Can't Write

I've been blogging less lately, but with no less desire to write.

Sometimes, though, even if I want to, I just can't write about what's on my mind.

I can't write about how worried I am about the city of Manila.  How I think to myself we Filipinos are #12 for population in the world, and an eighth of that population is soaking wet in that city, and now dealing with sewage, trash, loss, and disease as the waters start to recede but more rain is on the horizon. Yet here I am safe, warm, dry, and comfortable enjoying a quiet night with my husband and kids.

I can't write about how deeply I disagree with some opinions that have been expressed about faith, medicine, politics, and other related matters on various blogs, news articles, facebook posts, etc.  It's too tiring.

I can't write about bad cross-cultural experiences that still leave me feeling sour.

I can't write about people I've been reminded of lately who really, really, really bring back unpleasant memories and sentiments.  

On top of all this, I have an outside writing project I really want to work on, and I can't seem to believe in it enough to move forward.

Am I depressed?  

But I don't feel depressed.  I'm actually quite happy these days.  Work is fine.  Kids are doing great.  Husband's a sweetheart.

And my thoughts, my swirly thoughts, continue streaming around my mind in colorful, noisy little ribbons, like the decorations for a barrio fiesta in my home city.  Lots of thoughts. Those are all still there.

Yet I can't write right now.  I wonder why.  I miss it.

Disaster in Manila

Tropical storm Ondoy/Ketsana has been devastating.  Please click here if you are able to help.

A street in my neighborhood:

People trying to get by:

Photos courtesy of Kathy E. Zablan.  More photos here.

Overheard at Preteen Birthday Party

Kid, about a young female character in the movie being watched: "She has no self esteem."

Girl at party: "I have no self esteem."

Another girl at party: "Like, NO girls have self-esteem. Or, barely any girls have self-esteem."

I have come to abhor the word (and some conceptualizations of) self-esteem, but that's a post for another day.

What I wonder now is,

a) Is this true?

and

b) If it's true, WHY is it true?

A Harvard Course Everyone Should Take

Michael Sandel's course entitled Justice stands out in many students' memories as one of the very best experiences Harvard has to offer. One of my biggest regrets was that I missed out on the chance to take it formally. Now I (and anyone with internet access) can get that chance back - without the pressure of papers and grades. Thank you, Harvard, for this incredible (and timely) gift!

The above video made me so nostalgic for college...

Click here (justiceharvard.org link) or here (Youtube link) to watch Episode One of Justice persented by one of the greatest teachers EVER. If only all our teachers could be as good as Sandel - knowledgeable, encouraging, incisive, engaging, thought-provoking, SUPPORTIVE of his students and never disdainful...always aiming to bring out their best. I love the way he challenges students and gives them the courage to present their ideas - even to disagree with the "great" philosophers and say they were wrong! Way, way cool.

My Daughter is Twelve

Twelve. Twelve.  My daughter is twelve years old.  Only one more year before we have a teenager in the house!

This weekend her friends will come over to celebrate with a spa party (manicures, face masks, art therapy corner), game session, and movie night.  Next month we'll go to the ballet, just us, mother and daughter, for a girls' night out.

Twelve.  Same age as Meg in A Wrinkle in Time, Vicky in Meet the Austins, Claudia in From the Mixed-Up Files of Mrs. Basil E. Frankweiler, and - gulp - Patty Bergen in Summer of My German Soldier.  

When can I date?  she asks. And don't say thirty the way you always joke around.

Thirty-five?  I say with a grin.

Already she has stood up for her political beliefs and for her convictions about gay rights.  Already she has been both excited about a guy and disappointed by a guy.  She has tried on some make-up (then decided she didn't need it), been concerned about weight and exercise, had to negotiate school life and theater commitments.  She wants to take self-defense classes.  She's worried about global warming.  She dreams of having a pet chinchilla.  She's considering singing with the adult choir in church.

She's beautiful and smart and kind and exuberant.

A blink of an eye ago we were bringing her home from the hospital wrapped in swaddling blankets.  

Where did all the time go?

So Far

Our bedroom windows are open.  I can hear all the neighborhood kids playing on our street - a raucous, post-dinner game that seems to say, "Summer's not over till we say it's over!"  Darkness fell hours ago, but the kids' energy is high, even as a sudden gust of wind heralds the setting-in of a predicted overnight chill.

Sometimes when I actually have a moment to pause and enjoy such moments of domestic contentment, I glance at my life and ask:  Are you still where you wanted to be when you imagined being here years ago?  

I am sitting at home after a ten-hour work day trying to make plans for my daughter's upcoming home spa party.  Fall, my favorite season, is here de facto if not de jure.  I made a good dinner and everyone ate well.  My husband and I love each other.  My adorable son just knocked on the door to let us know the neighborhood kids were moving a little further down the block.  (I knew that, of course, because I can see much of our street from the bedroom window and hear the kids' voices, among them my daughter's clarion soprano singing something from Spring Awakening.)

So far, the answer to my question is still yes.

My thoughts tonight were spurred in part by this article posted on Facebook by my former thesis advisor.  It asks, indirectly,  What else might you have been doing in life?  Do you regret not choosing that path instead of this one?  What is it you really want?

Should I have been instead a dancer / writer / editor / home-maker / chef / U.N. interpreter / Paris shop-keeper / art collector / philologist / anthropologist / wedding planner / chocolate taster / lab technician / movie industry something-or-other / neonatologist / librarian / relief worker / theologian / baker / museum curator / alpaca farmer?

I suppose these kinds of questions place us well within Erikson's generativity versus stagnation phase of life, which feels about right to me.

The kids have just come in.  I can hear them play-arguing about who won the last race outside.  The neighborhood parents have called their young ones home to safe havens and warm beds.  The street is quiet now, except for crickets.

My thoughts are loud and clear:  this is definitely the life I want.

[Photo:  me and a friend, at around ten years of age, doing a Czech folk dance or something like it.]

A Dancer Dies

Dance was a huge part of my life when I was younger. HUGE.

So although celebrity deaths can sometimes leave me numb, I'm really sad about the death of Patrick Swayze.

Of course everyone thinks of classics like Ghost and Dirty Dancing when they think of him.  What was high school without Dirty Dancing?  What girl hasn't rolled her eyes at herself in the spirit of "I carried a watermelon?"

But the movie that brings tears to my eyes, especially now, is the dance movie he did with his wife Lisa Niemi: One Last Dance.  

For people who are not "dance people," this movie may not seem that interesting, and the situations and feelings presented may strike many as unfamiliar.  It expresses a lot that I think perhaps only people who have had their lives tangled up in dance can really understand and which at times might strike some non-dancers as a little melodramatic.  I think it's right on, though.  The writing isn't perfect, but it's so true, to my mind; I could watch the film over and over.

Now I watch clips of it and tears come to my eyes.  I think to myself, never again those muscles, that grace.  Never again that leap, those strong arms supporting his partner on stage and in life, that smile. There are others with strength and grace, of course; other dancers who might leap higher, spin faster, be even better - there's always an athlete who can do more.  But never again this beautiful athlete, this dancer.  His body, his moves, his very dynamic physical presence, are gone; our time with him is over.  I am sad for that.  I sympathize with his wife as she expresses in this fictional scene (time index 5:37) emotions she must surely have known in real life:  "You're beautiful.  I love you."  What wife in love with her husband doesn't feel that, and feel her pain?

I am indulging, wallowing in sentiment here, I know.  Maybe it's the dance thing, or the spouse thing, or both.  But while the death of Michael Jackson left me marveling at his talent, career, and eccentricity, the death of Patrick Swayze has left me saddened in a way I can actually feel.  Both had their troubles, both achieved much more with their talent than most of us do in a lifetime - as did many of the people who passed away this year:  Cory Aquino, Ted Kennedy - and, in fact, both were amazing dancers; but Swayze was closer to home for me, and perhaps that's why his passing moves me more than I expected.

ZMD says it so beautifully in this tribute:  "Farewell, Patrick Swayze.  You were a part of my growing up, and your death only reinforces what we should hold dear in life:  family, friends, integrity, character."  Amen.

The Problem With Asking, "What Are You?"

["Corset de grossesse vu de côté." Image source.]

Categorization is one of the fundamental skills of our human intellect.  When we learn to categorize, we are able to organize, understand, and interpret our perceptions of the world around us.  Categorization helps us establish standards and form sound judgments, without which we wouldn't be able function well in community.

The problem is that in establishing standards and making note of common patterns, we run the risk of forming very, very bad judgments when people or objects fall outside the perceived norm.

This is particularly true, to my mind, with issues of race and gender.  In the case of race, the arguably neutral intellectual skill of categorization has become a savage tool for oppression and a justification, albeit fallacious, for the hatred of difference.  In the case of gender, categorization has led to injustice and personal suffering for those whose gender neither science nor philosophy can easily define.

I am thinking now of Caster Semenya.  I am disheartened by my impression that we as a human community are still willing to look askance, and coldly, at "outliers" and treat those who cannot easily be categorized as specimens in a global freak show.  Why does it seem so easy for the rest of the (white) world to treat her like a circus act, subject her to the probings of medical experts, and put her private matters on display?  I hope those experts are at least advising her on the potential clinical dangers she may be facing and concerning themselves with her health and safety. 

Semenya's case is problematic on so many levels.  It forces us to ask,

• What is a woman supposed to look like, to have, to be able to do?
  
• If a woman has some male traits, are her achievements as a woman - in this case, a female athlete competing in women's events - rendered invalid?
• If athletic ability is in any way influenced by gendered traits such as hormone levels, should everyone then get their hormone levels examined and made public? Should competitions only occur in the presence of a chemically level playing field? Should we question the participation of athletes with biomechanical "advantages" as well, such as height and leg length?  But aren't many competitive athletes gifted with what might be considered physical advantages?
• What makes someone a man or a woman?
  

I live in a multiracial family and work in a sexist subculture.  Issues of race and gender are of a deeply personal interest.  I am also intensely interested in cultural, religious, and sociopolitical definitions of human identity.  Which race box should my white daughter who is genetically part-Filipino and who feels Asian check off on her medical forms?  Medicine has taught me that while labels can be useful, boxing people into categories can be completely useless and perhaps even tragic.  

My church takes the medically uninformed position, "Everyone, man and woman, should acknowledge and accept his sexual identity."  As a physician I see that norm as wrong on so many levels.  What would the Church tell the boy I anesthetized so his uterus could be removed, or a girl undergoing surgery to remove her internal / undescended testes?  What would it advise people who are externally female but genetically male, as in the case of pure gonadal dysgenesis or male pseudohermaphroditism / androgen insensitivity syndrome?  Or genetically female, but externally masculinized, as in congenital adrenal hyperplasia?

  

If you can't necessarily define gender with physical structures or chromosomal identity, you're left with the strong, deep, neuropsyschological needs and inclinations of the individual.  But granting those validity would mean the unraveling of so many other questionable assumptions.  Semenya's situation and our response to it teach us so much about ourselves and our assumptions.  By questioning her validity as a woman, we indirectly challenge her humanity and perhaps diminish our own. 

I don't envy the IAAF.  At the end of the day I don't think there's a scientifically reliable "bright-line" test for gender validity.  This opens up a whole can of worms for athletics regulations and workplace gender issues for which I don't think a clear solution exists. 

For more medical information on intersexuality, please visit this Children's Hospital website.

School's Back

"Today one of our spelling words was duo," my son began telling us over dinner (baked trout, zucchini soufflé, and Greek salad).

"Dual?" I asked.

"No - du-o.  So we tried to come up with some famous duos."

We chewed our salad expectantly, waiting to hear which duos he might mention.  Sherlock Holmes and Dr. Watson, perhaps?  

"People had a lot of ideas. Mary Kate and Ashley.  Mario and Luigi. Lewis and Clark."

We stopped munching for a second and looked at him.

"Oh, and of course Calvin and Hobbes," he finished, popping a lettuce leaf into his mouth.

Ah, fourth grade.  The halcyon days.  

***

These were my favorite passages from President Obama's back-to-school speech:

"Every single one of you has something you're good at.  Every single one of you has something to offer.  And you have a responsibility to yourself to discover what that is.  That's the opportunity an education can provide...What you make of your education will decide nothing less than the future of this country..."

"At the end of the day, the circumstances of your life - what you look like, where you come from, how much money you have, what you've got going on at home - that's no excuse for neglecting your homework or having a bad attitude.  That's no excuse for talking back to your teacher, or cutting class, or dropping out of school.  That's no excuse for not trying.  Where you are right now doesn't have to determine where you'll end up.  No one's written your destiny for you.  Here in America, you write your own destiny."

"That's why today, I'm calling on each of you to set your own goals for your education - and to do everything you can to meet them.  Your goal can be something as simple as doing all your homework, paying attention in class, or spending time each day reading a book...Maybe you'll decided to stand up for kids who are being teased or bullied because of who they are or how they look, because you believe, like I do, that all kids deserve a safe environment to study and learn."

and the part I loved most of all:

"You can't let your failures define you - you have to let them teach you...Don't be afraid to ask questions.  Don't be afraid to ask for help when you need it.  I do that every day.  Asking for help isn't a sign of weakness, it's a sign of strength...And even when you're struggling, even when you're discouraged, and you feel like other people have given up on you - don't ever give up on yourself."

Amen, Mr. President.  I hope our young people and their parents had the wisdom and respect to be open-minded enough to listen to this patently NON-ideological, NON-self-aggrandizing, very important, very worthwhile message delivered in a speech that, as advertised, and contrary to the paranoid predictions and vociferous preconceived notions of a frenzied, irrational, prejudiced, lie-fomenting right wing, stayed right on topic about the value of education.

My Favorite Word In Medicine

Sialolithiasis.

A surgeon reminded me of this word yesterday.  

"Isn't it almost like poetry?" He said.  "Sigh-yallow-lith-eye-a-sis."

It does fall trippingly from the tongue.  It means stone formation in the gland that produces spit.

Other favorites:

electroencephalogram

fulguration

chordae tendinae

echocardiography

adenopathy

fluoroscopy

gammaglobulin

but none of these has the same flow as

sialolithiasis.

You know you're an ex-English major when after being up for almost 36 hours straight, with maybe a half-hour snooze between obstetric calls, the one salient memory you have of your work day is a surgeon admiring the word sialolithiasis with you.

Caldereta: Filipino Comfort Food

Last night I made a dish I grew up with but have always been too intimidated to try: a stew called caldereta, derived from the Spanish word caldero (cooking pot). My family devoured it over sticky white rice and went back for seconds. It goes nicely with a Spanish Rioja - Ergo Tempranillo 2006 is delicious. Traditionally we're supposed to use goat meat for this but I stuck with beef. It would probably work with lamb or chicken too. There are recipes here and here for it. This was mine (concocted after reading Kulinarya by Barretto et al. and the wonderful little volume Filipino Homestyle Dishes by Norma Olizon-Chikiamco):

Caldereta (or, if you want to spell it the Tagalog way, Kaldereta)

Ingredients:

• 1.5 lbs stew meat cut into chunks
  
• 2 medium onions, chopped
  
• 5-6 cups of water
  
• 4 small linguiça sausages (about hot-dog size) or chorizos, sliced
  
• 12 large garlic cloves, chopped
  
• 1 4.25-oz can of liver paté (I was totally scared of this but it was fine)
  
• 1 15-oz can of tomato sauce (about 2 cups)
  
• 1/3 c vinegar
  
• 1 c grated mild cheddar cheese
  
• 2 Tb sugar
  
• 2 Tb soy sauce
  
• salt and pepper to taste
  
• 2 medium potatoes, peeled and cubed
  
• 4 sliced carrots
  
• 1 5.5-oz jar of pitted green olives (about 2 cups / 80 small olives)
  
• 1 bay leaf
  
• 1/2 of a red bell pepper, cored, seeded, and thinly sliced
  
• 1 c green peas (frozen = okay)
  
• optional: red pepper flakes to add a little heat
  

Directions:

• In a large casserole, brown the meat in oil over high heat with half of the onions.
  
• Add the water and bring to a boil, then reduce heat to low and simmer.
  
• In a separate pot, cook the linguiça/chorizo pieces, then set aside.
  
• In the same pot (the chorizo one), sauté the garlic for a minute or so, then add the liver pâte and stir together.
  
• Add the tomato sauce, vinegar, salt, pepper, and sugar. Stir to combine.
  
• Add the grated cheddar cheese and soy sauce and stir till smooth.
  
• Pour into simmering beef and continue to simmer for 20-30 min.
  
• Add potatoes, carrots, bay leaf, olives, and the rest of the onions and continue to simmer for about an hour. Add liquid if stew gets too thin.
  
• Stir in the cooked linguiça slices, red pepper, and peas toward the end. Serve over rice.
  

Some people use peppercorns, cinnamon sticks, pineapple juice...the variations are endless. It's a tasty dish that reminds me of childhood and home. As we say in the Philippines, "Sarap!" ("Yum!")

Movie Night and Pasta Provençale

On Monday my husband and I saw the Ridley Scott film "A Good Year," starring Russell Crowe and Marion Cotillard, with an appearance by Albert Finney.  What a lovely, charming, feel-good film.  It's about how a ruthless London stock trader (Crowe) finds his soul again when he has to return to his childhood home on a vineyard in Provence and reconnect with old friends and great memories. [N.B. - It was filmed in the villages of Bonnieux, Gordes, and Ménerbes (of A Year in Provence fame) in France, near the medieval-but-still-working Abbaye de Senanque, which is surrounded by lavender fields in bloom July and August...MUST VISIT!)]

It's not specifically a "food" movie but I couldn't help but want some Provence-inspired food after seeing footage of the golden sunlight of Southern France over the vineyards and villages, and scenes in which good meals were enjoyed in good company.  After harvesting some grape tomatoes and basil from our lback yard yesterday, with the sun warm on my back and the crickets' song vibrating loudly through the air all around me, I came up with this pasta dish, which, though not perfect, satisfied my

 craving well enough:  

3 1/2 - 4 cups orecchiette cooked al dente (a 1-lb box makes about 6 cups), tossed with a mixture of 

-breadcrumbs (about 2 Tb, sautéed in olive oil till golden), 

-chopped anchovies and capers (about half the contents of a tin of fillets rolled with capers), 

-garlic (1 large clove, minced and sautéed with above), 

-cured black olives (about a dozen, pitted and halved), 

-broiled small plum tomatoes (again, about a dozen, halved), 

-golden raisins (about 1/2 c), 

-toasted pine nuts (about 1/4 c), and 

-shredded fresh basil.  

I did use a tablespoon or two of dry white wine to deglaze the pan after sauté-ing the breadcrumbs, garlic, anchovies, and capers.  The cured olives were a tad salty, so maybe I'll use plain canned black ones next time, and I regret not picking more basil leaves and tomatoes to use, but overall it was just the kind of dish I wanted to eat after seeing this movie.  Not perfect, or not yet perfected, but workable.  Maybe I'll add some shaved fennel next time, and some kind of soft white cheese, and an herb or two...

No More Totes/Isotoner for Me

I am so, so, sooooooo angry.

I'm supposed to be working on peace and compassion and trying to let go of resentment.

But after I read THIS article yesterday I posted a very resentful, very non-peaceful update on my facebook page:  "T. is totally disgusted and thinks the Ohio Supreme Court shouldn't be allowed to take unauthorized pee breaks even if their painful bladders swell to the point of near-rupture."

So there.

I cannot possibly understand a) why any woman should be denied the opportunity to express breast milk if she needs to; b) how the need to express breast milk can be said to have nothing to do with a woman's "sex or condition;" and c) how firing someone because she needs to express breast milk can be considered anything other than patently discriminatory, especially when people with painfully full bladders have all the right in the world to get relief without permission.

Breast engorgement can be EXTREMELY painful.  Without relief, milk can spurt out at embarrassing moments and stain clothing, making the situation quite public.  Was the Isotoner company expecting this employee to go without relief ALL DAY?  I'm sure it would never impose such restrictions on their male employees who were doing a little peepee dance in the production line because their bladders were so full.

When I was nursing my son I had different reactions from different people.

When I went to the old-timer chief of surgery at my med school during my surgery rotation to ask for permission to drive home during my lunch break so I could nurse my son, to my great shock he said, "Of course!"

His young male chief residents, though - maybe because they hadn't had children of their own yet? - were less understanding.  I was begging to scrub out of surgery one time and one of them at first wouldn't allow it.  I was in so much pain that I was practically in tears.  Milk was starting to come out onto the front of my scrubs.  It was at that point, when it was a threat to the sterile field, that I was finally allowed to go.

The nurses in the OB/gyn department didn't want me pumping in the nurses' locker room.

The OB/gyn chief resident warned me not to use the back room of the residents' lounge.

The surgery residents were ok with my closing the door to the call room in the surgery residents' lounge but one of them jokingly called from outside, "Do it out here!  Do it out here!" When I opened the door one of my filled bottles was still on the night table waiting to get put away, and this resident or his buddy next to him said, "Oh my gosh, it looks just like real milk!'

I had to laugh.  "It IS real milk, man!" I said.  

I tried my best to keep up the nursing during those rotations, but after three months, my milk dried up, and on that day, I held my son and cried and cried.

Nursing is a deeply personal decision, and I think women who choose it should be supported in their efforts, not criticized or undermined, and certainly not persecuted or punished.