A Wish for Divining

I met a teenage girl who had a devastating familial neurologic disease. She couldn't walk. In fact, she couldn't move any voluntary muscles. She couldn't speak, swallow, wipe away her own drool, protect her airway, or breathe on her own. She was trapped inside her own body but fully aware. This happens to people sometimes, in certain kinds of stroke or trauma, but this poor girl was born to this state of progressive, incurable, unimaginable silent horror. Alive but unable to live. Conscious only of a life-experience filled with sensory input but also the torment of being totally cut off from the world, walled-in, paralyzed.

According to my colleague who gave her anesthesia, her mother had left her and her father after finding out that the condition was genetic, from the father's side.

Her father had been caring for her every need - feedings, tracheal tube changes, diaper changes, wheelchair adjustments, ventilator maintenance - and bringing her to all her medical appointments, until he developed the condition and died.

Now she is cared for by visiting nurses who shuttle her to doctor visits and minor hospital procedures and perform all the tasks for which she had been entirely dependent on her father.

I have a heroic friend (yes, another one!) - she has visited here on occasion: speducatorlvc - who has spent her career courageously and lovingly serving devastated children like this girl. I don't know how she does what she does, but I long to have that kind of open-hearted, brave, unselfish spiritual energy.

The nurse that brought her to one of our hospitals for a tracheal tube change under anesthesia claimed that the girl could communicate with her by telekinetically manipulating a dowsing rod. I wanted it to be true. Doesn't everyone wish for superpowers? Invisibility? Flight? Telepathy or telekinesis? I went to visit the girl and her nurse in the recovery room to learn more, trying to keep an open mind, but knowing that the possibility of there being any observable truth to this assertion was remote at best.

"Her spirit, her energy, fills this whole room," the nurse said, "Whereas yours and mine are much smaller, much closer to our own bodies. She'll move this and make it turn when she means 'yes,' " explained the nurse, holding up an upside-down-L-shaped brass thing, "and makes it stop when she means 'no.' "

She asked the girl a question. The top part of the upside-down L began turning in its little brass dowel. I could see that the nurse's hands were spinning it. She asked another question. The rod stopped.

"See, she says she's not in a lot of pain. Where is it on a scale of one to ten, honey? Ten? Nine? Eight?..." The rod magically came to a halt at 6. I think that's actually a lot of pain. More than I would have expected.

There's a remark in the Wikipedia article about dowsing which states, "Both skeptics of dowsing and many of dowsing's supporters believe that dowsing apparatus have no special powers, but merely amplify small imperceptible movements of the hands arising from the expectations of the dowser. This psychological phenomenon is known as the ideomotor effect. Some supporters agree with this explanation, but maintain that the dowser has a subliminal sensitivity to the environment, perhaps via electroception, magnetoception, or telluric currents."

I asked to hold the dowsing rod. The nurse asked the girl questions. Nothing happened with the rod in my hand. The nurse tried moving it around in relation to me and the girl, then physically moving me around, then holding her hand over my hand as it held the rod, but the rod was silent. Like the girl.

"Come on, honey," the nurse said to the girl. "Let's make a believer out of this doctor. Are you glad the procedure's all done?"

The rod drifted a little, swinging in its brass sheath, but otherwise didn't budge. The sound of the ventilator rhythmically sighing, the other equipment ticking, and the steady beep-beep-beep of her pulse-ox monitor filled the silence among us.

"She's still got some sedation on board," I said to the nurse. "I'm sure she's tired."

"She can move out of her body, you know," the nurse told me. "She visited her last nurse while she was on vacation in Hawaii. Her spirit has power and energy that's way bigger than ours."

I believe if we do have souls, some of the greatest souls on earth, those closest to "the Kingdom of God," are in these catastrophic lives, prisoners in these suffering-ravaged bodies. But as far as I can tell, we're bundles of parts at the mercy of our own cells and chemicals. If we are more than the sum of our frail little parts, I'm going to have to take it on faith. The day I met this girl I didn't know what to believe. What I could see was that there was a lot of pained wishfulness around her, but very little visible good, except perhaps in our wish for her healing.

It was one of saddest stops I've made on PACU rounds.

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Photo credit (bottom image): diseased rose by Richard Cocks, license under Creative Commons Attribution ShareAlike 2.5

Lost in Beantown in a Silver Punch Buggy; and, Why I Blog

Ordinarily I would be using this blog to vent about the day I had today at work, where I spent over two hours trying to manage someone who was trying very, very hard to die on my table.

But I don't want to write about that stuff today.

I just want to curl up in my little blog, my writing home, my very own little piece of space-time, and RELAX. It really is home-y here for me; I feel like each post, whether I'm writing one or re-reading one, is an easy chair in which I can snuggle up or stretch out and just enjoy my rambling thoughts, spread them out in front of me like little treasures bought at a fair, and see if I can make sense of them at my own pace.

This home-like feel of one's own blog is one of the things that Anali and I talked about yesterday when we met each other for the first time and had lunch - and not the lunch we were expecting to have!

Our blog meet-up had a pleasingly comical aura about it as we navigated through what might have been discouraging setbacks and re-framed them as celebrations of serendipity. First of all, it was POURING rain. Secondly, Anali's usual parking garage was temporarily closed, so I jumped into her adorable silver beetle and we drove around for a bit scouring the streets for parking, but no luck. We wound up in a now-unfamiliar area of Summer Street that has been built up considerably over the last few years, and somehow found ourselves parking at the waterfront Westin hotel, unsure of whether they even had a restaurant! How ever did we get there (they did have a restaurant: Sauciety, "an American grille"), wind up munching salad from charming, lop-sided bowls that looked like they were offering us their little morsels of radicchio and chicory, then sampling a dessert called "cappuccino intrigue," from our original plan of lunching at a tiny Boston coffee shop in the financial district?!

So there we were whipping out our picture-taking machinery to snap photos of the food. At last, someone who not only doesn't scoff, but also understands! It was wonderful to be able to have a conversation with another blogger, especially one like Anali, who is every bit as sweet as I pictured. I started blogging almost a year ago because I was inspired by Hilda's blog and needed some place to explore this oboe adventure. Then it became that "room of one's own": a place for me to enjoy retreat and expansion at the same time, to learn about medicine, faith, the arts, my own responses to what goes on around me, especially when in "real life" it's often hard to strike up conversations with people about very esoteric elements of those things, like oboes and anesthesia!

When I got home I did a google/blog search using the terms "why blog" and came up with some interesting results, examples of which include the posts here, here, here, here, and here. I thought about why I blog, and about some of the things Anali and I talked about. I decided I'd explore my own motivations for blogging with a list of my own:

Top 10 Reasons Why I Blog

10. To keep in touch with family and friends

9. Narcissistic tendencies. I am opinionated. I enjoy sharing my opinion, venting my frustrations, telling my stories even if they only matter to me, etc.

8. Self-expression feels emancipating (and is cheaper than therapy!). Ditto above (I enjoy sharing my opinion, venting my frustrations, telling my stories even if they only matter to me, etc.)

7. Who can I talk to about anesthesia, besides other anesthesiologists?

6. Who can I talk to about oboes, besides Kyoko and fellowkyokostudent?

5. To remember certain special moments.

4. Blogging is versatile. Journalism or journaling? Tool for school project, or fundraiser for a good cause? We pick.

3. I enjoy the interactive nature of the medium. It's intriguing to exchange thoughts with others across the world.

2. Learning about things like archaeology, photography, molecular psychiatry, waiting tables, monastic life, almost anything you can think of, is totally cool - especially through the creativity of others.

1. Writing is FUN! I write for the sheer pleasure of it, even if no one's reading (which is totally how I thought this blog would be, although I guess there are some folks reading it after all!) :)

What Can One Person Do?

In Prior Convictions: Did the Founders want us to be faithful to their faith?, an article in this week's New Yorker, Jill Lepore describes a debate between two characters in the 1797 novel The Algerine Captive by Royall Tyler. One character is a mullah and the other is Updike Underhill, a Calvinist surgeon captured by pirates and sold into slavery among Muslims. The following is an excerpt of her description of the debate, which lasted five days:

"But Christianity must be the one true religion, Underhill counters, else how had so much of the world been so persuaded by the teachings of a few fishermen, so quickly? 'If you argue from the astonishing spread of your faith,' the mullah answers, remember that 'Mahomet was an illiterate camel driver,' born nearly six centuries after Christ, and yet his faith had spread through Arabia, Asia, and Africa and a great part of Europe: 'In a word, view the world.' ”

Whatever one believes about faith and its meaning, or religion and its value or lack thereof, I think this exchange brings up a crucial idea that has been highlighted lately in the media.

The ideas and actions of individuals - courageous, creative, thoughtful individuals willing to put action into their ideas - can truly change the world.

I think Padraig O'Malley, the University of Massachusetts professor who was instrumental in getting opposing sides in South Africa and Ireland to come together and TALK to each other, should get the Nobel Peace Prize. Last August he flew 36 Iraqi leaders from enemy groups - Kurd, Sunni, Shia - to Helsinki to face each other and TALK - a remarkable accomplishment. O'Malley's approach is simple but revolutionary. He says in a Boston Globe article from last October,

"'Governments can't deal with divided societies, because they don't understand them...People from divided societies are in the best position to help others from divided societies.' The process can be slow and incremental, and by its nature is devoid of political sound bites. But if it works, it can pay off in a way that traditional diplomacy cannot: creating a lasting peace from within, rather than a truce imposed by larger powers from outside."

This same article from last October left me with an idea that has stayed with me:

"These negotiators have found that individuals, not governments, hold the key to resolving conflict."

This past week a second round of talks took place - Helsinki II. The Boston Globe article that describes these current efforts quotes Sherman Teichman, executive director of the Institute for Global Leadership at Tufts, who noted that

"...while many have called for dialogue, few have stepped in to fill the need. 'One of the things that perplexes me is why we find ourselves filling this void,' Teichman said. 'I'm very proud that we've done it. It came down to the intellectual and moral courage of Padraig O'Malley who stands as an example of what one individual can do to work toward peace.' "

Another individual I heard about just today was Thomas Taha Rassam Culhane, an urban planner who is installing solar water heaters on rooftops in the slums of Cairo and promoting environmental awareness and activism in the city's most impoverished Coptic Christian and Muslim neighborhoods. Just one person, using his gifts, education, and hard work to teach others and change lives by transforming ideas and practices, can make such an enormous global difference.

As I think of shining individuals like these I can wish my Orthodox Christian friends a happy Easter with a truly hopeful spirit:

Χριστός aνέστη! Aληθwς aνέστη!

Христос воскресе! Воистину воскресе!

!المسيح قام! حقا قام

Si Cristo ay nabuhay! Siya nga ay nabuhay!

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Photo credit: top image originally posted by to Flickr as Iraqi Children by JoAnn S. Makinano USAF, February 7, 2007 ; licensed under Creative Commons Attribution ShareAlike 2.0 License

My Other Favorite Instrument

Mr. Phil, a balloon-making entertainer, was chatting with us at the local diner last weekend and figured out that we all play musical instruments. While he was making the penguin balloon my daughter requested, he went around the table asking us what instruments we played.

My husband plays guitar.

My daughter plays the piano and composes, but she'd rather be singing. She was pleased to be able to join us adults in her first adult choral piece last Saturday by sight-reading with the sopranos.

My son sat up straight and tall when his turn came and announced proudly, "I play the violin."

"What kind of balloon would you like?" Mr. Phil asked him.

My son thought for a moment. "Can you make a pterodactyl?"

To our surprise and delight Mr. Phil replied, "I sure can. Purple ok? Brown's too boring."

Then Mr. Phil turned to me.

"How about you? What do you play?"

"Guess," I said.

"Hmm...you have a bit of the 'earth-mother' about you...I would have to guess cello."

I think what he was actually suggesting was that I was plump, but I couldn't complain. I LOVE the cello. I love the richness of its voice, its ability to lend both beauty and grounding to a piece, its deep expressiveness. But I had to tell him I was learning to play the oboe, which he opined had a comparable role among winds despite its much higher register - a special voice, one that could express the music in versatile, emotionally compelling ways either with a principal melody line or as a rich undercurrent. I liked his line of thinking. Cello passages started to waft through my head...the adagio from Act II of Tchaikovsky's Sleeping Beauty; lines from Vaughan Williams' Fantasia on Christmas Carols; the Bach cello suites.

Recently I heard this NPR feature on cellist Rufus Cappadocia (totally worth a listen!). I was completely enthralled by the places this musician could take his instrument - incorporating sounds from all over the world (including much of the modal music I love so much), even modifying his cello by adding a fifth bass string to maximize its versatility. His music brought together sounds from Sufi and Middle Eastern music, flamenco, blues, Gregorian chant...I felt like I was listening to creativity itself made incarnate through his playing. I found his track "Prayer" particularly haunting. His music, slow or fast, makes me want to dance. I'm going to have to put his CD Songs for Cello on my birthday wish list...and the video for his piece "Transformation," which includes a dancer, below.

I will never be the virtuoso that talented musicians like Cappadocia are, who can use their instruments so skillfully as truly one-of-a-kind voices with fresh ideas to express, but I am so inspired by them and the music that comes from the work of their hands and minds. I am still working on Gabriele Marie's La Cinquantaine, and last Monday Kyoko added Solveig's Song by Grieg to my homework assignments. It's like learning a language. The trouble is my patience (or lack thereof): whether it's speaking something new or playing music, I want to be fluent, like, YESTERDAY!!!

Brief Book Meme

Elaine Fine, who writes the blog Musical Assumptions, sent me the following meme/game today:

1. Pick up the nearest book.

2. Open to page 123.

3. Find the fifth sentence.

4. Post the next three sentences.

5. Tag five people, and acknowledge who tagged you.

So here are the three sentences I found in the book which, in a roomful of books, currently seems to be occupying the spot closes to me:

"I couldn't articulate it then, but I was writing my way out of a former North Dakota, the seven-year span with my parents, into the space I would occupy as a young man.

The elm in the furnace bubbles, still juice, and I wade to the garage-granary in the rising wind, a hand up to ward it off, and go to a pile of oak one-by-fours I've saved for a furniture project and sigh. I load the staves in my arms and head for the furnace through the wailing white."

These were penned by North Dakota poet laureate Larry Woiwode in his memoir What I Think I Did: A Season of Survival in Two Acts. Even his day-to-day chores evoke for me a writer's life - every act a metaphor, an incarnation, of the mind-spirit labor of the creative process, of noticing the world in a particular way, of being and becoming a writer and dealing with the "wailing white" of an empty page, arms sometimes loaded with staves and sometimes empty.

There are a few special teachers in my life whose hope in me I feel I've betrayed, by going to med school instead of living a life in art, be it dance or writing, or by choosing the field of medicine I've chosen despite the promise of other areas, like pediatrics. He is one of them. Over a dozen years ago when I was sitting in a writing workshop he led at Cambridge University, his faith in my voice was a gift. It was as if he had laid a blessing hand on my lips and ears, my eyes and my mind, and said "Ephphatha: be opened." I would carry the experience of that workshop with me long after it was over...and perhaps it is alive in some way still as I go about my "day job" hoping to be of help to a few patients. I hope so.

Inexpressible

I have to talk about it. I can't not talk about it.

Underneath all the daily routines, the anesthesia work, the chopping of vegetables for dinner and the making of to-do lists, something emotionally important has happened in my life.

I have a new friend.

This is someone I've been waiting to meet and to embrace for years, and he has just arrived in this country and married one of my dearest friends, a heroic woman I've looked up to since I met her in college and who is, I think, one of the greatest souls alive on this earth.

I have to gush about her first. Sheila sang at my wedding. She sings like an angel, writes like a Pulitzer-prize winning author, and is pure grace and and athleticism on a pair of roller blades or on a soccer field. She is one of the most intelligent and articulate people I know. She is kind and generous and deeply spiritual. She graduated from Harvard with honors, has an advanced degree in theology, spent years doing humanitarian work with Christian Peacemaker Teams in Iraq, and now speaks fluent Arabic. She applied to medical school under great personal stress (due to her problems trying to negotiate Thaer's safe passage to the U.S.), did exceedingly well in her premed classes and on the MCAT despite these stresses, and will begin her medical career at Harvard Medical School this fall. She's my hero. I imagine the people around in her study groups, anatomy lab, hospital rotations, etc. and wonder what would happen if they, especially the senior residents and faculty, truly realized they were in the presence of a human being who is greater than most. I really believe that. But she's so humble you'd never guess, unless you got to know her. Sheila is a being of light.

Sheila met Thaer while she was with Christian Peacemaker Teams; CPT workers accompanied Palestinians who were fleeing persecution in Iraq to camps on the Syrian border. They fell in love and got engaged. Thaer is an artist and had been a leader and humanitarian activist in his community of Palestinians living in Iraq, with no citizenship and few rights. He has been trapped in refugee camps, caught in legal no-man's-lands of displacement and unimaginable deprivation, imprisoned and tortured with beatings and simulated drownings, and endured sufferings that I may never be able to comprehend in a lifetime. For years Sheila and Thaer have fought through a jungle of catch-22's and horrible conditions that have kept them apart. Then Thaer was able to escape through Turkey to Greece on a boat filled with refugees - a cramped, three-hour voyage across the sea filled with mishaps and fear. By some miracle, despite a mountain range of obstacles that had been preventing his immigrant visa to the U.S. from being completed, he and Sheila prevailed, his visa was approved, and he is now here, safe and sound, with my dear, dear friend. They were married yesterday.

When I met him last Saturday for the first time I threw my arms around him and wept. He is every bit as gentle and sweet as I imagined from my conversations with Sheila about him. He's a wonderful story-teller (even with my embryonic Arabic I could tell!), with a great sense of humor and a visible spirit of joy with the children who were at the same gathering. It's easy to see why Sheila loves him.

I have been given amazing friends from whom I have much to learn.

How a "Humble" Task Taught a Humbling Lesson

During my residency I had the opportunity to spend several months getting some pediatric anesthesia training at Children's Hospital in Boston. I have many valuable memories from that place. Some are from my clinical experiences, like the time I had to use a fiberoptic scope to place a breathing tube into a young Peruvian boy's trachea while he was awake, for safety reasons, because he had a dangerous anatomical abnormality distorting all the tissues of his oral cavity, making visualization of his vocal chords extremely difficult (and thus dangerous to do with the child totally anesthetized and unable to breathe on his own). I went to visit the kid in his room the next day and he threw his arms around my waist and thanked me. Then there was the time I placed an epidural in a little boy who was having robotic surgery to remove his uterus. And of course there was the time I was on the other side of the curtain, when my son split his eyebrow open and needed sutures in the emergency room. He got stellar care.

My favorite mental picture is that of all the stretchers lining the corridor outside the operating rooms, each with favorite stuffed animals or other fuzzy friends waiting for their respective children to come out of their surgeries. I was always touched to see that row of stretchers with their comforting occupants - and for a second I would become like a child again, believing in their secret animation as loyal companions with invisible hearts full of affection for their owners. Or charges.

One thing I haven't thought of again till recently was a particular task we had to do as residents as part of our equipment preparation, to ensure our patients' safety. Every morning we arrived early to the O.R. to set up the usual - airway instruments, drugs in their syringes, monitoring equipment - but also to connect tubing to I.V. fluid bags and make sure the tubing was "primed" with some of the I.V. solution. At most hospitals the task of filling I.V. tubing with some of the solution is left to support personnel who also come to the O.R.'s early to help with the set-up tasks. At Children's we were required to do this for ourselves so we would learn to be particularly vigilant about air bubbles in the tubing and be sure to eliminate them so as not to cause complications for children undergoing surgery. I didn't mind it too much, but I didn't look forward to it much either, and after my training, I didn't give it another thought.

Till now. This week I was asked to replace an I.V. in a patient prior to surgery. The bag of I.V. solution had been connected to the I.V. tubing by a nurse, as was customary at this hospital and in fact all the hospitals served by my anesthesia group. Most of the I.V.'s, in fact, are placed by the nurses unless they have trouble with them, in which case they call us to help.

I inserted the I.V. fairly easily and hooked up the tubing. Before directing the nurse to open the line and let the fluid start dripping into the patient's vein, I noticed something about the tubing. A subtle difference in the color of it (though it's colorless), or in the way light was being refracted through it (or not), or SOMETHING - I don't know exactly what - made me stop in my tracks. I disconnected the tubing.

"Could you check the line?" I said to one of the nurses. "I don't think it's been primed."

The nurse opened up the tubing at her end to see if it had indeed been primed with fluid by the nurse who had hung the fluid bag there for us. It had not. I was totally shocked. I tried not to show too much displeasure in front of the patient, who was waiting for her I.V. to be hooked up, had this nurse prime the tubing, and finally reconnected it so we could start her fluid.

I felt angry over the near-miss, and a bit shaken. We could have infused an entire air column into this woman's vein and caused some serious complications. What if I had taken the first nurse's preparations for granted and assumed the tubing had been primed properly? What if I hadn't checked before letting the I.V. run, or hadn't noticed the suspicious appearance of the tubing? Anesthesiologists by nature are totally obsessed with safety and check things almost compulsively - labels on every drug vial before pulling the drug into a syringe, times of particular events, eyes constantly roving, checking, checking, checking...but what if I hadn't glanced down this one time? What if I had failed to keep to the habit just this once? It could easily have been at the very least an unpleasant, stressful afternoon for all, and at worst, a catastrophe. And what if I hadn't seen the difference between empty, air-filled tubing and fluid-filled tubing - a very subtle, almost imperceptible difference - a hundred times at Children's? Then it wouldn't have mattered if I had examined the tubing or not before hooking it up.

So I am grateful for my time at Children's, not only for the big, glamorous, dramatic cases, but also for the so-called smaller tasks related to patient care, work at once menial, tedious, and incalculably important, with as much potential impact on a patient's life as learning the proper use of a medication or a laryngoscope. I started out my anesthesia career claiming I was attracted to it because every task, from the most mundane to the most clinically showy, was meaningful. I learned first-hand this week how true that really is.

Today I had the chance to teach a nursing student to place her first I.V. As I gave her technique pointers beforehand, then walked her through every step of the procedure, I was astounded to realize how many little steps there are that can so easily be missed and that have become so fluid for me now (no pun intended) that I don't even think about them any more. We both felt happy and proud when she got it on the first try. I told her she did a good job. And of course I told her to make sure from now on that she always, always primes the tubing.