret Elsewhere where the presences that have left you dwell.

May you be generous in your embrace of loss.

May the sore well of grief turn into a seamless flow of presence.

May your compassion reach out to the ones we never hear from.

May you have the courage to speak for the excluded ones.

Make you become the gracious and passionate subject of your own life.

May you not disrespect your mystery through brittle words or false belonging.

May you be embraced by God in whom dawn and twilight are one.

May your longing inhabit its dreams within the Great Belonging.

______

Jean gave me a book of blessings, To Bless the Space Between Us by John O’Donohue. We read from it most mornings and take great inspiration from the reading. It is a wonderful way to start the day – a blessing in itself.  

Thoughts on life review at an advanced age

The final stage or conflict (or state of mind or life theme) in life is integrity vs. despair. As with so much else in a person’s life, these states of mind are not necessarily clear-cut. I think what we want to do is incline ourselves toward integrity vs. inclining toward despair or kind of drifting along with under-lying despair. How does that happen?

Andy’s Dream by Jean Cacicedo. Used with permission.

I believe it’s true that we’re generally doing the best we can under the circumstances. Most of us could sometimes do better, but still, looking back, not bad.

It’s not about accomplishments in the common use of that concept. For some people it’s a great, great accomplishment to be a half-way decent person – to not be abusive or mean. I mean, wouldn’t it be a beautiful world if everybody was non-abusive, not mean, not a cheater! So yes, good work, mate!

One way to move toward positive resolution (integrity or integration) is to deepen one’s life review. I say “deepen” because most people do think about their life, even when they try not to think about it. Too often we focus on negatives, losses, mistakes, failures, bad things beyond our control (like a hard childhood or poverty or death), and stay stuck on those parts or even pretend that they don’t exist. But they do. How does one get past failures or lacks in life? Here we go with one conception of the deepened life review.

(Life review is a psychological, emotional, social, and ultimately spiritual process of exploring one’s life past and present, how it unfolded, choices made, relationships, losses, patterns, themes, values, and other core dimensions of a life.)

One way to review in a holistic way is think about in detail 5-8 things in each of the below categories:

  • What is missing in life now (people, activities, abilities).
  • Wonderful things that have happened.
  • Regrets and mistakes and bad things that happened, including those we had no control over.
  • Hard times and getting through them.
  • Good moves/accomplishments.

Looking closely at these, we can see that there may much to grieve, there may be things that have wounded us, things that have wounded others, things that are hard to see and accept, things that were and were not our fault. It is my firm belief that going deep into the negatives is necessary to really see the positives – the beautiful things, the life accomplishments, the strengths, the beauty in not being mean.

Ahhh, the beautiful Wind Rivers

There are other life review processes. My focus is on words, but of course there are other means of expression such as art, music, and other ways of self-expression. Many include recommendations to do it as part formal group or with professional guidance. That’s not necessary. Google or ChatGPT will yield several structures for doing one’s own life review.

Life review processes or techniques include:

  • Mapping time, e.g., a history of life (key events, motivators, people, emotions, decisions, stressors, etc.)
  • Taking a deep dive into turning points and thresholds (what was life like before and after and after the change, what inner and outer resources were involved, what was left behind and gained, and what issues still linger).
  • Writing letters to my younger self at three specific ages/turning points.
  • Writing four to five “stories that made me who I am today,” including lessons learned.
  • These are directed toward integration vs. nostalgia.

It is a worthy thing to do is write one’s obituary, eulogy, or things you would like to be remembered for after you die.

6 am

This is written with the idea that some readers might consider this for themselves. Any age is a good time to do it. Old age is an especially good time to do it.

Background: Based on experience and other explorations of life and death I developed training for staff in the first hospice in Texas. Training included values clarification and life review for everyone who would be working in hospice (originally called the “obituary exercise”). The idea was to increase self-awareness and thus increase understanding and empathy around this major life event – the end of a life. Every training, class, or workshop included a lot of content on the practicalities of physical care at the end of life. Variations on the initial training continued in the original hospice, other hospice programs, workshops, and into undergraduate and graduate courses on the end of life. I also taught values clarification and life review as tools to use in working with patients and families facing the end of life.

We were at a friend’s home, talking. My friend said, “I haven’t really accomplished much in life.” I looked around and thought, “What a beautiful home and life you’ve created. Actually (I thought) you’re a truly beautiful person.”

Life review – thoughts

I began listing a few things I miss in my life now. I tried to limit it to 5-8 things. That led to consideration of beautiful times, which led to…

Things I miss

  • Leslie.
  • Backpacking in the wilderness.
  • Being a part of the global underground, especially trance gatherings in the forest.
  • Related to the above, DMT, MDMA, LSD/psychedelics, smoking cannabis.
  • Smoking cigarettes.
  • Of course I miss being strong, quick, pain-free, all that kind of thing.
  • I don’t miss work, though if I was younger and stronger I would certainly be deeply invested in working as I once did. I just don’t have much strive left. I feel that I did the best I could – I left it all on the field.
  • Gardening.
  • Sunday mornings with David, like at the rail yard; having lunch every week with David in California.
  • Flying across the mighty Pacific in a 747 on the way to or from another two-month trip to Asia.

Some beautiful times

  • Being in the chow hall they had set up for the sole use of Marines returning from Vietnam and I was eating chocolate cake and drinking cold milk (as much as I wanted!) and listening to Groovin’ by Young Rascals on the jukebox. I was alive!
  • Getting to the bottom of a >1000 foot glissade down Twins Glacier in the Wind River mountains past the crux of a great trek and it was my 65th birthday!
  • Sitting in the kitchen with Jeff in the apartment on Oram (so homey, walls with a little sideways slant, painted yellow), coming on to Orange Sunshine. Truly, truly, everything was perfect.
  • Marrying and being married to Leslie.
  • Being in Burma, being exactly where Supilawyet sat “By the old Moulmein Pagoda, lookin’ lazy at the sea…” In Kathmandu, Bangkok, Saigon, Sapa, Hue, Granada, Santa Fe, Mendocino, Berkeley, all those places!
  • Being on a 747 coming home after two months in Asia at the perfect intersection of the perfect trip and going home.
  • Being married to Jean, living in Berkeley, living in Northern California!
  • My work (hospice, refugees, teaching, scholarship, serving, being part of the good).
  • Sooo many mornings lying in bed, having coffee together, talking…

Mistakes and regrets

  • Being a fuck-up in elementary and high school.
  • Smoking cigarettes.
  • Saying stupid things (multiple instances).
  • Wasted time, especially related to anger.
  • Never getting straight with my father – I’m not talking about forgiveness; it’s something else, but I’m not sure what.

Hard times

  • The war in Vietnam, especially the Hill Fights
  • When Leslie was sick and after she died.
  • Much of my childhood and teen years.

Good moves/accomplishments

  • Learning to be a good parent – Thanks, Leslie!
  • Being (for the most part) a good husband to Leslie and Jean and for the most part, a good Dad to David.
  • Becoming a nurse.
  • All the scholarship (books, articles, papers).
  • Hospice and refugee work, Agape; learning how different people live; being part of so many lives.
  • LSD, MDMA, psytrance.
  • Starting back to Backpacking in my 60s; dropping back into the global underground also in my 60s.
  • Staying true to the vision for the last 60 years of my life.
  • Taking good care of my mother and of Leslie at the end of their lives.

Eulogy

Eulogy, Charles Kemp

(10-minute reading, so relax)

Born August 30, 1944, in Tyler, Texas. Died ______________ in Berkeley, California. His greatest achievement in life was overcoming the karma of a difficult childhood and becoming a decent man, husband, and father.

He dropped out of high school in his senior year and spent a year and a half as a “climbing bum,” rock-climbing and hitch-hiking around Colorado and Wyoming, and working as a short-order and dinner cook. After returning to Dallas he completed high school, then returned west to climb. He started college but dropped out and joined the Marines in 1965.

After eight months of training, he was sent to Vietnam as an infantryman in the 26th Marine Regiment Special Landing Force. He saw heavy combat throughout his 13-month tour of duty near the DMZ but was only slightly wounded. He was proud to have fought in both the 26th Marines and 9th Marines in Operation Deckhouse (IV and V), Operation Prairie, the Hill Fights, Con Thien, Dodge City, and other engagements. Decorations included the Purple Heart, Combat Action Ribbon, Presidential Unit Citation, Navy Unit Commendation, and others. He learned that life is a gift. His entire life he was grateful to be alive.

He returned home in 1967 and attended college for a few semesters, but much of 1967-1972 was spent integrating the experience of the war with civilian life. He married his high school sweetheart, Leslie, in 1969. They had met outside the cafeteria at Thomas Jefferson High School when they were 16 – it was love at first sight and it endured. They were married 45 years. His healing came through Leslie, LSD, and the personal strengths he carried within. In 1972, he returned to school and graduated magna cum laude in 1975 from Baylor University School of Nursing. After working in community health for several years he entered graduate school in 1977 at the University of Texas at Austin, earning a master’s degree in psychiatric nursing.

In 1978, he founded the first hospice in Texas, the Visiting Nurse Association Home Hospice, serving as its director and hospice clinical specialist. Under his leadership the VNA Home Hospice had the largest daily census in the US and became a National Hospice Demonstration Project. He worked with people at the end of life for most of the rest of his life.

He taught at Texas Woman’s University and Baylor University, where he led courses in end-of-life care, psychiatric nursing, and community health nursing. Under his guidance in clinical settings, students took on expanded service-learning roles in planning and delivering health services in underserved refugee communities. In 2000, he completed the family nurse practitioner program at Baylor. He worked as an FNP at the Agape Clinic serving mainly immigrants and refugees for the rest of his career.

Hospice care, refugee health, community health, and primary care were the primary focuses of his career. Most of his professional work centered on building and sustaining collective efforts involving multiple individuals and entities. Throughout his life he was committed to doing and teaching compassion. He authored three books, over 70 articles in professional journals, and numerous papers.

In addition to hospice work, he had sole or primary responsibility for planning, implementing, and/or securing funding for the below.

  • District health services through Baylor School of Nursing and community agencies serving refugees
  • Expansion of the Agape Clinic
  • Vietnam Veterans Resource Center (later part of the VA VSO service)
  • The East Dallas Health Coalition, a community-oriented primary care clinic now open seven days a week with multiple adult and pediatric services

These and other services benefitted thousands of people. Most are still in operation today.

In addition to his Marine Corps decorations, awards included inclusion in the Great 150 Baylor graduates over the 150 years of Baylor’s history, Fellow of the American Academy Nursing (national), the Abner V. McCall Humanitarian Award (Baylor University), Faculty Award for Excellence from Elsevier Science (national award), Outstanding University Scholar at Baylor, Outstanding University Lecturer at Baylor, Margaret Stein Award for Outstanding Service in Community Health (national), Presidential Citation Vietnam Veterans of America (national), Outstanding Volunteer from Dallas Volunteer Center/ARCO, J.C. Penney Golden Rule Award, and other awards from the Dallas Police, DFW Vietnamese Community, DISD, State of Texas, Presbyterian Church, and others.

He was a serious baker, gardener, and rosarian. He was a backpacker with numerous treks in Wyoming and Colorado, culminating in a 10-day trip deep in the Wind River Wilderness to celebrate his 65th birthday. In his 60s, he reconnected with his hippie roots through involvement in the psychedelic trance scene. He (re)learned to dance in these underground forest parties and led workshops on the end of life and psychedelic therapy at gatherings in Texas, Colorado, and New Mexico.

He and Leslie adopted their son, David, at birth, and took great joy in “our little family.” David was a good and faithful son to Leslie and Charles. Charles and Leslie worked closely together in the Cambodian refugee community and at the Agape Clinic. From the time David was a baby riding on Charles’ shoulders to now David has been involved in these efforts to serve the poor and for justice. They found happiness in their simple family life, their home, and in working and traveling together. Leslie died in 2015, and Charles cared for her during her final months. They had been married for 45 years.

Written in the beautiful city of Hue in Central Vietnam in 2012: We went to the Thien Mu Pagoda, 45 minutes up the perfume river from Hue. This where the monk Thich Quang Duc lived before he went to Saigon in 1966 to immolate himself in protest against the VN government and the war. The pagoda and grounds were quietly beautiful – understated and mossy with just a few people around and a view from the grounds across the wide river, past the plains, to these mist-covered mountains where we fought and bled, where so many from every side fought and bled and died, aching for life – me for a beautiful dark-haired girl whose photo was so washed out from the constant slogging through rain and padi water that only the shadow of her left eye was left and now, 45 years later, looking across the room from where I write she’s sitting on the bed, the love of my life, beautiful, her hair white now and here we are in Hue and I look out through the glass-paned doors through the mist toward palm trees and mossy buildings.

In 2021, after living together for five years, he married the artist Jean Cacicedo. Together they enjoyed an “endless summer” (that lasted more than two years), the magic of Berkeley, countless intimate days, and the fullest life imaginable. They traveled all over California, Colorado, Montana, and Wyoming, and in Asia and Europe. They prepared numerous meals together, endured health challenges, got through the pandemic together, and they lived happily ever after in Paradise (Berkeley).

He was fulfilled in every respect.

He is survived by his son, David Kemp; his wife, Jean Cacicedo; and his brother, John Kemp.

“Walking downhill in Paradise”

Avenue of Trees on the way into cabin near Mendocino

Parked on Cedar Street, walked past one beautiful garden after another (it’s mostly gardens here, not lawns), walked past the original Peet’s on Vine at Walnut and down to the Cheese Board Collective on Shattuck. Standing in line at the Cheese Board today, surrounded by people more or less like me. What a great thing to be able to do this quintessential Berkeley thing, walking through a beautiful community and standing in line for a great bakery. People and dogs walking by, people sitting and standing at the sidewalk tables, babies and old pe

Red Sea Orange Feather

ople and everyone in-between. Inside, past all the great cheeses and on to the bread counter. Got sourdough batard, spelt loaf, cheese roll, double chocolate cookies. I do this once a week, along with trips to a truly great produce market and to the big and unique Berkeley Bowl.

In the past two months we had lovely three-day visits from David and Charles and from Jean’s niece Anne and her great niece Beatrice. They were the first overnight visitors we’ve had since the downstairs bathroom was redone and everything worked well.

Red Sea Orange Feather

Drove to Carmel for a show at the Carl Cherry Art Center featuring Jean’s and Janet Lipkin’s work. It was the first time I’ve seen Jean’s work on a person and finally I really get it that these coats she’s made are sculptures. https://carlcherrycenter.org

Peter Goodman wrote a book about his family bakery on Telegraph Avenue in the 1950s and 60s. The Berkeley Historical Society sponsored an event around the book and about a hundred people showed up. Lotta white hair and canes in that crowd!

The mighty Pacific from van

Drove to Mendocino. Stayed in a nice cabin across from the small town of Mendocino on the other side of a fjord-like inlet along the Pacific coast. From Mendocino you can barely see the cabin on the headland among the trees. Spent a beautiful day at the Mendocino Coast Botanical Gardens. The dahlias are in full and breathtaking bloom. https://www.gardenbythesea.org

The journey with getting the VA to recognize my service-related challenges is over with my goals achieved.

Watching the sun go down behind Mount Tam with the mighty Pacific stretching endlessly beyond into the great beyond. And in the morning in the hot tub looking out over the SF Bay with fragrant Philadelphius flowers hanging down above us.

Morning from deck

I’ve been writing my obituary and planning my funeral. One of the “tasks” at the end of life (or, preferably before the end of life) is a “life review.” Involvement in hospice and related work has led to an understanding of the importance of reviewing and an obituary is really a summary statement of review (and thus is worth doing).

Happy Birthday in Mendocino Coastal Gardens

I flew to Dallas for an appointment. The flight was scheduled for 6pm, delayed until after 8pm, and after an hour and a half, turned around and went back to Oakland. There were emergency vehicles lined up where we landed, but nothing happened. The passengers all disembarked, walked to another gate, and got on another plane. I got home at 5:37am, took a quick nap and showed up at 8am appointment, then went elsewhere to transact business (feeling impaired after 24+ hours awake).

Going to friend’s homes for dinner or having people over. Meeting friends for lunch. This week we celebrated my birthday with Jean at Dalida in the Presidio. Nancy and Peter had us over for another birthday dinner and we had Andy and Simone over for dinner the next evening. Happy birthday, CK!

Morning – in hot tub looking up

Peter N-R and I were walking home from lunch at the Kensington Inn. It’s an uphill walk – uphill is getting harder and harder – to get there and a downhill walk going home. Peter said, “We’re walking downhill in paradise.” That’s right.

The reason why

After I came home from the war, I experienced visions—glimpses of a deeper reality, including the realization that we are all One. One outcome of those visions was my decision to take the Bodhisattva vow: to liberate all sentient beings. That vow, and the visions that preceded it, became guiding forces in my life. They made it possible for me to hear—and to answer—a calling to become a nurse.

I returned to school for three years, then began work as a registered nurse, later becoming a leader, educator, and, after further training, a family nurse practitioner (FNP). My career carried me through community health, hospice care, and, in its final twelve years, primary care. Whether working in hospice or with refugees and immigrants, my focus remained constant: to reduce and relieve suffering. I was inspired by Leslie and for many years worked in partnership with her.

Omayra Sanchez. Photo by Frank Fournier

In hospice care, this meant addressing pain, loneliness, fear, advanced illness, family distress, and a host of other challenges. In refugee health, it meant responding to trauma, cultural and personal isolation, poverty, illness, loss, and more. In education, the goals were to help students grasp foundational principles, cultivate responsibility, strive for competence, realize their potential, and embody compassion—along with other essential aspects of caring.

As part of a broader effort to inform and support others working to reduce suffering—and thereby contribute to the collective movement toward liberation—I wrote numerous articles, papers, and chapters, and authored or co-authored three books:

Terminal Illness: A Guide to Nursing Care (1995, 1999, Lippincott)
This book explores the individual, familial, cultural, and spiritual dimensions of the end-of-life experience. It offers practical guidance on managing symptoms such as pain, dyspnea, and nausea, and includes a detailed section outlining the natural progression and metastasis patterns of the 16 most lethal cancers—enabling clinicians to anticipate complications and intervene more effectively.

Refugee and Immigrant Health, with Lance Rasbridge (2004, Cambridge University Press)
The first section addresses the refugee experience—including physical and mental health, spiritual and religious influences, women’s health, and cultural frameworks. The second section profiles 31 cultural groups frequently seen in refugee and immigrant care, including Afghan, Cambodian, Haitian, and Mexican populations.

Leslie taking care of business behind the apartments at 4400 San Jacinto

Infectious and Tropical Diseases, with Tao Sheng Kwan-Gett and Carrie Kovarik (2006, Elsevier Science)
Written for primary care providers, missionaries, and refugee health workers, this compact guide opens with an overview of infectious and tropical diseases, followed by 647 pages covering over 90 conditions—from cholera and malaria to lice infestation and schistosomiasis. The final section helps clinicians link symptoms to geographic regions and likely diagnoses. Designed for fast settings, the book fits in a lab coat pocket and features a soft, durable binding.

Looking back now, at these books and the work in hospice and among refugees – the progression of the work and books and their intent, from the first sentences to the last – I see that I did do my best to live out that early vision of Oneness, to relieve suffering, and to honor the vow for Liberation.

I also remember that there were times when nothing could be done about the suffering and all that was left to do was to bear witness – “My soul is deeply grieved, to the point of death; remain here and watch with Me.”

Days in the life – Berkeley, 2025

Looking out bedroom door from bed. Fog bank in the distance.

In the end we’re just carrying the water, tending the fire, planting and harvesting…

I was prompted to make this post by contact with a distant relative and a question from a friend near Point Reyes. My friend had asked, “What do you do?” (as I live my life). (Click photos to make big; then back arrow.)

Saturday. Got up at 6:30, fixed coffee and a little fruit bowl for Jean to have before her medications, and brought these to her. We drank coffee together, watched the sky and the distance from bed, and talked. From Jean’s place in bed she can see SF Bay and Golden Gate Bridge; I can see the Bay, Marin headlands, and Mt. Tamalpais. We call what we see in the mornings “the today show.” ♥

A little after 8:00 Jean got up and bathed and I fixed breakfast. This morning it was the usual: fruit bowl with yogurt and granola for Jean and toast and almond butter for me. We’re close to California’s Central Valley and Oregon’s orchards, so the fruit here is exemplary. This morning we had a mix of pear, apple, orange, strawberries, blueberries, banana, and grapes. When I was in Dallas I baked all our bread for quite a few years. Now here, there are several great bakeries, selling levain, spelt, and other crusty, coarse, tasty loaves that are even better than what I baked. Today’s bread is levain from the Cheeseboard Collective.

We ate together in the living room, and talked, again with the view. I showered and Jean did Pilates. I tended the plants on the deck (again, the view) and Jean made some phone calls. The way we live with the Bay, the City (SF), Marin, and the sky and clouds and sun and fog and garden all right here means that outside and inside are not separate. When it’s just a little warmer we’ll sleep with the French doors in the bedroom open to the outside – “one door nights” and “two door nights.”

Jean is working in the kitchen, getting a to-go lunch together for a friend who is unwell. Someone is coming over in a few minutes to help with the irrigation system. He came – thank you! We planned on a walk at the nearby middle school track, but didn’t do it. With my iPhone I’m in my third year of counting steps. In year two I increased steps by about a quarter mile and in year three, by another quarter mile.

Thyme in flower

Watered front garden for an hour. Plants in bloom right now are thyme, nasturtium, sweet alyssum, two kinds of alstroemeria, two kinds of California poppy, calla lily, three kinds of iris – including from Jean’s father, butterfly sage, borage, tansy, agapanthus, columbine, lavender, rose geranium, yellow tagetes, coreopsis, impatiens aloe vera, day lilies, and the lime tree.

Back downstairs garden

Jean has had a contractor working on the downstairs bathroom. To start the job she had to move quite a bit of fabric and artwork out because the bathroom was basically used as a large storage area with a toilet and sink. There were many remnants of dyed and felted wool, which Jean sorted and bundled according to colors, and then stacked in the downstairs bedroom. Somehow, to me anyway, the stack of bundles became an art installation. Some of the textiles went to art schools or artists collectives. It’s like the extras from a lifetime of textile art.

At work in her studio

Right now, she’s in her studio, working on the third in a series of self-portraits related to health challenges over the past few years. This one is heart-related. Others include the spine/pain and the neurological challenges of dysautonomia. I’m unsure about how long she’s been working on this series – a month, at least.

The house is kind a kind of unassuming one-story bungalow on the outside (with an extravagant garden). Inside it is like in the song, “hangings rich of many strange designs” very beautiful. The hidden away downstairs down winding stairs has a small room for Jean’s archives, a laundry room, a bedroom, a storage room, a bathroom, and a large bright, high-ceiling studio opening out on a deck and more garden. The deck reminds me of a Thai or Cambodian artisan area with its bamboo poles for hanging fabric.

Being as old as we are means (among other things) spending a lot of time taking care of our bodies. We’re like athletes, always working out, dealing with injuries and infirmities, eating special diets, trying to stay in shape…

Tonight we picked up our friend, Susan and went to dinner at Kiku Japanese restaurant.

Sunset from deck

Jean and Susan split some sushi and I had yakisoba noodles. Not unlike pad Thai.

I always look forward to going to bed with Jean in the evening. The goal is to get there before 9 pm and we usually make it. We take turns deciding on “the entertainment” (computer TV) which basically lasts for an hour. Right now it’s kind of rotating among White Lotus, the Americans, This is Us, and some mash-up of Seinfeld, Colbert, Midnight Diner, and Mark Wiens. For us, TV is one of the outcomes of the pandemic, i.e., something that changed as a result of the pandemic and lockdown. Other changes include having as much mayonnaise and butter as I want, because, you know, we could all die at any time. I’m out there on the edge again, man.

The track at King Middle School

Sunday. Up at 6:15, fix coffee, meds together, small fruit bowl for Jean so meds won’t be on empty stomach (I always put it in the plastic bowl I got on a Cathay-Pacific flight about 25 years ago). Lying in bed watching the sky and sea and land. We did a short “grateful” – in which we set an alarm for five minutes and lie there quietly thinking of things for which we are grateful.

Breakfast was poached egg and toast. My secrets to poached eggs is very light oil to skillet, cold water brought to boil, slip egg sloooowly into the water so that it cooks a little as it goes in, cover to skillet. When they’re about done, use spatula to loosen eggs. Turn over if wanted (I sometimes make a mess doing this.) and poach to desired doneness. Serve on toasted levain or spelt. Trader Joe fresh “medium” salsa from cold case. In this and all other matters, no salt cooking or serving. Tastes great!

Walked at Martin Luther King Middle School track. There were people of every age – old and young – and every physical ability, walkers, runners, fast and slow, and soccer teams playing. When the soccer game is over there will be a volleyball game on the field.

Lunch together. I had a sandwich made from leftover bun bo xao beef and Jean had leftover sushi.

Front garden

Nap.

I worked on the sprinkler system in the garden. As always I got soaked but finally got things set up for the dry season. Jean worked on her “Kona’s rug,” which was just cleaned. Kona was her well-loved black Labrador. We talk about getting a dog, but it doesn’t seem practical at our age. Still…

Obsolete: 25 years ago I realized that one of the major disconnects between the healthcare system and refugees and immigrants was that patients from foreign lands were worked up like patients from the US (except of course that there were more barriers for foreigners). Despite a high probability of parasites among patients from developing nations, parasitic infection was a distant differential so there was always months of delay before getting to the cause of a problem. And, at least in primary care, emergency care, and elsewhere there was a general lack of awareness of infectious and tropical diseases. Thus was the book Infectious and Tropical Diseases conceived.

I developed the differential diagnosis sections of the book and then two colleagues and I worked on diseases sections for over a year and in 2006 it was published by Elsevier Science. A unique characteristic of the book was that diseases, symptoms, and geography were extensively cross-referenced, so that readers could quickly zero in on symptoms/diseases endemic to particular locales. It was a good book and we got good reports from practitioners working in refugee and international health. Yesterday I had the jarring realization that the innovative cross-referencing concept has been made obsolete by AI. Of course, the book has been out-of-date since a few years after publication, but the concept!

Here is what Chat GPT said in response to the query “50-year old Kurdish male from Iraq with abdominal pain 10 years duration:” “The diagnostic approach should consider both common global causes and region-specific infectious, environmental, and psychosocial factors, particularly given the Kurdish population’s potential exposure to trauma, limited healthcare access, and endemic infections.” Hydatid disease, strongyloides, and schistosomiasis were noted as risks by ChatGPT.

If this all seems irrelevant, recall the 2014 Ebola case undetected for several days at a major Dallas hospital. Now that was scary, at least among ER staff, refugee health workers, and people living near the sick man! Three cheers to AI!

I lost track of keeping track of everything. Getting a little random.

From my last trip to the bathroom about 0500 I saw through the deck door the yellow/orange moon hanging low over the Bay. It was beautiful but not enough to wake Jean.

Leaving Point Reyes

I’m thinking there’s a certain sameness to life these days. There is love, there is surpassing beauty in life, lots of gratitude, some seriously good times and seriously hard times. I feel like I understand life better. I think of the challenges of the day. I think often about David and Leslie and Jean. I think about traveling, war, working with refugees, the clinic, friends, people who have helped me (and people who have hindered me, people I’ve worked with, writing, teaching, hospice, life, the end of life, the house in Dallas. I’m happy I worked so hard and accomplished what I accomplished. We do social things 2-4 x week like dinner with friends, lunches out, museum trips (Jean does the museums; me, not so much.

Another day: Tracking in detail.

Coffee in bed – Jean’s mug is from a gallery in Red Lodge when we went to see Courtney in Montana and my mug I bought from a Chinese dollar store during David’s and my first trip to San Francisco. Fruit snack in a Cathay Pacific mini-bowl from long ago. ♥

Sunset

Talking

Breakfast – JC smoked salmon and cream cheese on spelt, fruit salad (orange, apple, grapes, strawberries, blueberries, banana); CK fruit salad with yogurt and toast (levain and spelt) with almond butter from Berkeley Bowl – all served on plates from Jean’s Mom and bowls made by a neighborhood potter, James Newton, and I’m eating with my spoon from Cathay Pacific. 

We go to a bayside art and nature place (“The Bulb”), but the wind off the Bay was so strong and cold we left and went to our usual weekend walking place, the MLK Middle School track. On the way stopped at Monterey Market for the first fresh corn of the year and a big bunch of chard. On to the track.

The other night I made stuffed small new potatoes like we had at the Amet Haveli hotel in Udaipur (this time I stuffed with cheese, chives, ham, z’atar). Baked, split, scooped out, mix cream cheese, lots of chives, tiny pieces of a small slice ham, potato and stuff the little potatoes. Top with cheese – used provolone. Re-baked ~10 minutes.

Morning, Mount Tam in distance

This week Jean has been to a women’s gathering in Sonoma, I’ve had lunch with Peter N-R, and we’ve had dinner with Nancy and Peter and with Susan.

Jean finished an art piece: The Heart. See above re series. 

Challenges faced: Pain, feeling tired, medication side effects, the complexities of navigating the health care system even when things are going pretty well, rising prices, the moral decline/the corruptionof America, the gutting of values of decency, honor, honesty, and so on.

Back to the photo of the morning sky:

Morning has broken, like the first morning.
Blackbird has spoken, like the first bird.
Praise for the singing, praise for the morning.
Praise for them springing fresh from the Word

“Baby, ain’t it all worthwhile.”