Engage with Grace

We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don't express our intent or tell our loved ones about it.

This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they've talked to them about their preferences.

But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking.

Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide – wherever and whenever they can…at a presentation, at dinner, at their book club. Just One Slide, just five questions.

Lets start a global discussion that, until now, most of us haven’t had.

Here is what we are asking you: Download The One Slide and share it at any opportunity – with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started.

Let's start a viral movement driven by the change we as individuals can effect...and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them.

Just One Slide, just one goal. Think of the enormous difference we can make together.

(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team.)

A Few of My Favorite Fabulous Things

One of my BBFF's - best-bloggy-friend-for-life - gave me this blog award yesterday. Thank you, Katy! I am honored to get this shout-out from one of the most courageous, talented, kind bloggers I know.

As a recipient of this award I am supposed to list five things that I think are fabulous. Katy, you already named one of my favorite things - Christmas in New York! But here are five more:

1. Old movies. To Kill a Mockingbird. Roman Fever. Casablanca. Anastasia. It's a Wonderful Life. Bringing Up Baby. They don't make 'em like this any more - engaging even without outrageous special effects and lots of action, captivating even without color, powerful enough to draw us in primarily through word, character, and story and hold our attention completely.

2. On a related note: the backstage scene just before the ballet, as well as the ballet itself, in the movie The Red Shoes. This is a truly FABULOUS sequence; no other piece of film captures so brilliantly the tension, anticipation, and sick-to-your-stomach excitement of the moments before the curtain rises on opening night. From the sound of violin bows thumping to welcome the conductor, through the chaos of missing props and broken scenery, we follow dancers practicing their lifts and turns, fretting about the choreography, counting down the seconds, and finally signalling their readiness for curtain rise. It's a wonderful scene, and the ballet after it, with Brian Easdale's incomparable score, is one of our favorites as a family.

3. A really great massage. My back and leg muscles tighten up so easily. I think massage therapists are truly FABULOUS.

4. Log homes. I could browse through log home decorating magazines and books for hours. There's something so comforting about the thought of curling up with a mug of something warm in front of a fire in a cozy (or, alternatively, luxurious) log cabin overlooking some lovely mountains, with nice music playing in the background. That's my idea of heaven right there.

5. Children's books. People who come to my house usually think our bookcases are lined with our children's favorites but I've had most of our inventory since I was their age. :)

I have so many fabulous fellow-bloggers out there - I can't pick just five! (Too much pressure!) But you know I think you guys are fabulous!

***

Had a wonderful visit and lesson with Kyoko this morning. My scales and fingerwork have improved. She's pleased with the improvements I've made despite the limits on my practice time. She has promoted me out of my "beginner" book and onto more "real" music today! Corelli and Cimarosa concertos glimmer ahead of me this year. As a special celebratory treat - which I much appreciated because it's been uncharacteristically hard for me to get in the Christmas spirit this year - we spent the last few minutes sight-reading Christmas carol duets. I was happy!

Yummy Words, Yucky Words, Happy Sounds, Sad Sounds

I think I might have a mild case of synesthesia. Ever since I was little I liked or disliked certain words because of the way they "tasted" in my mouth when I said them. I wouldn't get a physical taste sensation, exactly (hence the reason I call my case "mild"), but certain words evoked pretty specific taste experiences for me. The word "song" tasted like a buttery Filipino sponge cake called mamon. The word "hate" tasted like cheddar cheese.

When I looked up synesthesia on the web I learned there's actually even a name for this: "lexical-gustatory synesthesia," which is supposed to be a rare type. Figures!

It seems my brain likes the taste of words with the "r," "gr," or "cr" sound in them: Christmas, cryptography, graphite, garrison, gripe, grammar, figure. I recoil from "p" and "n" in close proximity, though: penis, panty, pons, nape, nope. Ugh.

This trait, or whatever it is, adds an interesting dimension to my day-to-day life in the hospital, wherein I spend my day speaking a different sub-language for hours on end.

Medical terminology has its treats that roll trippingly off the tongue. Chordae tendinae. Fulguration. Nissen fundoplication. Cardiac contusion. Urticaria. Hyperbilirubinemia. Gammaglobulin.

Then there are those shudder-inducing words and phrases. Spermatogonia. Bile ducts. Mastocytosis. Morcellator. And my all-time un-favorite, a phrase I dislike intensely, probably more than any other: pulmonary toilet. Yuck.

I have no idea what this little phenomenon of mine says about the way I think or function. I don't think it means I am either cognitively impaired or unusually gifted, more creative or less creative than the next person. In fact, I don't think it's anything more than a personal curiosity. I think my brain just happened to connect a few wires differently while it was growing. Maybe there are indeed extra connections between my insula and my temporal lobe* (there goes that temporal lobe again!).

I was wondering while listening to a symphony in a minor key the other day how it is that certain sound frequencies in combination produce such dark emotional associations for us, and how other sounds and chords evoke lighter, brighter moods. What explains that? It must be something similar to this word-taste synesthesia. Why is it that a plaintive passage can conjure up the image of a weeping, suffering person, or such a person's words or feelings, even though the sounds themselves don't resemble actual weeping? Is it because certain harmonies set off different parts of the temporal lobe and limbic system? Rationally speaking a sound is a sound is a sound - vibrations hitting the eardrum and ossicles - but the brain interprets these physical phenomena in such complex ways. I wish I could ride a sound wave and follow it into the mind, see what electric impulses and neurotransmitters get fired, study from my unique vantage point why certain connections get bridged and not others. But even if that were possible, I have a feeling the mysteries of music and language, of sorrow and joy, wouldn't so easily be solved.

See here for an enjoyable old post by Aggravated Doc Surg which also highlights medical terms.

___________________________________________________

*Ward, J.; J. Simner & V. Auyeung (2005), "A comparison of lexical-gustatory and grapheme-colour synaesthesia", Cognitive Neuropsychology 22 (1): 28-41

Renovations

Renovation (′ren·ə′vā·shən): (1) the process of improving a structure (2) the process of restoring something to life, vigor, or activity. From Latin renovare, "make new again."

You'd think someone who restores people to consciousness and activity every day, who revives people for a living, would find renovation somewhat appealing, at least conceptually, right?

Wrong. I hate it. Hate it, hate it, hate it.

But doesn't everybody, though, until the endpoint appears, and all is well again?

This is why my blogging has been so sporadic lately. I am renovating.

We are re-doing our kitchen, which was poorly designed and aesthetically bereft of any redeeming qualities. It is gutted. A new window is in, but the electrical work, cabinets, counters, sink, flooring, tiles, paint job, and appliance hookups are like a dream out-of-reach.

My job is undergoing renovations. It's a very long story, but I got to the point of resigning. But there are some major "renovations" on the horizon. The hospital administration has been supportive beyond my wildest imaginings. The chief of surgery asked me to reconsider. Some other surgeons and nurses have approached me and asked me to stay. The president of the medical staff urged me not to go. New leadership and restructuring under a well-run group seem very promising. It's been as stressful as gutting the kitchen. The endpoint isn't in view yet, so for now I'm still dealing with exposed pipes and sledge-hammered walls.

Some of my relationships - friendships old and newer - have undergone changes that have rocked my world. Like ripping down your own house, it's painful while it's happening, but if you can get to the point of saying out with the old and hello new, it's ultimately a gift.

On the up side: we did make some progress on the roof work we needed to do. Our shingles are replaced - better stuff, nicer color. We have a new window in an upper room in which we hope to create a cozy library with a beautiful view. It isn't all bad.

But it's stressful. I'm exhausted. I'll be glad when it's all over, and we can have some peace.

A Word from My Little Sage

"Mommy - everyone can see molecules.  They just can't see them one at a time."

There's a nugget of wisdom in there somewhere... :)

The Play's the Thing

[The Adagio from the Serenade for thirteen wind instruments (K. 361) begins to sound. Quietly and quite slowly, seated in the wing chair, SALIERI speaks over the music.]

SALIERI: It started simply enough: just a pulse in the lowest registers — bassoons and basset horns — like a rusty squeezebox. It would have been comic except for the slowness, which gave it instead a sort of serenity. And then suddenly, high above it, sounded a single note from the oboe.

[We hear it.]

It hung there unwavering, piercing me through, till breath could hold it no longer, and a clarinet withdrew it out of me, and sweetened it into a phrase of such delight it had me trembling. The light flickered in the room. My eyes clouded! ...I called up to my sharp old God, “What is this? . . . What?!...Tell me, Signore! What is this pain? What is this need in the sound? Forever unfulfillable, yet fulfilling him who hears it, utterly. Is it Your need? Can it be Yours? . . .”

-from Amadeus, Act One, Scene 5

Last night I took my daughter to see a high school production of Peter Shaffer's play Amadeus. I was a little younger than she is now when my parents took me to see Ian McKellen as Salieri on Broadway. I can still remember the production. Taking me to the theater was one of the best things my parents did for my education during my childhood. I want my children to have the same opportunity.

It was a big first for us. My daughter had never seen a real play before - our theater outings have been to musicals, ballets, and opera, but so far no plays. And she had never really been allowed to watch anything R-rated, or any piece with real "adult content." We were both eager to see what this cast would do with this challenging work.

We were not disappointed. In fact, our jaws were on the floor over the principals, Jacob Scharfman and Rob Knoll, the extraordinarily talented, impressive young actors who played Salieri and Mozart. I always love watching amazingly gifted young performers bring to life these complex, often difficult works; their energy is boundless, and they have none of the jaded arrogance that older professional performers can sometimes project. They throw themselves body and soul into these roles, generously, and the result, if they have some native skill and some strong guidance, can be breathtaking.

I realized after seeing it again that I liked the play even better than the film, despite my love of the movie's incomparable dictation scene. Salieri in the play struggles more, shows more complexity and passion, and when you watch this live - the flesh-and-blood character searching his soul even while he's giving in to his evils, just a few feet away from you - the effect is stunning.

My 11-year-old daughter had some wonderful insights from her enjoyment of the performance. She noticed the living, breathing, dynamic nature of live performance as opposed to performance on film; the energy added by the audience; the responsibility the actors bear, to carry the entire story with their own voices and faces and movements, without being able to rely on help from songs, scores, or special effects; the way physical acting can be just as important as vocal, a fact underscored by the outstanding portrayal of both the boorish, goofy Mozart and the tremulously ill yet feverishly driven Mozart by Rob Knoll in last night's production.

Children should go to the theater. They should absolutely go and see LIVE THEATER. Not just the fun stuff - though I love a good Christmas revue - but the challenging stuff, too. We should put our kids in touch with material that makes them ask questions, and think of more than one side of an issue; stories that draw them into a world that makes them see their own world anew; characters that open their eyes, through the specifics of a few, to insights about humanity, and perhaps to a more developed compassion for its members. The stories we learn, read, write, hear, and enter into ultimately recreate us. I'm looking forward to the next play!

My Favorite Plays

The Crucible by Arthur Miller

Proof by David Auburn

Amadeus by Peter Shaffer

You Can't Take It With You by George S. Kaufman and Moss Hart

The Arabian Nights by Mary Zimmerman

Copenhagen by Michael Frayn

Noises Off by Michael Frayn

Master Class by Terrence McNally

Trouble in the Operating Theatre

[Photo credit.]

I never thought much about workplace violence until the year after I graduated from med school. I was working in a community hospital in the Bronx - a place I actually still have tremendous affection for, probably because I had a wonderful mentor there. We admitted an adolescent patient who clearly had violent tendencies and a lot of anger at baseline. When I went to interview the patient, a tall, solidly built male medical student silently volunteered to accompany me into the room. Perhaps feminists would find this lame, but I was glad to have him standing beside me as I talked to this very hostile, erratic patient, and it made me stop and consider for the first time that there might be many other clinical situations in which I would feel personally threatened. Was I willing to face that?

Over the years there have been others in the hospital setting who have made me wonder about my own safety. Patients suffering from psychosis. Belligerent family members. My children were surprised, though, when I told them that as a group, federal prisoners have been among my most polite and deferential patients. What I never wanted to witness or experience was verbal, psychological, or physical violence among coworkers. But I have seen it, and I have experienced it. It's disappointing, unsettling, and deeply wounding.

Here's what I've learned as I've perused the internet for more information on this issue.

• According to the U.S. Department of Justice, the most dangerous place to be in America is the workplace.
  
• One in four to one in six workers is attacked, harassed, or threatened each year.
  
• Instances of verbal violence are triple those of physical violence.

What's the typical "profile" of a bully in the workplace? According to this source, over 80% of bullies are bosses. A bully is equally likely to be a man or a woman. Bullies tend to be profoundly insecure, with "poor social skills and little empathy" or with less ability than most to understand another's point of view. They get tremendous satisfaction out of cutting capable people down. A perpetrator of violence in the workplace may not fit this "profile," of course. He or she may have a pathologic rage problem without exhibiting any of these "expected" traits. It's a problem either way.

Whom do adult bullies / perpetrators of workplace violence frequently target? "The common stereotype of a bullied person is someone who is weak, an oddball or a loner. On the contrary, the target chosen by an adult bully will very often be a capable, dedicated staff member, well liked by co-workers. Bullies are most likely to pick on people with an ability to cooperate and a non-confrontational interpersonal style. The bully considers their capability a threat, and determines to cut them down." (same source as above) Over 2/3 of attacks are by strangers or customers, but women are more likely to be attacked by people they know (see here).

From this site: Who is at greatest risk of workplace violence?
"Anyone in a job that involves extensive contact with the public, especially if limited attention is paid to customer satisfaction. (Witness the increasing accounts of airline passenger rage.) Also, anyone working in markedly bureaucratic organizations where limited attention is paid to employee satisfaction."

What are some measures one can take in order to combat intra-worker workplace violence?

• zero-tolerance policies for abuse in the workplace


• staying calm and not giving into one's own anger at any time


• maintaining safe distances with perpetrators of abuse


• avoiding isolation


• allowing for a full airing-out of grievances without necessarily caving to unreasonable demands or reinforcing bullying behavior with compliance


• detailed documentation of and complaint about all incidences of verbal, psychological, and physical violence; no sweeping of stories under the rug


• removal of oneself from any situation that threatens to compromise personal safety

I think it's sad that any of us even has to think about such an issue. But we do have to reflect on this, and talk about it, and deal with it. The last thing any of us should do is stay quiet.