Monday, July 26, 2010

I Am Not Always Nice

I relieved a CRNA for his lunch break. He gave me a very good report on the patient before leaving the room. A few seconds after his departure I looked over the drape to check on the surgeons' progress, because I noticed one of the drugs we were using at regular intervals was starting to wear off.

(Surgeon #1 is generally well-liked among the nurses, anesthetists, and anesthesiologists for his competence and humor.

Surgeon #2 is almost unanimously disliked for his arrogance, rudeness, and inferior skill in comparison with Surgeon #1.)

Me: "How much longer do you think you might be?"

Surgeon #2 (muttering): "Why are these people always chomping at the bit?"

Me: "Why do you assume that I'm asking because I'm 'chomping at the bit?' "

Surgeon #2: "Well, that other guy asked the same thing a while ago."

Me: "Has it not occurred to you, after all your years of experience, that questions about the duration of surgery have nothing to do with being in a hurry to finish surgery but rather have everything to do with planning and executing a safe anesthetic for your patient, and making sure the TIMING of the drugs we give coordinates with what you're doing? Some of us actually try to put some THOUGHT into our moment-to-moment management of patients. When we ask you how long you have, it's almost always for the sake of pharmacologic timing, so we can be sure to provide the drugs you NEED for the procedure to go on, not because we give a flying fig how long you're going to take."


Surgeon #1: "About twenty more minutes."

Me: "THANK you."

Don't mess with me.

Sunday, July 25, 2010

Martha, Martha

Yesterday I was in full-out St. Martha mode trying to cater my husband's pontoon boat sunset cruise.

"What's a pontoon boat?" I had to ask him.

I saw a picture and decided it was a rectangular ring of benches on a floating platform covered by a canopy. I had to figure out what kind of food would be satisfying enough for the "light supper" his invitation mentioned but portable enough to eat on such a vessel.

"Finger foods," said a CRNA at work.

"Sandwiches," said another. "And watermelon slices."

My final menu consisted of the following (which, I realize, aren't at all coordinated with one another as a menu, but everything got eaten, so I guess no one minded):

Cherub tomatoes and carrot sticks with buttermilk ranch dip
Organic corn chips with chunky guacamole
Cucumber tea sandwiches with butter and dill
Cocktail meatballs with a sweet grape-jelly-and-chili-garlic sauce
Mediterranean pasta salad
Fresh strawberries and watermelon slices
Assorted cupcakes from Yum Bunnies Cakery

I was busy. I mean, running around, organizing, shopping, slicing, cooking, trying-to-make-everything-look-and-taste-good busy. Work has been like this too recently - difficult airways, busy obstetric service, M&M (not the chocolate kind), running, running, running. It's definitely been a very "Martha" couple of weeks.

The "Martha" I keep mentioning was a woman who, according to the Gospel of Luke, welcomed Jesus into her home, which she shared with her sister Mary and her brother Lazarus. The story goes like this (Luke 10:38-42):
As Jesus and his disciples were on their way, he came to a village where a woman named Martha opened her home to him. She had a sister called Mary, who sat at the Lord's feet listening to what he said. But Martha was distracted by all the preparations that had to be made. She came to him and asked, "Lord, don't you care that my sister has left me to do the work by myself? Tell her to help me!"
"Martha, Martha," the Lord answered, "you are worried and upset about many things, but only one thing is needed. Mary has chosen what is better, and it will not be taken away from her."
Does anyone find this just a little annoying? Does anyone else think the Son of the Most High could have used a little Sensitivity Training here?! You think turning water to wine was hard? Let's see you try to put a nice spread out for people you care about, at short notice, with no miracle-making powers, when you also care about food quality and presentation, etc.!

I jest, but there's truth in the spirit of what I'm saying. For the Marthas of the world, this New Testament story irritates. We work hard because we care about our welcome, we Marthas. We worry about the details because how you approach even the smallest thing is how you approach everything. All our fussing and fretting comes from a place of love. It's so unfair. Not only did Jesus fail to appreciate Martha's efforts and admonish Mary to help out a little more but he also actually praised the seemingly neglectful sister instead. What gives?

I can understand the need to emphasize contemplation and an interior life in the midst of day-to-day busy-ness, especially nowadays. People can't seem to slow down and just think, or watch sunsets, or listen to the hum of cicadas. A life of action without reflection can quickly drain the spirit, while a contemplative life without some kind of action remains hollow and unrealized. I get that. And I also understand putting priorities in perspective: it makes no sense to have every doily perfectly placed if one has missed out on a wonderful teaching moment or spiritual experience. I get that too. But work done out of love - not out of pride - is such a treasure in itself; couldn't Jesus have given Martha a little credit?

We had our share of "Mary" moments on the sunset cruise out of Cape Ann Marina in Gloucester. The weather was perfect, the water smooth, and the company warm and friendly. My husband put his arm around me as we looked out over the water and breathed in the sea air. Quiet moments nourish and refresh and can sometimes open up the world in new ways - there's no question about that. But as the feast of St. Martha approaches (July 29), I had to give a shout-out to her and all the Marthas of the world, whose nourishment, generously provided, makes a difference.

Sunday, July 18, 2010

The 7-Link Challenge

Today I thought I'd participate in Problogger's 7-Link Challenge as described by Lisa on her blog Anali's First Amendment. Here are the rules:

"The idea is to publish a post that is a list of 7 links to posts that you and others have written that respond tothe following 7 categories. Your links should be to

  • Your first post.
  • A post you enjoyed writing the most.
  • A post which had a great discussion.
  • A post on someone else's blog that you wish you'd written.
  • Your most helpful post.
  • A post with a title that you are proud of.
  • A post that you wish more people had read.
You might like to add a few explanations to different links."

Harder than it sounds! But here they are:
It's been fun walking down memory lane on this hot Sunday afternoon!

Photo above: View from a window in the abbey of Mont-St.-Michel through which the monks would haul a sled loaded with supplies from below. Here's what the sled ramp looked like from the outside:

Monday, July 12, 2010

If I Were a Physician in France

On my way onto the plane for my recent flight home from France I picked up a copy of Le Figaro thinking I might enjoy the article about actress Sophie Marceau, who was on the cover of EVERYTHING while we were in France in celebration of her turning 40. I did enjoy catching up on Marceau - I still remembering watching La Boum in my high school French class - but I couldn't help but notice a two-page spread showing a large group of physicians in their white coats standing on the staircase at the Université Paris Descartes - a staircase I remember descending last year after my visit to the Musée d'Histoire de la Médecine.

It was the central image for an article about physicians writing a letter of protest to Sarkozy regarding French health minister Roselyne Bachelot's healthcare reform bill. Whether it's in the U.S. or Europe, it seems, health care reform must provoke controversy! The article discussed the doctors' objections to the allocation of decision-making power exclusively to hospital chief administrators (CEO's / CFO's), to cuts in staffing and services, and to decisions about patient care being made based on financial rather than medical criteria. Their battle cry, "Let's Save The Public Hospital," pointed to the increased economic burden that the current bill implied for teaching hospitals carrying the brunt of high-acuity, high-volume patient care.

Physicians weren't the only professionals openly protesting Bachelot's bill. Nurse anesthetists blocked train tracks at the Gare Montparnasse last May to protest the bill's failure to recognize their specialty (France currently has 7500 nurse anesthetists).

Though I am much less familiar with the French system than the American, the article made me think about how my life might be quite different, both as a physician and as a patient, if I were living in France, as I have often fantasized.

If I were a physician in France I'd be making less. Primary care physicians in France get $32 for consultation ($37 if it's a house call), whereas Americans under Medicare get $92 for the first visit and $125 for a "moderately complex consultation." French Anesthesiologists make from 4000-7000 euros a month, according to one website.


As a physician in France I wouldn't have crippling student loans to pay back (the government would have paid for my education), and my malpractice costs would be significantly lower. I'd also be able to make decisions as I please without being muzzled by an insurance company - though as an anesthesiologist in the U.S. I can already do that; it's usually primary care physicians in American who have to deal with the frustrations of having to adjust medical decisions based on insurance company restrictions.

In France I would, however, have had to have been in a science / medical track for most of my scholastic career, starting in high school, and would probably never have been able to do what I did in the U.S. - major in literature, then switch to medicine after university. I'd have had to do a lot of demanding oral exams - not just the few I got through here in the States. I'd have had my exam results posted publicly and my class rank determine my specialty choice (which does occur to some degree in the U.S., but less stringently).

As a patient in France, I'd be entitled to health care, but I'd perhaps be paying higher taxes, waiting longer to see specialists, and maybe even having to travel out of my home area for access to certain services, such as a labor and delivery ward. In either country, the system is tiered, with people able to pay for additional private insurance getting access to more services.

I don't think there's any perfect training system, practice situation, or place to be a patient, but as both a physician and a patient I'd probably want for myself the flexibility of an American education system coupled with the universal access enjoyed by the French. I dream of living in some idyllic little French village without worrying about whether I can get care when I need it; then I watch shows like BostonMed, and the familiarity of the American system wins me over all over again. The problem neither country seems to be able to solve is the high cost of universal health care; Assurance Maladie, the French state health insurer, has been "in the red" for decades. I'm interested in seeing what both countries come up with in the coming years.

Saturday, July 3, 2010

Vacation Highlights and France Top 10 Lists

This trip to France has been completely wonderful - relaxing, educational, filled with breathtaking experiences and good times spent with family and friends. We really couldn't have asked for a better vacation, and with just a few more days to go I am already starting to get sad about leaving. Some highlights:

Peaceful country life:

Stumbling upon some charming towns while driving around Normandy:

The old mill in Vernon

Picturesque spot in Cocherel


Mont-Saint-Michel and the Musée des Manuscrits du Mont-Saint-Michel in Avranches (a.k.a. the "Scriptorial"):

And of course, Paris:


I am a list-maker, and I couldn't resist creating a few France-related Top 10 Lists. Here they are:

Top 10 Favorite Experiences in Paris

10. Going to the top of the Arc de Triomphe.
9. Walking through the area around the Place Vendôme (and drooling over the chocolatiers' windows...).
8. The green spaces: Jardin du Luxembourg, Jardin des Tuileries, Place des Vosges, and many others
7. Visiting the Musée Cluny and the area around the École de Médécine.
5. Enjoying the street performers in Montmartre on summer evenings.
4. Browsing the bouquinistes on the Quai de la Tournelle and Quai St.-Michel after Mass at Nôtre Dame; we also like the the bandes dessinées shops in the Marais
3. Walking the Quartier Latin.
2. Visiting the Musée d'Orsay (even when my favorite Caillebotte painting is out on loan, as it was this year).
1. Hanging out on the Champ de Mars (in front of the Eiffel Tower) at night when the sun doesn't set till 9:30 p.m.

Top 10 Experiences in France Over the Years

10. Shopping for groceries at Carrefour (the United States just doesn't make food this good)
9. Giverny
6. The Loire Valley / chateau country
5. Our afternoon in Dieppe
4. Paris, of course - especially off-peak
2. Mont-Saint-Michel
1. Relaxing in my husband's family's place in the country

Top 10 Things We Have Yet To Do As a Family in France

10. Versailles
9. The lovely villages in the south of France featured in the film A Good Year
8. Marseille
7. Caen, Omaha Beach, Bayeux
6. Ski trip to the Alps
5. Brittany coast
4. Reims
3. Some pilgrimage sites: Taizé, Aubazine, Lourdes
2. Honfleur
1. Spending the night IN Mont-Saint-Michel