Tuesday, February 23, 2010

Making Whole Wheat Pasta Palatable

My curse is that I love carbs. I love Asian-style sticky white rice. I love pasta. I LOVE bread. I also know that when I eat a higher ratio of proteins to carbs and eat "better" carbs than the lily-white kind I so enjoy, I feel and probably look better. This is a problem when one is not over-fond of fowl. *Sigh*

Last night I decided to try once again to prepare a "healthier" pasta dish, using Barilla Plus multigrain rotini with ALA omega-3. Each cup contains 17 g of protein, 360 mg of ALA 0mega-3, and 7 g of fiber. I would roll my eyes if I hadn't given up sarcastic and resentful thoughts for Lent.

Well, my dish was devoured with enthusiasm by the entire family, and I have Larry Elder of Charlotte, NC to thank for his recipe for Sicilian Lemon Chicken with Raisin-Tomato Sauce, which I found on Allrecipes.com and adapted for my family. Thank you, Larry!

Here's what I did.

Mediterranean Whole Wheat Pasta D'Après Larry Elder
  • Soak 1 cup of golden raisins in warm water to plump.
  • Zest 1 lemon and set aside the zest
  • Thinly slice 2 small onions and 6 garlic cloves.
  • Chop up half a can of medium pitted black olives (about 20 olives).
  • Heat some olive oil (about 3 Tbs).
  • Dump onions, garlic, olives, and 2 Tb pistachios (supposed to be pine nuts, but I only had pistachios) into it, and cook till soft and fragrant.
  • Season with 1/4 tsp dry oregano, 2 bay leaves, and a dash of cayenne pepper.
  • Stir in 2 cans of diced tomatoes (15-oz each).
  • Season w/ salt & pepper. Cook 5 minutes.
  • Drain raisins and add.
  • Add 2 Tbs balsamic vinegar and 1 1/2 tsp sugar.
  • Cook 5 more minutes.
  • Remove bay leaves and add some shredded fresh basil (which I didn't have, sadly).
  • Cook till heated through. Toss with 1 to 1 1/2 lbs whole wheat pasta along with lemon zest and, if desired, some shredded fresh Parmesan or Piave di Vecchio.
Larry's recipe also calls for some cooked chicken breast that has been tossed with the juice from the zested lemon - I did that, too, but the pasta-and-sauce part can stand on its own.

Photo source.

Saturday, February 20, 2010

Satisfaction II

Recently a patient was describing how much he had enjoyed spending time with members of the film-making industry in L.A. "It's so great to be around be people who love - absolutely LOVE - what they do for a living. Everyone -the actors, the directors, the make-up people, the camera guys - they all LOVE their work! For most people, their jobs are just...jobs."

People who are able to do what they love most in the world for a living are truly fortunate. Most people in the world don't have that opportunity, either because of lack of talent or lack of resources. But there must be ways to find some fulfillment even in "ordinary" jobs.

Recently I wrote about going through a slump in terms of my work satisfaction. I've been trying to turn my attitude around, and I'm finding that cherishing small / hidden moments, and focusing on those rather than on frustrations, can be really helpful.

One afternoon I brought an elderly woman with a potentially difficult airway and not one but two heart problems, one of them fairly risky, to the operating room. This was someone for whom every cubic centimeter of drug administered had to be given gingerly and deliberately, each drug with a very clear and concrete purpose. Most people can be given a variation on the same combination of medications for the induction of anesthesia: a syringe of propofol, some muscle relaxant, maybe a little narcotic. For some, though - either because of their medical history or because of surgical issues - "the usual" isn't appropriate. For this woman, the usual mix could have been quite perilous.

I had goals in mind. I wanted to get her heart rate below its rather rapid baseline. I wanted her pressure not to fall sharply below a systolic of 120, even 130 if possible, during induction of anesthesia. I chose my drugs carefully and I gave some of them practically a cc at a time. As she fell into unconsciousness I watched as her vital signs did exactly what I wanted: heart rate down to the 70's, blood pressure 132/77, breathing tube placed smoothly (with emergency airway equipment at the ready), patient completely safe every moment of the induction. It was one of the most elegant inductions I had done recently.

No one knew or understood my plan or what I was doing differently. No one realized the potential dangers I had avoided. It was a job done completely anonymously, and not even the patient would ever know the kind of moment-to-moment attention her challenges and her anesthetic demanded. Surgeon walked in, did his thing, and left with a quick thank-you to the team, also unaware of the meticulous care taken to protect his patient with her individual medical issues and needs. To everyone else, it was just another anesthetic.

But not to me. And you know something, the fact that I and only I knew that was strangely comforting. It's like producing a poem or painting or short story that you know will never be seen by anyone else but feeling wonderful about it anyway, because you created something beautiful, and it's yours. Sometimes the satisfaction is so fulfilling that external affirmation becomes completely unimportant - in fact, unnecessary.

It's a good feeling.

Sunday, February 14, 2010

What's in Your Heart?

Whenever I hear phrases like, "follow your heart," "trust what's in your heart," "hold it in your heart," I must admit that the first image that comes to my mind is this:

I see chordae tendinae, papillary muscles, ventricular walls: the inside of an actual human heart. What do people mean when they say "in my heart I know this," or "there's so much going on in my heart?" Why do we so easily identify our deepest of emotions and the most important of convictions with a pump inside our chests, rather than with our brains?

It's an ancient tradition, this conflation of the heart and the heartfelt. I think we make the association because among the parts of the body that a person can sense internally, the heart is simply the easiest to feel. Stomach aches and muscle movement can be vague, but the heart speeds up when we're excited or afraid, pounds loudly and palpably when we fall in love, has a rhythm we learned to hear and recognize in the womb, and in addition is almost frighteningly vulnerable, in need of protection from within as well as from the outside.

When I can get past the image of the heart's four chambers through which our lifeblood rushes, in and out, in and out, every moment of our lives, I start to see other things. My children, my husband - they occupy my heart. My heart is full with them. Yet, as is the nature of human hearts - the invisible kind, that is - there's room for more: music, medicine, stories, friends, a longing for God. I can feel them swirling around, and the more I have in there, the more room there seems to be, the more life comes pouring out, bringing exhilaration to body and mind.

What's in your heart? Or, as James Fowler asks in his book Stages of Faith: the Psychology of Human Development and the Quest for Meaning,

What are you spending and being spent for?

What commands and receives your best time, your best energy?

What causes, dreams, goals, or institutions are you pouring out your life for?

As you live your life, what power or powers do you fear or dread?

What power or powers do you rely on and trust?

To what or whom are you committed in life and in death?

With whom or what group do you share your most sacred private hopes for your life and for the lives of those you love?

What are those most sacred hopes, those most compelling goals and purposes in your life?

These are what I think reflections about love should consist of, on Valentine's Day or any day. The rest is just fluff.
Anatomic illustration above by Patrick J. Lynch, medical illustrator & C. Carl Jaffe, MD, cardiologist

Tuesday, February 9, 2010

Temple Grandin

"I believe that doing practical things can make the world a better place."

I first learned about Temple Grandin through NPR's This I Believe series. Now the outstanding HBO film Temple Grandin has brought her experiences as a high-functioning autistic person, her revolutionary creative and scientific work in the humane treatment of animals, and most wondrously, her mind, to life.

Claire Danes is phenomenal in the title role - that, we could have expected, though watching her become Temple Grandin physically, intellectually, and emotionally before our eyes is astonishing even beyond those expectations. But equally impressive is the way in which this breath-taking film captures the lived experience of Grandin's unusual mind. My husband and I were stunned and deeply moved as we watched it last night.

The film Temple Grandin manages to use cinematography to manifest intellect. Sometimes the camera cuts away temporarily to the very concrete images that come to Grandin's mind when people utter words like "miracle" or "animal husbandry," giving viewers an idea of the way she really does think in pictures. Camera angles and direction are used to help us understand her perceptions of the world around her, the discomfort of certain stimuli such as the clatter of eating utensils, the brilliant, intuitive insights she had about the mathematical relations of objects and their mechanics. Small moments convey a lifetime of struggle to understand humanity - her own and others', as well as the inhumanity she witnessed. As she says in the film, "Nature is cruel, but we don't have to be."

Since I learned about her, Temple Grandin has been an inspiration to me. I am not autistic, but I have had occasion to seek neuropsychological testing for certain cognitive challenges - and it was almost a relief to be told I had outright failed a couple of measures, so I could say to the people who had seen me get straight A's for much of my life and couldn't believe I might have a problem, "See? The world isn't always simple for me! There's a reason I get stressed out!" I grew out of my childhood echolalia and sensory integration issues (for the most part), but I often still feel like a mind in cognito, an individual with subtle issues and challenges passing for "normal" by being capable of achieving things.

Nonsense, some people might be tempted to say; you graduated from medical school - how can you talk about cognitive problems? To them I say, do you have any idea how many people struggle through med school, and succeed and become great physicians, with learning disabilities, mood disorders, ADHD, and other perhaps undefineable brain issues? Don't you realize how ways of thinking, perceiving, and processing just can't be so easily boxed into constructed categories?

I found myself able to relate so well with the perceptions of the world brought to life in the film and in Grandin's own words - especially the "thinking in pictures" (though how I wish I had her photographic memory!), discomfort and stress with certain kinds of sound and touch, and anxiety (and seeming "lost") in new environments or with the way people gIve directions or explanations. Grandin's story reminds me that none of us is alone in our struggle to relate to the world and each other; that there are those like her who have suffered much more and then achieved much more; that we all occupy an intellectual spectrum that connects us much more than it divides us. In the end, it was a story of hope - subversive, uplifting, challenging, and timely.

Just out of curiosity, I took the non-diagnostic Autism-Spectrum Quotient found here. "Average" score was 16, likely to fall on autism spectrum was 32. ("Eighty percent of those diagnosed with autism or a related disorder scored 32 or higher. The test is not a means for making a diagnosis, however, and many who score above 32 and even meet the diagnostic criteria for mild autism or Asperger's report no difficulty functioning in their daily lives.")

I scored a 30, probably kept out of the spectrum by a "normal" empathic ability, ability to process noverbal social cues, and perhaps my love of fiction. When my husband looked at the test with me and gave the answers he thought I should have given, I scored even higher, 31. Good thing he makes such a good "hug machine." :)

Thursday, February 4, 2010

The Cleaning Guy

Sometimes when Pablo pushed the enormous, wheeled, plastic trash receptacle down the hallway, he would see faces among the bags of waste. Faces from his past, from the once-war-torn home he'd left behind, and from his more recent life in this new world, where after twenty years he still couldn't speak, couldn't understand what people were saying. The trash bin was his scrying glass, the rhythm of its wheels coaxing memories forward that he didn't want but couldn't hide from himself.

He lived alone among others like him, others who spoke what he spoke and ate what he ate. It took him a long time to commute here at night to collect the trash and clean the floors in this place where suffering and healing touched at the edges. He had a wife who had found another man, and a six-year-old son he was never allowed to see. His back ached and his false teeth were loose, so even if he did find someone who spoke and understood Spanish, they kept rattling around in his mouth when he talked to them. His life was one of silence, loneliness, and prayer. His faith was everything he had, everything that mattered.

There was a doctor where he worked at night who sometimes spent the night there on duty. She looked young - just a kid, though she must have been older than she looked. She always smiled and said, "Hi, Pablo" whenever she saw him. She would say hi to Anita too, who cleaned the women's locker room, and Campbell, another guy on the housekeeping staff who had recently quit the night shift.

One night, when there were no emergencies in the operating room and the women in labor had all given birth, this doctor was in an office along the corridor where Pablo did most of his work. She saw him walking by, pushing the giant trash can along, and she ran to the doorway. "Pablo! Pablo, may I ask - where are you from?" And Pablo realized he understood what she was saying, though she was speaking fast. The doctor spoke Spanish.

"El Salvador," he replied.

All of a sudden the doctor was excited. She threw her hands up toward heaven and said she needed help with something, some music project or something, and wanted to learn about his country.

"Were you there during the war?"

Her Spanish was a little rusty, and sometimes she had to take a moment to find a way to express herself, so more often than not she would just blurt out such questions, questions which should have been jarring but which Pablo found strangely normal. Tell me about it, she was saying. Tell me what you saw. I want to know. I need your help.

They talked for a long time. Anita came and emptied the office wastebaskets while they were talking. Across the hallway, the recovery room nurses were turning monitors off and packing up their last patient for transport. Bits of story came rushing out of Pablo, and the faster they came, the more there were. He couldn't understand how something could feel both painful and wonderful: to remember, but also to be heard.

"It was even worse, then, than what the movies about it show," the doctor said. "How on earth did you survive?"

"The mercy of God," Pablo said.

But what of those who had perished? the doctor was thinking. Were they meant to know no mercy, to be tortured and treated as if they were more worthless than the dust and excrement on the road, and then left by the road to die?

What a topsy-turvy thing, this night. The war had taught him that people were worthless (though his faith proclaimed otherwise), and he knew he was nothing, nobody, but then here this doctor was hanging on every word as if nothing were worth more to her at that moment. What was it the young people said? W - T - F, or something like that?

Then somehow they were no longer talking about the war. He talked about this life, how he rediscovered his faith, how it sustained him in his solitude now. And as he talked, his heart opened more and more, and he could feel something changing, as if a beam of light were shining into the chambers of his heart and illuminating them from within.

"God has a purpose for you," Pablo said to the doctor. "Find it." And he began to pray over her. The words, like his story, came spilling out almost involuntarily. It was almost as if he were not the one praying, but rather some other voice, an energy like a wind blowing him along, blowing through him. The gust intensified, carried his words toward her; he felt another power at work, something from beyond the two of them, and he trusted it.

When he finished his prayer, he opened his eyes and looked at the doctor. She had her eyes closed and her hands folded in her lap, her head bowed as if receiving a blessing as Pablo stood over her. Then she opened her eyes.

"I don't know why we had this conversation," he said to her, with tears in his eyes. "But I thank you." Then he went back out of the office and continued pushing the bin of trash down the hall.

Best Anesthesia-Related Blog Post in Recent Memory

Please check out Mommydoctor's post Anesthesia Residency By the Numbers, recently re-posted on Mothers in Medicine. It's funny, it's TRUE, and it's just plain great.

Her blog is fantastic, as are some of her older writings, where the aforementioned post dwells.