Wednesday, July 29, 2009

Gospel Truth

The religious scholar Willis Barnstone’s “The Restored New Testament,” which will be published in the fall, includes not only the canonical Gospels but also three Gnostic gospels: those of Thomas and Mary Magdalene, from Nag Hammadi, and the Gospel of Judas. But, if we’re going to start rewriting the Bible, where will that end?...

...All this, I believe, is a reaction to the rise of fundamentalism—the idea, Christian and otherwise, that every word of a religion’s founding document should be taken literally. This is a childish notion, and so is the belief that we can combat it by correcting our holy books. Those books, to begin with, are so old that we barely understand what their authors meant. Furthermore, because of their multiple authorship, they are always internally inconsistent. Finally, even the fundamentalists don’t really take them literally. People interpret, and cheat. The answer is not to fix the Bible but to fix ourselves.

Amen. Amen.


The above photo of a portion of the Codex Tchacos, the manuscript of the "Gospel of Judas" mentioned in Acocella's article, is a perfect symbol for our knowledge and grasp of Scripture, its history, and its meaning.  We can never see or know the whole truth; much of it is irrevocably lost, and what remains cannot always be fully understood or clearly interpreted.

I've written before about my views on Scripture.  I embrace a contextual rather than literal approach to the Bible.  But part of me does wish I had some kind of scrying glass and could look back on ancient times and see what went on, just to clear up some of the mysteries. I think many of the disputes and differences of opinion that exist today, though, were already alive and well even at the outset:

3As I urged you when I went into Macedonia,
stay there in Ephesus so that you may command certain men
not to teach false doctrines any longer
4nor to devote themselves to myths and endless genealogies.
These promote controversies rather than God's work—which is by faith.
5The goal of this command is love,
which comes from a pure heart
and a good conscience
and a sincere faith.
6Some have wandered away from these
and turned to meaningless talk.
7They want to be teachers of the law,
but they do not know what they are talking about
or what they so confidently affirm.              -1 Timothy 1:3-7

The one time I see a significant impact on my work in medicine from the difference between my approach to Scripture and a literal interpretation of Scripture is when I am asked by Jehovah's Witnesses to avoid blood transfusion even in the case of impending death.  Two Jehovah's Witnesses stopped by my house one morning, and I asked (for my own education) for some information on this, with what I hoped was a polite but clear disclosure of my intention to stick to my own views of faith and Scripture.  The discussion was informative and positive, and I affirmed that from most physicians' point of view, there was a strong ethical imperative to respect the wishes of all adult patients who are Jehovah's Witnesses.  But I'll admit that for many physicians this is one of the consequences of a literal reading of the Bible that's hardest to live with, if only because most of us are deeply motivated to do everything we know how to do in order to protect a life.

Tuesday, July 28, 2009

Top Ten Books

While reorganizing my bookshelves today I rediscovered the book The Top Ten: Writers Pick Their Favorite Books edited by J. Peder Zane.  I realized that while I've described a timeline of influential books and discussed other favorites (a list which needs to be updated with my favorite chocolate, Milka's Tendres Moments Au Mousse Praliné, and my favorite dessert, Trader Joe's Mango Passion Torta Cotta!), I haven't yet made a list of favorite books.

Of course, I do have one in mind.  Here it is. Books were chosen based on how much I absolutely loved them when I read them, how much of a difference I feel they make in the world  just by existing, and how great I think the author's writing is.

10. Lying Awake by Mark Salzman
9. A Ring of Endless Light by Madeleine L'Engle
8. Gilead by Marilynne Robinson
7. A Christmas Carol by Charles Dickens
6. The Curious Incident of the Dog in the Night-time by Mark Haddon
5. The Christmas Miracle of Jonathan Toomey by Susan Wojciekowski
4. Tuck Everlasting by Natalie Babbitt
3. Prodigal Summer by Barbara Kingsolver
2. The Help by Kathryn Stockett
1.  To Kill a Mockingbird by Harper Lee

Runners-Up (So close.  Oh, so close.):  The Graveyard Book by Neil Gaiman; Winter's Tale by Mark Helprin;  The Fourth Wise Man by Diane Summers; Jane Eyre by Charlotte Bronte; Harry Potter and the Sorcerer's Stone by J.K. Rowling

Anyone else have some favorite books to recommend?  Do you have just ONE favorite, or a list of favorites?  Do you have a favorite in each of a number of genres?


Aw, what the heck.  I'm on a roll.  Here are my top ten favorite movies too:


5. While You Were Sleeping
4. Roman Holiday
3. Elf
2. The Trouble with Angels
1. By the Light of the Silvery Moon


5. Jesus of Nazareth
4. The Color Purple
3. The Illusionist
2. The Mission
1.  To Kill a Mockingbird

Saturday, July 25, 2009

Care for All?

I've been silent on the health care debate because I've been trying to understand what's going on, both in the world and in my own mind.  The process can be intimidating and confusing.  I don't have organized thoughts or answers or certainty on all of the issues, but I've been giving them a lot of thought.

My recent trip to Europe has left me admiring much about French health care, but it's not all roses over there.  Though there have been many news reports extolling the virtues of access to health care in the E.C., and the physician-friendlier malpractice situation, people seem to be forgetting that many European countries pay for that with an enormous tax burden and what would be considered unacceptable physician salaries here.  I still think they have it pretty great over there, but they do pay dearly for it. [Click here for discussions on NPR about the Canadian system.]

At the heart of much of the debate about health care, I think, lies another debate, about whether or not health care is a right.  Fellow-blogger and physician Edwin Leap raises this challenging question:  if it's a right - that is, if we're all entitled to it - shouldn't we all be able to get it for free?  This gave me some pause.  We're supposed to strive for equal opportunity via universal access to free education in U.S. public schools, but that doesn't mean we don't pay our teachers.  People may be entitled to get something for free, but somebody still has to pay for it.

Does this mean we all have a right to an education but not a right to get treatment if we're sick or injured? I had always thought in the back of my mind, "Sure, everyone has the right to get help if they need it."  But I hadn't really challenged myself to consider all the details in depth.

When I've imagined patients who need my help, have I really believed, "They have a right to my attention and care, regardless of their ability to compensate me for my time and work" - which on some level the idealistic bleeding heart in me wants to believe - or is it more accurate for me to say, rather, "They all have an equal right to my attention and care (though not necessarily and equal need for it), regardless of their situation or what brought them here?"  That, at least, I believe to be true.

Like complicated math equations that can be simplified and simplified until you finally get one clear statement that articulates a truth about the world, all these concepts churning about in discussions about health care, or race relations, or political freedoms in other nations like China and Iran, etc., I think,  can be distilled in my mind to a pretty simple idea:  every individual has the RIGHT to have his or her intrinsic dignity as a human being respected AND not violated.  

This means I think people shouldn't be arrested or even threatened with arrest in their own homes simply because they are angry and Black, especially when such a threat of arrest would never even come up in an equivalent situation in a white person's home.  This means I think China, Burma, North Korea, Iran, and a host of other nations should allow for freedom of opinion, of religion, of speech, and of the press.  This means I consider child abuse and rape among the most heinous of human behaviors.

But what else can that distillation tell us about our rights?  Do we all have a right to eat and have shelter?  If so, should farmers and builders be providing food and housing without pay?  I certainly don't believe that.  Or, are food and shelter just basic needs - not to be confused with inalienable rights?

This is the question I've been pondering.  Does something being a basic need mean it counts as a basic right?  And if something should be available universally, does that necessarily mean it belongs to everyone by right?

I think people should be able to see a doctor, get care at a hospital, or receive treatments for acute and chronic illnesses and trauma regardless of their employment status.  I simply think people who need help should be given help, just as I believe people who need schooling should be taught.  This doesn't mean I think teachers, doctors, or nurses shouldn't be paid. I'd also want to avoid a tiered health care system in which rich people can get deluxe health care and less privileged people can't - but that's a pipe dream; people who can pay for more stuff can get more stuff.  Somehow I just think it's more unjust when that applies to care for human lives than when it's a relatively materialistic good like a house or car.

So this brings me back to this question: if there's a man in front of me who will die unless I intubate him, does he have a right to get life-saving care from me?  I certainly feel he's entitled to get my help - by virtue of my duty as a physician and fellow-human being if not by right.  I believe if there's any implied request for my help as a physician, I have a responsibility to provide it.  Is that the same as this patient having a right to get it?  I honestly don't know. Perhaps that's a question best left to philosophers with bigger brains than mine.  

Thursday, July 23, 2009

Kids, Computers, Coming of Age, Classics, and Other Kitchen Table Contemplations As I Get Dinner Ready

A reconstruction of a recent cyber-conversation (whose format may, if you haven't used "Chat" functions on Yahoo / Gmail / Facebook / some other website, be unfamiliar to some and somewhat mystifying):

Daughter's Facebook update:  

"[T.s daughter] is happy even though she was frowning a minute ago."

Daughter on Facebook Chat minutes later:

"Hi, Mommie!"

T.:  "Hi, Sweetie!"


"Why the frown?"

[Pause.  Daughter typing.]

T.'s Daughter:  "Annoyed at somebody's..."


"...Facebook update that said..."


"...they were tired of hearing about the MJ stuff."


T.:  "Oh.  I guess..."


"'s understandable."

[Daughter typing some more]

T.'s Daughter:  "It's mean, though. Somebody did DIE."


T.:  "I'm proud of you..."


"...for having compassion."


"That's my girl."

T's Daughter:  "Tee-hee.  Thanks."

Technology ain't so bad.  

And fear not - we talk and hug plenty face to face as well.


Heard an enjoyable program on NPR's Talk of the Nation today about Lizzie Skurnick's new book Shelf Discovery:  The Teen Classics We Never Stopped Reading.  I wonder if it's a "girl" thing, but I still have (and occasionally re-read) the coming-of-age books that I absolutely LOVED from my pre-teen and teen years.  There seems to have been a period between the '60's and '80's during which classic after classic got published; I wonder if young people today find similar books-for-life among their favorites today, beyond blockbuster phenomena like the Harry Potter and Twilight books - books whose pages they want to dog-ear and write in and bring to college and pass on to their children.

Having recently finished Neil Gaiman's The Graveyard Book (stayed up past midnight unable to put it down till the end), I am definitely putting it on my shelf of beloveds to pass on to my kids.  The Newbery awards are pretty good at pointing to well-written, fresh, compelling stories that can stay with readers for a lifetime.

The books I read during my childhood and adolescence had a profound influence on my development.  Writers read by young people can play such an important role in shaping the way they think - about almost anything.  If I had to credit one author for having helped form my character from the inside out, in complementary fashion to the work done by my family from the outside in, it would have to be Madeleine L'Engle, author of the classic A Wrinkle in Time.  I hope my children find authors and books that can do the same for them.

Wednesday, July 22, 2009

It Starts Early

I've been going through my kids' old school papers and found some relics of their beginning education in science. I was pleased to see that they've been encouraged to approach scientific observation with the intention both to notice and to wonder.

From Second Grade:

Object: "ruelers" (the measuring kind)
I noticed: "Thir are lotts of words."
I wonder: "how they make ruelers."

Object: "nickl" (the 5-cent coin, not the metal)
I noticed: "a hed is on the back."
I wonder: "where is Monticello."

And from Fifth Grade:

Activity: Dissection of a chicken wing.
Daughter's observations: "When I removed the skin of the chicken wing I saw muscle. Lots and lots of muscle. The muscle was pink and squishy - EW."

Now THAT's academic honesty for you.

Tuesday, July 21, 2009

The Game is Afoot

Doc Gurley put together a highly enjoyable edition of Grand Rounds this week (Vol. 5, No. 44) with a mystery theme. Please check it out!

I am using her theme choice as an excuse to mention how much I love Sherlock Holmes, "consulting detective." The 1892 Sidney Paget illustration above is from the adventure of "Silver Blaze" and is captioned, "Holmes gave me a sketch of the events." I have special fondness for this story from The Memoirs of Sherlock Holmes because it is the origin of the phrase, "the curious incident of the dog in the night-time," which in turn is one of my favorite books (by Mark Haddon, 2002).

I first discovered Sir Arthur Conan Doyle's stories when I was nine (yes, I owned a deerstalker cap and the Sherlock Holmes board game). I was enthralled with the way Holmes was able to figure out just from a few shoe scrapes in A Scandal in Bohemia that Dr. Watson had been out in "vile weather" and had a clumsy maid. One of my favorite reading memories is that of being immersed in a forest green, leather-bound volume of the the complete Sherlock Holmes stories given to me by my grandmother for Christmas. I can still remember the book-y aroma that wafted up from the pages.

My favorite Conan Doyle book? The Casebook of Sherlock Holmes

My favorite actor to portray Sherlock Holmes? The incomparable Jeremy Brett, who starred as Holmes for the Granada TV series. He is quoted as having said (commentary in italics mine), "Holmes is the hardest part I have ever played - harder than Hamlet or Macbeth. Holmes has become the dark side of the moon for me (see Mark Twain's moon quote on yesterday's post). He is moody and solitary (maybe that's why I like him so much?) and underneath I am really sociable and gregarious. It has all got too dangerous."*

My favorite episodes in the Granada TV series? "The Red-Headed League" and "The Norwood Builder." Worth a rental from Netflix.

Of course on our recent side-trip to London I had to re-visit Baker Street. I am well aware that Holmes is a fictional character; that street numbers didn't go above 100 in what would have been Holmes's time; that there's a municipal building where 221B Baker Street would be now if the numbers went in order; that the Sherlock Holmes Museum claiming the address 221B further down the the street, out of sequence, is merely an imagining of Holmes's home. The museum was closed when I was in the neighborhood (which was fine with me - I am content with my own imaginings of Holmes's London), and we didn't have a pint at the Sherlock Holmes Pub, but I did get a neat picture of the tube station - Holmes's silhouette, made of many little Holmes silhouettes.

I think I'll go curl up with a good mystery on this rainy day before I have to go into work for the night. Anyone have any favorites? Agatha Christie? Josephine Tey? Ellis Peters? The Father Brown series? (I think I'm dating myself...)

Currently I'm reading Neil Gaiman's Newbery Award-winning novel The Graveyard Book - highly unusual, entertaining, quirky, impossible to put down - a must for those who enjoy ghost stories with both a little humor and some darker underpinnings.

*A little trivia: Brett is among only three actors who have played both Holmes and Watson (Brett played Watson opposite Charlton' Heston's Holmes in an L.A. production of The Crucifer of Blood). The other two are Reginald Owen (Watson in the 1932 film Sherlock Holmes, Holmes in the 1933 film A Study in Scarlet) and Patrick Macnee (Watson in the 1976 film Sherlock Holmes in New York, and Holmes in the 1993 Film The Hound of London).

Monday, July 20, 2009

Moon Anniversary

I've been listening to an old favorite from high school in honor of the 40th anniversary of the lunar landing:  Apollo XI by OMD, from their album Sugar Tax.

I love the way historic radio broadcasts are used in this song.  In fact, they make the song - I probably wouldn't even like it so much without them.  I get nostalgic when I hear it because it reminds of college, when I used it for an across-the-floor exercise during a dance audition I was running for a production of West Side Story.  

User nigel2568 on Youtube created a highly enjoyable Apollo XI video using this track.  Enjoy the memories!

Is it geeky of me to swell with pride every time I watch the movie Apollo 13 and see all those heroic scientists at Mission Control confirming the math calculations with their slide rules?  Maybe a little, huh? But they're just so cool!   :)

Perhaps I feel a certain sympathy with the behind-the-scenes thinkers because they remind me of anesthesiologists.  The astronauts get the glamour and recognition, but it's the scientists watching over the mission that keep it safe and running...


Fascination with the moon is so ancient.  Children look with wonder at it, parents show it to their children, lovers embrace each other beneath it, doctors joke about it being full when work gets crazy, stories are based on it...

Here are some moon quotes for the occasion:

"The moon was a ghostly galleon tossed upon cloudy seas."  -Alfred Noyes, The Highwayman (that one's for you, Dad!)

"Everyone is a moon, and has a dark side which he never shows to anybody."  Mark Twain

"Oh, swear not by the moon, th'inconstant moon, that monthly changes in her circled orb."  -Shakespeare, Romeo and Juliet 2:2:115

"I like to think that the moon is there even if I am not looking at it."  -Albert Einstein

"Don't think. Feel.  It is like a finger pointing out to the moon.  Don't concentrate on the finger or you will miss all that heavenly glory."   -Bruce Lee

"You want the moon?  Just say the word and I'll throw a lasso around it and pull it down."  -It's a Wonderful Life

"Guarda la bella luna. Guarda!" -Moonstruck

Friday, July 17, 2009

You Know It's Bad When...

One day I was giving someone a lunch break and wheeling her patient to the O.R. with the circulating nurse when we heard over the P.A. system,

"Any available surgeon stat to the emergency room. Any available surgeon to E.R. stat."

That stopped us in our tracks for a second. The nurse and I exchanged a look.

"Sounds pretty bad," I said.

"Do you think it'll delay my surgery?" our patient asked.

It was hard to say.

We proceeded to the O.R., where we were met by the anesthetist who had been on lunch break. As we started placing monitors on the patient together, my boss walked in and asked me discreetly,

"The E.R. called. Could you go down there and help out?"

That's when I really thought it had to be bad. If they were making stat calls overhead AND individual calls to our department, someone was having major trouble.

When I arrived in the emergency department I looked for a busy cluster of people and found them in one of the trauma bays. The E.R. doc spotted me and said, "Are you anesthesia? Oh, good."

He gave me a brief synopsis of what had happened to the patient and what he had done to try to intubate her. Then he handed me the laryngoscope.

I feel like every time I write about a difficult airway I'm claiming it was the most difficult airway I've seen in my entire career. I'll qualify that claim this time by stating that while I think under more controlled circumstances this would probably not have been the toughest airway ever, this particular situation made it so. I was looking at a tongue so swollen it was about size and shape of a small Bosc pear, but reddish purple in color, and the person assisting me with suction couldn't suck the blood collecting in the patient's mouth fast enough before another a pool of it would collect.

At first I had a view of the bottom rims of the vocal cords, but the symptoms were evolving quickly, and pretty soon I was just looking at blood, blood, and more blood. I tried twice to pass a breathing tube, but though the tubes seemed to be brushing against the right landmarks, they just would not enter the windpipe.

My boss arrived to see if I needed a hand. Behind him, I saw with gratitude one of the ENT surgeons I had worked with earlier that day.

"Is the neck prepped?" I asked. The neck was prepped and ready for an emergency cricothyroidotomy.

Someone handed me a smaller endotracheal tube to see if I would have any luck with one last attempt at an intubation. By this time there was barely any use even looking into the airway; the tongue was enormous, and the blood kept collecting.

"You're starting to get some runs of v-tach," said one of the nurses.

I maneuvered the tip of the tube toward the trachea, or what I thought would be the trachea, advanced it a little, then advanced it some more while an assistant removed the stylet. The physician applying pressure to the cricoid cartilage raised his eyebrows and said, "You know, that actually felt like it went in."

"Someone listen for breath sounds, please," I said. Two stethoscopes popped onto the patient's chest. It felt great to have so many helping hands! It was one of the few times I actually didn't feel so alone during an airway emergency.

The respiratory therapists hooked up the bag mask ventilator and looked for the carbon dioxide indicator to change color, indicating a tube in the right place. Purple square. Breath given. Yellow square. We were in.

"All right. See you upstairs," said my boss cheerfully as he exited the room. The ENT surgeon waved. Not long afterward, I left my place at the head of the bed and let the rest of the team continue stabilizing the patient.

It was only after the tension of the situation had dissipated and while I was writing my note in the chart that I was able to watch some of the care-giving that was still going on for the patient. I had forgotten how many people can crowd into a tiny space during a code. There were three or four nurses, a respiratory therapist, two firefighters (who had brought the patient in by ambulance), and two physicians, not counting my O.R. buddies who had been there.

I realized I'd been the only female physician on the team when the E.R. physician asked if I was one of the nurse anesthetists. For once the stereotyping didn't bother me; it hadn't mattered during the acute situation, when the team felt like just that: a team. It's rare to feel like everyone's really in synch, truly working together, but I felt it that day - people were helping each other, focused, respectful, thankful. Definitely makes the job, and asking for help with it, a little easier, especially when the stress-o-meter is in the red.

Wednesday, July 15, 2009

The Sticky Subject of Patient Responsibility

Over the last couple of days I've heard this suggestion on the radio: reimbursements for physicians should be restructured such that they are based on patient outcomes.

I disagree.

For almost any other profession or trade, payment is based on a certain expectation of skill and work. I don't wait till after a job is done to pay my carpenter or plumber; he or she charges a rate based on the "going" rate for the job at that particular level of training, and a job well done is expected. If a job is not well done, some money wrangling can ensue; but a priori the quoted rate is based on things other than outcome.

But that's not why I disagree. I disagree because a reimbursement system based on patient outcome makes the assumption that physicians are entirely in control of outcome, when the fact of the matter is some patients bring factors to a given situation that portend poor outcomes. Some of these factors - genetics, environmental exposure - are largely out of patients' control; others, however, derive directly from patients' habits and choices.

Reimbursement based on outcome completely absolves patients from any kind of responsibility for their own health. Physicians whose patients, for example, insist on smoking liking smoke stacks all day every day for decades would be punished merely for having such patients on their rosters. Reimbursement based on outcome would also punish those physicians whose patient populations live at increased risk for disorders such as asthma or malnutrition by virtue of their geographic or socioeconomic lot in life and would reward physicians who live in Gucciville, USA and practice at Dolce & Gabbana Hospital, simply because their more advantaged patients happen to be healthier.

One report I heard held up transplants, and the rigorous outcome measures applied for patients receiving them, as an example of why such a system would ultimately compel physicians to do better. I believe this is a disingenuous comparison; transplants are highly specialized clinical scenarios on which physician practices have direct, observable, concrete impact, but many of the situations that arise in primary care medicine depend as much on patients' actions as on those of physicians.

I firmly believe physicians should be responsible for the care they provide. I believe they should accept responsbility for shortfalls in care and always strive to improve. But I also believe patients, who so often voice the desire to be decision-making partners with their physicians, should also take some responsibility for their own health. If my primary care physician is going to have some dollars taken from her because my blood pressure is still high on my next visit, some dollars should be required of me to compensate her for the loss because despite her entreaties I have not been consistent about getting enough exercise, maintaining a healthy weight, eating a healthy diet, or what-have-you.

Physicians aren't all-powerful. They shouldn't be expected to work miracles, change genetics, manipulate temperament, cure addiction, or read people's minds when they are lying or failing to disclose all pertinent facts. We as patients need to do the work of taking care of ourselves, reporting our symptoms and habits truthfully, making efforts to improve our lives. Only then can the doctor-patient relationship be a kind of "partnering" interaction.

[Photo: painting by Jules Adler of a blood transfusion from goat to human, hanging above a huge staircase at the Université René Descartes.]

Sunday, July 12, 2009

What Stinks?

Here's another memory for the "only in Paris" category.

We had just gotten through security at the airport.  We were walking toward our gate, past the usual array of shops selling luggage, designer scarves, and chocolate.  All of a sudden an unmistakeable odor assailed us.

"What is that SMELL?! Did someone...?" 

Not long after waiting ten minutes for the saleswoman at the Maison du Chocolat counter to place four tiny chocolates into a bag, between conversations with her fellow saleswoman that inexplicably could not wait until after she had finished bagging our minuscule order, we found the source of the pungent odor.

The duty free shop across the way.  It had a CHEESE section.  As if passing all the major historic sites of Paris on the drive out of the city hadn't been enough salt in our wounds, here was an olfactory reminder from Paris, which seemed to be telling us with her characteristic self-satisfaction, "Yes, here, only here, can you find the world's finest culinary delights, and you are leaving them all behind. I stink wonderfully in your general direction.  Enjoy and weep."  

On top of that, in a final, almost iconic gesture of inexplicable, arbitrary Parisian unpleasantness, the saleswoman in THAT shop curtly hissed at me, when I tried to snatch a bloggable memento of this cheese corner, "Taking photos is forbidden!" I mean, honestly.  Why the heck should you care, lady?  Leave me alone. I took one anyway, because I can  be stubborn and defiant, but I couldn't get a really good one.

But it was soooooo typical.  Paris shopkeepers will make up a rule on the spot if you so much as get a hair out of place that annoys them.  They'll size you up to see if you're worthy of their attention.  They will look down on you if you're too sweet. They will take FOR. EVER. to do the smallest thing - wrap an item in tissue paper, top a pizza, enter information into a log book - often because they'll be chit-chatting at the same time (after all, how dare you intrude on their day by actually wanting service).  If you get a defective product, forget about returns, exchanges, or refunds that you've tried to obtain after standing forty to sixty minutes in a line that several Parisians have tried to jump.  Besides, who are you to assert their products are defective?  How dare you.  Lowly expat.

Customer service and work ethic seem totally absent in the workings of small French businesses.  As a Frenchman once said to me of his perception of the French mentality toward work, "Employment is just a vehicle for obtaining paid vacation and paid maternity leave. Why should they put in more than minimum effort when they can get a lot of benefits and by law can almost never get fired?"  I realized that the motivation, the drive, to work as hard as possible, as efficiently as possible, and always try to do better than one has done before, is very, very American.  "Your French employees would never tolerate your standards if you tried to run a business here American-style," he continued, as if reading my thoughts.

I found myself pondering these annoyances as I sat in the airport trying not to be sad about leaving.  Trying to convince myself that visiting was great, but living here would be a pain.  Would I really want to spend the rest of my days in a place where people don't seem to believe in deodorant, or shower curtains, or proper food preparation hygiene, or air conditioning during heat waves, or helping customers struggling to bag groceries at the store before the next person's groceries come rolling mercilessly down the conveyor? Where they just have to judge you by appearances, and everything has to be just so? Where the bureaucrats are arbitrary and nasty, and the red tape thicker than the Conciergerie walls?  Where a single load of laundry (about half the volume of a load in the States) takes two hours to get through a wash cycle, where nothing's open late or on weekends, where you're lucky if you can find a bathroom in a public place, much less a clean one, and where it seems people would almost rather let someone exsanguinate in front of them rather than take the initiative - rather than be bothered - to help a person who's hurt?

The truth is, I could totally see myself living there, despite all my pet peeves.  I could make a pet peeve list for any country - the Philippines, the United States - just as I could make a list of things that make those places great.  Every time I go to France to visit my husband's family, I fall in love with it all over again, and every time I have to leave France, my heart aches a little more.  I don't know that I could ever develop a true sense of belonging over there, but that has eluded me almost everywhere, so that wouldn't be such a big deal.  

I wonder what makes our souls crave certain places with an almost primal longing.  I guess I'm not going to solve that mystery any time soon.  One thing's certain:  I definitely appreciated the more laid-back demeanor of the folks we've encountered back on American soil.  People live and let live over here, and it was nice to come home to that.

Saturday, July 11, 2009

Friday, July 10, 2009

Passage d'Enfer - mais pas vraiment

I had a chance to take a leisurely stroll through Paris on my own today - our last full day here - mostly in the St. Sulpice and Odéon area.  It was nice to find some tucked-away corners, be asked for directions as if I were a local, have no major tourist-y goals, and just enjoy wandering through a city I've really come to love.

It's midnight here.  The Eiffel Tower is in the middle of its hourly sparkle.  It's probably the last time we'll be seeing it for a long while.

My heart hurts.

Wednesday, July 8, 2009

What We Did in London

Fifteen years ago I came to London and fell head-over-heels in love with it.  Today, thanks to my family situation, I think I  might actually have more affection for Paris despite my past love-hate relationship with the city, but London still has a very special place in my heart.

We only had a couple of days here visiting some of my cousins, but we did do many typical touristy things:  took pictures in front of Big Ben; visited Trafalgar Square, Shakespeare's Globe (where we got to watch part of a rehearsal of Troilus and Cressida), and the Tower of London; ate fish and chips; and watched street performers in the lively environs of Covent Garden's Central Market.  My daughter went with her cousin to see a West End show (Sister Act), of course.  

I made some food discoveries:  the soup-and-sandwich chain EAT, where one can get delicious food made with fresh ingredients (I had edamame salad with Thai dressing, delectable pho, and a light sandwich); the cupcakes at the London Review of Books Cake Shop at Bury Place off Bloomsbury Way, thanks to a tip from Shuna; and the  De Gustibus, where I found some absolutely heavenly blueberry cakes and chocolate-dipped brownie sticks.  

We also did some quieter, less flashy things that made this trip even more enjoyable:

My daughter and I enjoyed the brass rubbing center at St. Martin-in-the-Fields, between the gift shop and the crypt café.  Great way to relax on a rainy day.

My whole family enjoyed Cecil's Court, a quiet pedestrian lane just off Charing Cross Road that has some wonderful book shops for those who love browsing.

And finally, the highlight of this visit to London, for me, was All-Hallows-by-the-Tower, a church across the way from the Tower of London and the oldest church in the city (originally founded in 675).  Here the bodies of Bishop John Fisher and Thomas More were sent for a time after their executions; John Adams was married and William Penn was baptized; Samuel Pepys watched the Great Fire of London; and an old Saxon arch was uncovered during a bomb blast.  Here you can find a mariner's chapel, with models of ships hanging from the arches; a brass-rubbing center; and many interesting pieces of art, old and new, including an embroidered banner dedicated to prisoners of conscience.  I came here alone after a long day of sightseeing to recharge at a Taizé prayer service, and it was like drinking cool water after a day of thirst.

Some of the best moments of any trip are those spent finding and enjoying some "hidden treasures."  We've certainly found our share here.

Monday, July 6, 2009

Walking Among 5000-Year-Old Secrets

I hope blogs are considered "personal use" of photographs; those were the rules about Stonehenge pictures.  I cannot believe we were standing right in the middle of the stone circle today.  I don't have word to describe how amazing it was, but I have pictures.  

Stonehenge at dusk:

A portal to an ancient, lost world...

Rain clouds gathering; my husband and son tiny next to the sarsens...

One last look...

Sunday, July 5, 2009

My Beef with the American Educational System

After hearing French people talk about their schooling, I am of two minds.  

I think American students should be required to pass a national exam like the bac (or the British A levels) at the end of high school.  We're not held accountable for our learning at ALL in the states.  We should be able to do more than recognize an answer among multiple choices; we should be able to write about our ideas and discuss our knowledge base, such as it is, in conversation.  It's no wonder that French students who pass the bac qualify to start as sophomores in American universities.  They're just held to a higher standard, one I think we should try to emulate.

The problem with the bac as it is right now, according to the French, is that it's a bit of an elitist exam. It's not that every exam that requires some actual critical thinking and expression must, forcément, be elitist.  But the content makes it so, apparently - so perhaps it's time to revise the traditional exam.  I don't know.  

I do know, from my husband's first-hand experience as well from conversations with our French relatives, that the French system can be extremely rigid, inimical to creativity, and inflexible, in that young people are shafted into a particular track early, with little opportunity for transfer should that be their desire later - either because their aptitude in a particular area improves, or because they're miserable in the original track and want to do something else.  I have the American system to thank for being pliant enough to allow an English major to attend medical school; such a path would be next to impossible in France, from what I understand.

I'm still mulling this over.  Neither system is perfect, but it's clear to me that young Americans are in some ways far behind their European counterparts in terms of responsibility for their learning.

Saturday, July 4, 2009

A Little French Poetry

J'aimerai toujours le temps des cerises.
C'est de ce temps-là que je garde au coeur
Une plaie ouverte,
Et dame Fortune, en m'étant offerte,
Ne saurait jamais calmer ma douleur.
J'aimerai toujours le temps des cerises
Et le souvenir que je garde au coeur.   
   -Jean-Baptiste Clement (1837-1903)

I will always love the time of cherries.
It's from those times that I hold in my heart
An open wound
and the offerings of Lady Luck
Can never soothe my pain.
I will always love the time of cherries
And the memory I hold in my heart. 


So fleeting, these simple pleasures, but these are what I am cherishing here away from the hustle and bustle of the city:

-almost total quiet, except for the crickets chirping, the rooster crowing in the morning, the occasional sheep bleating, and a bell chime or two from the neighboring villages
-the scent of honeysuckle that wafts over me every time I open the back door
-the golden light on the wheat fields in the afternoon
-the kids happily biking to through the medieval village with their French cousins
-white nights till about 10 p.m., then a gorgeous moon over the Normandy fields
-simple meals, ordinary talk, and laughter

Friday, July 3, 2009

Heaven on Earth


1. The company of cherished loved ones
2. Peaceful, beautiful surroundings with good weather
3. Simple, home-cooked, country fare (today for lunch, a salmon terrine with a salad of tomatoes, cucumbers, and carrots, then home-made sorbets from fruit growing in the garden; for goûter, some chocolate and French bread...)
4. A relaxed pace
5. A great book to read (see below)


The Help by Kathryn Stockett is one of THE BEST BOOKS I have EVER read (I haven't quite finished it yet, but part of me doesn't want to - I just want it to go on).  I have not felt this excited about a book since Barbara Kingsolver's Prodigal Summer.  This is Stockett's debut novel, and it is an absolute tour de force - amazing characterizations, gripping story, compelling themes, marvelous voice.  HOW DID SHE DO THAT?!  I say to myself every few pages.  I cannot put it down.

The book is about three women in the 1960's in Jackson, Mississippi - two African-American housekeepers and one young white woman who longs to be a writer and wants to write about them.  It's also about stories and storytelling, truth and lies, having a voice and keeping silence and secrets, writing and how it transformers both writer and reader, and the true meaning of dignity and significance.  Don't miss it!

Thursday, July 2, 2009

Passages Couverts

The Passages Couverts of Paris are among her hidden architectural gems.  They are covered passages dating back to the late 1700's to mid 1800's used then and now as shopping arcades. I hadn't heard of them before this year, but when I learned about them, I really wanted to explore them.  

Each one has its own character.  Some are almost unchanged from their 19th-century gas lamp days; others are gritty and modern; some are fancy; some are casual and artsy.  Most of them are  tucked away in the area near the Palais Garnier (Paris Opéra), and their entrances can be easy to miss, but they're definitely worth a leisurely stroll if you've done everything else you want to do.  

We started at the Passage Verdeau, connected with the Passage Jouffroy (my favorite) and the Passage des Panoramas, hit the elegant Galerie Vivienne, with its mosaic floor and fancy book stores, and finished at the Passage Choiseul, which is lined with Japanese take-out and discount clothing stores.  Here's a little photo album of our walk (the picture of art cards above is from the Passage Jouffroy, which has many charming storefronts, a wax museum, the Musée Grevin, and a little hotel, the Hotel Chopin).

Passage des Panoramas:

Galerie Vivienne:

Passage Choiseul:

If it hadn't been so hot today I think we would have taken a stroll through the Jardin du Luxembourg too, a lovely garden among many in Paris.  But it's TOO DARN HOT!!! How can an industrialized nation not believe in a little A.C.?

I'm hoping it'll be cooler in the country. We're off to Normandy tomorrow to visit with more family.  I'm looking forward to the peace and quiet of a village that's barely even on the map.