On Suffering

Here's something that has never made sense to me regarding suffering: asking, "Why?"

If the earth were uninhabited, its tectonic plates would move all the same. Earthquakes and tsunamis would happen all over the desolate world, hurting no one. We suffer because we live on a planet on which the shifting and fracturing of the upper mantle are a natural and inevitable occurrence. We suffer because accidents and illnesses happen. We suffer because stupidity, self-interest, insanity, or power-lust cause people to harm one another or themselves. We suffer, finally, because we cherish those who feel the effects of these natural occurrences, accidents, and evils, and because love makes loss almost unbearable.

We happen to live here and we have the capacity to care, about ourselves and/or others. Of course we suffer. That capacity to care is also what enables us to experience wonder and joy.

I suppose it's only natural that we seek to avoid suffering. That is, it's understandable to want to avoid it. But I also believe we are morally obligated not to turn a blind eye to it, and the reason I'm bringing this up is a Facebook thread I read yesterday that really, really bothered me. These are the statements that I found irritating:

Person A: "I have not been able to bring myself to look at images from Japan yet."

Person B: "There are some of us who can truly feel deep compassion without the visuals."

Person C: "I refuse to. I don't need to be traumatised by that flood of images (can we call it disaster-porn?) in order to pray for the people of Japan."

Person H: "I think I used up my year's quota of natural disaster media coverage in the Queensland floods."

Person L: "I am in tragedy overload and cannot bear to watch it. It's not entertainment and it turns my stomach when people talk about it as if it is."

I understand some of the points made in the above statements (and others I didn't bother to quote), but what turns my stomach is the image of a bunch of safe, comfortable Americans / British people / Europeans WHINING from their comfy homes about how "tough" it is to look at others' pain and suffering. THEY WON'T EVEN LOOK, they REFUSE TO SEE the faces of their brothers and sisters suffering across the world - and thus, to my mind, in a way deny or refuse to affirm the reality of that suffering. It made me think of a kid plugging her ears and willfully refusing to hear the sobbing of another kid - I don't see you; I don't hear you; therefore I won't see or hear or feel your pain or have to take any responsibility for it.

I understand that sensationalism is negative and disrespectful in itself, but I felt like saying (and please consider that I was feeling very upset about the posts at the time), "Y'all are a bunch of wusses. Suck it up and LOOK! It's not happening to YOU! The >10,000 people who suffered and died under the debris deserve better than to have a bunch of comfy foreigners hiding their eyes and 'praying for them.' Solidarity is the highest form of compassion, and sometimes allowing ourselves to experience a little secondary trauma is the right thing to do. So many people spend their energy avoiding the REALITY of suffering that they can't even confront it vicariously. SAD."

I did not stick my nose into the discussion for reasons too complicated to elaborate here, but I was so deeply bothered by the way the majority of respondents felt justified in their insistence on looking away. It's so easy to claim, I feel for people anyway even if I don't know exactly what they've been through. I can pray for them without having to understand the details of their their pain. I guess I feel it's disingenuous. Don't we have an obligation to do more than "feel for" others? Shouldn't we seek to know and understand in order for our compassion - from the root, to suffer with - to have integrity? How can we feel we have the right to just erase someone else's misery from our minds by refusing to see it? Isn't that selfish, and cowardly?

I'm not saying my point of view is necessarily right. I'm still working it out, and trying to figure out why I had such a strong reaction to this thread. Someone there shared a lovely blog post that offered a beautiful alternative to disaster-porn mentality, and I appreciated that, but I also knew that it didn't convey the experience of those who witnessed or were directly affected by the disasters, and I still couldn't shake the bothered feeling I had when I thought about people willfully refusing to see their suffering.

I'm venting it here because I am trying to make sense of my own jumbled thoughts and feelings. I suppose it's normal when the unthinkable happens to wrestle with all sorts of ideas and emotions. There are never any simple answers when it comes to human suffering, are there?

Diaries at the Morgan

Christine Nelson , Drue Heinz Curator of Literary and Historical Manuscripts at The Morgan Library and Museum, has done a lovely job with the current exhibit, The Diary: Three Centuries of Private Lives. From the exhibit's companion blog:

"Where does a diary end and, say, a sketchbook or scrapbook begin? And what do we call a string of digital updates in which we reveal a little bit each day (or each hour, or each week) about what's on our minds? Or a public blog that tracks our periodic observations? All these forms of self-documentation have something in common with the traditional diary, with its focus on what I thought, felt, read, ate, spent, observed, or did today (and the next day, and the next)."

I've been wanting to see this exhibit since the day Prof. Michael Leddy mentioned it on his wonderful blog Orange Crate Art. I had the chance to go to the Pierpont Morgan Library with my kids today, and it was everything I'd hoped. The exhibit is housed in one room, sparsely adorned with only selected quotations from a few of the diaries displayed on the walls. The diaries themselves are presented neatly in cases with informative captions highlighting interesting facts about the authors or the writings themselves.

The diaries are presented in groupings such as "war diaries," "spiritual diaries," encrypted diaries, and diaries about works in progress, etc. with each diary open to a page of interest that gives the viewer just enough of a voyeuristic glimpse into the author's mind to be both intriguing and satisfying. John Steinbeck wrote famously on May 31, 1938, "Here is the diary of a book and it will be interesting to see how it all works out." The book was The Grapes of Wrath. We also saw the musings of Hawthorne as he was working out The Scarlet Letter, E.B. White on The Trumpet of the Swan, and diary drafts of Kingsley Amis's poems.

There were also observations of an American teenage actress in London (discussing how the British boys couldn't hold a candle to the ones back home), a chess diary by Ruskin, and diaries by Pepys (of course!), Thoreau, Einstein, Charles Seliger (whose penmanship strains the eye), Tennessee Williams (whose penmanship, by contrast, is large and loopy and a little multidirectional), John Tudor (from the period of the American Revolution), Bob Dylan (from much later!), Arthur Sullivan, and Sir Walter Scott. Charlotte Brontë's need to vent her frustration into a diary became kindling for her fiction writing, and I couldn't help smiling at one acerbic comment about "another who seems a rosy sugarplum but I know her to be colored chalk."

I was especially taken by the very first volumes we encountered when we entered the room: a small notebook dating from the Renaissance with erasable pages coated with gesso, and the 19th-century hand-sewn diaries of Elizabeth Eastman Morgan, who lived in Western Massachusetts and wrote about her household chores (sausage- and candle-making, butter-churning, pickling, spinning wool, etc.) and the signs that marked the change of seasons (the peeping of frogs in April, the appearance of whortleberries in August). Her diary is featured in the companion online exhibit and podcasts, which are captivating in and of themselves and well worth an afternoon of browsing, especially for people who are unable to visit the Morgan before May 22 this year.

A special bonus was the chance to see Pierpont Morgan's restored 1906 library . Walking into the East Room reminded my kids and me of the scene in Disney's Beauty and the Beast when the Beast gives Belle the gift of a library, and she opens her eyes and sees a vast collection of books lining the walls from floor to ceiling. On display in the library's beautifully appointed rooms are some gorgeous illuminated manuscripts, a 15th-century block book, exquisitely detailed Babylonian cylinder seals, and music scores by Chopin, Liszt, and Mozart. The library website also offers, incidentally, a Music Manuscripts Online project, providing access to digitized versions of more than forty music manuscripts from the Morgan's holdings.

This was a wonderful exhibit. We bloggers are diarists of a sort, and collections like these churn up those delicious questions about why we do what we do and how we tell the stories of our lives. It's a lot of fun to see how some illustrious people have done just that over the centuries, setting down fragments of their minds for themselves and readers to see and contemplate again and again.

Reflections on Happy Coupledom

This Van Eyck portrait, traditionally known as the Arnolfini Wedding, is sometimes held up as an early (1434) example of marriage being portrayed in art as an actual partnership rather than a mere contract or event. If that's so, I wish the man didn't look so miserable! Some people call this "The Shotgun Wedding," but more likely the style of the woman's dress, not pregnancy, accounts for the exaggerated size of her abdomen in the painting.

I love the convex mirror painted on the wall behind the couple and occupying such a central focal point in the overall composition. The mirror is decorated with ten scenes from the life of Christ and shows the presence of witnesses in the room - the minister and perhaps the artist.

When I think of the institution of marriage as it has evolved in Europe and the Americas over the centuries, with some even feeling today that it is obsolete, all I can think is how thankful I feel for my almost-fifteen years of happy marriage. I look at other happily married couples and have two other thoughts: 1) It's so great to see people who are so comfortable, truly comfortable, with themselves and each other and 2) I hope my kids are lucky enough to find healthy relationships like these.

I know that luck or blessing or whatever you want to call it is only part of the favorable set-up. There's also diligence, and patience, and good character, and the capacity to see and want and choose good character in others.

As my children get older and begin to be interested in more grown-up experiences and relationships, I often wonder: how can we guide our children to make choices that will bring them relationships like these, the kind that will give them peace, joy, and lasting love?

Modeling a healthy and mutually respectful relationship is crucial, and I'm contented that my children seem to see marriage as a beautiful and valuable bond, one to welcome if a compatible partner and the desire to build a life with that partner transpire. We also tell them that being in love is important but that love is not enough; common values and the commitment to support each other through shared victories and problems, to build a life side by side with hard work, are essential and go beyond the bonds of friendship and romantic love into a more sacred love, the intimate love of family. The kind of love that is an active process and a daily decision, not merely a feeling or an experience.

Over the years I've nurtured both indirect and direct ways of trying to pass on some guidance and wisdom, as much as I have, to my kids. When we watch movies together, for instance, I always make a point to comment on the relationships in them - what makes them work or not work, why certain ones look promising and other don't, who's a jerk and who isn't. Two films we've watched on DVD recently stand out in my mind as having moments that exemplify relationships with promise: Little Women and Amazing Grace. In both, we saw couples who were able to see and appreciate the truth about one another and were not afraid to confront each other honestly with that truth, even if it was hard. Along the same lines, both films showed couples who were at ease talking and opening up to each other, listening well, and valuing each other's thoughts.

If I were to add one more characteristic to look for in an intimate partner besides those already mentioned - respect, diligence, thoughtfulness, patience, integrity, supportiveness, appreciation, and the ability to talk and listen comfortably and truthfully - I would advise my children also to seek partners who are happy with and in themselves. This kind of happiness requires self-knowledge, security, a healthy spirit, humility, and responsibility and can be found in individuals who don't look to others to provide happiness for them and don't blame others when happiness eludes them.

I think my kids are getting the idea, and I'm glad. I'm also glad, though, to see that when a Facebook questionnaire asked my teenage daughter, "Is it possible to be single and happy?" her answer was, "Of course. I am."

This, I think, already sets her on the right track.

Black Swan

Photo: Polina Semionova as the Black Swan conspiring with the evil Von Rothbart to seduce Prince Siegfried

I finally got around to seeing the much-hyped Aronofsky film Black Swan today. I want to see it again. I just don't know if my nerves can take it.

It was about as creepy as I expected it to be from the trailer. The sex scenes, which I wasn't too thrilled about sitting through, were also about as explicit and gratuitous as I expected (quite). The dancing was predictably strong from Natalie Portman's double (ABT's Sarah Lane) and, to a trained dancer's eye, noticeably flawed but nonetheless respectable from Portman herself. Portman's acting, though, was spot on. She deserved her Golden Globe.

First, a quick review. Black Swan is about a young dancer who desperately wants the lead role in Swan Lake, one of the most demanding roles in the classical dance repertoire. The ballerina must be able to play Odette, an innocent young girl transformed by the wicked magician Von Rothbart into the Swan Queen - the epitome of purity, vulnerability, fragility, sweetness, and helplessness - and Odile, her alter-ego and doppelganger, Von Rothbart's daughter, who embodies cunning, uninhibited sexuality, confidence, invincibility, and heartlessness. The sworn love of Prince Siegfried would have broken Von Rothbart's spell over Odette, but because Siegfried is seduced by Odile into promising his love to her instead, his original vow to Odette is nullified, and Odette's only escape from the imprisonment of being the Swan Queen is to leap to her death.

Audiences have been willing to watch this drama unfold over and over again for more than a century. I think it's because we recognize the two sides, light and dark, in ourselves. We empathize with Odette's sorrow and love; it breaks our heart. But with Odile we enjoy being impervious to such weakness; we relish being able to live freely, skirt danger, gratify our passions. In Black Swan, Portman's character, Nina, is seen as perfect for the "white swan," Odette, but her director is frustrated by the inhibitions - which he clearly feels are sexual - that prevent her from embracing the role of the "black swan," Odile.

The fascinating visual and thematic elements in Black Swan are some of the same themes that make the ballet Swan Lake itself such a crowd-pleaser year in, year out, generation after generation: the struggle between good and evil, light and darkness, and the close-to-home truth that sometimes that struggle is within, with darkness that lurks in every soul. We all have the Black Swan inside us, and sometimes, evil wins over good. That's just reality.

And there's that - reality. What is reality? Can we lose our grip on it, as Nina does progressively throughout the film? Where is the border between creative imagination and the psychotic unraveling that took a hold of Nina and intensified with every passing scene in Black Swan? For artists especially, there's this question: can you create a character or a world with such verisimilitude that you recreate reality, and what price can you, do you, pay for that? Anyone who's over-identified with another, or been involved in an artistic production that dredges up darkness, knows how dangerous that darkness can be when we get close to it, when life and art intertwine and reflect or imitate each other. The darkness can hurt. It might even be able to kill.

As can the quest for perfection. There's a clear message in the ballet Swan Lake that transformation involves, must involve, suffering and sacrifice. It's hard to separate that message out from the real-world process of becoming a dancer. Like the shoes in the familiar beating-of-the-pointe-shoes ritual glimpsed through this movie, dancers have their bodies and spirits smashed time and again against a variety of very hard surfaces - the demand for perfect technique, the absolute requirement to have perfect (read: thinnest) bodies, relentless competition to be the best.

The physical mirror dancers have to gaze into each day is as ruthless as the obsession with body image it engenders, and like other symbols for the search for self and identity - masks, portraits, faces - mirrors figure prominently in this film, as do (predictably) black and white color schemes and decor. There's also plenty of mutilating behavior - directed at self and others - reflecting the merciless hurting of the body and mind to which some dancers subject themselves. Art promotes plenty of obsession in general, but dance in particular seems to foment it to an extreme degree - not just over the art itself, either - and Black Swan holds up a magnifying glass that chillingly exaggerates and distorts this tendency into a dangerous current that sweeps its hapless protagonist into a transformation that threatens ultimately to destroy her.

While many bloggers and reviewers found this film cliché-ridden, I found it compelling as well as disturbing. Very dark, but definitely worth seeing. One of its best (and, I think, unsung) features, which I noticed from the very first moment, is its film score by Clint Mansell. It opens with the famously lugubrious oboe passage that open's Tchaikovsky's Swan Lake - already I was sucked in - but in subsequent scenes Mansell takes Tchaikovsky's ballet and reworks it into a suspenseful soundtrack that retains just enough recognizability to make it spine-tingling and spooky. If you know the ballet score well, you know you're hearing bits of Swan Lake, but it's the scary version - it's very effective. I think this impressed me almost more than anything else about this film. I guess a ballet-loving oboe student WOULD notice something like that, right?

Bottom line: I was expecting a psychological thriller with some decent ballet and some disturbing unanswered questions, and I wasn't disappointed.

I Am an Oboe Too

Anna McNonymous, who blogs at Dangerous to French Fries, wrote a post about why she would be an oboe if she could be a musical instrument.

All I can say is, ME TOO, ANNA! Thanks for that great reminder of my oboe self, and how after several months of hiatus because of The Big Project, I simply MUST go back to it again.

Some characteristics of my oboe self?

-I need lots of TLC. Lots.

-I don't like the cold.

-I may not crack under pressure, but one day you'll find a little crack in me and you'll be like, "How did THAT happen?" But then take me to the right place and I'll be able to sing again. Go figure.

-I need to be handled JUST RIGHT if you want me to produce good work.

-I have nice parts. Er, ORCHESTRAL parts, you know?
-I've done a lot of ballet.

-I'm capable of ugliness that makes you groan with exasperation or throw up your hands in despair, and heart-stopping beauty that makes you sigh and feel glad that we met.

-I'm picky and particular and hard-on-myself and obsessive and critical and...oh, wait. That's the OBOIST.

Someday I want to play something with this glorious pianist (and composer). But I don't think I'll ever be competent enough!

Snow Day

Addendum 6/14/11:

It has come to my attention that there are readers out there who are unwilling or unable to read the post below as an occasion of BLOWING OFF STEAM on a particular day about a particular set of individuals at a particular practice. Really? No one at work EVER did anything to annoy you? You never mouthed off just to VENT about a particular frustrating occurrence - even those of you who might be on, for example, a forum "designed to act as an outlet for blowing off steam?"

Please consider that in the comments section under this post I do take to heart the admonitions of readers who point out that my views might be biased or unfair or objectionable, and I do reflect and admit that I have some growing to do; that I do realize my mouthing off about two or three people was probably not fair to the dozens who don't come under the same category; that I try to describe to a reader the advanced training and clinical abilities of CRNAs; and finally, that this was actually discussed among physicians and CRNAs in our practice, and the views of both sides - the objections of CRNAs to being lumped together and criticized unfairly, and the objections of physicians to subpar work ethic from some CRNAs who, despite considering themselves MD equivalents did not demonstrate an MD-equivalent commitment to actually SHOWING UP - were laid out on the table. Each side asked the other to shape up on the particular problem being pointed out. Nevertheless, my chief and I persisted in the opinion that we did not feel we were "allowed" to call in sick, ever (though we sometimes do actually get sick enough to require it), and that we were held to a (perhaps unreasonably) higher standard than most professions have to meet.

While I can see why it would be tempting to demonize me for expressing how I felt on this particular day, I would ask that people consider that I was venting, that I was not alone in feeling this way, that some CRNAs in my practice actually agreed with me, and that some of the points raised (especially in the comments) might be worth discussing or even be of some value despite how grating they may sound.

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Boston had another blizzard today. I was really worried about this one. It was supposed to snow hard, about three inches an hour from 3 a.m. to 12 p.m. with poor visibility, impassable roads, etc. I've driven home in snow like that, and I find it terrifying. Your car won't do what you want it to, and worse, OTHER PEOPLE can't be counted on to be either careful or able to control THEIR vehicles or even able to SEE you.

I texted my chief to see if there was any chance the O.R. would close and cases would be cancelled for non-call personnel, but it was business as usual.

So I went back to the hospital to spend the night last night before the snow started. My husband and I had been planning a quiet evening together, but all he could do was wave sadly at me from the window as my car pulled away.

My chief, worried that the bridges connecting his area to the hospitals would be closed, drove to the hospital at 2 a.m. and set up an air mattress in the anesthesia office.

My other colleagues left their homes at least an hour earlier than usual to brave the blizzard and arrive at work on time.

100% of the doctors in our practice made sure they reported for duty at the appointed time, literally come hell or high water.

How many of the nurses and nurse anesthetists did the same?

To be fair, one of the nurses had the honor and dedication to trudge through the snow from her house in order to make it. I don't mean to imply that there aren't dedicated, hard-working nurses. But several of the nurses called in "sick" and only ONE of the nurse anesthetists who were scheduled to work this morning actually bothered to come. What was their excuse? Too much snow.

It has become common for nurses to seek to be recognized as equal to physicians in much of the work that they do (even publishing articles to that effect in newspapers and journals). But on days like this, it's IMPOSSIBLE for the docs to gather around the water cooler without noticing and commenting on the vast difference in work ethic between M.D.'s and non-M.D.'s. It's just not possible to get through med school and residency making excuses for not showing up and meeting your duties to patients, just because conditions are inconvenient. Nor do we get to feel entitled to extra pay or time off for the extra time and effort spent getting to work hours and hours early due to a snow storm.

Moreover, with our verbal Socratic oath I believe most of us take an attitudinal, internal oath to be there for our patients whether or not we feel like it, have had enough breaks during the day, etc. Why else be a physician, if you don't have this kind of commitment to taking care of your patients?

So it grates. I hate to admit it, but it grates when what you think of as the practice of medicine, not only a duty but also a calling to be there to heal others, gets generically lumped in with the practice of other "health care providers." There is a difference, generally speaking, not only in training but also in the overall attitude to the work. Doctors don't take snow days.

More Untold Stories

What helps us get to know each other better? How does that happen?

I had an experience on the afternoon of December 31, 2010 that taught me that some of the most worthwhile time spent on this earth can be very brief.

If you've followed this blog over the years you know that I love learning about, or at least catching a glimpse of, the untold stories people hold. I also cherish the chance to get to know people I might not ordinarily spend much time with in the course of day-to-day work or life. I feel especially grateful to those who work the hardest and get compensated the least. I often feel bad at how tough their jobs are, and how little I help, and how spoiled I am. (If there's life after death and I can be assigned to watch over a particular group of people, I want to be the protector of those who make a tough living - though of course the time to try to share each other's burdens is NOW.)

Sometimes, especially when I'm in the Philippines, I let myself get hustled a little. I just bought a piece of carved driftwood from a beach peddler because he was asking for so little, and even though his sob story about having to go back to Rural Wherever might have been a bit of a story, there's always a grain of truth in there, and if I had to make a living combing the beach selling folk art in sweltering heat to privileged resort visitors, wouldn't I say what I could to make a sale?

Anyway, here I am at a luxurious resort with my family, getting R&R, paying $10 an hour for massage therapy, while diligent, cheerful resort workers - the ratio of resort staff to guests is 2:1 - work and work and work to make our stay comfortable and pleasant. I don't know why the lovely woman in this photo and I were able to connect as more than service provider and client for a few moments, but it was truly a gift. She was giving me a luxurious massage, and thanks to her, a giant, painful knot in my left shoulder - a recurring problem - was experiencing considerable relief. But we got to talking, and in the course of our conversation I learned something about her life and personal story, and I think it was probably one of the most powerful and memorable moments of 2010.

She is only five years my senior but she looks about ten years older. She lost her husband two years ago to a devastating gun accident. She had at that point just had her eighth child; her eldest is 20. She gave birth to all her children at home with only a female relative to help - hospitals are too expensive. One of her children, who had been in breech position, was stillborn. She has been a massage therapist at this resort for 18 years and works at least nine- or ten-hour days. Sometimes she takes call and has to leave home at night - the resort can call for a massage as late as 10 p.m. A neighbor helps watch over her kids while she's at work. Sometimes her kids visit her, as her fourth child did, the delightful eleven-year-old standing with her in the photo above.

I sympathized with having to be on-call and how hard it was to leave children at home. I told her daughter what a difference her mother's healing work made and how good her mom was at it. They had a good laugh at my Tagalog, which from long periods of disuse comes out in broken bits sometimes.

Life's interesting - you can go halfway around the world and have the most beautiful, luxurious surroundings and services at your fingertips, but in the end it's still the human connections that are the most satisfying and memorable gifts of all.