Composition and Decomposition

I remember being afraid as I stood in line waiting to enter the anatomy lab for the first time in medical school. What I can't remember is why. Dead bodies can't hurt us. Practically speaking, we can't really hurt them any more either. But I was scared. I was nervous about entering a room and seeing dead human beings everywhere.

But I needn't have been. The most beloved professor of anatomy at my school, Matthew Pravetz, made sure to teach us from the start that we could not approach our cadaver, our "first patient," as he reminded us, without deep reverence in our attitude, demeanor, behavior, and indeed in our hearts. Dr. Pravetz, also a Franciscan priest, brought the gifts of his spirituality into his work, and ours, without imposing any kind of religiosity on us. Every time he gave a lecture or demonstration, you could see his sense of wonder at the way every sinew and vessel in the body had developed; his love of the human body and faith in its sacredness permeated the course and set us off on the right foot toward becoming true physicians. That's a good teacher for you.

The following year, when it was our turn to help the new first-year students take that first step into the anatomy lab, I was stunned to find myself breaking out of my usual timidity and lack of self-confidence, carried away by my own excitement about anatomy and growing love of medicine. I remember trying to pass on some of what I'd learned, touching a cadaver's thorax and explaining what its "barrel chest" might have signified about lung disease in life, laying their hands on the chest so they could feel for themselves and no longer be afraid, as I had been. The medical school chaplain was there, standing by just to support us all, and later he took me aside and said, "Good teaching in there."

I can still see my cadaver clearly in my mind, down to the graceful loop made by her recurrent laryngeal nerve after we dissected it free from the other tissues in her neck. Some of my other fond memories of the anatomy lab are spottier, though I remember my three wonderful lab partners vividly. I remember a guy once had an itch on his nose but his gloved hands had just been handling the cadaver, so in desperation (and apologetically) he rubbed the tip of his nose on the shoulder of my scrub shirt as I walked by. I remember being alone late at night with my cadaver studying for an anatomy exam and being startled when a light turned on at the opposite end of the lab, followed to my great relief by a friendly classmate's voice saying, "It's just me!" I remember having no child care for one of my anatomy oral exams and handing of my then-one-year-old daughter to the group ahead of us as they came out of their oral so I could go in with my lab partners and take mine.

It was so great to come out of that exam and find my little girl waiting in the lobby with my kind-hearted classmates. A new, fresh little life, bright and sunny, just beginning her journey.

***

I started thinking about the ubiquity of decay today because of mushrooms. We spent the afternoon at the Adirondacks' natural history museum, The Wild Center, a small but beautiful museum in Tupper Lake, NY. Despite the fact that I have almost completely shed the "doctor" part of my identity during this vacation, I was happy to see this defibrillator situated halfway through one of their nature trails:

You'd think the highlight for me would have been the adorable river otters, or the natural history hands-on cabinet, or the live kestrel presentation, but no, the highlight for me was...the mushroom exhibit. I didn't know there were 1.5 million species of fungus in the world (compared to 4,630 mammals). I had no idea that oyster mushrooms are predatory. But I did know that morels are DELICIOUS as well as mysterious.

***

Speaking of morels, I have to give vent to the foodie in me and rave about the dinner we had last night at our amazing hotel. My husband and I have been trying for weeks to celebrate our anniversary with a nice dinner, and last night we had our chance: the Narnia movie was showing in the hotel's small movie theater, and our kids were more than happy to be dropped off while we had our romantic dinner for two. We were done with it in time to see the last battle scene with them - perfect!

I had some delectable morel risotto with a perfectly prepared halibut garnished with a frizzled wild leek and some small carrots, paired with a delicious Sheldrake sauvignon blanc. My husband had lamb. For dessert I had a strawberry "shortcake" assembled from candied ginger scones, whipped cream, and strawberries with sorbet and a dark-and-white chocolate stick on the side. YUM.

Yesterday the New York Times featured a story about a chef , Rebecca Charles, who was fighting for her recipes and restaurant design to be recognized as her intellectual property. I don't know much about the case, but I do think it's time for creativity with food to have its due. Creativity and composition balance out ever-present decomposition and the relentless law of entropy, and the necessity for all life to fall into the cycle of decay and renewal.

In a couple of billion years our sun will explode and take all of our achievements with it - human language, writing, architectural treasures like Chartres cathedral and the great bridges of the world, chemical engineering, great musical works, art, painting, inventions, medical technology, spiritual insights, movies and shows, all lessons and artifacts, not to mention relationships and unique individuals...unless we find a way not to lose these by then. For now, our creativity is what we have as evidence of our vitality and witness to our preciousness. Creativity in the kitchen included!

***

This recipe for Morel Risotto is courtesy of Phillip J. Speciale and quoted from www.thegreatmorel.com/recipes.html:

Ingredients
1 cup of small dried morel mushrooms, reconstituted and cut in quarters
1 medium sized yellow onion, chopped
2 cloves of garlic, chopped
4 Tbls of butter
6 cups of chicken stock
1/2 cup of Marsala wine
2 and 1/2 cups of arborio rice
1/2 cups of freshly grated parmesan cheese
1/4 tsp salt
1/4 tsp of freshly ground black pepper

Preparation
Pour broth in a medium size saucepan and heat to a simmer. In a slightly larger saucepan add the butter and sauté the garlic and onions for about 1 minute. Add rice and mix well coating the rice with the butter. Stir in the wine until it has evaporated. Stir in mushrooms. Add broth 2 cup at a time and stir until broth has been absorbed. Repeat until all the broth is used. When rice is tender mix in parmesan cheese.

Writing, Reed-ing, and a List of the Week

When my eighth grade English teacher, Mrs. Riederer, asked us to keep a journal, she changed my life. To each of us she passed out a super-sized version of those black marbled composition books you get at the drug store, and she said we could write about anything, any time, without worrying about spelling mistakes, criticisms from her, grammar corrections, or anything like that. How liberating!

Along with the journals she handed out a page or two of suggested topics and questions, single-spaced, a few of which are reproduced at the bottom of this blog. Although she asked us to write in the journal only about once a week or so, it wasn't long before I found I just had to write in it almost every day. It became almost a meditative practice, like a liturgy of the hours, a physical act making incarnate the process I was going through, of becoming the person I was to become. I found that this daily writing, poured onto the page, was doing its work within, carving out the shape of my mind and filling in cracks and crevices, sculpting my intellect and my character day by day. Writing made me notice and pay attention - to my own life, my world, my own formation in that context.

When I look back on the entries now, I am profoundly embarrassed by my florid style as a thirteen-year old, and probably the best writing advice for me would have been what the father in A River Runs Through It said: "Half as long." But in a way having time and space in which to express myself without worrying about rules, style, or perfection gave me the freedom to cultivate greater mental agility, a better eye, a more versatile voice. Writing and thought are intimately connected and feed one another. I am convinced that cognitive (and, often, spiritual) development can be greatly enriched when people use writing as a tool for learning. Teachers should use it more.

Of course, I also believe in discipline and rigor in the writing process. Playing has its place, but exercise, revision, and just plain work are crucial. That terse comment from A River Runs Through It is still good advice for me today (no, the irony of this post's length is not lost on me!), along with Zinsser's incomparable work, On Writing Well, which is perhaps the best writer's guide I know. Among writers' reflections on the writing process, though, my favorites are Anne Lamott's Bird by Bird and Julia Cameron's The Right to Write. The latter contains so many inspiring, beautifully articulated passages about why we can and should embrace "the writing life."

"Daily writing," she reflects on p.150, "writing simply for the sake of writing, is like keeping a pot of soup on the back of the stove; it is always there, always ready to be tasted, always ready to be added to, always nourishing, savory, life-sustaining. Like soup, your daily writing doesn't have to be fancy. A few simple ingredients are enough."

Among my favorite lines, though, are these from pp. 50-51: "Valuing our experience...is the act of paying active witness to ourselves and to our world. Such witness is an act of dignity, an act that recognizes that life is essentially a sacred transaction of which we know only the shadow, not the shape...Writing is an act of self-cherishing."

I was crushed when a good friend of mine during residency heard me start a sentence with the words, "As a writer, I..." and said cynically, "Oh, you're not a writer," as if to say, you're not a "real" writer. Obviously I'm still preoccupied with this question of artistic validity. I was hurt not because the casual remark "put me in my place" - I don't think he intended that - but rather because I felt he was assaulting my self-concept. I realized that writing wasn't just an activity for me but something like an internal organ - a very real part of me. I wanted "being a writer" to be, not what I am, but who I am.

I have not danced ballet or modern dance seriously in years, but I still feel I can truthfully start a sentence with, "As a dancer, I..." Even if I never dance again, I think, I will still think of myself as a dancer. It's in my soul. Writing's in there too, and now, I think, being a musician. They're intertwined. Perhaps music is what started it all; music inside me has emerged as dance or as writing because those have been the instruments I've had so far (ok, piano too). I'm hoping I'll eventually find another path for this inner music, with my trusty little oboe.

***

A quote from Ralph Vaughan Williams about one of his works (4th Symphony, I think): "I don't know if I like it, by it's what I mean." What a great guide for creativity - to aim not necessarily for like-ability, but rather for genuine self-expression!

***

I went music shopping today. I bought a portable music stand and some staff paper so I could work on arranging a piano accompaniment for the Raymonda adagio. I got the same momentary pleasure I get when I go to the store to get writing supplies or at Christmas when I wrap presents for people (one of the happiest activities I can think of). I had so much fun.

Practicing is getting more multilayered. There's so much to work on! Long tones, scales, interval etudes, dynamics (which are at this point still so reed-dependent for me), breath support, the Bach and the Morricone, the smaller works I'm trying to learn (Simple Gifts and other churchy things). I can get through all of Gabriel's Oboe now, ever since Kyoko clued me into the left octave key (like, DUH!), so now I want to push past just "getting through" the notes and actually start to make some MUSIC. The Bach's gonna be a while.

***

Top 15 List of the Week (after today's O.R. conversation)(tweaked up from 10):

Attractive Leading Men in Movies Old and New

15. Viggo Mortensen in The Return of the King.
14. Bill Pullman as the president in Independence Day and the adorable brother in While You Were Sleeping.
13. Johnny Depp in Chocolat.
12. Anthony Andrews in the jail cell scene in The Scarlet Pimpernel.
11. Hugo Weaving as Elrond in The Lord of the Rings. Jeff Chandler as Cochise in Broken Arrow. Same type of concerned-father/warrior/ruler character.
10. Half the cast of King Arthur (e.g. Clive Owen / Ioan Gruffud) was eye-candy. The other half...wasn't exactly, but still enjoyable to watch.
9. Gary Sinise in anything in which his character isn't evil.
8. Antonio Banderas in The Legend of Zorro. Or in Take the Lead - whew!
7. Orlando Bloom in Kingdom of Heaven, more for the character he played than anything else.
6. Oded Fehr in The Mummy and The Mummy Returns
5. Yul Brynner in Anastasia. White shirt and guitar - 'nough said.
4. Paul Newman in Cool Hand Luke.
3. Hugh Jackman in pretty much anything.
2. Daniel Craig in Casino Royale.
1. Gregory Peck in Roman Holiday. Drool, drool, drool.

Where does It come from?

I marvel at a gift my daughter has and that I, alas, do not: composing. She took up piano a little over a year ago. I heard her playing something so evocative after only two lessons that I poked my head out of the kitchen, where I was doing something completely ordinary like chopping vegetables, and asked her, "What's that you're playing?" The music reminded me a little bit of a procession for kings in a fairy tale or a bible story. Like something out of Menotti's Amahl and the Night Visitors, which we had recently seen and try to see every Christmas season.

"Oh, I'm just composing."

Composing! Wow, she was making that music up? How do people do that? Where does that music come from?

"It's wonderful, sweetie. Reminds me of Amahl."

"Yeah, actually, I'm calling it A Royal Appearance." That was her first composition. She was 8.

More recently she has composed a piece called At the Arcade, which sounds just like someone playing pinball or video games, and another called (at my suggestion), Stirring the Brew, a playfully spooky piece that sounds just like, guess what, someone stirring brew in a cauldron. She's also working on a musical, and the parts she has sung for me so far have blown me away.

Where does creativity come from?

One could spin an endless web of theories. In ancient Greece there were the nine Muses. Today the fashion is to attribute most things that involve human cognition to the function of little molecular messengers, the neurontransmitters. Some might add genes, spirit guides, environmental factors, God, faith, early childhood education, exposure to music, good nutrition, or any number of influences to explain people's gifts, and logically a combination of any of these factors might certainly contribute to human creativity. But it's like trying to explain how it is we hear certain combinations of sounds and call them "music," or why certain strains of music elicit tears or fears or longings. Ask my daughter where her music comes from, and she'll say, "It's been with me for months," or "I hear it in my head."

"Intuition" is similar. The day before my oral boards, at my husband's suggestion, I booked myself a massage. What better way to de-stress, right? There's a funny story about the whole spa experience that day that would take a whole other post to relate, but for purposes of what I'm thinking about right now, let me skip to the part where the massage therapist, seemingly out of nowhere, placed a hand right in the middle of a muscle in my lower back that couldn't have been more in need of a little un-kinking. I was shocked at the sure-fire accuracy of the maneuver and asked, "Wow, how did you know that?"

The laconic, Italian-accented reply: "Experience."

And I've said the same thing. At one of the hospitals my anesthesia group serves, we teach EMTs and paramedic students about intubation. When they really can't see the vocal cords or can't place the breathing tube in the trachea, I quickly step in and complete the procedure, and often I'm asked, "How did you know how to adjust that so you could get it in?" The answer truly is experience. I always tell the paramedic students it took me HUNDREDS of airways (as in, intubating 3-4 times a day for 2-3 months) to feel really comfortable with the "straightforward" ones, and hundreds more to feel I had the ability to tackle a challenging one.

Once in the ICU during my residency the surgeon in charge watched me do one of those God-help-me intubations, and while I was doing it he asked, "Can you see anything?" The answer was no, but I asked him to hand me the tube anyway. It went in. "Lucky," he said. Maybe, but the more I learn and the more experience I have, the luckier I seem to be. Yet never "lucky" to feel smug about intubating people. If I've learned anything in my line of work, it's respect for the airway!

Just last week at one of the other hospitals we serve, the E.R. doc had a really tough time with the airway, had tried for a while to secure it, but then sent someone to the O.R. to ask me to come and take a look (another long story that would take a separate post to relate). I looked. It was tough. Darn tough. I could easily have missed. But something told me to bend the tube a certain way, and wiggle the laryngoscope just so, and thankfully the tube went in. But no amount of success, at least for me, will make these "scary" airways less caution-worthy. Difficult airways just can't be taken lightly, ever. My heart still quickens a little every time, and I still say a split-second mental prayer over them to help focus my efforts.

But this is all stuff that involves training, learned skills, and practice. Granted, creative acts take work and practice too, but with those, there's that inexplicable element, the mysterious "place" that works of art (and life) come from. How did Ralph Vaughan Williams come up with his Concerto for Oboe and Strings? How did Harper Lee's vision of Calpurnia or Jem come to life so vividly on the page?

Sure, neurotransmitters are important. I've seen and heard of enough anecdotes about people "losing" their creativity when they take certain neurotransmitter-altering drugs. One writer I read recently also describes the opposite - a medication that seemed to give her hypergraphia, a need to write often and copiously (and no, despite what the entries in this blog might suggest, I am not taking the aforementioned medication, unless it's at all similar to any compounds found in chocolate!). So yes, the brain matters. (And just as an aside, I think people should be less critical of the use of some of the medications I've alluded to here. You wouldn't tell diabetics to just "get over" their pancreas problem if they need medication. If people with neurotransmitter issues need medication as well, and have the guidance of experts to help select those medications, they should take the meds they need, and/or practice yoga to boost their levels of GABA, etc.) Clearly, neurotransmitters are powerful agents for human ability, behavior, emotion, health. etc. But are they the whole story?

When I think of my children's faces, my daughter's pieces, places I love, stories I want to write, I have a hard time imagining how those thoughts could simply be stored and recalled, repeatedly, by neurons and their neurotransmitters. I think there's more to thought than we think.

***

Had my 5th oboe lesson today. Lots of fun. We laughed over how "I hate half holes!" Went over C, F, & G major scales as planned, and a couple of others, E flat and A major. I have my work cut out for me but I'm excited to get into some "real" music-work. Started to work on dynamics too for the first time - and again, that feeling of "where did that come from" arose when I hit a note more piano by accident after trying several times.

Kyoko asked, "What did you do just then?"

"I don't know, I don't know! What did I do? I have no idea why that worked!"

But just like intubation, playing repeatedly gives you an idea, maybe one that you can't verbalize readily, but it's certainly there. A "gut feeling" about how to move your muscles to produce an effect. I hope as I practice and play more, I'll have more of that inexplicable "instinct" about what adjustments to make. Dance was like this too. After a while, with lots of training, lots of practice, lots of work, I needed less thought to do what I wanted to do. Less thought, more...what? Very mysterious, all this brain / spirit / creativity stuff.