T. Unmasked (just a bit): the Interview

It's my one year blog anniversary!!!

I cannot believe this blog has been part of my life for a year. Thank you so much to all of you who stop by, read, and support it!

Happy one-year anniversary, too, to Dr. Ramona Bates, who writes the extraordinary blog Suture for a Living.

As part of the blogiversary celebration I invited readers to send me "interview" questions for today's post. Some of your questions overlapped, so if you see yours worded a little differently, that's probably why.

Enjoy!

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What crummy (or not so crummy) jobs did you do before becoming an anesthesiologist?

I worked behind the pastry counter at Sutton Place Gourmet once. Lots of yummy crumbs, so not so crummy.

What’s your favorite food?

Chocolate! And, really good Thai.

What is the healthiest food you love and the most unhealthy food you love?

Healthy: ripe, plump, sweet blackberries. Unhealthy: unfortuately I really enjoy sweets (really great cakes, chocolate-chunk cookies, creme brulee, and ice cream), and deep-fried stuff – hush puppies, onion rings, yucca, plantains, dough…

Do you do crossword puzzles?

Love ‘em. Also love sudoku and logic problems.

Do you speak any foreign languages (badly or fluently)?

I can speak some Spanish, French, and Tagalog, and a little Italian. I’m in the beginning stages of Arabic, Russian, and ASL (and may be in these stages indefinitely!). I learned some ancient Greek in high school but all I can do now is read some words. Ditto with Syriac, except it was college, not high school. I don’t consider myself fluent in anything except English.

Why did you choose anesthesiology? Did other specialties cross your mind?

I was going to be a pediatrician! I even did a year of training in pediatrics at a tertiary care center that had a large number of kids with cancer. Then I was going to do a fellowship in medical genetics or neonatology…

But I fell in love with anesthesiology after an anesthesiologist at this same tertiary care center taught me how to mask-ventilate a 12-year-old boy. It was so direct, so visibly effective, and it felt so great to be able to make a difference in a particular moment, to help a child breathe when he was unable to breathe for himself. It seems incredible that one’s life should change so drastically because of the inspiration (so to speak) of a moment, but after exploring the field a little further, I was hooked.

That episode explains in part what I love about anesthesiology. You can see the help you provide coming to life right in front of you. Every act, whether it’s running a code or drawing medication up into a syringe, is meaningful and requires complete mindfulness. Anatomy and physiology, which so many doctors feel they don’t get to use much once they leave med school, are integral to our daily work. And being present to people when they’re at their most stressed-out – even after I’ve rendered them unaware of my presence – can be rewarding in and of itself.

Anesthesia Oral boards sound frightening and beyond stress...

They were!

How did you make it through all the stress and the pressure to prepare for those 70 minutes of your life?

Well, for one thing, I had my friends C. and O. going through the process with me. If we hadn’t spent all those months calling each other once or twice a week to do mock orals, there’s NO WAY I would have passed. Practice and prayer. These seem to be my main coping strategies.

After you found out that you had passed, what was the first thing that came to your mind? Just curious about life after Oral Boards...

To be honest it took me days to accept the fact that I had passed. The results were posted online earlier than expected, and I kept having irrational feelings that it was all a mistake. Because people had said the pass rate was 2 out of 3, I was sure that it would be C. and O. moving on and me left to bite the dust. I even asked my husband to look at the page to see if I was hallucinating or something. “Um, I think the word PASSED in big letters means you passed,” was his sardonic rejoinder.

Once I got over the shock I spent time celebrating repeatedly with my family, then I thought to myself, oh my goodness, I can read whatever I want, spend free time NOT studying, have vacations and weekends not marred by the burden of anesthesia books…I’m free at last! So I looked up oboe teachers online and the rest, as they say, is history…

How did you select the oboe as the instrument you wanted to learn how to play?

I’d never considered being able to choose an instrument - till now. My son’s violin teacher once said it’s always better when students actually ENJOY the sound of the instrument they’re studying. I’m grateful I studied piano as a child, and I think it’s key (no pun intended) if you really want to learn theory, but I have to admit it’s not my favorite instrument. I didn’t realize how deep my oboe-longing was until I was actually FREE to spend my time and energy as I chose. Many of my favorite passages of classical music are oboe parts, and I’ve always loved the sound of the instrument.

How do you feel about the concept of making your own reeds? I bet, with all of your other areas of expertise, you would be rather good at it. Have you tried?

I feel…INTIMIDATED! I haven’t tried yet because my teacher wants me to focus on playing right now, and I think her instincts are right on – perhaps she senses that the perfectionist in me would get trapped in a cycle of obsession & frustration if I tried reed-making right now. I don’t know that I’d be good at it at all – so much fine motor, such an art to judging how much to scrape off the end - athough I guess, as with arterial lines and sutures, it just takes practice…

When do you have time to write, read, and play your instrument?

Before dinner (while I’m cooking), or after dinner, while the kids are practicing their instruments or showering. Or after the kids go to bed, which is getting later and later with each passing year. Weekends. Vacations. Post-call days, which I usually have off.

Where do you get the energy to do everything you do?

Love o’the game, as they say, and also from the affectionate support of a loving husband. That really keeps me going.

Do you and your hubby share domestic chores?

Often he’s better about those chores than I am. He has always been a hard worker, at home and away from home, and he’ll do almost anything – laundry, dishes, taking out the trash & recycling, diaper changes when our kids were babies, maintenance stuff. No cooking, though.

What is the one thing you have to do nearly every day that you really dislike doing?

Interact with unpleasant people.

If it were easy to pick up and move where would you like to live?

Some place with lakes and mountains. I haven’t actually been (yet), but I dream of British Columbia. Nelson, or Kaslo, or the Vancouver area…

You seem to really love dance, so why didn't you pursue it? Ever wish you had?

Professionally? I’m actually glad I didn’t pursue it. I would probably have missed out on so much of the life I have now if I had stuck to it and made a successful career out of it. Moreover I wasn’t genetically endowed with the requisite body type and would have had to center my life around a strictly limited diet in order to maintain the expected weight. I do miss it, though, and I still dabble sometimes.

Pants, skirts or dresses?

Pants, usually - I’ve gotten used to them. But I love finding dresses that work!

Have you ever had acupuncture?

I’ve never had a full treatment but did have auricular needles inserted once during a workshop. My father-in-law had acupuncture for migraines with wonderful results.

Hey T! I know this is a long shot, but I was wondering if you've ever met Oprah?

I have! I got to be one of the discuss-ers for her book club. They flew me to Chicago along with some other readers, wined and dined us, and taped the book discussion. After that we had lunch with the author and with Oprah, and I got to sit right next to her. It’s been ages since I’ve had a chance to check in on her show but from what I recall she’s exactly the same off-screen as she is on the show - gracious and exceedingly smart.

If you could invite a few special guests to dinner (other than family), real or fictional, from the past or the present, who would be your chosen guests?

René Goupil, Jean Donovan, Pierre Teilhard de Chardin, Mary Catherine Bateson, Madeleine L'Engle, and Avicenna.

What books would you want with you if you were stranded somewhere indefinitely?

Prodigal Summer by Barbara Kingsolver, the New Testament, the Norton anthologies of poetry and short story, and a blank journal with pen.

Is there any way you can adjust your schedule so you can attend more orchestra rehearsals?

I’ll have to ask the scheduling person at work!

Picture yourself at 90. Which message would you like to send back to yourself in 2008?

Don’t wish; be. And trust in the process.

What does T. stand for?

The truth? My childhood nickname, which only my family’s allowed to use.

When I first started this blog I didn’t have much patience for the sign-up process and didn’t think anyone was going to read it anyway, so I put the T. down in haste. Then people started using it…I'll take votes for a lengthier pseudonym, though!

What makes you happy?

My children's affection and delighted laughter. My husband's kindness. My family enjoying a meal I've prepared, and eating well. Life's simple pleasures - quiet evenings in the park with my husband and kids, browsing through a book store, beautiful music, good company.

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That's it for now! Thanks again, everyone, for celebrating with me!

Last Chance to Send Me Your Questions

Blogiversary's almost here!

If you have any last-minute "interview questions" for me,
please e-mail them before midnight tomorrow (Thursday) EST
to anesthesioboist@gmail.com, and I'll try to put together
a blogiversary post by Friday evening.

My Looooooong Day

In the space of one call (yesterday) I

-anesthetized a woman for a brief gynecologic procedure (7:30 a.m.)

-did post-op rounds, pre-op interviews, and gave breaks to colleagues

-performed a spinal right after a nurse was inexcusably rude to me; then helped an expectant mother through her urgent C-section (mid-morning)

-anesthetized another woman for another gynecologic procedure (mid-day)

-in the afternoon, took over for a colleague in the vascular surgery room...and found myself still there, 5 hours later, in the same procedure to de-clog the femoral arteries of a (relatively young) woman who had smoked SOOOOOOO much that her blood vessels were practically destroyed and the circulation to her legs was compromised

-got paged by the obstetric floor to do an epidural which I could not do because I was stuck in the 5-hour vascular case

-wrangled with my colleague who was supposed to be the back-up call person but did not want to come in and do the epidural while I was stuck in the O.R.

-wolfed down a ham sandwich - my first real food that day - that the nurses had set aside in the fridge from an untouched patient tray

-brought an elderly man to the operating room (by now 8:30 at night) to have his gangrene-afflicted extremity amputated above the knee

-got paged stat to the cardiac intensive care unit to intubate a woman in respiratory failure just as I was placing monitors on the amputation patient

-ran up to the CCU, where the nursing supervisor tracked me down by phone and insisted on speaking to me as I was talking to the covering physician (and the nurses were getting medications ready) because she wanted to know why it was taking "anesthesia" so long to show up for the epidural on the labor floor

-intubated the now-truly-distressed woman

-ran back down to anesthetize the guy for the ampuation

-wheeled him in stable, comfortable condition to the recovery room (close to 10 p.m.)

-dealt with e-mail problems

-talked to my husband on the phone

-heard an overhead page for respiratory therapy to go stat to labor and delivery (midnight)

-ran up to find a greyish-looking newborn with no respiratory effort; could not see the vocal cords because of copious fluid in the oral cavity; suctioned, then got the oxygen saturation up with positive-pressure ventilation; father, in tears, invited to bedside to be with his newborn when his condition had stabilized

-collapsed into the call room bed wishing I were in my own and dreading the next beeper sound...

Tomorrow: gotta do it all again...maybe it'll be quieter?

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P.S. Thanks to Anali for clue-ing me in to this cute little piece of comic relief.

Oboe Risks

On the eve of my one-year anniversary playing the oboe I'm thinking about where music and medicine intersect. There's one obvious interface: injury. This past week I was at Johnson Strings to pick up violin books for my son - Adventures in Violinland, Books 2A and 2B - and found a very interesting book by Janet Horvath, associate principal cello of the Minnesota Orchestra: Playing (less) Hurt: An Injury Prevention Guide for Musicians. I was pleased to see that she includes information and suggestions for players of all kinds of instruments. Who ever thought playing such a sweet little instrument could be risky? It's true, the oboe is lovely, but it's also a tough task-master - sometime hard on body, mind, and spirit all at once. I made a list for myself of things I'd have to watch out for if I actually played the oboe with the ability, frequency, and intensity of a professional.

Headaches, eye strain, and eye damage. The oboe is a high-resistance instrument. Other instruments in this category include the bassoon, the trumpet, and the French horn. Playing these instruments a lot, especially when increased blowing force is required (high pitch), can put eyes at risk due to increased pressure. According to an article from the journal Ophthalmology, "The cumulative effect of long-term intermittent ocular pressure elevations during high-resistance instrument playing may be sufficient to create long-term damage to the eye."

Teeth. Horvath informs us, "Playing reed instruments, brass instruments, and violin and viola can affect a young person's occlusion...It is essential to monitor the duration and intensity of playing...Overbite can occur in oboe, bassoon and violin and viola players even after only one or two years." She quotes the Journal of the American Dentistry Association which states, "Because less than 100 grams of pressure is required to orthodontically move a tooth, the forces of a musical instrument (up tp 500g) can harm the occlusion and teeth."

Hearing loss. Chronic exposure to the decibel levels of a music ensemble such as an orchestra at close range can place musicians at risk for hearing loss, which is irreparable and which, in a musician, can be devastating even if subtle.

Thumb issues. Most of the oboe's weight exerts its force against the right thumb, so pain syndromes can occur as a result of thumb tension, tendonitis of the extensor tendons at the joint, and De Quervain tenosyovitis, a condition in which there is inflammation at the base of the thumb. Loading stress on the thumb is exacerbated by holding the thumb straight (rather than flexed) while load-bearing for long periods of time - a tendency I definitely have when I hold my instrument, which of course as luck would have it is the heaviest oboe out there.

Finger, wrist, and neck pain. Keys in an odd position for one's hands can cause strain and lead to pain. The stresses of reed-making can increase the risk of developing carpal tunnel syndrome. Poor position or neck straps (which benefit the thumbs) can strain the neck. An endpin or commercial oboe support like the FHRED might be a viable alternative to take the weight of both neck and hands.

Respiratory issues. Oboists can be vulnerable to upper respiratory tract infections, but playing a wind instrument, which at times can mimic exercises such as incentive spirometry used in hospitals, can also confer some respiratory benefit by conditioning respiratory muscles.

Focal dystonia. This is a rare neurologic condition that is thought to be caused by a "blurring" of the "map" of the human body contained within the cells of the cerebral cortex, where normally specific cells are "assigned to" or "responsible for" specific areas of the body. In focal dystonia, these "assignments" can get jumbled such that the brain sends nerve impulses to the wrong muscles, causing them to contract - a phenomenon which is experienced by the individual as painless "cramping," abnormal positioning, or an inability to rely on intentional movements for certain tasks. It is task-specific, often affects those who engage in large amounts of fine motor activity, and affects men more often than it affects women. Frequent intense repetition is thought to be contributory. Sensorimotor retraining activities, sometimes using mirror boxes, can be helpful, but medical treatments and acupuncture are not. Notable people with this condition include oboist Alex Klein, pianists Gary Graffman and Leon Fleisher, and writer Scott Adams of Dilbert fame.

Some of Janet Horvath's suggestions for musicians, to reduce the risk of injury:

Warm up.
Maintain good posture.
Vary your movements.
Wear hearing protection.

Take breaks / get enough rest.

Keep instruments well-adjusted.

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Addendum 5/16/06: Patty at Oboeinsight.com reminded me,

"But T., you didn’t write about mental health. About how crazy we go over reeds. Over the fear of failure. The humiliation we sometime face. Nerves that can eat us alive. All that fun stuff!

"And I continue to wonder, too, about the cane we use. I’ve known of so many reed players (single as well as double) who have had cancer. Far too many. Could it be something that’s in our cane? Does our cane get sprayed with something? Insecticides? Anything? Where does it grow and how clean is the area? (One oboe maker told me I’d really rather not see where cane is grown! He said I might not want to play any more.) Maybe it’s just coincidence that so many reed players have had cancer, but I do wonder. (All the ones I’ve known are non-smokers.)

"And then there are the joys too. Those great job rewards! I’m guessing lots of jobs bring people joy, but I sure do read a lot of complaining from people in other professions. While I ramble on a lot about rotten reeds and other negative issues, I wouldn’t want to give this job up. There are too many wonderful things about it!"

Thanks, Patty!

May Invitation for Anyone Who Reads This Blog

Happy Cinco de Mayo! And speaking of May celebrations...

I have a lot of little celebrations ahead in the month of May this year:

-my birthday (THIS WEEK!);

-MY ONE-YEAR OBOE ANNIVERSARY(May 10), which coincides with

-my son's First Communion;

-Mother's Day;

and, believe it or not,

-MY ONE-YEAR BLOG ANNIVERSARY, COMING UP ON MAY 16!

To mark this last happy occasion, I'm asking readers to e-mail me some questions they'd like to ask me, and I'm hoping to put together an "Interview of T. by her readers" type of post for my blogiversary.

So don't be shy! Now's your chance to put me in the hot seat! (Can't guarantee I'll be able to answer everything, but I'll try.)

Please send your "interview" questions to anesthesioboist@gmail.com. Thanks to all who have already sent me questions so far! I have my homework cut out for me!

Arts First

Arts First, an arts festival held at Harvard every spring, is the Boston area's best cultural event. Period.


Hundreds of talented students involved in the visual and performing arts share their (sometimes world-class) gifts with the public during this amazing festival, during which most events are FREE. There is no better deal than that in this city.

I had the pleasure of sharing Arts First 2008 with my children and one of my daughter's friends yesterday, and it was with a bittersweet sense of love and pride that I strolled through campus, visited a number of performance venues, and reminisced about performing in the very first Arts First ever, established by actor John Lithgow in 1994, my senior year. Some of the groups that performed yesterday - like the Harvard Ballet Company and the Harvard Pops Orchestra, which started us off with a rousing selection from the soundtrack to The Lord of the Rings - were founded by students who were my contemporaries and friends.



Very often productions by gifted college students have something the flashier professional productions in New York, L.A., and London can't capture. A fearless energy, passion, and raw exhilaration in the midst of costumes put together at home and soundtracks scraped together on laptops. The best production I've ever seen of the Gilbert and Sullivan operettas and of Arthur Miller's The Crucible have been ones put together by Harvard undergrads, and the best Amahl and the Night Visitors I ever saw took place in a tiny little church in Arlington with simple props but a great deal of musicality and heart. Bigger, more prestigious, and more expensive aren't always better! Then there are the affectionate shouts of support from roommates and buddies in the audience - where else can you get that?



I was thrilled to see that the dance portion of the festival, which still takes place in Lowell Hall as it did when I was a student, was one of the most packed events. The line waiting to get into Lowell Hall stretched halfway down the block. It consisted of various campus dance groups performing ALL AFTERNOON in 20-minute blocs; we stayed for three different segments which included Irish step dance, stunning hip-hop by EXP, energetic numbers by my former company (Mainly Jazz Dance Co.), absolutely gorgeous ballroom dance numbers by the Harvard Ballroom Dance Team, break dancing, Philippine folk dancing (woo hoo!), and modern dance (we missed the ballet, tap, and capoeira segments, unfortunately). As I watched from our seats on the upper balcony I could almost see ghosts of myself and my classmates superimposed on the performers below, diaphanous visitors from our past, moving with the music under the colored lights, reminding me of a life and energy I often forget I had.



One of the most memorable offerings was an outdoor interactive exhibit in Harvard Yard which consisted of lantern-like sculptures made of upside-down tissue boxes containing messages as well as extra-large apples strewn about under the campus's stately trees. There was a sign there that said "Take One," so of course my son scooped up an apple, encouraged by one of the artists of the exhibit, Peter Hedman, class of 2010 (internet research is a wonderful thing!). He's a thoughtful, creative, talented man who will no doubt go far. The other artists who helped create the exhibit were Tom Lee (from the Office for the Arts) and Yichen Feng ('10). I wish I could describe how captivated passersby were with this work, peering into the "lanterns" from below and delightedly taking pictures of the apples under the trees, enthralled just as passersby had been during last year's festival, when Hedman and his colleagues, under the tutelage of local artist and instructor Gary Duehr, put together an interactive exhibit entitled "Ten Red Phones," consisting of red telephones around a central sculpture. What is art but creative work that elicits a strong response from people? In this regard the work by Duehr's students has definitely met with great success.



The great thing was that the art work extended its presence throughout campus and had a life outside its original home in the Yard. ALL AFTERNOON people responded to the giant apple under my son's arm with, "Whoa! Is that REAL?!! It's HUGE!" and asked us questions as we found spots for it at our feet at the concerts, juggling event, and dance performances that we attended. I was happy for the artists, excited that their work had such an extended reach.

We finished up our afternoon listening to my favorite Harvard a cappella group, the Harvard Opportunes. As was true when I was an undergrad, the group today still has some of the strongest voices on campus. I was glad my daughter had a chance to see young adults enjoying their musicianship in an environment in which they were also expected to excel academically.

I envy these undergrads, who like me and my friends probably won't fully realize, till they bring their own children back to Arts First in fifteen years, how precious this opportunity is to pour themselves completely into their arts and to explore their creativity with such abandon. But mostly I am inspired, and I feel that the work of art continues on in us even after some of us leave a more active participation in it, through our continuing love of the arts and the passing-on of its practice and appreciation to our children.

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