Wednesday, September 26, 2007

Women's Harvest Celebration

There is frost on the vines and snow on the mountaintops as the women gather to celebrate the beauty and bounty of harvest time, to renew our ages-old commitment to each other and to life, to stand as witness for others and be fully present to ourselves. It is a time of opening, of healing, of insight.

For eighteen years, an evolving group of women has gathered in the mountains of western Montana each September to spend four days together, witnessing, sharing, honoring. With compassion and honesty, with love and caring, we sit together in circle and tell the stories of our lives, what holds us down, what lifts us up. Where we are stuck and where we flow. How we are nurtured, and how we need to be but are not. We speak to each other with full eye contact and complete attention. We sing, we dance, we drum, we chant, we breathe. And we do it all in the context of a deep and abiding love that is the sacred space where flows the source of all life. After four days together, crying and laughing in each other’s arms, we are as close as true sisters.

This annual gathering, The Women’s Harvest Celebration, is the creation of a gifted therapist and counselor, Dr. Susan Rangitsch, a psychologist who lives and works in Missoula, Montana. She works both with individual clients in her office, and with groups of people, often in remote areas, doing spiritually-based work. (Susan came to visit me last March and I wrote about our adventures here, here, and here.)

I first heard of Susan’s work through friends in the Seattle area in 1993. I was immediately intrigued and wanted to meet her. That year was my first Harvest Celebration, and I attended each year after that until I moved to Alaska in 1999. For reasons which must have made sense at the time--but which I can’t fully recall--I did not attend Harvest again after 1998 until this year. Having returned, I am aware all over again of how important this work is to me, and how valuable. I will not be absent again.

For the last few years, Harvest has been held at the Blacktail Ranch in Wolf Creek, Montana. A huge working ranch on the eastern side of the Continental Divide, Blacktail is a beautiful place with craggy mountains and wide, sweeping vistas. Both deer and bear roam the hillsides and come right up to the lodge. Hawks and eagles soar on the wind currents and coyotes howl above the canyons at night. Mountain lions pace the rocky outcroppings and scream their irascible natures into the night sky. And that sky will take your breath away. Miles from even a small town, there is no light pollution whatsoever; the sky is inky black and scattered with an infinity of stars. The Milky Way fairly leaps out of the sky it is so bright. Familiar constellations seem bigger, brighter, closer. Shooting stars flare and die every few minutes, until all my wishes are whispered to them.

In the meadow above the main lodge, there is a beautiful octagon-shaped building called the Hogan. It consists of one large room with a door in the eastern section and windows in each of the seven other sections. Each window looks out upon a slightly different view of mountains, meadows and tall trees, and each is beautiful. A small entry room is attached with space for hanging coats and a cabinet unit holding supplies for tea. The structure has electricity but no running water; there is an outhouse about twenty feet away. It suits the needs of our group perfectly.

There are two dozen women attending Harvest this year. Five of us have worked with Susan for many years and often act as her assistants; we are known as “the teachers.” About half of the women are young, in their twenties and thirties, and half are older, in their fifties and sixties. Some are attending for the first time and some are veterans of many Harvests past. Some come with huge issues to wrestle and some come simply to be in service, to hold space, to witness. We are a kaleidoscope of personalities and natures.

At the center of it all is Susan: leader, teacher, counselor, mentor, friend, holder of the mirror, asker of hard questions, challenger of assumptions, demander of honesty and deep personal integrity. She holds all present to the same high standards she requires of herself, and all rise to that expectation with their best effort. Susan is incredibly intuitive and deeply perceptive to the energies flowing in those around her. It is often amazing to watch her work with an individual in the circle; whether it is a gentle word, a piercing question, or a wrestling match on the floor, she unerringly knows just what is needed.

The rhythm of our days forms quickly. Breakfast is served in the main lodge at 8 am and we gather in the Hogan at 9:30 for the morning circle. At noon we break for lunch and the afternoons are open for a variety of activities: horseback riding, hiking, cave exploring, sleeping in the sun, journal writing, beading and craft making, meditation, yoga, massage/body work. Sometimes there is a late afternoon circle from 4 to 6, sometimes not. Dinner is at 6 and evening circle begins at 7:30 or 8 and lasts until around 10. After the evening circle some women go immediately to bed, some stay up for hours talking and visiting.

The entire experience of Harvest is about living in spiritual community with openness, honesty and loving kindness towards one another. The time in circle is about working out the issues we all have in our daily lives, both large and small. Difficulties with child-rearing, problems within marriages, poor or failed relationships, issues with self esteem, the challenge of shutting down our internal self-criticism with which we nag ourselves constantly. The issues which come up are universal to women’s experience, and often painful to the individual woman struggling with them. Sometimes with tears and sometimes with laughter, each woman’s story is heard. The work she needs to do is supported. She may be quite shaken by what transpires, but she inevitably leaves the circle feeling stronger and with a clearer vision of her path.

Women come to Harvest from all different religions and spiritual traditions. Christian, Jewish, Buddhist, Pagan, Agnostic, Atheist have all been present, and all are honored. Susan draws from many different spiritual disciplines in guiding the prayers, meditations and activities of the group.

The final evening is one of joyous celebration. Women come to the circle dressed in their best finery and wearing a party mood. There is a tradition of a small gift exchange known as Giveaway; if someone’s story has touched you, if you have been impressed with someone’s work to deal with her issues, if someone has shown you a special kindness as you have worked with your own issues, it is appropriate to give her a small token—something which is meaningful to you, and which will therefore become meaningful to her. The process of Giveaway is often accompanied by many hugs, kisses and tears.

The final circle often has dancing and drumming as a part of it. Youthful energies run high and want an outlet for exuberance. This year’s circle contained a number of young women who are excellent dancers, their bodies lithe and limber and their movement an expression of pure joy. It brought tears to my eyes to watch them.

The Women’s Harvest Celebration is for me a most blessed event. It is a brief time spent in spiritual community with a loving and supportive circle of women, shepherded by a caring, sensitive and intuitive leader. It enriches my life immeasurably to be there and I will see to it that my attendance does not falter again.

For more information regarding Women's Harvest Celebration and other programs by Susan Rangitsch, please see her website:

Thursday, September 13, 2007

Feeling Like Autumn

Rainy. Cold. Windy. It has been this way for so long it is hard to remember when it was anything else. Seems like summer ended on the last day of July and we’ve had a crappy fall ever since. The thermometer has been parked at 50 degrees for weeks and the rain is coming down in buckets. Roads are a muddy mess. Trees and outside dogs look bedraggled, and people’s spirits are about the same.

Occasionally the constant barrage of rain storms will slack off for a few hours—maybe even half a day—and it feels like a giant reprieve. If it happens around 9 pm we might get a stunning sunset, like the one here.

Some days ago the weatherman predicted a full day of minimal precipitation, so Henry called and wanted to get a fishing trip in. The best tides were early in the day and we planned to launch by 9:30 am. Most people who are still fishing are reporting poor results. The salmon runs in the Kuskokwim are about over for this year. But Henry is an excellent fisherman, and he usually brings home fish when others get skunked.

“I know there’s a few silvers left in the river,” he said. “Let’s go find ‘em!”

It didn’t actually rain on us, but the sun played coy with the clouds and never gave us more than a few minutes of his rays. We watched numerous rain showers blowing around in the middle distance, as if giant unseen hands were squeezing out full sponges over a big table. Fortunately the wind was in a fairly gentle mood, which helps a lot in handling the boat and the drift net.

We went to one of our favorite spots and did two long drifts. The results were fairly disappointing. We caught about two dozen silver salmon when we were hoping for fifty to a hundred. But they were beautiful fish, still bright and firm. We both wanted some for the dinner table, and Joan wanted some for putting up in jars (known as…yeah…”jarring” salmon).

Hardly anyone was out on the river. A few boats went by on their way to somewhere else, but no one else was fishing. A big gravel barge and tugboat went by, reminders that the Kuskokwim is a working river.

At the cost of gasoline, nearly five bucks a gallon, it gets pretty expensive to go fishing if you don’t catch much. Henry decided that this was probably going to be the last trip of the season.

It really feels like summer is over, and has for a while. Really doesn’t matter that it is over a week yet until the autumn equinox. We still have plenty of daylight; the sun is rising around 8 am and setting around 9 pm, when the cloud cover breaks enough to see it. But the dreariness of this endless rain has everyone hoping for an early freeze up. We are far more likely to have clear skies when the weather is cold, and life is so much cleaner when the mud hardens up.

Another month, perhaps. Sigh.


Tuesday, September 11, 2007

Grand Rounds Time

For those of you searching for your weekly smorgasbord of the best of the medical blogosphere--otherwise known as Grand Rounds--you'll find it at The Efficient MD. This week's theme is "Healthcare Innovations and New Technologies." Click over and enjoy your Tuesday morning read!

And on a more serious note, I hope all Americans will take a few moments today to remember the events of six years ago--when we sat horrified in front of our television sets watching the unimaginable happen before our eyes--and to honor the thousands of our fellow countrymen who lost their lives on that fateful morning. Terrorism is very real, and less than half a world away there are fanatics who live each day with a burning zeal to see each and every one of us meet the same fate as those who were in the World Trade Center on September 11, 2001. We would do well never to forget that, and to honor and support the American soldiers fighting for our right to live our lives peacefully and without fear of such atrocity happening within our own borders.


Tuesday, September 04, 2007

Time for Grand Rounds

Tuesday mornings would be so much duller without Grand Rounds--the weekly selection of the best of the medical blogosphere. This week's host is Dr. Emer at Parallel Universes. With this edition he becomes the third blogger to be a four-time host for GR; having done it once, I truly appreciate the magnitude of this accomplishment!

This week's edition is hefty: thirty-five blog posts to savor, including yours truly! I was delighted that Dr. Emer was able to squeeze me in, as I was quite late in getting a submission to him. Thanks, Dr. E.

Grab your coffee and click over to Parallel Universes for some excellent reading.


Monday, September 03, 2007

A PSA Story, Part 2

This post is a follow-up to a previous post about Evan, my patient with a very high PSA. I should have mentioned that it was with his permission that I wrote about him, and that (of course) Evan is Not His Real Name.

It has been a month since I saw him in the clinic. He started taking Septra (trimethoprim-sulfamethoxazole) the next day and had no side effects from it. Several days later I received the results of the urine culture and sensitivity. The bacteria causing his infection were Kluyvera ascorbata, sensitive to ciprofloxacin.

I had never heard of this bacteria, and it seemed odd to me that it would be sensitive to ciprofloxacin but resistant to a six-week course of levofloxacin. I called my urology consultant. He had also never heard of the bacteria and was equally puzzled by the sensitivity report.

“Talk to an infectious disease person,” he said. “But go ahead and switch him to ciprofloxacin.”

Infectious disease (ID) is one of the few specialties that we do not have a consultant for at the Alaska Native Medical Center in Anchorage. To get an ID consult, I have to call the University of Washington in Seattle. They maintain a 24-hour phone consultation service—for every known specialty—known as Medcon.

I was quickly connected to an ID fellow and presented Evan’s case to him. He said that Kluyvera is a recently-delineated subgroup of Escherichia, the common gut bacteria that cause most urinary tract infections (the “E.” of E. coli). He was as puzzled as the urologist and I had been that it was sensitive to ciprofloxacin but apparently highly resistant to levofloxacin.

“Ciprofloxacin does have more specificity for the prostate and concentrates in the tissue better than levofloxacin does,” he said. “Definitely put the patient on six weeks of it, and then do follow up cultures.” He also agreed that with such a large post-void residual (300 mL), the patient needed to be self-cathing to help resolve the infection.

I sent an order to the pharmacy to send out ciprofloxacin to Evan’s village and notified the health aides that it would be coming and that Evan needed to start taking it right away. He could stop the Septra, as the bacteria were resistant to it.

The issue of teaching Evan to self-cath was somewhat trickier. I knew it was unlikely he would be able to fly in to Bethel just for this. If he were from one of the nearby villages on the Kuskokwim River, I would jump in my boat and go visit him at the village clinic to teach him how to do it. But his village is not on the Kuskokwim. I considered flying to his village on my day off, but did not really want to bear the expense of that myself (several hundred dollars). Then I remembered another resource: the public health nurses.

PHNs are employees of the State of Alaska. There is a long tradition here of village visits by PHNs and a more clinical focus to their work than in other places. The earliest access that Alaska Natives had to western medicine was provided by public health nurses who traveled by ship to the coastal and riverside communities. When I first came to Alaska, the PHNs made regular trips to all the villages in the Delta, providing well-child care, immunizations, Pap smears, and exams for sexually transmitted infections. Recent budget cutbacks have curtailed much of their travel, but PHNs still make some village visits.

I called their office and learned that Evan’s village had visit coming up. I spoke with Pam, the PHN who was going out and told her about Evan’s case. She said she would be glad to check up on him and teach him to self-cath, but she did not do prostate exams.

The day after her visit she called me to report that Evan was taking the ciprofloxacin without any problems, and that he was feeling much better. He could now urinate without any discomfort; but he still had the pressure sensation in his pelvis, which he continued to describe as “poking” pain. It was somewhat improved, though.

When I first saw him, he had reported a sense of incomplete emptying after urination; that, too, was now gone. Pam taught him to self-cath, which he was able to do without difficulty, though he really didn’t want to. And he had NO post-void residual. She marked the catheter for depth of insertion and measured it at over twice the length of his flaccid penis. I was delighted with this news; I immediately called him and said that he only needed to self-cath if the sense of incomplete emptying returned. He was quite happy about that.

In a few days it will be four weeks since Evan started taking the ciprofloxacin. I will call the health aides in his village and ask them to draw blood for a PSA level and get urine for urinalysis and culture. I am deeply hopeful that he has cleared the Kluyvera and that his PSA is back down to something less than 10. There is still the issue of whether I really felt a nodule; that follow up will require at least a trip to Bethel, and at least two digital rectal exams—mine and Dr. H’s. I want confirmation from a more experienced prostate examiner that a nodule either is, or is not, present. With these added data points I’ll consult the urologist again and we will arrange whatever next step Evan needs.


Sunday, September 02, 2007

Life Rating

This Is My Life, Rated
Take the Rate My Life Quiz

Guess things aren't too bad, ah? 'Cept maybe I need a few more friends...
Thanks to Monkeygirl for the link.

And once started, I had to do the book quiz too. I'm really a sucker for these things...

You're The Mists of Avalon!

by Marion Zimmer Bradley

You're obsessed with Camelot in all its forms, from Arthurian legend
to the Kennedy administration. Your favorite movie from childhood was "The Sword in
the Stone". But more than tales of wizardry and Cuban missiles, you've focused on
women. You know that they truly hold all the power. You always wished you could meet
Jackie Kennedy.

Take the Book Quiz
at the Blue Pyramid.

The questions seemed odd and unrelated to anything, but I can't believe how accurately they pegged me. Scary! Even more than meeting Jackie Kennedy, I would like to meet the Lady of the Lake.

Now I wonder--which answers would make me The Clan of the Cave Bear?