Blogiversary Day: the Interview

[Photo shows an entry in a Russian cake contest; photo source here.]

Welcome to the second edition of "T. Interviewed by Her Readers," wherein I answer some questions sent in by you and, perhaps, inspired by Michael Leddy, some questions not sent in by you! :)

What made you start blogging?

I was most directly inspired by reading Hilda's blog, Dominican Oboist. She's a wonderful writer and an incredibly talented woman. My blog has become a relaxing space for me - my "room of one's own." See this old post for a reflection on why I blog.

Is there a particular oboe piece that made you want to start taking oboe lessons?

"Gabriel's Oboe" in The Mission of course, but even before that, all the oboe passages in the Tchaikovsky ballets (Swan Lake, Sleeping Beauty, Nutcracker).

Do you have a favorite oboe piece right now?

To listen to, Ralph Vaughan William's Concerto for Oboe and Strings is still my absolute favorite. I love the adagio by Zipoli. I also really enjoy concertos by Albinoni and Cimarosa, the sonata by Saint-Saens, Schumann's second Romance, the trio by Dring, and There is No Rose by Stroope.

As for playing: I think Baroque music's always quite satisfying to play, especially in a group. I really enjoy the fourth of Gordon Jacon's "Ten Little Studies," (though they're all good in their own way). And I love playing songs from church - we use the Gather collections, with a lot of liturgical music by Marty Haugen and similar composers. I think if I get to the point where I could play the second oboe part of the Shepherds' Dance from Menotti's Amahl and the Night Visitors with someone, I'd be thrilled.

Did you have the most fun in high school, undergrad, med school, residency, or work after training? Which year of med school and residency did you enjoy the most? Is there any test harder than USMLE Step 1, or does it get easier after that?

College was wonderful despite the stress. I always tell people who are considering going to medical school to major in the one subject they love above all - music, Russian, physics, literature, astronomy, art history, anthropology, or whatever it is - because if they do go to med school, college may be their last chance to enjoy that one subject to the fullest.

The first two years of medical school are enjoyable because you're so sheltered - all the joy of learning with none of the frightening responsibility. But fourth year was the most fun, I think - clinical electives! I got to go to the N.I.H. for a month to do a rotationin clinical genetics. I was all set to become a clinical geneticist "when I grew up," in fact, but the future had other things in store for me.

As for the boards, you know what they say about the amount of time you need to prepare for USMLE Steps 1, 2, and 3: "Two weeks; two days; two pencils." A GROSS exaggeration, if you ask me! I never found test-taking easy. I thought the USMLE steps were easy relative to the anesthesia boards, though. I recall that after the written anesthesia boards, the entire group walked out completely ashen. But nothing compares to the experience of taking the oral anesthesia boards. I think the written was actually harder, but the oral was more terrifying for me.

What was the best course/module you've ever taken? High school, undergrad, med school - the one or a few courses which have influenced you the most?

Best single course overall: a summer writing workshop taught by author Larry Woiwode as part of the C.S. Lewis Foundation's program "Cambridge '94." Larry Woiwode is a phenomenal instructor who gave me the faith to keep writing, even after having put writing aside for a time.

Residency: our time in the simulator

Internship: working with Dr. Dasgupta

Med school: anatomy, pathophysiology, and an elective in clinical genetics

Grad School: a course in child art by Prof. Sylvia Feinberg & courses in child development by Prof. George Scarlett

College: Seamus Heaney's course on contemporary Irish poetry

High School: the intensive unit on New Testament studies my freshman year

Grade School: my 8th grade English class changed my life (it was the first time I found myself compelled, absolutely compelled, to write, and write often); my fourth grade reading class probably did too; my entire time at Stone Ridge was probably the best educational experience of my life, but before that, my Montessori experience in grades 1-3 was pretty influential and memorable.

Would you recommend your profession and specialty to your kids? If not, why? If you had a chance to go back in time and pick another medical specialty (i.e. pediatrics / emergency medicine), would you do it?

I would like my kids to be happy in their work. While I've written in the past that I hope they don't choose medicine because of the grueling training process, I do feel that if they truly loved medicine with a passion, then by all means I would support them and, of course, recommend that they consider the best specialty in all of medicine: mine! :) If I had a chance to go back in time, I MIGHT change my profession, but if I were to choose medicine again, I wouldn't want any other specialty but this one. I truly love it, much as I moan about some of the day-to-day work frustrations that go with it.

Why are anesthesiologists/CRNA's the go-to folks for impossible IV's? Do you have any tips for hard sticks?

We're good at them because of practice, practice, practice. We've done TONS (just as we've done tons of airways).

I always used to tell medical students that half the battle is choosing the right place to try. Sometimes that means being willing to go "outside the box" / to "non-traditional" veins. Besides that, I would also suggest applying enough traction on the vein to prevent it from rolling, to insert the needle right on top of the vein (rather than beside it), and to ease needle and cannula straight in together, slowly, until you have a few mm inserted, before sliding the cannula straight off the needle. This of course only applies to the NICE I.V. equipment that can be used with ONE hand (so the other hand can hold the traction), not the CRAPPY I.V.'s that require an inelegant, far less smooth, TWO-HANDED technique that I simple can't stand.

Do anesthesiologists-to-be undergo anesthesia, of various sorts, as part of their education, so as to know what their patients will experience?

No, actually - though once, one of the critical care docs in the ICU gave us a taste of artificial ventilation, through a T-piece, just so we could understand the differences among the various ways of administering it, and also know how unpleasant it could be.

Many if not most doctors, come to think of it, haven't had their various patients' experiences first-hand and can't truly know what their patients are experiencing - heart attacks, pregnancy, surgery, anesthesia, fractures, the various procedures we perform, major illness, tumors, strokes, crippling diagnoses, loss of quality of life, etc.

This is why I think the study of literature, theater, music, language, anthropology, history, and the other arts and humanities is such a valuable part of a physician's education. Our patients are more than just cells and biochemical pathways. If we can't physically inhabit another person's experiences, we should at least have trained our minds and 'hearts" to do so by entering as intimately as we can into the experiences of others through conduits such as these. (My pro-humanities, arts-loving bias can't help but chime in here!)

Now, I don't want people writing in and saying, "What! T. believes reading story books will make you a good doctor?" That would be a huge misrepresentation of what I'm trying to express here. But I've always believed in the importance of a strong education in the humanities as well as the sciences for all physicians, not only to develop those aspects of the brain not exercised by studying science, but also because I really do believe compassion and the capacity for empathy arise from a combination of actual experience, lessons that form character, and stories that contribute to a greater consciousness of human experience.

What's your feeling on nurse anesthetists? There seems to be some rancor among doc-bloggers towards NP's and MA's; do CRNA's tend to get the same grief?

They do. There can be tremendous tension and resentment between MDA's (M.D. anesthesiologists) and CRNA's, depending on where they're working. I've been fortunate to have worked in places where relations are pretty respectful. My feeling on CRNA's is the same as my feeling on docs: there are good ones and there are bad ones; the good ones are GREAT to work with, and the bad ones can be dreadful. Many CRNA's know a lot and have excellent clinical judgment; others seem almost under-trained, or the fact that they've spent fewer years in training seems glaringly apparent. It just depends on the individual.

What mistake or patient encounter during your training or career bothers you the most?

In general, I am deeply troubled any time I find myself thinking "Hindsight is 20/20" or feeling, "Oh! I should have done this" or "I should have done that." I've written here about one patient encounter I wish I had handled differently; there are certainly one or two others that make my heart ache even now. I think the only doctors that have no regrets are the ones that haven't seen enough patients.

What are your "ten commandments" for a successful intubation?

• Thou shalt have a comfortable, well-practiced mask technique.
  
• Thou shalt be aware of any elements of the patient's history that might have an impact on his or her airway.
  
• Thou shalt perform a conscientious examination of the airway.
  
• Thou shalt place the patient's head, neck, and shoulders in the best position possible.
  
• Thou shalt give enough drug to ensure the patient is adequately anesthetized before attempting to secure the airway.
  
• Thou shalt sweep the tongue into the hollow of the mandible.
  
• Thou shalt not have a "wimpy lift," as one of my attendings told me I had my first month or so in residency, when I hadn't quite developed that laryngoscope arm yet.
  
• Thou shalt aim for the tunnel above the arytenoids.
  
• Thou shalt have an LMA ready and a bougie handy.
  
• Thou shalt call for help promptly if you need it.
  

Do you have any tricks on keeping calm in the OR when things are completely out of control?

No tricks. Just know what you're doing, stick to the facts, keep your eye on the numbers, take charge and delegate, and if you need help, ASK.

Have you ever had a kitchen disaster?

Absolutely! My earliest one was a comical attempt to make a Philippine roll called a pan de sal - one of the most delicious breads I know. I killed the yeast with water that was probably way too hot for it, and my "rolls" turned out hard as rocks.

Then there's my "nemesis," as my husband fondly calls it: Spanish tortilla. I LOVE Spanish tortilla. I'm part Spanish - how could I not? But I cannot get that dish right! "The center will not hold." I am definitely doing something wrong.

Finally, most recently I had a disastrous attempt at lobster mac-and-cheese. I accidentally rubberized the cheese, so I had to convert the dish to linguini with lobsters and shallots in a light, creamy, white wine and garlic reduction. That actually turned out well.

If you could have any superpower, what would it be?

You mean, if I had to choose from among invisibility, flying, telepathy, super-strong spiderweb cables shooting of my wrists, and that sort of thing? I think I'd want telekinesis. Clean-up would be so much easier...

Finally, from my friend Anali, one of my favorite questions: I think that you've neglected to address a very important issues on your blog. I'm actually surprised that it even needs to be asked, with someone like yourself who doesn't shy away from the issues.

But it's been far too long. Your evading this truth must come to an end. Two years of evading a quintessential question. Where do you stand on frosting? Buttercream, glaze, boiled, or ganache?

That's easy. Buttercream all the way, my friend. Smooth, not-too-sweet, satin-on-the-tongue buttercream.

Thanks, everyone, for attending my Blogiversary Festival! I've had a great time with it. It concludes officially tomorrow with SurgeXperiences: the surgical blog carnival. Keep in touch!