I bid farewell to one of my favorite months on this Pentecost day with two stunning favorites by Gerard Manley Hopkins.
Sunday, May 31, 2009
I bid farewell to one of my favorite months on this Pentecost day with two stunning favorites by Gerard Manley Hopkins.
Saturday, May 30, 2009
Sometimes on a lazy Saturday morning, in addition to enjoying a cup of chocolate-flavored coffee and watching Saturday morning cartoons, I like to look at old family videos and albums, upload sepia-toned photos of ancestors, go through old letters and memorabilia, and reminisce a little bit.
Tuesday, May 26, 2009
Monday, May 25, 2009
Sunday, May 24, 2009
Saturday, May 23, 2009
Wednesday, May 20, 2009
My mistress' eyes are nothing like the sun;
Coral is far more red than her lips' red;
If snow be white, why then her breasts are dun;
If hairs be wires, black wires grow on her head.
I have seen roses damask, red and white,
But no such roses see I in her cheeks;
And in some perfumes is there more delight
Than in the breath that from my mistress reeks.
I love to hear her speak, yet well I know
That music hath a far more pleasing sound;
I grant I never saw a goddess go;
My mistress, when she walks, treads on the ground:
And yet, by heaven, I think my love as rare
As any she belied with false compare.
Sunday, May 17, 2009
Saturday, May 16, 2009
Do you have a favorite oboe piece right now?
- Thou shalt have a comfortable, well-practiced mask technique.
- Thou shalt be aware of any elements of the patient's history that might have an impact on his or her airway.
- Thou shalt perform a conscientious examination of the airway.
- Thou shalt place the patient's head, neck, and shoulders in the best position possible.
- Thou shalt give enough drug to ensure the patient is adequately anesthetized before attempting to secure the airway.
- Thou shalt sweep the tongue into the hollow of the mandible.
- Thou shalt not have a "wimpy lift," as one of my attendings told me I had my first month or so in residency, when I hadn't quite developed that laryngoscope arm yet.
- Thou shalt aim for the tunnel above the arytenoids.
- Thou shalt have an LMA ready and a bougie handy.
- Thou shalt call for help promptly if you need it.
No tricks. Just know what you're doing, stick to the facts, keep your eye on the numbers, take charge and delegate, and if you need help, ASK.
Friday, May 15, 2009
Welcome to The Writers' Rag-and-Bone Shop, my new blog-café for all things literary (inaugurated on the anniversary of Emily Dickinson's death from kidney disease in 1886). I've looked back on a number of posts in which I've shared passages of literature and poetry that have lingered in my mind after I've read them (see here, here, here, and here for examples), and I've decided I'll make a point of sharing such finds here from time to time.
I believe that art is the highest expression of the human spirit.I believe that we yearn to transcend the merely finite and ephemeral; to participate in something mysterious and communal called "culture" - and that this yearning is as strong in our species as the yearning to reproduce the species.Through the local or regional, through our individual voices, we work to create art that will speak to others who know nothing of us. In our very obliqueness to one another, an unexpected intimacy is born.The individual voice is the communal voice.The regional voice is the universal voice.
Thursday, May 14, 2009
I'll be announcing the winner of the Blogiversary Book Give-Away TOMORROW evening, so if you'd like to be considered, please send in an interview question (for Saturday's "Interview of T. by Her Readers, 2nd Edition") by midnight tonight to firstname.lastname@example.org!
Wednesday, May 13, 2009
The day she visited the dissecting room
They had four men laid out, black as burnt turkey,
Already half unstrung. A vinegary fume
Of the death vats clung to them;
The white-smocked boys started working.
The head of this cadaver had caved in,
And she could scarcely make out anything
In that rubble of skull plates and old leather.
A sallow piece of string held it together.
In their jars the snail-nosed babies moon and glow.
He hands her the cut-out heart like a cracked heirloom.
In Brueghel's panorama of smoke and slaughter
Two people only are blind to the carrion army:
He, afloat in the sea of her blue satin
Skirts, sings in the direction
Of her bare shoulder, while she bends,
Fingering a leaflet of music, over him,
Both of them deaf to the fiddle in the hands
Of the death's-head shadowing their song.
These Flemish lovers flourish; not for long.
Yet desolation, stalled in paint, spares the little country
Foolish, delicate, in the lower right-hand corner.
Every year in the month of May - the month in which I graduated from medical school - I think back to those years before I encountered patients face to face. Med students are in some ways like Bruegel's Flemish lovers - oblivious to the carnage, not yet involved in it, in fact quite shielded from it, yet with a front row seat and hearts full of interest.
At some point we have to enter into the fray. We have to see blood spilled, watch people die in front of us, take part in a person's very first moments, hear people's hidden thoughts and fears, see and touch parts to which even their most intimate loved ones haven't had access.
How do we prepare for that kind of intensity and intimacy?
We do it in stages. Our first patient, our cadaver in anatomy lab, doesn't risk suffering harm at our hands. Through this generous individual we confront death, the signs and scars of disease, internal organs. We place our fingers into the portals of the human heart. We trace the paths of nerves both delicate and tough, touch the glossy surfaces of liver and spleen, dissect the structures of the head and larynx.
We start seeing live patients as observers standing awkwardly behind seasoned preceptors. We learn to take a medical history and perform an exam, and we start doing a few. (Embarrassingly, my salient memory from my earliest preceptorship is of my turning visibly green and almost wretching when my preceptor had to lance an abscess in her office. I held it together...but just barely.)
Then there's the first time we have to deal with someone else's private parts. Tears and suffering I wasn't afraid of...but I felt very shy about invading others' bodies. At my school we were guided through our first pelvic exams by trained models, male and female, who would permit us to examine them and give us feedback on our technique in order to provide us with a greater degree of competence and comfort when we ventured to examine real patients. We all tried to be cool, almost nonchalant, as we inserted digits and metal objects for the first time into the orifices of strangers. Predictably, we uttered awkward things. But we learned. We learned to be careful without being afraid, and to be correct and professional. I can't say I found this training experience enjoyable, but I certainly found it extraordinarily helpful.
Eventually we are turned loose in the hospitals, to learn how to gather information from and about real patients, examine them well, and make judgments about their needs. In the end our patients are our most valuable teachers. We learn from them the mechanics of our profession, but we also learn the things that can't be taught in a classroom, except by simulation - how to discuss bad news; how to console someone who's weeping; how to convey sympathy, to touch people in comforting ways that don't involve percussing or applying a stethoscope. How to feel a portion of someone else's pain without being distracted or destroyed by it.
For most of us, these are recurring lessons to which we'll return for the rest of our careers. The word doctor in Latin means teacher, and perhaps the best doctors are those who are great teachers. But no doctor can ever be a great doctor without being a committed life-long learner, and being open to the teaching treasures other people and their lives have to offer. If this is true, then no doctor can be really good without being genuinely humble - not with the false modesty of someone whose insecurity causes constant self-deprecation, but with the true humility of someone who acknowledges that knowledge and power must be constantly earned and shared.
Tuesday, May 12, 2009
In the tradition of Grand Rounds, up at Health Blogs Observatory today (Great edition! Check it out!), and the upcoming SurgeXperiences blog carnival, I'd like to welcome you to my own mini-blog carnival, part of my week-long Blogiversary Festival. Below is a compendium of posts written since last year's blogiversary. Enjoy!
Monday, May 11, 2009
Welcome to the official opening day of Notes of an Anesthesioboist's Blogiversary Festival, a week-long celebration of two years of blog fun.
Stay tuned (so to speak) for tomorrow's Blogiversary special: "Best of Notes of an Anesthesioboist," a compendium of favorite posts from the past year.
Sunday, May 10, 2009
Friday, May 8, 2009
She was great!
Moments she and I don't want to forget from the run:
- Her great-grandmother's 102-year old sister, who had seen the original D.C. production of Annie way back, making it up here from D.C. to watch the second show.
- A three-year old girl wanting to meet her and get an autograph after one of the shows.
- One of the girls who had openly expressed resentment toward her approaching her after the show to say, "You deserved the part" before walking away as abruptly as she had come. A striking lesson in the way you can sometimes earn the respect even of people who don't really like you, through hard work, good character, and humility.
- Standing ovations the second two nights.
- Playing "Psychiatrist" at the cast party.
- Her school friends hugging her and presenting her with a bouquet of red roses.
- The family and friends who traveled from miles and miles away just to see her and support our family.
- The entire cast and crew showing up to school after the run wearing their "Annie" T-shirts in solidarity.
Thursday, May 7, 2009
When I was a child in the Philippines, really great books weren't so easy to get. The best ones were abroad, and I'd look forward to the moments when my father would unpack his suitcase from a business trip and hand me his latest acquisitions. These I would read over and over, relishing the weight of them in my hands, the aroma of the binding glue wafting up from the open pages, the illustrations.
Over coffee one afternoon, a book-industry professional (whom I can't identify) told me that for the past two months virtually no imported books had entered the country, in part because of the success of one book, Twilight by Stephenie Meyer. The book, an international best seller, had apparently attracted the attention of customs officials. When an examiner named Rene Agulan opened a shipment of books, he demanded that duty be paid on it.
"Ah, you can't be too successful in this country," I said. "If you are, then people start demanding a cut..."
...The importer of Twilight made a mistake and paid the duty requested. A mistake because such duty flies in the face of the Florence Agreement, a U.N. treaty that was signed by the Philippines in 1952, guaranteeing the free flow of "educational, scientific, and cultural materials" between countries and declaring that imported books should be duty-free. Mr. Agulan told the importer that because the books were not educational (i.e., textbooks) they were subject to duty. Perhaps they aren't educational, I might have argued, but aren't they "cultural"?
No matter. With this one success under their belt, customs curtailed all air shipments of books entering the country. Weeks went by as booksellers tried to get their books out of storage and started intense negotiations with various government officials.
What doubly frustrated booksellers and importers was that the explanations they received from various officials made no sense. It was clear that, for whatever reason—perhaps the 30-billion-peso ($625 million) shortfall in projected customs revenue—customs would go through the motions of having a reasonable argument while in fact having none at all.
Customs Undersecretary Espele Sales explained the government's position to a group of frustrated booksellers and importers in an Orwellian PowerPoint presentation, at which she reinterpreted the Florence Agreement as well as Philippine law RA 8047, providing for "the tax and duty-free importation of books or raw materials to be used in book publishing." For lack of a comma after the word "books," the undersecretary argued that only books "used in book publishing" (her underlining) were tax-exempt.
"What kind of book is that?" one publisher asked me afterward. "A book used in book publishing." And she laughed ruefully.
I thought about it. Maybe I should start writing a few.Harry the Cultural and Educational Potter and His Fondness for Baskerville Type.
Likewise, with the Florence Agreement, she argued that only educational books could be considered protected by the U.N. treaty. Customs would henceforth be the arbiter of what was and wasn't educational.
"For 50 years, everyone has misinterpreted the treaty and now you alone have interpreted it correctly?" she was asked.
"Yes," she told the stunned booksellers.