Excursions in Medical History: Shaker Medicine

On my most recent visit to the Canterbury Shaker Village (which I have visited, by now, several times for its beauty and tranquility), I was struck by how many lasting contributions the Shaker communities made to the "outside world" despite their brief existence. If they are known at all by us worldly folks, they are likely seen as an unusual religious sect in which dance and other ecstatic expressions of fervor were a part of daily worship; celibacy, pacifism, and living in community were considered essential practices; and hard work was one of the highest ideals, a way to build heaven on earth. But they were pioneers, too, in many ways, both in their approach to daily living and in their products. "The Shaker goal was for the individual to be freed from the insecurities of wage slavery and competition but also to enjoy the benefits of a successful economy...This attitude set the Shakers apart from many utopian thinkers..."*

The Shakers were diligent, harmonious, exceedingly orderly, resourceful, inventive, joyous in their spirituality, and very, very practical. An example of the latter is the way they decided to recycle their tomb stones, at least in the Canterbury community. Because the absence of descendants led them to foresee that few people would care to visit their marked graves after their passing, the Shakers removed grave markers, brought them home, and made use of them in other ways, for example as places to rest hot irons.

Because work was so important to the Shakers, they embraced technology, innovation, experimentation, and new trends in commerce, which allowed their communities to prosper and complete their work with maximal efficiency. Their deep respect for customers and reverence for order made them pay meticulous attention to the quality of anything they made, from furniture to herbal medicines. "The Shaker name stood for quality and reliability from the 1820s...The Shakers can be credited with establishing the word 'Shaker' as one of the first brand names in United States business history. The first products to approach national recognition were Shaker seeds and medicines in the 1820s, 1830s, and 1840s."*

In fact, they were the first to sell seeds in small packets rather than in bulk. They developed the first flat (rather than cylindrical) brooms, tilting tips for chair legs, an apple peeler, a revolving oven, an industrial washing machine, and the circular saw. Their expertise in herbal medicine, state of the art at the time, was led by Dr. Thomas Corbett in Canterbury, NH, Dr. Eliab Harlow in New Lebanon, NY, and Elisha Myrick in Harvard, MA. Many communities devoted facilities to the harvesting, drying, and pulverizing of medicinal herbs and to the distillation of syrups. Their home remedies includied highly efficacious cough drops and Corbett's Shakers' Compound Concentrated Syrup of Sarsaparilla; Shaker Hair Restorer; Shaker Vegetable Family Pills; The Shaker Asthma Cure, which may have contained plant-derived atropine, stramonium, or henbane; and Pain King (“Orders pain out of doors and sees that the command is obeyed!”).

I think what I appreciate most about Shaker medicine is its emphasis on healing through comfort - much like the holistic medicine advocated in complementary and alternative medicine today. Although they were interested in new developments and kept in touch with outside physicians, especially for surgery (one of the Shaker sisters, Matilda Tatterton, once required amputation of her arm at the shoulder!), they rejected other invasive practices from contemporary academic medicine, such as leeching and bleeding, in favor of herbal treatments and gentler methods such as therapeutic touch, attention to ambient natural light, and other comfort measures, even going so far as to construct an adult cradle to rock patients in the infirmary at Canterbury. As much satisfaction as I get out of using sharp objects to make a difference - an arterial line to monitor blood pressure, IVs to give helpful drugs - I believe gentleness can go a long way.

Top Ten Shaker Lessons for Anesthesiologists

10. Live humbly and simply.

9. Heal gently.

8. Waste little, including your own effort.

7. Serve abundantly.

6. Work hard and conscientiously, and always strive for perfection.

5. Be practical, organized, and efficient.

4. Pay careful attention to detail.

3. Prepare well.

2. Help one another.

and the Number One Lesson from Shaker Life for Anyone Who Works in the Operating Room:

1. “If you are obliged to sneeze or cough, don’t bespatter the victuals.”
(from a plaque enumerating "Shaker Table Manners.")

Photo credit: Sorensen ether-suction anesthesia machine (c. 1925) found among medical artifacts at Canterbury Shaker Village, uploaded here.

Sources:
"Shaker Herbs," an online article by Rita Buchanan

*Shaker Life, Art, and Architecture: Hands to Work, Hearts to God by Scott Swank

From Shaker Lands and Shaker Hands: A Survey of the Industries by M. Stephen Miller

lectures by tour guides at Canterbury Shaker Village, Canterbury, NH

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For my foodie friends out there: I cannot say enough great things about The Shaker Table, the restaurant at Canterbury Shaker Village. I think it is my absolute favorite restaurant. It offers everything that I would expect from a Shaker eatery - fresh ingredients, well-prepared, delicious meals, and a simple, beautiful, but unpretentious ambience. I went there for lunch with a friend, then for brunch with my family, and had

butternut squash bread

a mouth-watering spinach salad with candied pecans, blueberries, red onions, and honey-poppyseed vinaigrette

yummy potato croquettes

and the most amazing crème brûlée challah French toast ever.

If you're ever in New Hampshire, this is the place to enjoy a wonderful meal!

Losing Patients

One of my friends lost a patient some time ago. It happened during the induction of anesthesia. Just as aviation disasters often happen during take-off or landing, operating room codes or emergencies often take place as anesthesia is being administered or terminated. His patient was terribly, terribly ill, chronically with diabetes, heart disease, kidney disease, and vascular disease, and acutely with other things. She had been through many operations already. He prepared the anesthetic with meticulous care, spoke to the patient's family about the risks, but despite all his efforts, his patient was too weak to tolerate this one last anesthetic. He labored for over an hour to resuscitate her, to no avail. It was the kind of case every anesthesiologist hopes never to have to face.

Unfortunately, it's also the kind of situation that comes to every anesthesiologist's table sooner or later, regardless of his or her skill and experience. My anesthesiologist friend asked me a very thought-provoking question after he told me about his experience. He asked, "Are you willing to continue in a career knowing that this will happen to you someday, if it hasn't already, and you're going to have to deal with it and live with it and not give in to grief and self-doubt afterward? Do you love this work and believe in yourself enough to keep going? Because if you don't, you need to get out now while you can."

These were sobering reflections. If I left my work as an anesthesiologist now, what would I do? Where would I go?

I can only imagine what he went through. The indelible image of his patient's face seared into his mind. The questions he asked himself.

• Did I do everything I knew how to do to care for this person?


• Was there something I missed, something I should have changed?


• What will happen now? Will the family blame me for the consequences of their loved one's frailty? Will I lose everything I worked for even though I did the best I could?


• If the hospital or the family wants me punished, how much punishment will be enough, since no punishment could possibly bring their loved one back?


• If someone else had been taking care of her, would things have been different?


• Even if I am a good physician, will this forever color people's ability to recognize that and their willingness to hear my opinions and advice?
• Whom can I talk to who would actually understand?


• Even if losing this patient wasn't my fault, will this churning of thoughts ever heal, this ache ever go away?

Doctors grieve. Doctors shed tears, seen and unseen, over patients, for many different reasons - at least, the ones who care do. I know this to be true. Seen it. Done it. But doctors also can't be debilitated by grief or doubt or regret for too long. Other lives hang in the balance. The question is, how do doctors heal?

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Addendum 1/27/09:

Just read another brilliant post by Bongi of other things amanzi on the subject of post-traumatic stress in doctors who face the loss of a patient and had to reproduce its well-wrought final sentence here: "When we fall off the horse, most of the time before we can even shake the dust out of our hair, we are shoved back on and the horse is given a hard thwack on the rump." So true.

Happy Birthday, Little Sage

My son is 8 years old today!

To my great delight, what he wanted this year for his birthday was a stash of great BOOKS to read. Today he'll receive

Stoneheart by Charlie Fletcher - wherein a 12-year-old boy named George goes to the National History Museum in London and gets much more than he bargained for, like gargoyles and other statues coming to life, chases through the streets of an alternate London universe, a battle of good against evil...

The Battle of the Labyrinth by Rick Riordan - book four in the engaging Olympians series (he raced through books 1-3 about as fast as he got through all 7 Harry Potter books...)

Cornelia Funke's Ghosthunters series

Warriors by James Harpur, to feed his fascination for ancient civilizations.

The Last Dragon by Silvana de Mari, a classic "little underdog makes big" story.

Robots by Clive Gifford

The Mysterious Universe: Supernovae, Dark Energy, and Black Holes by Ellen Jackson.

and A Child's Introduction to the Night Sky by Michael Gifford, which is beautifully put together.

He'll spend the day at the beach with his cousin, then we'll go out to his favorite Chinese restaurant to enjoy scallion pancakes "that taste like actual pancakes," as he describes. Then perhaps we can play with his new Spongebob Legos or paper airplane kit and light up his new "Moon-for-my-room" at bedtime...

Ah, childhood.

***

I have been under some stress lately and have not blogged as much as I've wanted to, but I want to thank everyone who's been so supportive of all my endeavors. Special thanks to Ramona Bates, author of Suture for a Living, who passed along an "Arte y Pico" blog award to me today.

The rules of the award are as follows:

1.You have to pick five blogs that you consider deserve this award in terms of creativity, design, interesting material, and general contributions to the blogger community, no matter what language.
2. Each award has to have the name of the author and also a link to his or her blog to be visited by everyone.
3. Each winner has to show the award and give the name and link to the blog that has given him or her the award itself.
4. Each winner and each giver of the prize has to show the link of “Arte y pico” blog, so everyone will know the origin of this award.
5. To show these rules.

I hereby designate the following 5 blogs (in no particular order) as Arte y pico winners:

1. Orange Crate Art by Michael Leddy, because he helps people pay attention to language, and history, and literature, and NOTEBOOKS!

2. Eggbeater by Shuna Fish Lydon, because she is such a consummate artist whether she's holding a spatula, a camera, a pen/computer, or a good friend's hand.

3. POM by Dominican oboist Hilda Ramirez, for being an extraordinary musician, mother, writer, and now physician-to-be, and for being my own inspiration for starting a blog at all.

4. Anali's First Amendment, for the thoughtful way in which she sees - and helps readers see - the world and its little details.

and

5. Caroline's Crayons, for its refreshing artistry and ability to make anyone who visits feel like smiling, at least for a moment.

Thanks for the difference you make!

Sweetie, Please Don't Go to Med School

It happens so fast. Yesterday she was happily hurling projectile poop at us as we changed her diaper. Today she's dealing with her first acne break-out. Yesterday he was literally a bouncing baby boy, using our laps as a trampoline while we held him under his arms. Today he's teaching us about solar flares and planetary orbits.

We have dreams for them. We dream that she'll be able to write and sing and act to her heart's content but not fall prey to the seamier side of theater life. We dream that he'll keep reading voraciously, participating in sports, and finding wonder in science in a way that gives him love of his work and confidence in himself. We dream they'll enjoy the work of their hands and/or minds and be pleased with the outcome. We dream they'll find love, the love of people who will know them truly well and appreciate how special they both are, and cherish them, and support them.

But there's something I do not dream for them, which the blog MothersInMedicine reminded me of today. I don't want them to become doctors. That is, unless it's really, really, really their hearts' deepest desire and they'll die of grief unless they do it.

In the post "Mothers, Don't Let Your Daughters Be Doctors," Fizzy captured my thoughts exactly from the time my own daughter was younger:

People ask me if I plan to encourage my daughter to become a doctor. At this point, I'd settle for her not coloring all over the walls, but my specific answer to that question is, "Absolutely not."

In fact, not only will I not encourage her to become a doctor, but I will actively discourage her from entering a life in medicine. I will tell her every awful story I can think of about the abuse med students, residents, and (I can only presume) attendings are put through.

Not all doctors feel this way. But many do, because they want their children to be appreciated rather than insulted, and to have a life. "But Mommy," my kids might say, "You have a life." Well, yes, I have a life now. I spend time with them now. But I missed out on so much that was precious before, and I still can't be with them as much as I'd like, during these, their too-transient childhood years. Today she has a break-out. Tomorrow she'll be in her college senior play. And the day after that she'll be on her honeymoon. I suppose for every woman who makes the choice to work outside the home as well as within it, this is the problem. We knew this going into that choice. We made the choice with our eyes open, knowing the consequences. That doesn't mean we have to like everything that we have to accept about this path.

I can only hope that despite my training and my job, they didn't feel neglected. I hope they felt I was there for them anyway. I hope they feel some of what this child-of-a-doctor wrote - that time spent with her parent was memorable and precious, and that some missed award ceremonies and school plays were forgive-able. I hope. I hope they know I wanted to be there, tried to be there, for everything, and that they were always, always present, front and center, in my mind and heart.

Do I regret choosing this career? No.

Do I like my work? Yes.

Would I be sad to have to change my work? Well, it depends on the alternative! I do feel there's a spiritual element to my reasons for having chosen medicine, so I wouldn't leave that decision lightly...

Would I do it all again? Hmm...probably not. I don't know that the exhaustion, emotional abuse, sleep deprivation, and indentured servitude would be worth repeating...for any reason...

But would I have changed the life I've lived so far in any major way? No. I treasure the life I've had and the family we've grown to be, together.

I just hope my children choose something else.

(Photos: One of my cuties feeding the alpacas at our friends' farm; and, me and the cuties enjoying the top of the Oak Ridge Trail on the grounds of Castle in the Clouds.)

Incident at the Ferry

We were standing on the dock on a glorious day - temperature in the upper 70's, sunny and clear, with a cool breeze over the water. The boat had just pulled in to receive passengers for a leisurely cruise across the lake. Families like ours stood with tickets in hand, looking forward to a beautiful afternoon. Restless with anticipation, children scampered in and out of the gift shop, stared longingly at the fried dough stand, or chased seagulls on the boardwalk.

Behind us and a little to the side there was a loud thump against the wooden boards of the boardwalk. I looked back and saw a youth sprawled face-down on the boardwalk, head turned to the left, arms and legs twitching very slightly. He couldn't have been in that position for more than twenty seconds. A small child near him was crying loudly.

Instinctively I took a step toward him but then stopped and let my mental voice slow my movements down: Is his airway clear? (Yes, for the moment.) Is his family around him? (Yes.) Do they look like they've seen this before or are they in a state of shock and panic? (The little sister was very upset, but the other family members were protecting the boy's head, moving bystanders away, and managing very well.) Do they need help, or would you just be in the way (as so many emergency medical personnel feel when doctors try to step in and offer assistance in a public place)?

I stood by ready to help if needed and kept watch, but I left the family alone. Once the episode passed (like, five seconds after I stepped forward to observe), the boy sat cradled in a relative's arms on the boardwalk looking dazed and very tired. Another relative replaced one of his hearing aids, which had fallen out when his head hit the deck. He had a mild abrasion right under his right eye. Dock personnel with walkie-talkies stepped in promptly to assist.

"What happened, mommy?" my son asked.

An elderly woman behind me was muttering, "At least it wasn't a seizure or something. Poor guy musta' gotten anxious and fainted." I whispered to my son, "Looks like he had a seizure, sweetie."

"Will he be ok?"

"Yes, I expect he will."

"Is he still gonna come on the boat?"

"Not today, lovey."

Very soon after we boarded, from the top deck of the boat, we saw an ambulance pull up to the depot to pick up the boy.

I felt very sad. I felt sad for the boy and his family, who deserved to be enjoying their afternoon on the lake every bit as much as my kids and my family did. I felt sad not to be at their side offering help and support. I felt sad knowing that even I had been able to do that, I had no power to really heal the boy.

Out on the water, the sunlight, wind, and waves were perfect. We had a smooth sail, and a cloudless sky.

'Tis a Gift to Be Simple: a soul-healing day

I believe there are places in the world that are healing places. Spaces that have a special energy about them - a spirit of calm and renewal that can enfold those who enter and banish troubled thoughts, at least for a while.

I am away from work for a week, and that's a good thing. Work has been stormy; even with time and space away, in sunny, breezy weather near mountains and a gorgeous lake, it's been hard not to be affected by the malignant energy churning around lately. But I'm here now, with the people I love most in the world; I'm going to try to take a real rest.

Canterbury Shaker Village, which we visited today, is a great place to find long-lost tranquility, especially on a clear summer day that's cool enough to feel like fall. (See here for some beautiful black-and-white photographs of the place.)

We tried some home-made bread in the kitchen, and were reminded that the daily work of keeping a home can be a form of prayer.

We danced in the chapel, men and boys facing women and girls.

We admired artifacts that showed the Shakers' inventiveness and ability to unite beauty with usefulness.

We heard the touching story of Alberta Kirkpatrick, the last person to be welcomed to the Canterbury community as a child and raised there. She had had such terrible experiences in other foster homes that at the age of eleven she was suicidal. She described seeing her Shaker foster-mother-to-be running to meet her for the first time and dispelling all her fear and self-doubt by embracing her with genuine warmth and unconditional love. She felt that her self-concept was reborn, created anew, at that moment.

We were impressed by descriptions of the community's diligence, efficiency, and extraordinary organization. Clothes were labeled with building numbers, room numbers, and initials so they could be promptly returned to the right place after being laundered. Tools from a common list were likewise labeled so they wound up back in the appropriate drawers. Everyone, young and old, was expected to work hard - "Hands to work and hearts to God" - to create and maintain their little piece of heaven on earth, their village.

We walked the beautiful grounds and rang the bell at the school house. My daughter tried her hand at weaving. My son climbed the ruins of the long barn. We learned about some herbs commonly used by the Shakers (I didn't know lavender could be used as a moth repellent!). We learned the origin of expressions like "Sleep tight" and "Knock it off" (which shaker women would call out if the laundry got tangled up and the leather conveyor belts had to be knocked off their pulleys temporarily, to halt the work and allow them to undo the mess).

I especially enjoyed seeing the infirmary, which had an apothecary, a few patient bedrooms, one room devoted to assisted living of the elderly, and even a rudimentary operating room where village women would assist visiting surgeons - even give anesthesia! The placard outside the room said, "Shaker sisters assisted in surgery as 'scrubs' or 'etherizers.' "

It was a healing place.

Back home I was inspired to make an apple pie, much to my children's delight and satisfaction. There is nothing quite like the feeling of seeing your children eat well and feel content during and after a meal. It's one of my greatest pleasures in life. It's those simplest of pleasures that bring heaven a little closer to earth, I think, lending the work to create them a special beauty and dignity, tedious though some of the steps may be.

"Do all your work as if you had a thousand years to live and as if you were to die tomorrow." Mother Ann Lee.

Playlists

Yes, I was one of the curious ones that was wondering what Michael Phelps listens to on his iPod (photo: Getty Images). What can I say? I'm fascinated by the way people choose music, and why. Why, for instance, does Phelps listen to

-Eminem

-Li'l Wayne

-Jay-Z

-Young Jeezy

-Outkast

-Usher

-Twista and

-G-unit

before racing? Is it because rap music energizes him, motivates him, gets him "pumped up?"

And for any of us who have made playlists - why do we make them, and what makes us choose the music we choose? Does the music help us perform better at a particular task? Do we feel more energized, motivated, "pumped up?" Is it because we're telling ourselves a particular story that can be expressed in part by our own, individual soundtrack?

Chris, an American surgeon deployed to Iraq, explains why he chose the songs he did for the playlist on his O.R. disc - besides the study that showed it makes surgeons more efficient when they get to choose music to play, and (arguably) the O.R. staff happier: "Not only will this disk keep me in my game during the operation, it prevents me from falling asleep and sliding under a truck on the drive home after the operation at 2am."

Chris's O.R. Playlist:

Blur: Song 2

Green Day: American Idiot

Offspring: Come out and play

Violent Femmes: Blister in the sun

Clash: Rock the Casbah

Drowning Pool: Bodies

Marilyn Manson: Beautiful people

Alice Cooper: Feed my Frankenstein

Garbage: Supervixen

Cracker: Low

Smashing Pumpkins: Bullet with butterfly wings

Stone Temple Pilots: Flies in the Vaseline

Nickelback: How you remind me

Pearl Jam: Daughter

Fatboy Slim: The Rockafeller Skank

Lit: My own worst enemy

Butthole Surfers: Pepper

Linkin Park: In the end

Cypress Hill: Insane in the brain

Seven Mary Three: Cumbersome

Wheezer: Hash pipe

P.O.D.: Alive

Sublime: Santeria

One of the surgeons I work with has very similar proclivities. He'll throw in a little Evanescence and Disturbed - and turn it down without complaint when I need to concentrate on something crucial. He'll even play Sting's Desert Rose just for me because he knows I love it. My favorite ophthalmologist will have only classical...and enjoys playing this game of seeing if I can identify whatever piece happens to be on the radio at that moment.

I've had a medicine-oriented playlist that captures for me what I can't put into words about my job. It includes

Smash Mouth: Walking on the Sun (don't ask me why - maybe because it was on an episode of E.R. once)

Marc Cohn: Healing Hands

Queen and David Bowie: Under Pressure

the Harvard Opportunes' arrangement of Maria McKee's Breathe

the song Credo from Elizabeth Swados' play Missionaries

P!nk: Just Like a Pill

Leona Lewis: Bleeding Love

Tracy Chapman: The Promise

Five For Fighting: 100 Years

and a whole bunch of Rent songs - One Song, Glory; Life Support; Will I; and Without You

And I remember on my last day of residency I had a celebratory CD I blared in the O.R. as I was setting up the anesthesia stuff in the morning. I addition to Under Pressure, My Sharona was on it, as I recall - just loud and "obnoxious" enough to "get it all out."

What does an oboist choose for work-out music? Hilda, a.k.a the Dominican oboist, who has renamed her blog POM (physician-to-be/oboist wannabe/mommy), works out to Julian Oro Duro and Banda Gorda. I have 80's nostalgia on my work-out list - Janet Jackson's Miss You Much - but my daughter, very much a child of this generation, enjoys it too.

When I want to relax and let oboe music wash out my tired spirit, I turn to this playlist:

Albinoni: Concerto à cinque No. 2 in D minor (for oboe, 2 violins, viola, cello & continuo)
Zipoli: Adagio for Oboe, Cello, & Strings
Marcello: Concerto in C minor, 3rd movement
Bach: Concerto for Oboe and Violin in D minor
Schumann: Romance No. 2, Op. 94
Vaughan Williams: Concerto for Oboe and Strings
Saint-Saens: Oboe Sonata in D major
Fauré: Pavane, Op. 50
Poulenc: Sonata for Oboe and Piano, 2nd movement
Stravinsky: Pastorale
Menotti: Shepherds’ Dance

Aaaaaaaaah....music really does change everything.