Tuesday, April 29, 2008

Lost in Beantown in a Silver Punch Buggy; and, Why I Blog

Ordinarily I would be using this blog to vent about the day I had today at work, where I spent over two hours trying to manage someone who was trying very, very hard to die on my table.

But I don't want to write about that stuff today.

I just want to curl up in my little blog, my writing home, my very own little piece of space-time, and RELAX. It really is home-y here for me; I feel like each post, whether I'm writing one or re-reading one, is an easy chair in which I can snuggle up or stretch out and just enjoy my rambling thoughts, spread them out in front of me like little treasures bought at a fair, and see if I can make sense of them at my own pace.

This home-like feel of one's own blog is one of the things that Anali and I talked about yesterday when we met each other for the first time and had lunch - and not the lunch we were expecting to have!

Our blog meet-up had a pleasingly comical aura about it as we navigated through what might have been discouraging setbacks and re-framed them as celebrations of serendipity. First of all, it was POURING rain. Secondly, Anali's usual parking garage was temporarily closed, so I jumped into her adorable silver beetle and we drove around for a bit scouring the streets for parking, but no luck. We wound up in a now-unfamiliar area of Summer Street that has been built up considerably over the last few years, and somehow found ourselves parking at the waterfront Westin hotel, unsure of whether they even had a restaurant! How ever did we get there (they did have a restaurant: Sauciety, "an American grille"), wind up munching salad from charming, lop-sided bowls that looked like they were offering us their little morsels of radicchio and chicory, then sampling a dessert called "cappuccino intrigue," from our original plan of lunching at a tiny Boston coffee shop in the financial district?!

So there we were whipping out our picture-taking machinery to snap photos of the food. At last, someone who not only doesn't scoff, but also understands! It was wonderful to be able to have a conversation with another blogger, especially one like Anali, who is every bit as sweet as I pictured. I started blogging almost a year ago because I was inspired by Hilda's blog and needed some place to explore this oboe adventure. Then it became that "room of one's own": a place for me to enjoy retreat and expansion at the same time, to learn about medicine, faith, the arts, my own responses to what goes on around me, especially when in "real life" it's often hard to strike up conversations with people about very esoteric elements of those things, like oboes and anesthesia!

When I got home I did a google/blog search using the terms "why blog" and came up with some interesting results, examples of which include the posts here, here, here, here, and here. I thought about why I blog, and about some of the things Anali and I talked about. I decided I'd explore my own motivations for blogging with a list of my own:

Top 10 Reasons Why I Blog

10. To keep in touch with family and friends

9. Narcissistic tendencies. I am opinionated. I enjoy sharing my opinion, venting my frustrations, telling my stories even if they only matter to me, etc.

8. Self-expression feels emancipating (and is cheaper than therapy!). Ditto above (I enjoy sharing my opinion, venting my frustrations, telling my stories even if they only matter to me, etc.)

7. Who can I talk to about anesthesia, besides other anesthesiologists?

6. Who can I talk to about oboes, besides Kyoko and fellowkyokostudent?

5. To remember certain special moments.

4. Blogging is versatile. Journalism or journaling? Tool for school project, or fundraiser for a good cause? We pick.

3. I enjoy the interactive nature of the medium. It's intriguing to exchange thoughts with others across the world.

2. Learning about things like archaeology, photography, molecular psychiatry, waiting tables, monastic life, almost anything you can think of, is totally cool - especially through the creativity of others.

1. Writing is FUN! I write for the sheer pleasure of it, even if no one's reading (which is totally how I thought this blog would be, although I guess there are some folks reading it after all!) :)

Sunday, April 27, 2008

What Can One Person Do?

In Prior Convictions: Did the Founders want us to be faithful to their faith?, an article in this week's New Yorker, Jill Lepore describes a debate between two characters in the 1797 novel The Algerine Captive by Royall Tyler. One character is a mullah and the other is Updike Underhill, a Calvinist surgeon captured by pirates and sold into slavery among Muslims. The following is an excerpt of her description of the debate, which lasted five days:

"But Christianity must be the one true religion, Underhill counters, else how had so much of the world been so persuaded by the teachings of a few fishermen, so quickly? 'If you argue from the astonishing spread of your faith,' the mullah answers, remember that 'Mahomet was an illiterate camel driver,' born nearly six centuries after Christ, and yet his faith had spread through Arabia, Asia, and Africa and a great part of Europe: 'In a word, view the world.' ”

Whatever one believes about faith and its meaning, or religion and its value or lack thereof, I think this exchange brings up a crucial idea that has been highlighted lately in the media.

The ideas and actions of individuals - courageous, creative, thoughtful individuals willing to put action into their ideas - can truly change the world.

I think Padraig O'Malley, the University of Massachusetts professor who was instrumental in getting opposing sides in South Africa and Ireland to come together and TALK to each other, should get the Nobel Peace Prize. Last August he flew 36 Iraqi leaders from enemy groups - Kurd, Sunni, Shia - to Helsinki to face each other and TALK - a remarkable accomplishment. O'Malley's approach is simple but revolutionary. He says in a Boston Globe article from last October,

"'Governments can't deal with divided societies, because they don't understand them...People from divided societies are in the best position to help others from divided societies.' The process can be slow and incremental, and by its nature is devoid of political sound bites. But if it works, it can pay off in a way that traditional diplomacy cannot: creating a lasting peace from within, rather than a truce imposed by larger powers from outside."

This same article from last October left me with an idea that has stayed with me:

"These negotiators have found that individuals, not governments, hold the key to resolving conflict."

This past week a second round of talks took place - Helsinki II. The Boston Globe article that describes these current efforts quotes Sherman Teichman, executive director of the Institute for Global Leadership at Tufts, who noted that

"...while many have called for dialogue, few have stepped in to fill the need. 'One of the things that perplexes me is why we find ourselves filling this void,' Teichman said. 'I'm very proud that we've done it. It came down to the intellectual and moral courage of Padraig O'Malley who stands as an example of what one individual can do to work toward peace.' "

Another individual I heard about just today was Thomas Taha Rassam Culhane, an urban planner who is installing solar water heaters on rooftops in the slums of Cairo and promoting environmental awareness and activism in the city's most impoverished Coptic Christian and Muslim neighborhoods. Just one person, using his gifts, education, and hard work to teach others and change lives by transforming ideas and practices, can make such an enormous global difference.

As I think of shining individuals like these I can wish my Orthodox Christian friends a happy Easter with a truly hopeful spirit:

Χριστός aνέστη! Aληθwς aνέστη!

Христос воскресе! Воистину воскресе!

!المسيح قام! حقا قام

Si Cristo ay nabuhay! Siya nga ay nabuhay!


Photo credit: top image originally posted by to Flickr as Iraqi Children by JoAnn S. Makinano USAF, February 7, 2007 ; licensed under Creative Commons Attribution ShareAlike 2.0 License

Friday, April 25, 2008

My Other Favorite Instrument

Mr. Phil, a balloon-making entertainer, was chatting with us at the local diner last weekend and figured out that we all play musical instruments. While he was making the penguin balloon my daughter requested, he went around the table asking us what instruments we played.

My husband plays guitar.

My daughter plays the piano and composes, but she'd rather be singing. She was pleased to be able to join us adults in her first adult choral piece last Saturday by sight-reading with the sopranos.

My son sat up straight and tall when his turn came and announced proudly, "I play the violin."

"What kind of balloon would you like?" Mr. Phil asked him.

My son thought for a moment. "Can you make a pterodactyl?"

To our surprise and delight Mr. Phil replied, "I sure can. Purple ok? Brown's too boring."

Then Mr. Phil turned to me.

"How about you? What do you play?"

"Guess," I said.

"Hmm...you have a bit of the 'earth-mother' about you...I would have to guess cello."

I think what he was actually suggesting was that I was plump, but I couldn't complain. I LOVE the cello. I love the richness of its voice, its ability to lend both beauty and grounding to a piece, its deep expressiveness. But I had to tell him I was learning to play the oboe, which he opined had a comparable role among winds despite its much higher register - a special voice, one that could express the music in versatile, emotionally compelling ways either with a principal melody line or as a rich undercurrent. I liked his line of thinking. Cello passages started to waft through my head...the adagio from Act II of Tchaikovsky's Sleeping Beauty; lines from Vaughan Williams' Fantasia on Christmas Carols; the Bach cello suites.

Recently I heard this NPR feature on cellist Rufus Cappadocia (totally worth a listen!). I was completely enthralled by the places this musician could take his instrument - incorporating sounds from all over the world (including much of the modal music I love so much), even modifying his cello by adding a fifth bass string to maximize its versatility. His music brought together sounds from Sufi and Middle Eastern music, flamenco, blues, Gregorian chant...I felt like I was listening to creativity itself made incarnate through his playing. I found his track "Prayer" particularly haunting. His music, slow or fast, makes me want to dance. I'm going to have to put his CD Songs for Cello on my birthday wish list...and the video for his piece "Transformation," which includes a dancer, below.

I will never be the virtuoso that talented musicians like Cappadocia are, who can use their instruments so skillfully as truly one-of-a-kind voices with fresh ideas to express, but I am so inspired by them and the music that comes from the work of their hands and minds. I am still working on Gabriele Marie's La Cinquantaine, and last Monday Kyoko added Solveig's Song by Grieg to my homework assignments. It's like learning a language. The trouble is my patience (or lack thereof): whether it's speaking something new or playing music, I want to be fluent, like, YESTERDAY!!!

Thursday, April 24, 2008

Brief Book Meme

Elaine Fine, who writes the blog Musical Assumptions, sent me the following meme/game today:

1. Pick up the nearest book.
2. Open to page 123.
3. Find the fifth sentence.
4. Post the next three sentences.
5. Tag five people, and acknowledge who tagged you.

So here are the three sentences I found in the book which, in a roomful of books, currently seems to be occupying the spot closes to me:

"I couldn't articulate it then, but I was writing my way out of a former North Dakota, the seven-year span with my parents, into the space I would occupy as a young man.

The elm in the furnace bubbles, still juice, and I wade to the garage-granary in the rising wind, a hand up to ward it off, and go to a pile of oak one-by-fours I've saved for a furniture project and sigh. I load the staves in my arms and head for the furnace through the wailing white."

These were penned by North Dakota poet laureate Larry Woiwode in his memoir What I Think I Did: A Season of Survival in Two Acts. Even his day-to-day chores evoke for me a writer's life - every act a metaphor, an incarnation, of the mind-spirit labor of the creative process, of noticing the world in a particular way, of being and becoming a writer and dealing with the "wailing white" of an empty page, arms sometimes loaded with staves and sometimes empty.

There are a few special teachers in my life whose hope in me I feel I've betrayed, by going to med school instead of living a life in art, be it dance or writing, or by choosing the field of medicine I've chosen despite the promise of other areas, like pediatrics. He is one of them. Over a dozen years ago when I was sitting in a writing workshop he led at Cambridge University, his faith in my voice was a gift. It was as if he had laid a blessing hand on my lips and ears, my eyes and my mind, and said "Ephphatha: be opened." I would carry the experience of that workshop with me long after it was over...and perhaps it is alive in some way still as I go about my "day job" hoping to be of help to a few patients. I hope so.

Tuesday, April 22, 2008


I have to talk about it. I can't not talk about it.

Underneath all the daily routines, the anesthesia work, the chopping of vegetables for dinner and the making of to-do lists, something emotionally important has happened in my life.

I have a new friend.

This is someone I've been waiting to meet and to embrace for years, and he has just arrived in this country and married one of my dearest friends, a heroic woman I've looked up to since I met her in college and who is, I think, one of the greatest souls alive on this earth.

I have to gush about her first. Sheila sang at my wedding. She sings like an angel, writes like a Pulitzer-prize winning author, and is pure grace and and athleticism on a pair of roller blades or on a soccer field. She is one of the most intelligent and articulate people I know. She is kind and generous and deeply spiritual. She graduated from Harvard with honors, has an advanced degree in theology, spent years doing humanitarian work with Christian Peacemaker Teams in Iraq, and now speaks fluent Arabic. She applied to medical school under great personal stress (due to her problems trying to negotiate Thaer's safe passage to the U.S.), did exceedingly well in her premed classes and on the MCAT despite these stresses, and will begin her medical career at Harvard Medical School this fall. She's my hero. I imagine the people around in her study groups, anatomy lab, hospital rotations, etc. and wonder what would happen if they, especially the senior residents and faculty, truly realized they were in the presence of a human being who is greater than most. I really believe that. But she's so humble you'd never guess, unless you got to know her. Sheila is a being of light.

Sheila met Thaer while she was with Christian Peacemaker Teams; CPT workers accompanied Palestinians who were fleeing persecution in Iraq to camps on the Syrian border. They fell in love and got engaged. Thaer is an artist and had been a leader and humanitarian activist in his community of Palestinians living in Iraq, with no citizenship and few rights. He has been trapped in refugee camps, caught in legal no-man's-lands of displacement and unimaginable deprivation, imprisoned and tortured with beatings and simulated drownings, and endured sufferings that I may never be able to comprehend in a lifetime. For years Sheila and Thaer have fought through a jungle of catch-22's and horrible conditions that have kept them apart. Then Thaer was able to escape through Turkey to Greece on a boat filled with refugees - a cramped, three-hour voyage across the sea filled with mishaps and fear. By some miracle, despite a mountain range of obstacles that had been preventing his immigrant visa to the U.S. from being completed, he and Sheila prevailed, his visa was approved, and he is now here, safe and sound, with my dear, dear friend. They were married yesterday.

When I met him last Saturday for the first time I threw my arms around him and wept. He is every bit as gentle and sweet as I imagined from my conversations with Sheila about him. He's a wonderful story-teller (even with my embryonic Arabic I could tell!), with a great sense of humor and a visible spirit of joy with the children who were at the same gathering. It's easy to see why Sheila loves him.

I have been given amazing friends from whom I have much to learn.

Friday, April 18, 2008

How a "Humble" Task Taught a Humbling Lesson

During my residency I had the opportunity to spend several months getting some pediatric anesthesia training at Children's Hospital in Boston. I have many valuable memories from that place. Some are from my clinical experiences, like the time I had to use a fiberoptic scope to place a breathing tube into a young Peruvian boy's trachea while he was awake, for safety reasons, because he had a dangerous anatomical abnormality distorting all the tissues of his oral cavity, making visualization of his vocal chords extremely difficult (and thus dangerous to do with the child totally anesthetized and unable to breathe on his own). I went to visit the kid in his room the next day and he threw his arms around my waist and thanked me. Then there was the time I placed an epidural in a little boy who was having robotic surgery to remove his uterus. And of course there was the time I was on the other side of the curtain, when my son split his eyebrow open and needed sutures in the emergency room. He got stellar care.

My favorite mental picture is that of all the stretchers lining the corridor outside the operating rooms, each with favorite stuffed animals or other fuzzy friends waiting for their respective children to come out of their surgeries. I was always touched to see that row of stretchers with their comforting occupants - and for a second I would become like a child again, believing in their secret animation as loyal companions with invisible hearts full of affection for their owners. Or charges.

One thing I haven't thought of again till recently was a particular task we had to do as residents as part of our equipment preparation, to ensure our patients' safety. Every morning we arrived early to the O.R. to set up the usual - airway instruments, drugs in their syringes, monitoring equipment - but also to connect tubing to I.V. fluid bags and make sure the tubing was "primed" with some of the I.V. solution. At most hospitals the task of filling I.V. tubing with some of the solution is left to support personnel who also come to the O.R.'s early to help with the set-up tasks. At Children's we were required to do this for ourselves so we would learn to be particularly vigilant about air bubbles in the tubing and be sure to eliminate them so as not to cause complications for children undergoing surgery. I didn't mind it too much, but I didn't look forward to it much either, and after my training, I didn't give it another thought.

Till now. This week I was asked to replace an I.V. in a patient prior to surgery. The bag of I.V. solution had been connected to the I.V. tubing by a nurse, as was customary at this hospital and in fact all the hospitals served by my anesthesia group. Most of the I.V.'s, in fact, are placed by the nurses unless they have trouble with them, in which case they call us to help.

I inserted the I.V. fairly easily and hooked up the tubing. Before directing the nurse to open the line and let the fluid start dripping into the patient's vein, I noticed something about the tubing. A subtle difference in the color of it (though it's colorless), or in the way light was being refracted through it (or not), or SOMETHING - I don't know exactly what - made me stop in my tracks. I disconnected the tubing.

"Could you check the line?" I said to one of the nurses. "I don't think it's been primed."

The nurse opened up the tubing at her end to see if it had indeed been primed with fluid by the nurse who had hung the fluid bag there for us. It had not. I was totally shocked. I tried not to show too much displeasure in front of the patient, who was waiting for her I.V. to be hooked up, had this nurse prime the tubing, and finally reconnected it so we could start her fluid.

I felt angry over the near-miss, and a bit shaken. We could have infused an entire air column into this woman's vein and caused some serious complications. What if I had taken the first nurse's preparations for granted and assumed the tubing had been primed properly? What if I hadn't checked before letting the I.V. run, or hadn't noticed the suspicious appearance of the tubing? Anesthesiologists by nature are totally obsessed with safety and check things almost compulsively - labels on every drug vial before pulling the drug into a syringe, times of particular events, eyes constantly roving, checking, checking, checking...but what if I hadn't glanced down this one time? What if I had failed to keep to the habit just this once? It could easily have been at the very least an unpleasant, stressful afternoon for all, and at worst, a catastrophe. And what if I hadn't seen the difference between empty, air-filled tubing and fluid-filled tubing - a very subtle, almost imperceptible difference - a hundred times at Children's? Then it wouldn't have mattered if I had examined the tubing or not before hooking it up.

So I am grateful for my time at Children's, not only for the big, glamorous, dramatic cases, but also for the so-called smaller tasks related to patient care, work at once menial, tedious, and incalculably important, with as much potential impact on a patient's life as learning the proper use of a medication or a laryngoscope. I started out my anesthesia career claiming I was attracted to it because every task, from the most mundane to the most clinically showy, was meaningful. I learned first-hand this week how true that really is.

Today I had the chance to teach a nursing student to place her first I.V. As I gave her technique pointers beforehand, then walked her through every step of the procedure, I was astounded to realize how many little steps there are that can so easily be missed and that have become so fluid for me now (no pun intended) that I don't even think about them any more. We both felt happy and proud when she got it on the first try. I told her she did a good job. And of course I told her to make sure from now on that she always, always primes the tubing.

Wednesday, April 16, 2008

Practice, Practice, Practice

All right, I'll admit it. I have vices.

One of them is watching re-runs of Star Trek: The Next Generation and Star Trek: Voyager. Cheesy escapism at its intergalactic best. Did I mention my husband calls me Super-duper Dork?

The painstakingly literal, ultra-rational, emotionless character has become a series cliché. I especially enjoy the blunt pronouncements of Seven of Nine in Voyager, though I can't even say she's one of my favorite characters. Brutally honest she is, though. This is a woman who tells it like it is, who described her first lobster ever, served to her during her first date, by declaring in her typical monotone: "This creature has an exoskeleton." That's exactly what goes through my mind when my dinner companion orders one! (Though without the exoskeleton - say, slathered with dressing in a lobster roll, or on a bed of greens, or better yet, simmered in a delectable bisque - lobster suits me just fine.)

Today's quote from her was another example of her priceless candor. When Neelix, a member of the crew, comes to her for a pre-arranged singing lesson, she decides the lessons should actually be discontinued. When he protests that he had been looking forward to the lesson because he has been practicing, she tells him,

"In your case practice is irrelevant. Your vocal chords are incapable of producing basic diatonic tones."

Poor Neelix.

I have a more optimistic view of practice, be it musical, medical, or spiritual. In medicine the obsession with evidence-based practice sometimes reaches the point of absurdity - we need studies to prove that sleep deprivation affects performance, or that skill practice in simulators improves it. Human experience has shown us time and time again, however, that frequent use and repetition make something easier to do and do well, whether it's placing a central line or speaking a foreign language, playing an arpeggio or consciously converting uncharitable thoughts into appreciative ones. I don't need a study to teach me that.

I learned something startling about practice recently. I read in Oliver Sacks' book Musicophilia that mental practicing can be as beneficial as actually sitting down to do scales. I couldn't believe it. Could it be that having the brain fire those signals down the same command pathways actually created the same connections and reinforcements established by praxis, the physical act, the doing of something? Was mental rehearsal more than just superstitious, wishful thinking?

At my last oboe lesson Kyoko confirmed that I had indeed made headway with my embouchure. She was pleased with my incremental progress. "You've been playing," she said.

"But I haven't been playing enough!" I protested. "My schedule's been crazy lately. I don't have time to practice every day. Sometimes all I can do is IMAGINE that I'm playing. And I do. I'll sit there and go through all the motions in my head."

"Well, it helps," she said. We did some reed work, long tones, and anatomical verification that it was indeed the very tip of my tongue I was using agaist the reed. At the very end we played some passages of Corelli and started work on Gabriel Marie's La Cinquantaine. It was a productive lesson.

So Sacks was right? I think that's cool.

Sunday, April 13, 2008

Can You Describe Your Life in Six Words?

I was browsing tonight on Amazon.com (as is my wont) and came across the book Not Quite What I Was Planning: Six-Word Memoirs by Writers Famous and Obscure. SMITH magazine editors invited readers in 2006 to sum their lives up in the space of six words, and the results are culled together in this volume.

Some mini-memoirs (from the book and the website) that struck me:

"I asked. They answered. I wrote." -Sebastian Junger

"A sake mom, not soccer mom." -Shawna Hausman

"Cursed with cancer. Blessed by friends." -Hannah Davies, age 9

"One time, an emu bit me." -Matt Lewis

Intellectual games like this can be hard for me to resist, but I couldn't come up with a single set of six words that contained my whole life "in a nut shell." A few of my attempts included

Born early, doctored late, danced between.

Went sleepless to help others sleep.

Still wondering about that empty tomb.

After school, just wanted oboe lessons.

True happiness: loving husband, loved children.

The fewer the words, the harder the task! My distilled life is not that interesting...but it was an interesting exercise in uncovering what was most prominent in the memoir-writing department of my brain...

Friday, April 11, 2008

The Worst Story I've Ever Heard


Zawadi Mongane had 4 children. She lived in a village in eastern Congo.

The Interahamwe, Rwandan (Hutu) rebel soldiers who fled Rwanda after participating in the 1994 genocide, captured Zawadi, her brother, three of her children, and about 50 other people from their village.

They were brought to an isolated rebel camp where the village leader and all who were related to him were asked to stand up. Those who were standing were murdered on the spot. Literally. Right where they were standing.

More and more people were killed in the days that followed. By the end only Zawadi and another woman were left alive.

During those days the rebel soldiers ordered Zawadi's brother to rape her.

He refused. They decapitated him with a machete.

Zawadi had to watch as two of her children were killed before her eyes.

Zawadi was gang-raped by 19 rebel soldiers.

But this was not the worst thing that happened to her.

Zawadi was carrying her little baby on her back. The soldiers tied a rope around her baby's neck and forced her to pull the rope, hanging and strangling the baby until it was dead.

She would rather have died than have had to kill her own infant child, but she had another child, one who had not been abducted, one who was waiting for her, if she survived. "I had to stay alive for her, " Zawadi says.

Now physically debilitated because her pelvis had been shattered by the violence of the rapes, living in a slum as a social outcast, and psychologically destroyed, Zawadi barely makes a living as a porter and feels her 5-year-old little girl is living with someone who is as good as dead. "I get nothing out of life," she says. "I can't see anything in the future."

They cannot go back to their home village because Zawadi is afraid. She fears she will be raped again. And she knows her little girl is not safe; Zawadi has seen the same violence committed against even younger children. She is terrified that her little girl will fall victim to the people committing these atrocities - committing them right now, as I write this, as you read this, as your loved ones rest in your home or play in your yard, or browse in a book store, or sip coffee in a coffee shop, or moan about their work days, as I've been guilty of doing lately.

Zawadi in Swahili means "gift."


These photos were produced by the BBC and can be found at http://news.bbc.co.uk/2/hi/africa/7340074.stm.

This has been going on for over a decade.

Panzi hospital in South Kivu has become the region's go-to place for reconstructive surgeries for victims of these atrocities.

Just as the generation before us is often criticized for sitting silently by as millions of Jews were exterminated by the Nazis, perhaps we are the generation that will collectively be held in disgrace as we sit stupefied while the people of the Congo, Sudan, Afghanistan, and Iraq literally get torn into shreds inside and out.

I can't help wondering if our spoiled, sheltered existence is going to come back and bite us in the rear. It's already starting to ecologically...and I don't think we can be dismissive about the number of geopolitical tinder boxes dotting the globe (Iran, Pakistan, Tibet, Kosovo, North Korea...)

Anesthesiologists are obsessed with making preparations for contingencies. But how can I prepare my children for THIS mess? Did our parents worry about the Cold War like this? Are these just the same thoughts every generation of parents has?
Addendum 4/11/08:
Check out this post at Beyond Rivalry which mentions Zawadi's story but focuses at length on the journey of another woman, Etty Hillesum, a Jewish woman whose letters and diaries from her experiences from 1941-1943 offer much food for thought. The post is an eye-opening, humbling, astonishing, instructive, and well-written reflection on the mystery and reality of human suffering.

Tuesday, April 8, 2008

Confessions of a Worried Stage Mother

Is this a medical blog, a music blog, a food blog, a literature blog, or a faith blog?

Today, it'll be none of the above. So let me update all fronts in brief before moving on to what's been eating at me for a couple of days.

Medicine: life is busy. Been too exhausted to blog lately. Had a day off today (luxury) and actually visited a mall. It was like a different planet.

Music: I think I may have made a break-through with my embouchure, which had gotten too bite-like. Having the work-out of a piece like Handel's Agrippina Overture, which we're rehearsing in chamber orchestra, is like boot-camp for those muscles.

Food: I have found two wonderful ways to prepare pollock in the oven, but I am struggling with how to make a simple flourless chocolate cake. If anyone has good advice about that (Shuna? You out there? :) ) please consider it solicited.

Literature: am reading The Last Temptation of Christ.

Faith: am reading The Last Temptation of Christ, trying to do a little Benedictine meditatio every day, and trying to figure out why the heck Jesus was so darn mean to that Syro-Phoenician woman...

But this blog isn't about any of that today. Today it's a MOMMY blog - so if you're turned off already, bail now - I am going to wallow in motherhood for another several, long-winded, rambling paragraphs.

Today this blog is about how a mom who just wants her child to be well-loved, well-fed, well-schooled, and HAPPY navigated that psychological and emotional obstacle course known as the AUDITION.


My daughter loves to sing. She's been singing since she was tiny - a baby, really; even her pre-nap vocalizations as an infant were melodic. She has music vibrating through her very cells. She has a lovely, sweet, clear singing voice, and her acting is very natural, too. She's a good performer, and she loves it.

My daughter loves musicals. She has big dreams. Dreams of performing on the West End in London (though she'd settle for Broadway if that didn't work out).

Over the weekend she wanted to audition for a musical being produced by a nearby community theater company. She was excited for days prior to the audition.

I was excited for her, and I encouraged her because I love her love of music, her passion for theater, her exuberance. I want her to know that her father, her brother, and I support her 100%.

But I've lived a few decades longer than she, and I have some perspective on what auditions can be like. What's more cruel than a ballet audition, where you file into a room lined with anorexic-looking girls all of whom, like you, have a number pinned to their leotards and who want to be noticed, the thinnest, the most beautiful, the perfect? What's more painful than getting cut because even if you danced well, even beautifully, there was something about those other girls that they wanted more, that they found better?

Sure enough, as soon as we arrived at the audition place I knew we were up against a piece of the real world - you know, where not everybody loves you, where you are, frankly, judged according to someone else's standards and too bad for you if you don't fit the bill. A crowd of little girls, some with resumes and professional head shots, filled the foyer. Immediately an angel alighted on one of my shoulders and a devil on the other, and for the rest of the afternoon they shot thoughts into my head like little blow-darts as I removed the protective circle I had drawn around my lovely little girl, to shelter her, and let her step out into this un-loving world. I'll call the angel "Angel" and the devil "Screwtape," in homage to C.S. Lewis.

Screwtape: What kind of mother would let her kid compete with other little kids, knowing her kid will either be found wanting, and be rejected, or be found superior, at the expense of other kids? Is that any way to teach a girl to eschew the way this society judges a person's worth?

Angel: Oh, but this is her love, her dream. If you don't help her at least try to follow her dreams, what message does that send? Think of the joy she could bring to others if she finds joy in her own work...

After filling out registration cards - she was number 59 out of over 100, maybe 120 girls - we were ushered into a large auditiorium to wait while they rehearsed part of a song as a group, then called the girls into a studio in groups of ten. My daughter caught sight of a girl over whom she felt a little competitive, and I urged her to wish the girl well mentally and not allow herself any feelings of cattiness or envy. A hard thing to ask, because I find it hard to live up to myself.

After the third group was called in - a good two hours later - my daughter felt comfortable staying there chatting with a friend and having me pick her up later. I stopped at home for a quick bite to eat and drove right back to wait some more. It would have been excruciating without technological distractions - an iPod with good music on it, and photos, and videos, and sudoku.

Occasionally a girl would come out of the studio area, go to her mother, pick up her coat, and exit. The weeding-out process was churning along, complete with public departure. It was hard not to watch them as they walked up the auditorium aisle to the doors in the back.

Screwtape: That could be you. Any minute now.

Angel: Don't give up hope. This is what she loves. What she has inside will shine through in her face and her voice. They'll see that.

Screwtape: Yeah, if lyrical and angelic is what they're looking for. But I bet they're more into the showy and loud for this one...

At 2 p.m. there was an announcement: any kids who had been asked to stay for a dance call-back and were there waiting would have to return at 5 p.m. because of a shortage of pianists. My daughter was still inside doing her first round of auditioning. "Um, I have a TECH rehearsal at 5," piped up one very experienced-looking child, who was told to make sure the directors had all her contact information. Just then my daughter emerged from the studios with a smile on her face, saying, "I made it. I get to come back!"

Her friend, however, with whom she had spent the morning, got cut.

Screwtape: See. The hurting starts already.

We all went to Panera for a bite to eat, then I took my girl home for a rest before her 5 p.m. call-back. For the 5 o'clock audition I had to bring my son with me because my husband had to attend a board meeting. There is not a more supportive seven-year-old-boy in the world. He asked his sister concerned questions, never once complained about the long wait, read his Harry Potter volume 4, and was just as sweet as a little peach throughout. I noticed there were only about two dozen girls at the call-back out of the original group of 120. They all went into the studio area together.

By 6:05 I had played about 6 games of sudoku on my iPod and listened to a bunch of songs meant to inspire calm. But it had been an hour and I was getting antsy. At 6:07 I looked up and saw some girls filing back into the auditorium from the studio area. I scoured each face looking for my daughter's. Two, then three more, a total of ten, came out. No sign of her. Two of the girls went and sat on their mothers' laps, threw their arms around their mothers' necks, and started crying. Others walked up the aisle, some stoic, some red-faced holding back tears, one girl shrugging and trying to look indifferent, another looking dejected.

Screwtape: See? More misery. Even if she gets close, she could still end up here.

Angel: You've got to see this through. It's important to her, and even if she doesn't get what she wants, the experience will have been a valuable learning experience.

Screwtape: Or a devastating, discouraging one that could wound her for years to come.

Angel: Not if we don't let it.

At 6:25 there was another announcement: we had to vacate the auditorium for a rehearsal and move to the band room. A mother who had been there since that morning brought her needlepoint with her. I notice she had gone from having about a third of the sky on the frame stitched blue to over half during the course of the day. By that point I couldn't play puzzle games or listen to soothing music any more. I was overcome with tension, very suddenly and intensely. Lines from Broadway musicals started floating through my mind: "God I hope I get it..." (A Chorus Line), "It's not your aptitude, it's the way you're viewed..." (Wicked)... A couple of girls were released so they could attend a rehearsal. Then at about 6:40 mine came out, no smile, big, sad eyes.

"How was it?" my little boy asked.

"Bad," came the one-word reply.

She felt she had done poorly, that she could have sung so much better (oh the ache of that kind of regret!). She had been sent home while others remained. She felt miserable with the loss and grief of a dream that didn't unfold as she'd hoped. There was some vague mention of her being considered as an alternate, but none of it was clear and I didn't press her on it.

Screwtape: See. Told you.

Well, I couldn't let him have the last word, insert the last thought.

Go back to hell, Screwtape, where you belong.

Angel: You tell him, T.

At home I lay beside my weeping daughter and murmured what I could from my own experiences - that she shouldn't beat herself up for one or two little mistakes, because the folks evaluating her had the experience to know what she could do based on the things she had done well; that getting a part was often as much a reflection of how well someone fit into someone else's ideas about the look and sound of a show, rather than just a reflection of the individual's abilities; that getting to the final dozen from over a hundred children was no small accomplishment; that if this experience wasn't meant to be hers, there would be others that were. That there was no doubt in anyone's mind about how well she could act and sing. That her gift of music had already made a difference to so many. That I loved her.

Then I spent the rest of the night second-guessing myself. Should I have encouraged her to go through this? Should I be supporting her involvement in something with the potential for so much heart-break? But isn't that a description of life itself?

There's no user's manual for any of this. I guess I'll just have to keep stumbling along and just try make sure at the end of every day that they know they're as loved as can be.

Wednesday, April 2, 2008

It Doesn't End in the O.R.

I've vented before about how annoyed I get when people ask me if I get to leave the operating room once I've induced anesthesia.

When I inject the anesthetic into someone's vein my job is just beginning.

It actually begins even before I meet a patient, when I go over the chart and history to be sure I have the information I need to keep someone safe.

If I feel reasonably good about bringing patient this far:

Then I can usually be reasonably confident that I can get the patient through this:

But even with every known precaution taken, sometimes the trouble starts here, in the recovery room, or PACU (post-anesthesia care unit):

Recently I arrived at work at about midday for an overnight shift and was paged by one of the PACU nurses because of a patient with low blood pressure. I made some preliminary recommendations and said I would be over to see the patient shortly. As I was wrapping up what I was doing there was another page. Things had taken a turn for the worse just minutes later. The patient's blood pressure was alarmingly low, his heart rate unusually high, and he was reporting chest tightness.

I ran to the PACU, examined the patient, scribbled through a quick calculation for the rate of infusion of a drug, and ordered the pressor - a medication to boost and sustain his blood pressure - to give me time to assess all the variables and figure out what the heck was going on. What was this - dehydration, a heart attack, acute heart failure, or something else? I asked questions about his cardiac history, looked at old cardiac tests, ordered a few others. He told me he was feeling a little short of breath. His oxygen saturation was dropping. Without supplemental oxygen, in fact, it plummeted to alarmingly low levels, yet his lungs sounded clear. Even on the pressor, his next blood pressure was abysmal. I took the nurse aside.

"This is a P.E. [pulmonary embolism]. Looks like one, feels like one. We gotta call the hospitalist, get a scan, send him to the ICU..."

"I think they don't have room..."

"They're gonna have to MAKE room."

There was a flurry of activity as the appropriate people were called and arrangements for transport were made. Some time in the midst of all this I clasped the patient's hand to explain what was happening. He clasped my hand back, tightly. After explaining my line of thinking, what I was concerned about, and why we were taking the measures we were taking, I told him we would get him through this. The hospitalist arrived and eventually took over his care, and brought him to the ICU.

I visited him and his family in the ICU the next day after my overnight shift was officially over. He was on a heparin drip (for pulmonary embolism) and doing better, with a normal blood pressure and improved oxygen saturation on minimal supplemetal oxygen. I stayed with the family for 20 minutes or so, to answer questions and just talk.

No one should ever say that anesthesiologists don't spend time, important time, with their patients. In behind-the-scenes, "restricted" areas like the PACU and the O.R., often during moments unseen or unimagined by family members who are stuck waiting outside, we do, and that time does matter to us.