Wednesday, October 31, 2007

Happy Halloween from Anesthesioboeland

Ok, I'll admit it: this Halloween thing's not so bad...

I tried to get into the spirit of things (so to speak) by making myself a Halloween classical music mix (lots of oboe parts!):

1. from Giselle, Act II: the opening, subsequent allegro, and "allegro feroce," when the wilis dance poor Hilarion to death
2. Carabosse's appearance from Tchaikovsky's Sleeping Beauty
3. Selections from Swan Lake: the overture, Odile's entrance and exit, and the storm scene
4. "O Fortuna" from Orff's Carmina Burana
5. Catacombs from Musorgsky's* Pictures at an Exhibition
6. Musorgsky's Night on Bald Mountain

(I almost included the funerary procession from Prokofiev's Romeo and Juliet but I find it too scary and disturbing.)

What really put some cheer into my Halloween blues, in addition to that pumpkin carving game Anali told me about a couple of days ago, and a productive oboe lesson with Kyoko today, was the pumpkin contest at one of our hospitals. I thought the entry from Labor & Delivery was particularly cute, and that the "Witchie-Poo" created by one of our very own O.R. nurses was spectacular. I'll sign off and leave a pumpkin gallery here for fun, along with a couple of shots of our candy-serving mummy, Queepy, who makes an appearance at our door once a year. See below, too, for a suggested Halloween reading list. Happy haunting!










***

Suggested reading for the ghostly season:

Skellig by David Almond
The Devil's Storybook by Natalie Babbitt
A Great and Terrible Beauty by Libba Bray
The Woman in White by Wilkie Collins
The Haunted Mountain by Mollie Hunter
The Haunting of Hill House by Shirley Jackson
The Turn of the Screw by Henry James
House of Stairs by William Sleator
Jeremy Visick by David Wiseman

___________________________________________________
*A program note from Kyoko's last concert teaches that the correct transliteration of Musorgsky from Russian contains only 1 s; the double s spelling came to us via the French, but now scholarly writings in English are using the single s, though commercially, apparently, the double s is still in play (no pun intended) because it's what people are used to.

Tuesday, October 30, 2007

On Certain Ghosts

We've been sharing a lot of ghost stories in the O.R. these past few days. I don't know what it is about ghost stories, but people love them, me included. Someone was telling us about how she took a picture at a birthday party, and when the photo was developed, the woman in the portrait in the background had somehow been completely transformed. Another person described inexplicable happenings with one particular lamp in her home, which, every year, around the time of her grandson's death, has a way of turning on when she leaves the room. When she comes back, she finds it on, though it's not on a timer, and there's no one else in the house. It only happens in the winter, during the months he had been most ill with the leukemia that killed him. Who can say what's going on in any of our ghost stories?

I admit I have one too. I've written before that the possibility of spirits and visitations is well-accepted in my culture and family, and that people we know have actually had some experiences with spirits. I've always been wary of this "gift" some members of my family have - the ability to "see" dead people, or medical conditions, or what-have-you. Frankly I've always hoped it's a talent that totally skipped over me, or at least has been so diluted it's only perceptible as a kind of eerie intuition for certain things.




Many years ago my mother and I were staying with my godmother during one of our visits to the Philippines. The bedroom we were in was right above her driveway. One night we were spending a quiet evening in there - probably reading or doing crosswords, which would have been very typical for us - when I heard someone crying outside. It sounded like a woman, a very upset, inconsolable, sobbing woman. Sometimes the crying sounded a bit faraway, but mostly it was right under our window. I looked up from whatever I was doing and asked my mom, "Do you hear that?"

"Sounds like someone crying."

"I don't know. What is that? Is it right out there?"

"You'd better look. Someone might be in trouble & need help or something."

It somehow didn't sound like your average distress call on the street. I can't explain why. "Me? But you're the brave one! I don't want to look..."

My mom glanced toward the window. "I don't really want to look either," she said.

The sobbing continued. It was the saddest sobbing I'd ever heard.

"What if she's getting attacked or something?" my mom said.

"Go look," I urged. "You're closer to the window."

My mother got out of bed and parted the window blinds.

"What do you see?" I asked. "Is there anyone there?"

"No," she said. "I don't see anyone." By this point I think the crying had stopped.

"That was weird."

We later told my godmnother and her daughter exactly what happened, and though my godmother dismissed it as probably some wailing cats out in the yard, her daughter had a very different reaction. I couldn't believe it, but I saw the hair on her arms stand erect as we described the pitiful, despairing sobs. I thought that was just a cliché out of a mass market novel.

"What's the matter?" I asked her suspiciously.

"Um...you heard it right under your bedroom window?"

"Uh, yeah. Why?"

"A young woman who worked for us was shot to death not long ago right in that spot."

"Oh..."

Creepy coincidence, those wailing cats ...

***

We see some pretty disturbing things in the O.R. Amputated limbs. "Running the bowel," when the surgeon takes all the intestines out of the body cavity and runs his fingers along their length to be sure nothing's out of the ordinary. Stinky abscesses. But perhaps one of the most fascinating entities from the operating table, which I can't resist mentioning on this eve of All Hallows' Eve, is the "monstrous tumor": the teratoma.


(Photo from http://www.pathology.med.ohio-state.edu/ext/MedEd/Med2Visuals/Scripts/descall.idc?FolderNumber=10532)

This is a ball of many different kinds of tissues found as one big tumor. The mish-mash can include tissue that is recognizable as thyroid or lung or eye or any of a number of different parts of the body. Teratomas are a result of stem cells which get sequestered somewhere and develop higglety-pigglety into the various types of tissue that they have the potential to become. Some of the tumors contain individual teeth and hair, fully-formed - different expressions of essentially the same genes. It's a little unnerving.

Over the weekend I watched the compelling NOVA special "Ghost in Your Genes," which describes the exploding new field of epigenetics, the study of the cellular and molecular mechanisms that govern gene expression. These mechanisms are the machinery behind turning genes "on" and "off." Less than 2% of our genes are different from those of a chimp; the rest are identical. We simply express them differently - turn different ones "on" or "off." Cancer is a disturbance of this on/off balance, as are many (or, maybe someday we'll say, most) diseases. Teratoma parts are also examples of gene expression gone haywire.

I was in the middle of medical school at the turn of the millennium, and at that time we were taught that a person's traits resulted from an interaction between nature (genetic endowments) and nurture (environmental influences) in a dynamic, ever-evolving process. The study of epigenetics gives us tangible hooks on which to hang those ideas: DNA methylation and chromatin modification may very well be the molecular ways in which experiences cast their imprint upon cellular structure and function.

An example: mouse pups who were cared for by mothers who licked them attentively showed far healthier stress reponses, and far fewer methyl groups on their DNA, than mouse pups in the care of less attentive mothers. Mouse "personality" - or responses to life and environment - was not just a matter of innate temperament; it was also modifiable by experience.

What fascinated me about "Ghost in Your Genes" is that it took the nature v. nurture debate, turned it on its head, and added a new twist. The twist was this: some research demonstrated that the impact of behavior and lifestyle wasn't limited to the individual living the current life. The experiences of one generation can have reverberations in the biology of its descendants. Famine in your grandparents' village might mean your molecular regulators of gene expression are affected in such a way as to increase your risk of developing diabetes. Epigenetics is exciting because of its power to bring together the strengths of molecular biology and psychosocial theory and to shed light on connections between human experiences - nurture , abuse, smoking, famine - and human disease states and disorders - diabetes, cancer, autism, anxiety disorders. It's slowly becoming clear that we may not be able to claim we're only harming ourselves; our children's children stand to experience repercussions because of what happens to us now. Our world, our experience, interacts with us on the molecular level in ways that are only now being elucidated.

Watching the program, I found myself nostalgic for my genetics rotation at the N.I.H., my road less traveled, and I wondered, almost wistfully, what might have been if I had stayed there. Here was a core idea in my intellectual belief system - the idea that genetics and environmental factors act in concert to produce an individual's characteristcs - now with some concrete science behind it. Molecular biology, child welfare and development, social theory, so many of my interests, all crossing paths and opening up a new world of scientific discovery! I can't wait to see what future research brings...clearly the human genome project was just a scratch on the surface of machinery that was more intricate than we ever imagined. We don't just get genes from our ancestors...we get their experiences too, in our very cells, passed down through the molecules and histones that cling to the very blueprints from which we are made, marking us like spectral artifacts on developed photographs. We have a lot to learn from our ghosts, I think, especially if we're willing to expand our thinking.

Saturday, October 27, 2007

How Can They Like This Better than Christmas?

I hate Halloween.

I hate the creepiness, the figures hanging in effigy, the other "decor" - unpleasant, dirty, repugnant stuff, like cobwebs, slime, blood, bones, and very large bugs and rodents.

My kids love it. I have to admit I do enjoy the kids' enjoyment of dressing up, and we dress up with them. We still haven't topped the year we went as a medieval family with a Power Ranger.

Anyway, my kids are at a Halloween party right now, while I'm alone on call at the O.R. desk in a desolate section of the hospital, dimly lit, a little spooky when the lights aren't all on. And I'm sitting here surfing through Youtube for clips of the scary movies that made a permanent mark in my limbic system when I was a child back in the '70's. Silly, huh? Man, there was some SCARY stuff back then - not the digitally enhanced, over-the-top gore that has permeated more recent horror movies, but the more insidious kind, the ones with sinister PEOPLE, spine-chilling settings, and psychologically disturbing STORIES. Audrey Rose. Rosemary's Baby. And the two that I watched on TV at age 8 or younger and that terrify me still: The Changeling and "Amelia" from Trilogy of Terror.

"Amelia" is about a horrible, possessed Zuni warrior doll that resembles one of those shrunken heads with really sharp teeth. It comes to life and terrorizes the woman who purchased him, stabbing her repeatedly with his little warrior knife. I can still remember being afraid of small shadows in my parents' house when I was a kid because of the scene in which the woman glimpses its shadow flitting across the carpet in her apartment. The Changeling is really masterful. I really don't like horror movies at all, but this one is more a mystery/ghost story type of thing, with great acting by George C. Scott, who also stars in one of my favorite film versions of A Christmas Carol. Now that I'm an adult and a parent with a husband who has dedicated his law career to advocating for victims of child abuse and neglect, the film has a poignancy for me that went completely over my 7- or 8-year-old head when I first saw scenes from it at a family gathering. Back then I was just creeped out by the banging sounds.

Thinking about scary movies and Halloween got me thinking about fear and the nature of evil. The two are so inextricably intertwined. Does evil exist, or are we all just slaves to brain chemistry? If people become evil but are not born evil, what makes them turn? What is scarier in these films - insanity (Misery, The Shining, Fatal Attraction), human evil (The Silence of the Lambs, Dead Ringers, A Clockwork Orange, Halloween), or supernatural evil (Poltergeist, The Exorcist, The Amityville Horror, The Ring, The Omen, Nightmare on Elm Street, Nosferatu, 30 Days of Night)? Personally I think nothing's worse than the capacity to be cruel with relish and without mercy (Saw, Audition, Wolf Creek, The Last House on the Left, Hostel).

I've noticed some recurring preoccupations in scary movies that I think say a lot about what we human beings fear the most:

-loss of control or understanding of the world around us (The Forgotten, The Serpent and the Rainbow, Premonition, The Grudge)
-possession by an incomprehensible force, a subset of the loss-of-control theme (The Car, The Skeleton Key, Fallen, Child's Play)
-metamorphosis (The Fly) and/or dehumanization (The Stepford Wives, Children of the Corn, Dawn of the Dead)
-abnormality (pretty much all horror films)
-being trapped, tortured, or preyed upon - basically, anything involving pain, violence, isolation, or threat of death (again, pretty much all scary movies)
-ineradicable villains (Friday the 13th)

In graduate school I learned that at some point children develop a strong sense of what is "to be expected" and what isn't, and that they react in one of two ways: by finding the unexpected or abnormal element funny (for example, a red ball on the nose when they look in the mirror) or finding it extremely unsettling or scary. What I can't figure out is why some people really ENJOY the scare of a scary movie. I rarely do. I really regret having seen Gothika and The Butterfly Effect, for instance. There's no way to remove a striking image or idea from one's visual memory, and the negative energy emanating from a lot of the genre, I think, could ultimately be spiritually toxic, like a mind-contaminant. That being said, there are a few film thrillers / scary movies, and one terrifying play, that have enough admirable elements (intriguing story / well-written script / fascinating actors) to make them worth seeing. It's my List of the Month. If anyone has some scary movies that have stayed with them for one reason or another, let me know! I'm curious.


My "Favorite" Scary Movies and Play

The Seventh Sign - a B movie if ever there was one, but one near and dear to my heart from my teenage years, mostly because I had a crush on the lawyer-husband guy in it and even came up with a litmus test straight out of the movie to see who would end up being my future husband...long story...even weirder is that when I applied my test to my husband, long before we were married, he passed it...! Ah, the power of self-fulfilling prophecies...!

Psycho - gotta have some Hitchcock on here, and this just might be the defintive one for Halloween.

Dragonfly - a strange but entertaining ghost story; I'll never look at a parrot the same way ("Honey, I'm home!" Oooooh, creeeeeeeeepy).

The Sixth Sense - because some people do experience seeing dead people, and I could name a few!

Primal Fear - not a horror movie per se, more of a murder mystery; Ed Norton is stellar.

The Exorcism of Emily Rose - I was surprised at how much I admired this movie, I think because I enjoyed the court-room trial aspect of it, the clash between science and faith, the courage of the priest as he confronted what he believed to be ultimate evil.

The Woman in Black - saw the stage version in London and found it so scary (but also excellent) I couldn't sleep that night! SPOO-OOKY!

***

Many thanks to Anali for this great, highly addicting Pumpkin Simulator for anyone who wants to do a dry run (or 2, or 3...) before carving a real one. Makes Halloween a little more enjoyable for us Halloweenophobes!

Thursday, October 25, 2007

Righting Things

(illustration by Patrick J. Lynch, medical illustrator; licensed under Creative Commons)

In the children's movie Madeline, whenever Frances McDormand's character had a worrisome gut feeling about something, the camera would do a close-up of her face as she uttered the line, "Something is not right." I like that recurring trope because I think we all have little moments like that, when in the reel of our day-to-day lives, some instinct or vibe causes us to slow down and knit our brows, to pause and take the time to be careful, to prepare for unexpected trouble.

I had a moment like that one day when I went to the preop area to see my next patient and was handed his chart. The evaluation form from the preop clinic mentioned heart surgeries without going into a lot of detail. When I went to see the patient to investigate his situation better, I found him pale, almost greyish, the color of raw fish. His legs were completely swollen. He seemed, because of his cognitive limits, unable to formulate any helpful answers. Something was really not right. Here we had a middle-aged adult with the mental capacity of someone decades younger somehow expected to be in charge of his own condition, and I was sure there were some significant problems with that condition.

I found an old medical record with a cardiologist's note in it. I think I went pale reading it. There were phrases in it that signaled possible doom and the need to be prepared for battle. I tracked down his cardiologist, who happened to be in the O.R. area that day, and had a brief but intense conversation with him. Adding to all the "red flag" descriptions on the cardiology consult, he confirmed that the pulmonary valve was tight, tight, tight, and that the patient depended on the fluid entering his heart for whatever he managed to eject out of it to the rest of the body. Anesthesia could be very dangerous for this guy.

If I had been in a tertiary care center with cardiac bypass capability, once I was satisfied the patient was as good as he was going to get, health-wise, I might eventually have thrown up my hands and said to myself, oh well, when you gotta do it, you gotta do it. At least there's a perfusionist in the house, and lots of staff to help out. But there, at that little country hospital in the middle of dairy farm country, I took the surgeon aside and said to her, "Look, I know this isn't a huge operation, but it's not mandatory for the moment, and we shouldn't be doing it here. If anything happens to this guy on the table, I WILL NOT be able to resuscitate him." It killed me to say it. It was like an admission of failure. It hurt my pride. I knew how to take care of him; I just couldn't offer it there, in that setting. I had visions of big-shot anesthesia departments at academic centers looking at my referral of this patient to them as an act of cowardice or weakness rather than advocacy. But I swallowed my ego and pressed on. "He's a disaster waiting to happen, and we just don't have the resources." The surgeon agreed. The surgery was cancelled.


***

One of the most stressful things about my job is that you never know what you're gonna get, either from the people around you, or as a surgery unfolds before you. And if what you get is something baaaaaaaaad, you're supposed make it right.


***

I've been doing a lot of mental grumbling lately. "Ugh, I'm on call again." "What? I can't have a moment to rest after a long day in the O.R. because we've run out of milk?!" "What do you mean we're out of leftovers? I have to cook?"

I'm making myself a rehab program: Grats for Gripes. I want to try to replace every griping thought or muttering I produce with a thought about something for which I'm really thankful, and which I tend to take for granted.

Tonight while I was preparing to make a Concord grape pie after a recipe by Rebecca Beaton, I started thinking about hands. That's my "grat" for the day: the wonder of the human hand. Our hands quite literally make us human. By acquiring the capacity to hold and change things with our intricate little interossei and lumbricals, we have developed all sorts of other abilities - affection, relationship, artistry, construction, destruction, a doctor's physical exam, a computer wiz's impact on communication, a chef's culinary creations. Our hands, like our faces and our language, give us a way to engage with the world that can transform our thinking and our way of life. I do take them for granted, and I know I shouldn't.

I went to chamber music rehearsal having shed a lot of my discontent of the last few busy, stressful, tiring days. Using my hands with others to bring to life the music of Pachelbel and Mozart tonight replaced all those negative neurotransmissions in my brain with lovely, endorphin-laden messages about what is in fact right about the world right now. Besides the Red Sox being in the World Series, that is...

Sunday, October 21, 2007

Optics, Acoustics, and Matters of the Heart, Not Necessarily in that Order

My son's questions have a way of keeping us on our toes. The other night at the dinner table my husband and I were reminiscing about college and he made a facetious, ironic remark about "the many men" I surely dated back then - a risible idea considering my awkwardness and in light of the fact that one of my husband's pet names for me is "super-duper-dork," upgraded from a mere "super-dork" only recently. My young son, though, doesn't have a fully developed sense of irony just yet, and in fact will be the first to admit, "I'm just very literal; I can't help it." His rejoinder to his father's joking comment, addressed to me, was, "So why'd you pick Papa?"

We all laughed, but it was also a good question. Why DID I want to build a life with this particular guy, and what wisdom should I pass on to these little ones about such a choice? They know the suggestions I've mentioned in the past - look for a good heart, a believer in equal human rights, a respectful person who's also hard-working, intelligent, full of integrity, funny, someone you wouldn't mind seeing every day, who can be your closest friend but also can make your heart beat a little faster once in a while, who can teach you and learn from you, who helps the elderly cross the street and the very young enjoy games and songs, who will let things that matter to you matter to him or her even if they're not inherently interesting to him or her. I wanted a shared life with this kind of person and knew my husband was the one who could bring all these gifts into that life.

We recently visited a friend whose wife had suffered a pretty bad fracture. We started talking about marriage, about the great guys we were married to, and she summed it up for me: you have to be able to picture your spouse willing to empty your commode and pull up your underpants for you when you can't do so for yourself, and know that that person will still look at you with love. I thought immediately of when I broke my arm a few months before starting my anesthesia training, of the compassion I saw in my husband's face, his gentleness as he helped me in the shower, his patience and kindness through it all. Your husband should definitely be someone you don't need to pretty yourself up for, because life can throw in some un-pretty moments!

***

My son's other questions this weekend were about rainbows. There was a rainbow over our cabin after a passing shower at sunset yesterday evening, and we started talking about the signficance of rainbows. I explained how in ancient times some people thought of rainbows as signs of hope - of the fact that even the worst storms pass - and how that idea had come down to us biblically in the story of Noah's Ark and God's promise not to destroy the world. My son also wanted to know about the science behind rainbows, so I had to try to resurrect my high school physics and talk about how sunlight from behind an observer got refracted into its component wavelengths as it passed through raindrops in front of the observer. I said we could also do that by passing light through a prism.

"Do we have any prisms?"

"No, I'm sorry, not at the moment."

"Can't we do the same thing shining a light through a jar of water?"

I knew the answer was no, or at least not exactly, but I had to think about why not. "Mmm...I don't think the jar of water would bend the light waves enough times to get all the colors..." My memory of high school optics was fading fast. Angles of incidence, anybody? But he asked me an even harder question then.

"If we make the rainbow by using a prism, does that cancel out God's promise about taking care of the world?"

I looked at him stupidly for several seconds. "Not at all, sweetie," I said. "It doesn't matter how the rainbow happens..." I searched for more thoughts on the subject. A groping search. "Rainbows have been happening in nature as long as sunlight's been shining through water droplets. People in ancient times, some people at least, thought of them as a kind of greeting card from God, a sign, but everything around us can be thought of as a sign if we see glory in it..." At this point I wanted to shut up because I was beginning to sound like a watch-therefore-watchmaker proponent, and I wasn't entirely happy with that analogy. "I think the fact that we can make rainbows, or appreciate rainbows, is as much of a gift as the rainbow itself." Where's my parent-of-a-little-sage handbook?! I must have missed it when they were handing those out...!

***





Today we caught part of the Head of the Charles regatta under the glorious weather of a perfect October day, then headed to Sanders Theater to hear Kyoko play with the Boston Philharmonic. They had a terrific program lined up: Variaciones concertantes by Ginastera, a concerto for violin and tabla by Korde, and Musorgsky's Pictures at an Exhibition, all magnificently played by this superb orchestra under the baton of Benjamin Zander. I got so moved and excited when she sounded the first A to tune everybody. She was simply amazing in the oboe solos from the Ginastera variations, and as principal oboist for Pictures. The trumpet solo that opens Pictures was perfect too. The violin and tabla virtuosi took our breath away. The whole concert was a treat like I haven't had in a long time, in an acoustically impressive concert hall. I never appreciated as a sleepy undergrad how astonishing the acoustics are in Sanders. We were sitting in the balcony just at eye-level to the Latin inscription above the stage which reads: QUI AUTEM DOCTI FUERINT FULGEBUNT QUASI SPLENDOR FIRMAMENTI ET QUI AD IUSTITIAM ERUDIUNT MULTOS QUASI STELLAE IN PERPETUAS AETERNITATES. "They who have been learned shall shine like the splendor of the firmament, and they who educate many to justice shall shine as stars for perpetual eternities.” As the final chords from The Bogatyr Gates soared over and around us, filling the hall with their majestic sound, I felt totally swept away, filled to the brim with music, and in awe of the musicians below who, as the inscription described, shone like the splendor of the firmament.

Friday, October 19, 2007

René


Today is the feast day of the patron saint of anesthetists: St. René Goupil. He was born in Saint-Martin-du-Bois, near Angers, in 1608, grew up to become a surgeon and a lay missionary to New France with the Jesuits, was captured by the Iroquois along with his close friend St. Isaac Jogues, tortured brutally for weeks, and finally tomahawked in 1642. By all accounts he was a sweet, gentle, humble person who showed tremendous patience in adversity, trust in God, kindness even for those who behaved cruelly toward him, and a willingness to work hard physically and spiritually to be of service to others in whatever capacity was needed, whether the task was menial or noble - a give-you-the-shirt-off-his-back kind of guy. Some nurse anesthetists in 1955 asked the Pope if he could be patron saint of anesthetists when one of their patients, a man named René, suggested it.

I painted an icon of René (portion above) that I modeled a little bit after the character of Gabriel in the movie The Mission. I tried to hint at the landscape around Lake Champlain and the St. Lawrence River and to use color symbolically, the way "real" iconographers do - white for his purity of heart and intention, red for his violent death, greens and blues for life and sacredness. I'm not satisfied with it, of course, and will probably do it over some time.

This may sound strange coming from someone who's supposed to exalt science and rationalism by profession, but I think René takes this posthumous assignment to heart. I have a feeling that as a "spirit guide" - do all Native American cultures hold a belief in spirit guides, or only some? I'd love to learn - he's the kind of guy who'll go out of his way to help anyone who asks, anesthetist or not, anesthesia-related concern or not. Just as he was in life. Frankly, I don't think he gets a lot of customers, which doubles my affection for the guy.

***

Once in a while we get in the O.R. or ICU what every anesthesiologist dreads more than anything: an "unanticipated difficult airway." I had one just yesterday, and boy, was my heart racing. The trouble, too , with keeping a cool exterior is that sometimes even if you say the words, "This is going to be really hard, guys, it's bad," people around you don't get how bad the situation is. I switched laryngoscope blades, repositioned the patient's head, did all the things I was trained to do, but I absolutely could not see the vocal cords through which I was supposed to place the necessary breathing tube. Moreover, I could tell just looking deep into the mouth that no amount of adjusting was going to reveal those cords. The patient's oxygen saturation was dropping. I needed to find the right spot and place the tube fast, by feel and not by sight, with the hope that my educated suppositions about the patient's anatomy would serve me well; otherwise I was going to have to either ventilate him some other way or get him awake again quickly. No, I didn't say a prayer. In fact, I don't think I had any complicated thoughts in my head at all; just monosyllablic commands to myself: In. Up. Up more. Come on. Just do it. I was the only person in that room who knew how to do this. In fact, I was the only anesthesiologist around for miles. I was basically alone with the worst airway I had seen in months.

Or was I? Are we ever really alone?

I was talking to an atheist acquaintance this past summer about the tsunami tragedies and she affirmed her own faith: "I don't think we human beings are alone at all." Even if all that happens after we die is decomposition, if God and saints are vain dreams of wishful minds, if our faith turns out to be far from the truth, if the people around us who are supposed to be helping us fail to understand, or to come to our aid - are we alone? Because that, I think, is many people's biggest fear. Loss of loved ones, separation, suffering, death, loss of consciousness to anesthesia by another's hand - fear of these, I think, is ultimately fear of being totally cut off and isolated, trapped apart from contact with the living.

Yesterday's patient had somebody pullin' for him, that's for sure. The breathing tube went into the right place.


***

I wrote this for any fellow-Catholic anesthesiologists out there who believe prayer is for transforming ourselves rather than transforming the will of God (an idea I first read in C.S. Lewis's stuff), and for those who enjoy talking to dead people. :)

Anesthesiologist’s Prayer to St. René Goupil

Dear René,
Help me keep my patients safe
and bring solace to those who suffer.
Help me prepare for any challenge,
Think clearly,
Understand completely,
Remember exactly,
Act appropriately,
Work productively,
Express myself well,
And be for those near me
A source of Christ’s love. Amen.

Thursday, October 18, 2007

I Did It!

I played in a music group tonight! As an oboist! I can't believe it.

I've dreamed for so long of making music in a group, of playing "real" pieces on the oboe with other musicians. I usually have a hard time going out on a limb, but this was totally worth it. My teacher has a flutist friend who conducts a chamber orchestra for beginner musicians, and she told me to go and rehearse with them, so I gulped down my intimidation and went. It was scary, but fun!


At first I had a total deer-in-headlights moment. The conductor put some Corelli in front of me, and I became completely illiterate. It's as if the 6 or 8 oboe lessons I've had, not to mention several years of piano and choral singing, had never transpired. I would have had an easier time reading a billboard in Cyrillic. But once I accepted the fact that I was going to have to just sight-read as best I could and play whatever I could, it got better.

After a break he plunked Fauré's Pavane in front of me and said, "Our first oboist isn't here, so you'll have to do the oboe part."

"Are you out of your mind?! I can't play that. That's for, like, real oboists. No way."

He just dismissed my protests and started conducting, and when the oboe part came around, he waved me in, so I played, and though it had some awkward moments - seeing as I had never seen the piece before, though of course it's a familiar one from radio and recordings - it actually came out better than I expected. As for the mistakes here and there...well, the ceiling didn't fall on me or anything, and the conductor was patient and good-humored, so I really just needed to relax about the whole thing...

Playing the final duet in the piece, with the flutist, was beyond enjoyable. There's something so satisfying about playing in harmony with someone else, and about being one musical voice among many different voices, each with its own special qualities, answering or complementing the others, in a group where faults are tolerated and forgiven rather than judged or cause for exasperation.

Why is it so challenging sometimes to translate this kind of spirit and focused energy into the rest of life?

Tuesday, October 16, 2007

Sweet Vitriol: Thoughts on Ether Day


Happy Ether Day... though I have to admit, Ether Day always makes me a little sad. It makes me think of how merciless the academic world can be, and of poor Horace Wells. But I'm skipping ahead.

On this day, October 16, in 1846, William T.G. Morton used a sponge soaked with ether to anesthetize Gilbert Abbott, a Boston printer. Surgeon John Collins Warren removed a tumor from below Abbott's jaw. When Abbott emerged from the anesthetic and reported having felt no pain during the procedure, Warren turned to the audience and said, "Gentlemen, this is no humbug." This was a reference to the awful Horace Wells incident. But again, I'm ahead of myself.

Ether Day was the most famous public demonstration of a general anesthetic but by no means the first, nor was it the first use of general anesthesia for surgery or the first medicinal use of ether. In March of 1842 Crawford Long used ether as an anesthetic to remove a sebaceous cyst from the neck of his patient, James Venable but did not publish his work until 1848 in The Southern Medical and Surgical Journal.

Nitrous oxide, or laughing gas, too, had already been publicly demonstrated in circus sideshows before the demonstration at Mass General took place. On December 10, 1844, a travelling lecturer and former medical student named Gardner Quincy Colton, who had already earned $535 with his nitrous oxide demonstrations, gave a show in Hartford, CT during which a volunteer from the audience felt no pain from an injured leg. Dentist Horace Wells was there. His interest in developing an anesthetic technique for dental practice inspired him to procure a supply of the gas from Colton. He began to administer nitrous oxide to his dental patients.

Before Morton demonstrated ether anesthesia at Mass General on Ether Day, Horace Wells had tried a similar demonstration there over a year before, using nitrous oxide. It was a disaster.

I have always had a soft spot for Horace Wells because of this, because I know what it's like to be on the spot publicly, in front of a bunch of academics who are not necessarily on your side and seem to be just waiting for you to screw up. I've observed on many occasions that, in many instances, academics are people for whom making intelligent remarks about something consists of pointing out what's wrong with the thing, often with great relish and self-satisfaction. Of course, I've also known truly great academics, those who are knowledgeable and can communicate their knowledge with a sense of joy and excitement rather than superiority, who are creative and open-minded, capable of enjoying a piece of music or theater without nitpicking, willing to admit they have more to learn, and in fact able to learn from others. I have a feeling this was not the type of academic Horace Wells was up against when he tried to demonstrate that nitrous oxide could be used as an anesthetic. In January of 1845, before a critical and demanding audience of medical students at Mass General, apparently something went wrong with the way the gas was administered, and the patient cried out in pain. Wells was publicly humiliated, with the students jeering "Humbug! Humbug!" as he left the auditiorium, and he lost his credibility within the medical community. After this miserable failure he became a traveling salesman and sold canaries, shower baths, and other household goods for the next two years.

I think it's interesting that William T.G. Morton had been Wells' student and then business partner in the early 1840's, when Wells first set up his practice in Hartford. They went their separate ways after only a couple of years in dental practice together. In 1847, after Morton's success and notoriety as a result of Ether Day, Wells ended up working for his former student: he went to Paris to sell anesthesia for Morton, who tried for years to get royalties for his "discovery" of ether anesthesia. Wells became addicted to chloroform while in Europe, in a state of delirium assaulted two women with sulfuric acid, got committed to Tombs Prison in New York, and committed suicide by slitting an artery in his leg with a razor. He was only 33.

An article by A.J. Wright from the 1999 newsletter of the American Society of Anesthesiologists acknowledges, "Recent work by Stephen D. Small, M.D., has demonstrated that Wells was a deeply religious young man concerned 'with a reality that transcended intoxication, a dangerous idea without scientific proof that the inhalation of nitrous oxide could be pushed to levels heretofore unknown, with great benefit.' Here then is Wells' main contribution - 'to push the inhalation much farther than for a mere exhibition for fun.' Wells' motivation seems to have truly been the discovery of surgical pain relief, not an exotic experiment performed a few times and abandoned, as with Dr. Long, or a process to be patented for profit, as Morton tried to do."

On the ASA website people can order Crawford Long, Horace Wells, or William Morton T-shirts to cast their vote as to "who was first." I think they need to get Gardner Quincy Colton up there, a med school drop-out with no academic credentials. Actually, what I really think, banter aside, is that each Ether Day, what we need to reflect on is the way in which academic cruelty can destroy a person and rob us of his or her gifts. If those med students who were watching Horace Wells had replaced their jeers of contempt with supportive actions and educational questions, the result might have been much more productive use of everyone's work and perhaps much less unnecessary tragedy.


***



Speaking of academe, I spent Ether Day enjoying the beautiful fall weather in Harvard Square on a rare day off with my husband. We had lunch at Finale, which is known for its terrific desserts but deserves accolades for its delectable gourmet sandwiches too.

"What did we used to talk about when we hung out here when we were younger?" I asked him as we ate our sandwiches. The places around Harvard Square were our old stomping grounds.

Chomp, chomp, sip. "I dunno. Why?"

"Well, what on earth could have brought us together at that age?" I wondered aloud. He and I have nothing in common, with the exception of some core spiritual values / ways of looking at the world. Nothing at all.

"Pheromones," he replied. Munch, sip, munch, munch. "Good sandwich."

I think our being totally different, like two puzzle pieces with completely different shapes, helps our marriage. That, and we find each other funny.

"Do you want my raspberry garnish?" The berries on my dessert were a little tart, but the crème brûlée was rhapsodic.

"Sure. Want my chocolate triangle?" He said, handing over the little wedge of dark chocolate from beside a delicious frangipane tart.

"Of course."

Ah, a marriage that works. Gotta love it.


***

Here's an Ether Timeline (by no means complete) for any who might be interested. I found a lot of the info here at bookrags and also compiled by Thomas J. Evans, CRNA, at the Anesthesia Nursing and Medicine Website:

1275: Spanish chemist Raymond Lullius discovers ether, calling it "sweet vitriol."

1540: Valerius Cordus describes the synthesis of ether. Paracelsus discovers it has hypnotic properties.

1730: Frobenius changes the name of sweet vitriol to ether.

1788: Matthew Turner writes An Account of the Extraordinary Medicinal Fluid, called Aether, now available for perusal through Project Gutenberg.

1794: Pearson and Beddoes use ether to treat scurvy, bladder stones, & catarrhal fever.

1800: Sir Humphry Davy described the effects of nitrous oxide.

1804: Japanese physician Hanaoka Seishu used a bunch of scary plants to produce general anesthesia in a patient in need of surgery for breast cancer.

1805: American docs use ether to treat pulmonary inflammation.

1818: Faraday, Davy's student, notes that like nitrous oxide, ether can produce analgesia and euphoria when inhaled.

1820's: "Ether frolics" became a popular way for U.S. chemistry students to amuse themselves.

1842 - January: probably inspired by a frolic, chemistry student William Clark of Rochester, NY administered ether to a Miss Hobbie while dentist Elijah Pope pulled her tooth.

1842 - March: Crawford Long uses ether to remove a sebaceous cyst.

1844: Gardner Colton demostrates nitrous oxide in Hartford. Horace Wells starts to use nitrous oxide in his dental practice.

1846: Ex-physician Charles T. Jackson suggests that Morton use ether for dental extractions. Morton does so and performs painless tooth extraction on Eben Frost in September. Ether Day in October.

1848: Death of a salesman: Wells commits suicide.

1850's and 60's: Big fight between Morton and Jackson as to who "discovered" ether anesthesia. Long and Wells also with claims, though Long never tried to patent his use of ether for personal profit.

1868: Morton dies in poverty, from a stroke.

1873: Jackson goes insane, dies in 1880.

1944: Gregory Peck's character anesthetizes a boy with some drops in the film Keys of the Kingdom.

1952: Bugs Bunny episode "Water Water Every Hare" features a slow-motion chase between a mad scientist and Bugs who are in a semi-anesthetized stupor due to a broken ether bottle.

Sunday, October 14, 2007

Barn Raising II: the follow-up



Yesterday evening we had the chance to drop in on our friends in Gilmanton, NH whose barn-raising we attended last June. My husband had a wonderful time helping with the construction, so it was a pleasure to see the finished product and say hello to the herd of 8 alpacas that now make their home there.


(Before:)



(Now:)




Tomorrow I am on call, away from my family. Years of doing this and I still haven't gotten used to it.

Saturday, October 13, 2007

Bad Friday

Warning: Though I usually try not to be a "downer," the following post isn't super-cheerful and will strike many as an example of wallowing in whiny self-pity. Please refrain from pointing that out - I already know it - and skip it if that sort of thing annoys you. This blog often serves as a venting journal for me, and I definitely needed an outlet yesterday where I could let it all hang out! :)



***

"Happiness is a how, not a what, a talent, not an object." -Herman Hesse

I have this cute little book by David Niven entitled 100 Simple Secrets of Happy People, which outlines a number of ways that essentially happy people approach life. It suggests things like laugh often, get enough sleep, enjoy a hobby, make time for friendships, etc. and backs up each suggestion with an anecdote and a relevant research finding. One of its suggestions is not to take failure personally.

I consider myself a happy person. I find life filled with blessings, and I enjoy it. But I also tend to take failure personally, and I ascribe this to a kind of perfectionistic temperament that leads me to be hard on myself and demand the best work I can do.

Yesterday I was asked to help one of the docs on the 2nd floor with a spinal tap. He had tried that morning and found it difficult. I went up and gave it a try, and I found it difficult. I wasn't able to get it either, and I'm supposed to be an expert at this procedure. Everywhere I inserted the needle, I found a wall of bone, bone, bone. I tried different positions, angles, and techniques, but nothing worked, and after putting the poor patient through discomfort for a while, we decided to give her a rest and reconsider our options.

To make matters worse, this was a patient I had cared for before. She was the same patient in whom I had heard a murmur a couple of weeks ago in the area of the mitral valve. At that time the combination of her extremely low blood count and her family's description of a 30-pound weight loss over a relatively short period of time had made me extremely suspicious for cancer. I called her primary care physician from the recovery room to discuss this as well as her surgical course with him, and what I had observed from her history and physical exam, but that was the last contact I'd had with this patient, until yesterday. She lay back down on the hospital bed after our failed attempts at obtaining spinal fluid to assess it for cancer cells and said, "I'm gonna die." When patients say this, and it's not because they have a martyr complex or have a tendency toward melodrama, but rather because they really feel it "in their gut," I listen, because it's like a prophecy, almost always fulfilled in the months that follow. I was sad.


Happy people don't let rough moments define them, personally or professionally. But I've been trained to look at everything as evidence, to exalt the importance of proof and observable reality. Wanting to be a good physician doesn't make me one. Yet hundreds of well-cared for patients and expertly-managed airways and other procedures all seem to disappear in my memory every time a difficulty disappoints me. I know there's more to being a good doc than being slick at lines and needle sticks. My husband blames my training experience for the way I take all these setbacks to heart and don't acknowledge the good I supposedly do. I think it's just me, the way I respond to things and the demands I impose on myself. A lot of my so-called "bad days" are "all in my head," but that knowledge doesn't help much.

Imperfection wasn't tolerated in the ballet studio when I was young or on the medical wards when I was older, and with good reason for the latter. I do recognize that it's easy for ego to be all wrapped up in our good intentions for our patients. Of course I want to do my best, be at my best, for them, but I also don't want to fail because of how important it is to me to be a good physician. The motivation's neither completely selfish nor completely unselfish. There are those who judge altruism harshly, saying that doing good for others is all about the do-gooder wanting to feel good. I say it's never only one thing or another. I do believe many people sincerely care for and want to help others but also want to feel good about their own work.

That's certainly how I feel about it. Which is why I feel bad, on both counts, right now.



***

While I'm giving vent to my frustrations, let me go ahead and get off my chest all the other things that made yesterday not-my-favorite day at work.

-Neither electroconvulsive therapy session for which I provided anesthesia was straight-forward; my first patient desaturated sharply during the induced seizure and was difficult to mask ventilate;

-I almost had a medically unnecessary C-section added on to my schedule which was going to be done because the mother didn't want to push the baby out vaginally - a practice to which I strongly object because of the increased risks, present and future, to both mother and baby (as in, the baby is 3 times more likely to die) as a result of "electing" to have the abdomen sliced open for major surgery;

-I had a spat with my boss over my objections to something I felt endangered patients and compromised my standards for delivering good patient care.

Is mercury in retrograde or something?! Thank goodness it's the weekend!

On the up side, my kids are adorable, my husband is wonderful, I'm looking at a gorgeous view of Lake Winnipesaukee right now with fall foliage just beginning to color the landscape in the foreground and the White Mountains clearly visible in the distance, I have oboe goals, and I am safely ensconced in a cozy cabin writing to my heart's content. For all this happiness I am deeply thankful.


Wednesday, October 10, 2007

Oboe Confession

I had SOOOOOO much fun at my oboe lesson today! Kyoko can turn every little gaff or setback into a huge laughing moment. We spent the 2nd half of the lesson doing a kind of sight-reading marathon, with her accompanying me on piano. I felt like someone who's not quite reading at grade level, but she actually seemed pleased with how I did, and also with how, despite the LOOOONG summer hiatus and my recent stressful schedule, I had managed to keep up some of what I had gained with the instrument. What a relief! I thought it was going to be a bad lesson.

She's gently trying to get me to consider a recital and put Gordon Jacob's lovely "Ten Little Etudes" under my nose, carrot-to-Bugs-Bunny style, to tempt me. When I started taking lessons I had told her up front that I would never, ever, ever, ever do an oboe recital. Now I'm enjoying the instrument so much that I'm not so sure I hate the recital idea the way I did before...except that being gazed at publicly is still such a horrifying thing for me to imagine. Play in a group? That I would do. In fact, I'd LOVE to be in an ensemble, if I could be just one of many voices, contributing my part but not alone in the limelight. She mentioned there might actually be just the group for me in a neighboring town; her friend conducts an ensemble of adult beginner musicians. But a recital? No way. The very word recital gives me the creeps. I suffer from physically incapacitating, stomach-gnawing, horribly terrifying, emotionally crippling stage fright. (There's a great article here at Mandolin Magazine that sums up the experience and possible ways to deal with it.) If it was bad during my dancing years, when I was at least performing in something I was good at, how can I possibly bring myself to do publicly something I'm barely tolerable at? I'd almost rather be coding someone in the O.R. ...

Meanwhile, my son's loving violin. He was practicing in the living room while I was in the kitchen and I overheard him talking to himself, saying "That was fun!" after a couple of the things he was practicing. I think I had about as happy a feeling for him as I could possibly have. I love the fact that we can now enjoy my violin mix together. We're suckers for Neville Mariner's cut of Vivaldi's Winter, and Gil Shaham playing Sarasate.

Kyoko's in concert next week with the Philharmonic at Sanders Theater, my old stomping grounds, where I struggled to stay awake through many an undergraduate lecture. They're playing a new work for violin and tabla as well as some Ginasteras and Mussorgsky. I think I'll bring the kids to hear Pictures.

Monday, October 8, 2007

Books That Made a Difference


A month ago, Madeleine L'Engle, one of my favorite authors, died. It's been hard to contemplate the passing of someone who was such a significant presence and influence in my childhood, through her marvelous books. There have been many blog posts about Madeleine L'Engle. Many of the recent ones are outpourings of how important her work was to the blogger's life and character formation. My own thoughts would only echo what they have stated about the power of the written word to transform one's world, one's very identity.

So I'm going to do my daughter's friend's homework here instead. She was asked to come up with a "Signficant Reading Timeline." I notice as I create it that there's a lot of L'Engle on there, and a lot of what's considered "children's literature." If anyone out there feels like sharing a significant reading / educational experience / movie / influential event timeline or a "books that made a difference" list (blogged about mine last July), please do!

Early childhood:
Where the Wild Things Are by Maurice Sendak;
Where the Sidewalk Ends by Shel Silverstein;
various fairy tale anthologies;
a children's bible;
a comic book of the life of St. Bernadette; and
some works by E. Nesbit and Enid Blyton

Age 8:
Harriet the Spy by Louise Fitzhugh;
Little Witch by Elizabeth Bennett;
various works by Ruth Chew, Betty MacDonald, Beverly Cleary

Age 9: Tuck Everlasting by Natalie Babbitt.
This was HUGE. I realized that you could make language beautiful on purpose as well as tell a meaningful story with it, thanks to Dolores Roberson, the librarian and teacher who guided us through this book in school.

Preteen years:
Mrs. Frisby and the Rats of NIMH by Robert C. O'Brien
Meet the Austins, A Wrinkle in Time, and A Wind in the Door by L'Engle;
Jennifer, Hecate, Macbeth, William McKinley, and Me, Elizabeth by E.L. Konigsburg;
The Ordinary Princess by M.M. Kaye;
A Gathering of Days by Joan M. Blos;
The Lion, the Witch, and the Wardrobe by C.S. Lewis;
Little Flower by Mary Fabean Windeatt (a bio for children of St. Therese of Lisieux)
The Velvet Room and The Egypt Game by Zilpha Keatley Snyder
Homecoming and Dicey's Song by Cynthia Voigt
various works by L.M. Boston, Helen Pearce Jacobs, Lois Lowry, John Bellairs, Katherine Paterson

Age 13:
A Ring of Endless Light by L'Engle;
To Kill a Mockingbird by Harper Lee

Age 15:
Many Waters by L'Engle;
Lives of a Cell by Lewis Thomas;
Two from Galilee by Marjorie Holmes;
Ethan Frome by Edith Wharton;
The Agony and the Ecstasy by Irving Stone

Age 16: Le Petit Prince by Antoine de St.-Exupéry

Age 17: Two Part Invention by L'Engle

Age 18: Winter's Tale, A Dove of the East and Other Stories, and Ellis Island and Other Stories by Mark Helprin

20's:
Catherine, Called Birdy by Karen Cushman;
Wild Swans by Jung Chang;
By the River Piedra I Sat and I Wept by Paulo Coelho;
The Christmas Miracle of Jonathan Toomey by Susan Wojciekowski;
Holes by Louis Sachar

30's:
The Fourth Wise Man by Diane Summers;
"The Expert on God" by John L'Heureux;
Lying Awake by Mark Salzman;
Bird by Bird by Anne Lamott;
The Sparrow by Mary Doria Russell
The Swallows of Kabul by Yasmina Khadra
Vipers' Tangle by Francois Mauriac;
Wicked by Gregory Maguire;
The Painted Veil by W. Somerset Maugham


***

My son's review last month of Robert Munsch’s Purple, Green, and Yellow:

“Brigid asked her mom for colouring markers and got 500 of them!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Brigid got permanent markers and drew on pictures and paper and herself.

Brigid tried to wash off the marker and it didn’t work so she colored herself back to normal. Mom called the doctor and Brigid took a bath and turned invisible. In the end Brigid was ok but dad was not.”

It pleased me to no end to find him curled up in bed reading the anthology Poetry Speaks to Children and to learn that one of his favorite poems in the book was "hist whist" by e.e. cummings. I'm thrilled that he devoured Born with a Bang, From Lava to Life, and Mammals Who Morph by Jennifer Morgan in the space of a weekend. I delight, too, in my daughter's discoveries - Sharon Creech, William Sleator, Louis Sachar. Everyone should have a significant reading timeline. I am enjoying watching my children's unfold.

Thursday, October 4, 2007

"Hot" Topics of the Day


I love it when brilliant, creative scientists take the latest medical break-throughs straight from nature's gift closet. Aspirin from willow bark. Hirudin from leech saliva. Protamine from salmon sperm. And now capsaicin from red hot chili peppers, which may be useful as a gate-opening molecule to let QX-314, a derivative of the local anesthetic lidocaine, do its job as a pain blocker. Looks like we anesthesia folks are going to have to learn some new tricks yet again! Thanks go to my mother-in-law, who alerted me to the article in today's Globe about the research on this substance, already known to riot police (it's the active ingredient in pepper spray), arthritis sufferers (who might use capsaicin-containing creams), and purveyors of hot sauce.


***

On the season premier of Desperate Housewives Teri Hatcher's character asks someone during a medical consultation to check "those diplomas because I want to make sure that they're not from some med school in the Philippines."

The producers had this to say to the Philippine government's outcry against the insult: "The producers of 'Desperate Housewives' and ABC Studios offer our sincere apologies for any offense caused by the brief reference in the season premiere...There was no intent to disparage the integrity of any aspect of the medical community in the Philippines."

What possible intent could there have been, then?

Considering that some of the best doctors in the world come from OUTSIDE the U.S., that some of the best nurses in the U.S. are from the Philippines, and some of the worst health care in the world can be found in the U.S. system, I have to agree with those who have characterized the line as an ignorant and offensive slur.


***

Happy Feast of St. Francis!

Many parishes hold a "blessing of the animals" event in honor of Saint Francis of Assisi. This year it's a little delayed at our parish, probably due to the holiday weekend, but we'll be there! For our kids, who don't have pets, it's always a blessing of the stuffed animals. I'll never forget young Fr. John at our church laying a hand on my son's teddy bear and saying, "God bless SuperBlueBear." The Jesuits are great.

But back to the Franciscans - I want to say hi with a big hug to my favorite Franciscans / Franciscan affiliates: James Stewart, one of the most talented spiritual teachers I've had the privilege to hear and learn from, and Fr. Matthew Pravetz, O.F.M., who taught me the anatomy of the human body without letting me forget about the human spirit.

Finally, although St. Francis probably did NOT write the "Prayer of St. Francis," I'd like to jot it down here because it's my favorite prayer ever. With its meditative rhythm, expressive humility, and beautiful ideas, it says it all. The oldest known version was found in the December 1912 issue of a French magazine La Clochette; that version (which contains a few lines the popular English-language one tends to omit) is reproduced here too.


Prayer for Peace

Lord, make me an instrument of your peace.
Where there is hatred, let me sow love;
Where there is injury, pardon;
Where there is doubt, faith;
Where there is despair, hope;
Where there is darkness, light;
And where there is sadness, joy.
O Divine Master,
Grant that I may not seek so much
To be consoled as to console,
To be understood as to understand,
To be loved as to love;
For it is in giving that we receive,
It is pardoning that we are pardoned, and
It is in dying that we are born to eternal life.


Belle prière à faire pendant la Messe (original version):
Seigneur, faites de moi un instrument de votre paix.
Là où il y a de la haine, que je mette l’amour.
Là où il y a l’offense, que je mette le pardon.
Là où il y a la discorde, que je mette l’union.
Là où il y a l’erreur, que je mette la vérité.
Là où il y a le doute, que je mette la foi.
Là où il y a le désespoir, que je mette l’espérance.
Là où il y a les ténèbres, que je mette votre lumière.
Là où il y a la tristesse, que je mette la joie.
Ô Maître, que je ne cherche pas tant à être consolé qu’à consoler,
À être compris qu’à comprendre,
À être aimé qu’à aimer,
Car c’est en donnant qu’on reçoit,
C’est en s’oubliant qu’on trouve,
C’est en pardonnant qu’on est pardonné,
C’est en mourant qu’on ressuscite à l’éternelle vie.