Acting

I think the common concept of "human nature" is misnamed.

"It's just human nature," we often hear, when a person is self-seeking, or catty, or makes a mistake.  Yet we also say that positive traits "humanize" people.  

I think what we tend to call "human nature" is just the opposite - inhuman, our dark side:  tendencies of a baser, de-humanized sort.  This is my concept of "original sin":  not a stain passed on magically from one generation to the next because of some disobedience over a piece of fruit, but rather, the tendency to fail to be more than the sum of our various parts - hormones, neurotransmitters, drives, dopamine cravings.  I think being fully human means being able to transcend this native machinery and rise above it, create more with it.

Which is why when a surgeon said this today, I was mightily disappointed indeed:

[Responding behind the anesthesiologist's back after she walked into the room to ask if he wanted a medicine consult for one of his patients, then walked out again]:  

"Why doesn't anesthesia just see the patient, so they can pretend they're doctors." 

Now, how does someone sink to such a disrespectful low, especially about a fellow-physician - and not just any fellow-physician, but the kind that actually CARES about a patient's pre-op medical problems and intra-op safety?  What can explain his snide attitude?  Lack of proper parenting?  Misplaced arrogance and entitlement?  Exhaustion from a frustrating day?  All the above? Would he want anyone to speak to or about his family, friends, spouse, or children that way?

As far as I'm concerned it's not "human" at all to be nasty.  It's base.  It says more about the speaker than about his subject. As problematic as the St. Boonie's job became in the end, this kind of talk would generally not have happened there; the surgeons, for the most part, were too good for that - as people and as surgeons.  I miss that.

Another example:  some kids at my daughter's school have been fabricating and repeating rumors about her in the wake of her getting cast as Annie.  According to her teachers and her friends, most people see her as a sweet, funny, thoughtful, outgoing, and wholesome kid who hangs out with other kids of the same ilk.  But there are those in the class who have actually said to her face, "Hey, did you bribe the music director to get the part?"  She has received some cat-calling and been told some people are spreading around the risible suggestion that she is, as she says in code, "you know - a female dog."  I am both completely un-surprised and profoundly disgusted by the behavior of some of her more spoiled, jealous, mean-spirited peers.  

I told her to give them no reason whatsoever to accuse her of anything but kindness.  I also told her there are two things that seem to be able to show us who our true friends are:  success and failure (or suffering).  Her true friends have rallied around her and seem to be keeping her grounded and feeling supported. This, to me, is fully human, truly human, behavior.

Cupcake Time

I made cupcakes last night.

Using a basic recipe from Gail Wagman's book Cupcakes Galore as a starting point, I made four different kinds:  vanilla, Earl Grey, mango, and calamansi.  They were YUMMY.

Getting ready for Mardi Gras, you might ask?  Certainly. But there was another reason.  We were celebrating.

Overcoming past audtion heart-break, my daughter tried out for her school's spring musical, Annie, and got cast in the leading role!

Now that the initial excitement has given way to imaginings - some enjoyable, some less so -about a season of rehearsal schedules, carpooling, training, and time management, my mother-worry has kicked in.

Not just any mother-worry:  anesthesiologist-mother-worry.  I am concerned about her vocal cords (picture source here).

As I may have conveyed in this poem and in other posts, the vocal cords are precious to me.  I treasure my daughter's in particular. She has a sweet, lyrical, angelic singing voice, with a clarity that can make you just sigh.  She can "belt" to a certain degree, but hers is not the brassy, Broadway, belting voice that yells Annie lyrics from stage to rafters. I don't want the native quality of her voice to be changed or ruined.  I also don't want her vocal health diminished by fatigue or strain, especially with hours of rehearsals and repetition several times a week (see here for a video of the vocal cords in action).

At the same time, I am looking forward to watching her grow as an artist in a role that seems made to order, with its combination of spunk and vulnerability, and its melodies right in her vocal range.  I want to help and support her efforts as much as possible but also give her the freedom to blossom in her own way and in her own time.

This will be a journey for both of us - with me watching, caring, and helping hopefully not too intrusively "from behind the drape," as is my wont.

_____________________________________________________

There's a special gourmet edition of Grand Rounds up today at The Blog That Ate Manhattan.  Check it out!

YES!!!

Slumdog WON!

My husband and I saw this film a couple of weeks ago and were COMPLETELY. BLOWN. AWAY. It was one of the most impressive film works we'd ever seen.

It totally deserves the Oscars it got for best directing, film editing, script adaptation, cinematography, sound mixing, original score (A.R. Rahman ROCKS!), original song, and BEST PICTURE!

If you haven't seen it already, go and see this amazing, painful, hopeful film. It's hard and compelling at the same time, brutal yet beautiful, without the cynicism that plagues so many treatments of dark subjects. What a story!

Anesthesioboist in the Kitchen

I've written about what makes an anesthesiologist similar to a pilot.

I've also written about how the practice of anesthesiology is very much like cooking.

I've thought about this a lot, because of course I think about food a lot. Here are about a dozen similarities between anesthesiologists and chefs:

1. We are held up to ruthless criticism and often downright meanness during our apprenticeship.

2. We train for years.

3. We work brutally long hours. On-the-go-on-your-feet, blood-sweat-and-tears hours.

4. We work behind the scenes. Invisible like angels, and perhaps just as busy in our efforts to help our worlds run smoothly.

5. We work alone, in a way. It can be lonely. But we're also surrounded by invaluable team members without whom our work couldn't get done.
6. We have to be able to work quickly and do many things at once.

7. We have to have good instincts (from tons of experience) about when to turn dials, add ingredients, take things away, etc. Hence # 1 and 2.

8. We have to be able to design a plan of action meticulously and carry it out flawlessly, timing and all, but also solve problems on our feet, quickly, and move on to a totally different plan if necessary.

9. Few people understand what we do. Few people can do what we do. Few people even think of, much less acknowledge, the value of what we do. The work has to be its own reward.

10. Our work is often physically, mentally, and emotionally exhausting because we work with our hands, arms, legs, and backs as well as our minds and hearts.

11. What we offer doesn't stay with people long but can be mind-alteringly wonderful (or terrible) while it's with them.

12. Our work helps sustain life.

"Our music will never be played on the radio. Like Vegas, what goes on in the kitchen, stays there. We work behind closed doors. We speak a secret language, wear our scars proudly, take oaths and share blood, read invisible ink, hear voices, follow an education that will never end, and that's all pretty interesting, if you ask me." -Shuna Fish Lydon

"When you cook for others, you become an intimate part of their lives, if even for a few hours." -Shuna Fish Lydon

***

Here's one idea my list above didn't elaborate on: anesthesiologists and chefs are both drug dealers of a sort. When I wrote "mind-altering" for item #11, I meant that quite literally. What we give to people changes them, affects their chemistry. We are manipulators of molecular biology - in one instance to protect against pain and suffering, in another, to promote pleasure and satisfaction.

It's simplistic to express it this way, but I blame the amino acid tryptophan for my love of comfort food. Tryptophan turns into serotonin and melatonin in the brain, and often does so better if we give ourselves a little calcium. So we feel good, and sometimes get sleepy, after some comfort food - some warm oatmeal with a touch of honey, maybe - enjoyed with a glass of milk. Here are the biochemical pathways if you're curious:

Or, if you just want to skip all this biochem and cut to the chase to foods and snacks that might help promote sleep, or see a list of foods high in tryptophan, that would be totally understandable!

***

And speaking of comfort food...

A chef and a heart surgeon once switched places so each could learn about the other's profession. Their exchange resulted in this recipe for Pan-roasted Stuffed Veal Heart (the article was interesting too). You can make it with moose heart if you prefer, though truth be told, I'm not quite carnivorous enough.

This one's more my speed: a recipe for my favorite cake, Tres Leches, which I got from Stephanie on Allrecipes.com.

Tres Leches Cake

• Preheat oven to 350. Grease and flour a rectangular (9 x 13) baking pan.
  
• Cream together 1 stick (1/2 cup) of salted butter with 1 cup of sugar (if I use unsalted butter, I add a couple of pinches of salt to the batter with the other dry ingredients).
  
• Add 1 tsp of vanilla.
  
• Add 5 eggs one at a time, beating well after each addition.
  
• Sift together 1 1/2 c cup flour with 1 tsp baking powder and add to batter a little bit at a time, stirring well after each addition.
  
• Pour batter into pan and bake for half an hour.
  
• Poke holes in cake with a fork after removing from oven. Cool.
  
• Mix together 1 14-oz can fat-free sweetened condensed milk, 2 5-oz cans (or 1 12-oz can) of evaporated milk, and 2 c regular milk. Pour over cake and let sit till milk sauce is absorbed. (Rate and degree of absorption will depend on the number and size of holes poked. If there is any milk sauce left over, pour off the top into a gravy boat and use as sauce for the cake.)
  
• Serve with whipped topping (1 1/2 cups whipping cream, 3/4 to 1 c sugar, 1 tsp vanilla) and fresh fruit if desired, or enjoy as is.

(Photo: Filipino White House Executive Chef Cristeta Comerford and sous-chefs, photographed by Shealah Craighead)

More on the "Canon": Words by Heart

Do students have to learn anything by heart any more?

Memorization is often spoken of with a hint of disdain.  In the hierarchy of learning, Bloom's Taxonomy, that includes comprehension, application, analysis, and synthesis, memorization for knowledge lies at the bottom. It's supposedly a "low" form of learning - does one really need to think if one memorizes? Perhaps this is why today, much to our horror as parents, our kids have not been asked to learn their times tables or parts of speech as we did when we were even younger than they.  After all, we can't have thoughtless automatons growing up through the American school system, now, can we?

This concept of memorization belies its educational utility and importance and fails to acknowledge how fundamentally we need memorized knowledge as part of a base on which to build all those other process - application, analysis, synthesis.  

Why does some memorized knowledge stay with us for life, and some evaporate as soon as the test is over?  I still remember clearly the Montessori symbols for the parts of speech - and yes, they did help me learn the parts of speech.  And because Kings Play Chess On Fine Green Sand, I am able to help my daughter get through her biology chapter on the classification of organisms.  But if you were to ask me to recite some geometric theorems, I wouldn't be able to.  And the Krebs Cycle?  I'm afraid that would be incomplete without a review.  

I think there's a distinction, too - in my own mind, at least - between memorizing facts and learning by heart.  This morning when my cousin in the Philippines read a message from me complaining about the loud rattling of the window in the call room last night, and she sent me a reply that asked, "Who has seen the wind?"  I was able to send her another message with words learned by heart decades ago:  

"Neither you nor I.

But when the trees bow down their heads,

The wind is passing by."

I haven't thought about that poem by Christina Rossetti in ages, but it was still with me, intact - learned by heart.  I didn't even know that I knew it.

I started thinking of other poems that I know by heart.  There aren't that many, sadly - my parents and the folks from their generation have many more under their belt.  I have Langston Hughes' Dreams.  John Donne's The Good Morrow.  A Shakespeare sonnet.  Barter by Sara Teasdale.  The Tyger by William Blake.  Some of these I learned through school, and some because my parents made literature a living part of my childhood.  My mother read me T.S. Eliot.  My father recited verses off the cuff by Carroll, Swinburne, Shelley, Herbert; quoted The Highwayman to me on moonlit nights, when "the moon was ghostly galleon tossed upon cloudy seas;" and bade me hear, with Tennyson, "O, sweet and far, from cliff and scar, the horns of Elfland faintly blowing."  I am so deeply grateful to them for instilling in me this love of the word.

There's something almost liturgical in the way words learned by heart can be kept alive, like psalms, among us.  It's a connection, through language, to great ancient thoughts.  My most precious memory of words learned by heart is from the day I walked with some women in my husband's family to his grandfather's grave outside a tiny medieval church in a village in Normandy.  There, his grandmother began to recite the Miserere in French (Psalm 51) - words she knew without having to try to remember, and uttered with total self-giving and reverence; beautiful words that had become part of her, and through her, part of us - a poem-prayer living and breathing in our midst.  This was not mere memorization; this was knowledge carried through life in the deepest portion of a person's spirit, rooted there like a living tree always ready to bear fruit.

I complained a lot about memorization during med school.  I did speak of it with contempt and criticize the lack of respect for creativity - "synthesis" - in physicians' training. But there is memorization that is not at all "low" by comparison as a form of learning, and it should be encouraged, embraced, and appreciated.  We should learn more things by heart.

For the Love of Humanity Please "Waste" Your Time on Dead Languages

Kitchen moment with my son, a week or two ago:

"Mommy, what's your least favorite bug?"

I have a horror of bugs. I have many "least favorites."

"Why do you ask, sweetie?"

"If I turned into your least favorite bug, would you still love me?"

Brief mental image. Try not to grimace. Look at adorable son. Heart melts within.

"Have you been reading Kafka?"

"No."

"Of course I would still love you. You would still be you, wouldn't you?"

"But how would you know?"

"I'm your mommy."

Son smiles contentedly and walks away with glass of milk.

***

A French-speaking surgeon I work with was frustrated about an exchange he had had with another doctor over a surgical specimen.

"I send it to him and he doesn't even examine it. He brings it back to me, and it's all cut up. Unrecognizable. C'est la metamorphose," he complained. "I might as well have woken up flat on my back this morning."

"With your legs in the air," I said behind the drape that separated us.

"Ben, oui."

"Unable to turnover," I continued, giggling at the mental picture.

"Mais exactement! It's the theater of the absurd in here sometimes. Did you hear that conversation? One moment he says 'suspicious,' the next, 'nothing definitive!' How am I supposed to continue?"

After a pause another person in the room spoke up. "I'm sorry - WHAT are you guys TALKING about?"

"That last specimen that went out," I said.

"No, all that 'legs in the air' bit."

"Oh, you know, Kafka?"

Uncomprehending expression. "What?"

"The Metamorphosis." Blank look. "Kafka? Metamorphosis?"

The surgeon completed a suture and explained, "A man wakes up one morning and finds he has turned into a giant insect."

"Oh...that's weird..."

***

Why is it considered "elitist" to value music, art, literature, the humanities - indeed, a good education?

I've been thinking a lot about education. As a mother I'm concerned about the deficiencies I see in American schools. My own town's high school is thinking of cutting all after-school programs except varsity athletics. At a meeting one parent objected to the support of an elite squad of sports participants at the expense of many others who are engaged, truly engaged, in enriching activities in other athletic programs as well as in their very strong performing arts activities. Another parent then took issue with her use of the word "elite" and demonstrated his lack of understanding of the difference between "elite" and "elitist" in his counter-criticism of students who enjoy the arts. There's a tremendous reluctance to see, or inability to comprehend, the great value of the arts and humanities in American schools and society. WHY?

It's been going on for decades, this emphasis on utility over "luxury learning," as Stanley Fish's New York Times piece last January sadly pointed out. He quoted Carnegie congratulating business school graduates for concentrating on useful learning and not "wasting time on dead languages." He also quoted Richard Teller Crane, who famously said [No one who has] "a taste for literature has the right to be happy" [because] "the only men entitled to happiness...are those who are useful."

Yet it's not necessarily useful things in themselves that make human beings happy but rather those things that define and perfect our humanity - stories, music, works of art, relationship. One might even argue that the invention and act of reading and writing themselves help define our humanity. Books are in our collective human intellect and soul. What gives? Even the dung beetle (or whatever it is) in Kafka's story learns to appreciate the arts in the end - making him more human than his own metamorphosed family, who are dehumanized by their ostracizing behavior.

Recently on Facebook a meme has been floating around - "The BBC Pretentious (and intellectually snobbish) Book Meme." All my friends and I, before we understood the true origin of this list, cried out, "But they left out this author and that author and this book and that book! What kind of list is that?!" The truth is, I don't think the BBC really conceived of this list as the meme that's being distributed around Facebook; in fact, I'm sure it's not a list of the 100 books they'd consider must-reads for all readers. According to their website, in April of 2003 they took a survey of people's favorite books in an effort to find the nation's best-loved novel, and when all the nominations came in, they came up with this list of 100 books loved by the Brits. So of course it's a very Brit-centered list.

But the meme got me thinking...what would I consider to be 100 must-reads (because of the writing, or content, or both) for a "good education" in the English-speaking world?

I started to make a list, but it got longer and longer as I thought of a host of non-fiction material that just had to go on it. So I decided I would make the list specifically a list of works of fiction, as Time magazine did when they made their version of the 100-books list. Apart from my list of individual must-read literary books, I would set aside such tomes as the Bible, the Koran, the Baghavad Gita, Tao Te Ching, Wild Swans by Jung Chang, Bonhoeffer's Letters from Prison, maybe Chesterton's life of St. Francis of Assisi and Gandhi's The Story of My Experiments with Truth, a lot of history books, and a good primer on the philosophies and/or works of Plato / Aristotle / Augustine / Aquinas / Hobbes / Descartes / Spinoza / Locke / Hume / Rousseau / Kant / Schopenhauer / Nietzsche et al.

As for my list, 100+ Must-Read Works of Fiction (and no, I haven't read them all, so my education must continue!)...

Here it is (subject to adjustment/change, of course):

Chinua Achebe - Things Fall Apart

Sholom Aleichem - Wandering Stars

Jean Anouilh - Becket (ideally, alongside T.S. Eliot's Murder in the Cathedral)

Natalie Babbitt - Tuck Everlasting

Georges Bernanos - The Diary of a Counrty Priest

Ray Bradbury - Farenheit 451

Charlotte Bronte - Jane Eyre

Emily Bronte - Wuthering Heights

Frances Hodgson Burnett - A Little Princess

Albert Camus - The Stranger

Lewis Carroll - Alice's Adventures in Wonderland and Through the Looking Glass

Willa Cather - Death Comes for the Archbishop

Miguel de Cervantes - Don Quixote

Geoffrey Chaucer - The Canterbury Tales

Anton Chekov - Collected Short Stories

Kate Chopin - Desiree's Baby and other stories

J.M. Coetzee - Disgrace

Wilkie Collins - The Woman in White

A.J. Cronin - The Citadel

Dante - Inferno

Charles Dickens - Bleak House

Charles Dickens - A Christmas Carol

Charles Dickens - David Copperfield

Fyodor Dostoevsky - The Brothers Karamazov

Arthur Conan Doyle - The Adventures of Sherlock Holmes

George Eliot - Middlemarch

Ralph Ellison - Invisible Man

Shusako Endo - Silence

Euripides - Medea

William Faulkner - As I Lay Dying

William Faulkner - Light in August

William Faulkner - The Sound and the Fury

F. Scott Fitzgerald - The Great Gatsby

E.M. Forster - A Room with a View

Michael Frayn - Copenhagen

Ernest G. Gaines - A Lesson Before Dying

William Golding - The Lord of the Flies

Nadine Gordimer - July's People

Graham Greene - The Power and the Glory

Thomas Hardy - Jude the Obscure

Joel Chandler Harris - Br'er Rabbit stories

Nathaniel Hawthorne - The Scarlet Letter

Seamus Heaney (transl.) - Beowulf

Ernest Hemingway - For Whom the Bell Tolls

Ernest Hemingway - The Snows of Kilimanjaro and Other Stories

Homer - The Iliad

Homer - The Odyssey

Victor Hugo - Les Miserables

Victor Hugo - Notre Dame de Paris

Zora Neale Hurston - Their Eyes Were Watching God

Aldous Huxley - Brave New World

Kahsuo Ishiguro - The Remains of the Day

James Joyce - Ulysses

Franz Kafka - The Metamorphosis

Nikos Kazantzakis - The Last Temptation of Christ

Ken Kesey - One Flew Over the Cuckoo's Nest

Yasmina Khadra - The Swallows of Kabul

Barbara Kingsolver - Prodigal Summer

John Knowles - A Separate Peace

Jhumpa Lahiri - The Namesake

Lawrence and Lee - Inherit the Wind

Harper Lee - To Kill a Mockingbird

Primo Levi - The Periodic Table

C.S. Lewis - The Lion, the Witch, and the Wardrobe

Gabriel Garcia Marquez - 100 Years of Solitude

Cormac McCarthy - The Road

Herman Melville - Moby Dick

Arthur Miller - The Crucible

John Milton - Paradise Lost

Thomas More - Utopia

Toni Morrison - Beloved

Vladimir Nabokov - Lolita

George Orwell - Animal Farm

Orhan Pamuk - Snow

Chaim Potok - The Chosen

Marcel Proust - In Search of Lost Time

Ayn Rand - Atlas Shrugged

Jose Rizal - Noli Me Tangere

Marilynne Robinson - Gilead

J.D. Salinger - Catcher in the Rye

Shakespeare - Complete Works

George Bernard Shaw - Saint Joan

Murasaki Shikibu - The Tale of Genji

Alexander Solzhenitsyn - One Day in the Life of Ivan Denisovich

Sophocles - Oedipus Rex

Muriel Spark - The Prime of Miss Jean Brodie

John Steinbeck - The Grapes of Wrath

Irving Stone - The Agony and the Ecstasy

W.M. Thackeray- Vanity Fair

J.R.R. Tolkien - The Lord of the Rings

Leo Tolstory - War and Peace

Mark Twain - Adventures of Huckleberry Finn

Mark Twain - The Adventures of Tom Sawyer

Sigrid Undset - Christine Lavransdatter

Voltaire - Candide

Kurt Vonnegut - Slaughterhouse Five

Evelyn Waugh - Brideshead Revisited

Eudora Welty - The Optimist's Daughter

Edith Wharton - Ethan Frome

Elie Wiesel - Night

Oscar Wilde - The Picture of Dorian Gray

Virginia Woolf - To the Lighthouse

So many authors from childhood that I've left off but wanted to include - Enid Blyton, E. Nesbit, Kenneth Grahame, Madeleine L'Engle...I guess I'l have to make a separate children's book list of 100 must-reads!

***

Additions/revisions suggested by readers/friends:

J.M. Coetzee - Foe

Charles Dickens - Great Expectations

George Eliot - The Mill on the Floss

Ernest Hemingway - A Farewell to Arms

Sinclair Lewis - Arrowsmith

Sinclair Lewis - Main Street

Vladimir Nabokov - Pale Fire

Arundhati Roy - The God of Small Things

John Wyndham - The Chrysalids

Doctors Who Write II: I *Heart* A.J. Cronin

Almost a year and a half ago I wrote a little post about physician writers in which I mentioned the Scottish physician and author A.J. Cronin.

Over the weekend my family and I watched the beautiful Gregory Peck film The Keys of the Kingdom, adapted from a Cronin novel by the same title, and once again I marveled at how those "old" black-and-white movies are able to capture children's attention simply by the power of story and character.  My kids were riveted to this poignant tale of a humble but courageous missionary priest in China and the nun who ends up working at the same mission.  No flashy special effects.  No flying superheroes, fancy gadgets, or magical worlds.  Just multi-layered, imperfect human beings trying to overcome their problems with dignity, creativity, humor, and kindness.

Today I watched a very different Cronin story, the 1938 film version of The Citadel, on Youtube (starring Robert Donat as Dr. Andrew Manson, also starring a very young Rosalind Russell, Rex Harrison, and Ralph Richardson!).  I was completely flabbergasted by the medical and medico-cultural practices depicted.  The following exchange between Dr. Manson and Christine Barlow sums up the prevailing paternalism of the day:

Christine:  "Why do doctors always write their prescriptions in Latin?"

Manson:  "So their patients don't know what they're getting."

Shocking!

In this film the doctor slaps a malingering patient - twice - to get her to snap out of her fake hysterics - and her sister thanks him for his effectiveness, mind you!  Also, doctors bill unfairly for services barely rendered - in much the same way the public imagines lawyers today calculate "billable hours" which might not all be expended doing actual work for a case.  Anesthesia for major trauma surgery is delivered without monitors, or I.V. access, or a secure airway (see time index 7:33 of this clip). Resuscitation protocols are non-existent; the neonatal "resuscitation" scene in particular makes one cringe.  But if you actually read Cronin's novel, the details in the writing for the latter - right down to the "joyful, iridescent bubble" of mucus finally escaping from the baby's nostril - make you forget for a moment all the flawed practices which an observer today would criticize.  Cronin can really bring stories to life.

I was first exposed to Cronin's work through the 1983 Masterpiece Theater adaptation of The Citadel, starring Ben Cross as Andrew Manson.  The one scene I remember vividly from that miniseries was one in which Manson picks up his black bag to attend to a loved one but is told even before he gets to the scene that he won't be needing it.  Being unable to help is terribly difficult for a physician, while actually causing harm is devastating.

In the film version there's a scene in which Manson finds himself at a psychological nadir - and what doctor hasn't been there, or close to it, at some point? - because he believes he has allowed harm to come to a good friend, and he finally realizes that he has strayed far from the ideals with which he began his career.  He is more than discouraged; he is contemplating giving up.  As a doctor, every day you face the unknown - "as though you had to take some citadel you couldn't see but you knew was there" - and it can be stressful and worrisome and disheartening, especially since you so often undertake the siege feeling quite alone.  But as A.J. Cronin once said, "Worry never robs tomorrow of its sorrow, but only saps today of its strength."  And so an inner voice comes to his flawed protagonist and says, 

"You must carry on.  You must keep on hoping and trying.  That's a doctor's job."

I should print that out and paste it inside my locker.

The Unexpected Path

I was doing rounds one evening when I stopped at the floor-to-ceiling windows along one of the hospital corridors to look at the outside world.  

I often try to steal these moments of stillness whenever I can (and usually a moment is all I have).  I think of them as micro-retreats, to make my body pause and give my soul a brief rest.

Imagine my surprise and delight upon seeing this unexpected sight when I happened to look down into the courtyard of this as-yet unfamiliar place:

A prayer labyrinth.  In my new hospital.  A replica of the one in the cathedral at Chartres.

In the midst of the hectic pace here and the stresses of adjusting to a foreign environment, I felt suddenly comforted by the sight of this quiet space reserved for a different kind of healing altogether - an open area of tranquility meant for the spirit, tucked away into the heart of an institution dedicated to the care of the body.  A circle, with its suggestion of infinity, within the confines of a square.

In the hospital we run around in circles in what can sometimes seem like an endless labyrinthine path as we prepare patients for surgery, check on them after surgery, and help each other with piles of work, always pressured to go faster, faster, faster.  There is little choice; we have to go, go, go.  It can be easy to lapse into distraction and the feeling of being constantly on edge, harassed.  

The prayer labyrinth, in its silence and patient openness, encourages the opposite kind of labyrinth walk.  A mindful crossing and winding, done at our own pace.  A peaceful and generative walk on a path freely chosen which, despite its circuitous turns, always leads home, to the center.

The ancients knew that there's a difference between a labyrinth and the maze.  A maze confuses and misleads, but a labyrinth can lead to the dispelling of inner monsters and rebirth into a new, more centered kind of journey.  I hope the prayer labyrinth at the heart of this maze of work, by its very presence, can gently inspire me with the energy to do just that.

But love has pitched his mansion in

The house of excrement;

For nothing can be sole or whole

That has not been rent.  -W.B. Yeats

As Good An Excuse for Chocolate As Any

Oh, all right.  Happy Valentine's Day already.

I already expressed my feelings about VD last year, so this year I'll just share an Anesthesioboist's Valentine fantasy (courtesy of PushinDaisies):

Mmmmmmm.   What could be better than an anatomically correct chocolate heart for Valentine's Day?

Maybe a T-Shirt with cupcakes on it that says "Oboist - will play for chocolate" (found here or here)?

I think I'd still have to go with the chocolate heart.

Here's an another anatomical chocolate to warm an anesthesiologist's heart. Anybody wanna name that body part? (No, it's not an oboe d'amore...)

***

My Lists for the Day:  

1) Favorite Uber-Schmaltzy or Romantic Things to Wallow In, For the Besotted Among Us

Classical music piece:  Balcony Scene from Prokofiev's Romeo and Juliet

80's Pop Song: St. Elmo's Fire Instrumental Luuuv Theme (or Glory of Love from Karate Kid)

Book: The Monk Downstairs by Tim Farrington

Short Story: Katrina Katrin' by Mark Helprin

TV Episode: any of the X-Files ones in which Mulder weeps over Scully; or when the Colonel on Stargate-SG1 has to confess under oath that he cares about the Major

Date movie: well, since we JUST saw it and found it completely stunning, Slumdog Millionaire, though in my younger days I would probably have picked A Room with a View

Old movie: Roman Holiday v. Casablanca...hmm...

Sizzling screen kiss: I'm gonna have to go with one of the Ben Hur ones for this one

Romantic places:  Weeks Foot Bridge, Harvard; or Florence; or Paris; or Cambridge University when the weather's good; or Prague; or Hong Kong (hm - two universities named in this category...)

2) Valentine's Day Movie Night Suggestions

Casablanca at the Brattle Theater, of course - if you don't mind the whole audience quoting along throughout the entire movie

Roman Holiday

Slumdog Millionaire, if you can deal with the intensity of it

The Illusionist

My Big Fat Greek Wedding

While You Were Sleeping

Legally Blonde

A Room with a View

The Scarlet Pimpernel (Anthony Andrews version)

The Mask of Zorro and The Legend of Zorro

Sweet Land

Happy wallowing, all!

Palpitations

Good palpitations: the kind you get when you see Gregory Peck gazing longingly at Audrey Hepburn in the press conference scene in Roman Holiday.

Bad palpitations: the kind you see on an anesthesia monitor when a patient's heart is fibrillating, and the rate's not controlled, and there was no indication at all from the history and physical that this was what you were going to see when hooked up the monitors, and you know you're going to have to cancel the case and the irate surgeon already hates you for something else which actually wasn't even your fault (but he feels like blaming you anyway)...

More bad palpitations: the nurse comes in after you drop the patient off in the holding area and asks you how to spell your last name because the patient wants to write it down.

Good palpitations: then the nurse tells you it's because the patient wants to be sure she can request you as her anesthesiologist once the cardiologist clears her for surgery and her heart rhythm's under control, because she was so glad you were paying enough attention to catch the problem and really appreciates the time you took to explain what was going on.

There are days when I am discouraged and encouraged about my profession all at the same time. This can lead to palpitations...

Enhancements: Just Some Questions to Ponder

All the recent talk about Alex Rodriguez has led to a lot of ruminations during my morning commute. I've been thinking about enhancement, in all its different manifestations, great and small, and what circumstances make it acceptable.

Is it okay for athletes to use steroids to increase their prowess?  If so, why, or if not, why not?

Is it okay for students to take medication that might enhance their cognitive abilities?

Is it okay for ANY woman to seek assisted reproduction, or should some be declined the opportunity?  What if a woman is unable to support children financially?  What if she is unemployed, on food stamps, and already has six other children under the age of eight?  Who can judge when a person can claim rights without responsibility for the associated duties, and when an individual's rights / desires should be denied? Are people just entitled to do whatever they want, reproductively, regardless of the consequences?

Is it okay for performers / musicians / public speakers who suffer enormous, intractable stage fright to take beta blockers before appearing in public?  What if they don't ordinarily suffer from debilitating anxiety?

Is it okay for people to undergo plastic surgery to increase their breast size / lip size / buttock shapeliness or decrease their accumulated adipose tissue?

Is it okay for women to use make-up to make themselves look better than they would naturally?

When is it okay to bring out or augment the best in ourselves with external aids, and when is it not, and why?

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The topic of the day today over at Mothers in Medicine is "mentors."  I contributed a post for the occasion, if anyone's interested.

Anesthesia in the Movies

There aren't a lot of flattering, never mind realistic, portrayals of anesthetists and anesthesiologists on film. Actually, there aren't a lot of portrayals period. 

Gregory Peck once played a priest who had to give a kid some drop ether (or maybe it was chloroform?) in the 1944 film The Keys of the Kingdom (based on the novel by A.J. Cronin). That was a pretty good scene.  Actually, the whole movie was good.

Anesthesia care in another film based on an A.J. Cronin novel, The Citadel (1938), was not ideal (see time index 7:33 of this clip).  But I guess we can't really blame the anesthetist, who had to work with no monitors, no endotracheal tube, no resuscitation protocols, and seemingly no I.V. access.  I think there's a lot about medicine back in those days, culturally and scientifically, as depicted in that film, that would shock us today.

The poor little female Asian anesthesiologist in Spiderman 2 met with a bad end. Doc Ock got her.

Then there's the scandalous anesthesiologist on Grey's Anatomy, Dr. Milton, who abandoned a patient on the table during a bomb threat in an episode which aired on February 5, 2006. I can't say what I would have done in his shoes, being a parent myself, but I HOPE I would have had the courage and integrity not to desert my patient. As was pointed out in a letter from the American Society of Anesthesiologists to the show's producer, "Of all medical specialists, an anesthesiologist is probably the least likely to fall apart or 'bail out' in a crisis situation."

And of course there's the movie Awake. The ASA wasn't too happy about that one either. Movie producer Joana Vicente was quoted to have said, "Awake will do to surgery what Jaws did to swimming in the ocean." Hmm. Awake. Jaws. Awake. Jaws. I'm not seeing the comparison. Has anyone actually seen Awake? How was it?

And who remembers this quote by the ghost of Jamie in Truly, Madly, Deeply, played by Alan Rickman? "Dying's all right...it's the general anesthetic I didn't like."  Bummer.

Last night I saw a movie in which anesthesiologists were actually a) written into the script and b) depicted fairly realistically. The film was Gifted Hands: the Ben Carson Story starring Cuba Gooding, Jr. as Dr. Carson. Although the transitions between time periods struck me as a bit choppy, the film really held my interest, especially during the most compelling moments in the O.R., which I thought were surprisingly well done.

The person playing the anesthesiologist trying to coax a young girl to open her eyes after a hemispherectomy for epilepsy had just the right manner and posture about him. Later, the depiction of the intricate separation of the German craniopagus twins that made headlines in the 1980's had us leaning forward in our seats, eyes glued to the screen. I was especially impressed that they bothered to show a moment in which Dr. Carson checked in with the anesthesia team to verify the stability of his patients and also to show those team members hastily re-hanging various bags of fluid, manually stabilizing the endotracheal tubes, and doing other important "busy work" as the separation of the twins was under way.

The 22-hour operation took not only a lot of daring but also a lot of "thinking outside the box" and preparation. And not just the preparation of a good set-up or of years of experience in medicine: the teams rehearsed, and rehearsed together. I think these were the crucial differences that allowed this operation to be a success where others had failed. I found this heart-stopping article about a more recent separation of conjoined twins that gives a detailed, vivid, blow-by-blow account of the operation. It's a worthwhile read - the story of a modern medical marvel, with all the associated highs and lows, made possible not only because of technology and talent but also because of the miracle of smooth, well-practiced teamwork.  Have a look.

Heard From a Patient Waking Up From Anesthesia

"Did they pass the stimulus package?!"

I kid you not.  He came out of the anesthetic and this is exactly what he said.

The Orange Bag

It's because of posts like this that I LOVE Michael Leddy's blog.  (In general he's learned without being snobby, articulate but never arrogant, and endowed with keen insight, sharp "eyesight," and great humor. Here he's also intellectually curious and artistically aware...)

I sometimes forget that people who don't inhabit the world of medicine on a daily basis can nevertheless be interested in its backstage area - the inner sanctum known best by those who have to live in it and with it.  

One of the things Michael has wondered about is what doctors who used to make house calls carried in their iconic black bags. (See here and here for more doctor-bag links and photo credit.)  It seems so small - what could possibly fit in there?  According to this 1948 photo by Life photojournalist W. Eugene Smith, quite a lot.  

During my residency years, the closest thing I had to the black doctor's bag - which represented a certain earned trust, a level of expertise attained that granted the bearer the privilege to hold some of the most important objects involved in practicing the art, as well as a connection to past practitioners - was the PACU bag.

The PACU bag was an orange duffle bag kept in the Post Anesthesia Care Unit - the PACU, or recovery room.  It was crammed to near-bursting with airway management supplies:   laryngoscopes of various sizes and shapes;  endotracheal tubes;  masks, gloves, syringes, oral airways, and LMA's; a gum elastic bougie or two; tube changers; rescue drugs.

I remember being a first-year and watching with envy and admiration as the more senior residents would get paged to code situations, grab the orange bag, and go sprinting down the corridors and up the stairs to offer their hard-earned skills to the rescue.  Then I started to accompany them to watch and learn what it was they did when they arrived.  They never let the code team forget they were physicians first and foremost - not just tube-girl or tube-boy - and insisted on being given adequate report of a given patient's condition. They took time to prepare - adequate IV flow, adequate suction - even when people were concerned about the shortage of time.  They collaborated with the rest of the team  - thank you, respiratory therapists! -  to maximize the efficacy of their work and get help to complete it if needed.

When I was deemed ready to hold the code beeper, I remember feeling both exhilarated and terrified.  Finally!  I was worthy of the PACU bag!  But wait - that meant going to CODES where people were DYING or DEAD and trying to get them ALIVE again. Ack!

To this day one of the tasks that makes my heart race with both tension and enjoyment is being asked to run to the ICU for an intubation.  I don't carry a big orange duffle bag anymore - I've streamlined a bit - but some part of me still holds, reverently, the spiritual black doctor's bag I continue to have to earn with each day in practice.

New Job: First Day

I've been dreading this day as much as I've been excited about it.  My first day at The New Hospital.

If there's one thing I find really difficult, it's being a stranger in a strange land.  Especially when that land happens to be a place I have to prove myself worthy to inhabit.

I suppose it's about par for the course that my first patient was there for a straight-forward procedure but was not a very straight-forward patient.  And of course his IV came out.

And I guess I shouldn't feel bad that the second patient had an unexpectedly difficult airway, when apparently two other clinicians in two other rooms had the same experience this afternoon.

And finally, I can't imagine it's all that unusual to find the morass of new paperwork, new rules and rituals, and unfamiliar building lay-out utterly confusing and stressful on the first day.

This is normal, right?  This feeling that you wish all the nice, new people who welcomed you so politely and helpfully and offered their support on your first day at work could be where your old colleagues were when you left them:  aware, believing, trusting in your ability to take good care of patients and do your work reliably and with integrity?

It takes time to build that trust up.  Even at St. Boonie's there was a breaking-in period. There was judgment.  Over time it became mutual respect, even friendship in some cases.  But it did take time.  And I'm so impatient, and sometimes so...doubtful.  It's very true what that old Cheers theme song says:

"Sometimes you wanna go

where everybody knows your name

and they're always glad you came."  

I'm still excited about this new job and the possibilities it holds for me.  But I can't help missing my old village a little.