Saint Anthony said, in his solitude, he sometimes encountered devils who looked like angels, and other times he found angels who looked like devils. When asked how he could tell the difference, the saint said that you can only tell which is which by the way you feel after the creature has left your company.”
– Elizabeth Gilbert.

Change is perhaps the greatest creative task. Although it often surprises and discourages us, it is one of the great constants of life. Change is life itself.

I see Karen Bruce every three months, and I call her my Health Care Angel. Health care in America is fraught with complex decisions, insurance companies, politicians, regulators, unpredictability and helplessness. Most people complain about it.

I have learned not to complain about my life, taxes, health insurance, old age or politics. I do not speak poorly of my life, although it breaks my heart to stand in the pharmacy line and see people walk away in tears because they can’t afford their medications.

My experience with health care has changed my life, in good ways and bad. In recent years, I was diagnosed with diabetes (my grandfather also acquired this disease later in life),  and then heart disease, I had open heart surgery several years ago.

When you have heart disease, the tendency of health care professionals and many other people is to assume you can drop dead at any moment, which I supposed is true. If  you tell anyone at a cardiologist’s office that something hurts, or you were dizzy or short of breath, or have a cold or cough,  they will tell you to get to the hospital quickly.

Almost everyone I meet looks sorrowfully at me, and asks in a whisper, “how’s your health.” Strangers online write to beg me not to shovel snow or lift firewood.

It is true that there is a boundary in life between people with chronic illnesses and people without them. Life is suddenly different.

These experiences have caused me to take better care of myself and learn more about nutrition, the heart and general health. I manage my medications, my diabetes is very much under control, my heart is functioning well, my blood pressure and cholesterol levels are fine. I know which doctors will speak to me openly, and which ones will not. I have identified a nurse-practitioner in every medical office I go to.

But these issues are complex and have challenged me to manage my health and medications carefully (I have retinal issues relating to diabetes also and will soon undergo injections into one eye monthly to heal the eye and to safeguard my sight.)

As I entered this bewildering and fraught world, the Gods were smiling on me. I started seeing a nurse-practitioner, my health care primary, her name is Karen Bruce. The big lesson about health care for me is to avoid men whenever possible and if you have any questions, get to a nurse.

I have the greatest trust in her and affection in Karen Bruce, she has been my primary care provider since the beginning.

My male doctors do not know how to speak to people, or choose to do it, and she always does. Like the best primary care doctors, she oversees my treatment and translates the indecipherable language of medicine to me. She thinks about cost too.

She not only monitors my health, but my medicine, suggesting new or different medications, explaining the tests that others have taken but cannot explain.  She asks about my life and answers my questions. She gives me a sticker when I am good, and chews me out in the nicest and most articulate way when I am not.

She is a family practitioner and has also gotten her degree in psych nursing. She is blunt, funny, caring and a fierce advocate for her patients, including for me. We laugh a lot in our examinations. She takes no prisoners when necessary and is sweet when appropriate. I do what she says, and what she says has kept me focused and productive. She told me today I am doing great, that I will be around for a good long time.

A few months ago, a nurse found that I had a heart murmur, something new, it seemed. I declined emergency care,  had exhaustive  tests done, and the results showed the murmur was real, but my heart was strong and in good shape. Nobody called me or told me about the results, Karen went and dug them out and let me know right away I was fine. No one else would have told me.

I have never had a male doctor bother to tell me that I am healthy, they just present me with data. Karen seems to remember that I am a human being, not a blood test. That has made an enormous difference to me.

Under her watchful eye, I have managed my diabetes so well she said I was the most conscientious diabetic in her practice.

I remember when I first saw her I had been trying to handle my diabetes entirely holistically, no medication or insulin or blood work. When I met Karen, she sat me down and told me what would happen if I didn’t take care of myself. She was persuasive. I started taking insulin and re-casting my ideas about nutrition and diabetes.

There are some things Western medicine can do, and managing diabetes and taking my heart out of my body and repairing it are two of them. I would probably be dead now without those skills.

When I told her one summer day that I thought I had asthma, she looked me in the eye (I can’t repeat the language) and she said no, you are having a heart attack, you are going to the hospital. I gather she saved my life.

Open Heart Surgery was a stunning surprise and shock to me, I had not been to a regular doctor in years. I swore I would never become enmeshed in the country’s chaotic health care system. Hubris pops open like a Pinata sometimes.

I was nearly overwhelmed with the insurance, medications, and details of my heart disease.I was plunged into the world of specialists, pharmacies, insurance companies, medicines and side effects. It is a cliché, but Karen was with me every step of the way, guiding me, grounding me, teaching me, sometimes yelling at me.

I don’t know if it’s true or not that I am one of her best patients, but she helped me navigate this new thicket. And I don’t recall Karen every bullshitting about anything.

She told me I was doing great, doing what I needed to do, learning what I needed to learn.

We became friends.

She briefly joined my writing workshop and wrote some wonderful poetry.

She is a gifted writer and also has wonderful stories to share.

She was always available to me, and she has always lived up to Elizabeth Gilbert’s definition of an angel: I always feel good when I leave my tri-monthly examinations, as i did this morning. I always feel encouraged, inspired and even proud of myself. That is the very definition of health in many ways. I’m always smiling, and not too many people walk out of the health center smiling, usually with  sticker on my shirt.

Karen told me months ago that she is leaving the health center where we meet. She is moving to the Adirondacks where she can help people with psychological problems as well and medical difficulties. She and her husband are building a new home, there a new and richly-deserved chapter in an adventurous life..

I told her I am proud of her,  she is, like me, open to change and challenge. She has great faith in her religion.

She is not one to stand  still and mildew. She has no use for pity or old talk or excuses. I am very happy for her, and so grateful for her helping me learn how to deal with these new realities in my life. For a while, I felt I was drowning. I can handle it now.

Three days after my open heart surgery, I was home working. Even Karen was shocked.

But I heard her voice over and over again in my head: get up and walk. So I did.[Saint Anthony] said, in his solitude, he sometimes encountered devils who looked like angels, and other times he found angels who looked like devils. When asked how he could tell the difference, the saint said that you can only tell which is which by the way you feel after the creature has left your company.”

We can complain because rose bushes have thorns, said one philosopher, or rejoice because thorns have roses.
Health care is a controversial mess in many ways, but Karen teaches me that it is really, after all, about people. People who care make it work. Karen said she was afraid to tell some patients at first that she was leaving. She felt guilty leaving them behind, I wonder if she knows that there are not too many people like her, it is a tough business to work in.

I can handle it now. I know the drills, understand the process, know who I can talk to and who I can’t. I know how to take care of myself, and I do. My heart is strong and I am determined. Angels, like spirit dogs, appear when they are needed, and leave when their work is done.

I told Karen this morning that she need feel no guilt about me. I am nothing but grateful to her, and I am also excited for her. She is undertaking a profound and wonderful change in her life, it is exciting and inspiring. She always grumps when I try to take her photo, but I insisted this morning (the Iphone X).

I’ll have one more visit with Karen early in 2018, and then she’ll be gone. I told her I’ll drive up to the Adirondacks and take her to lunch. She accepted.

I did not want her to slip away without a photo. Thanks Karen,  I have always believed in angels who appear on the hero journey, magical helpers who guide us to safety. I was lucky to have one when I most needed that.

I feel good, I told her as we said goodbye.

“You are good,” she said.