Reflections During the High Holy Days, Part One: Why I'm Still Here

I can truly understand the criticisms of those who feel religions do more harm than good. I don't agree, because I think there often exist in such criticisms a willful neglect of the good inspired by so many faiths, but I can definitely see the harm people can do in the name of their interpretations of their own religions and why the bitter opinions arise.

I'll be the first to admit that of all the times I've ever felt like rolling my eyes at, taking by the shoulders and shaking, or feeling totally embarrassed for the Catholic Church, this current period ranks right up there with any number of historic moments people have pointed to ad nauseum as evidence for why the institutional Church sucks.

And I can understand why Christians in general, not just the Catholic ones, can be a real turn-off. Who wouldn't be frustrated by a group that seems, despite a Messiah who taught, "Do not judge," to be comprised of some of the most judgmental people on the planet?

Then there's Islam. The religion of peace if one looks at all my wonderful Muslim friends and colleagues, but just the opposite if you're choosing to look only at Islamists: the misguided militant, the suicide bombers in Russia and the Middle East. If it's hard to be a Christian in today's world, it's probably even harder to be a true and faithful Muslim.

I have tried to learn about many of the world's religions in an effort to develop my own beliefs, moral convictions, and practices. I embrace the interconnectedness taught in many faiths of the near and far east, but I cannot relate to spirituality that seeks to cultivate indifference or imperviousness to physical realities, relationships, and sufferings, or to distance individuals from the world they inhabit. Archbishop Oscar Romero once said, "The Christian faith does not cut us off from the world but immerses us in it." I related more to that kind of statement of faith than any other. Faith, for me, is a way of seeing the world and living in it, not a set of beliefs. I want my faith to put me in the trenches.

Why, by this time, have I not left this troubled Church, with its frustrating history and frustrating issues and frustrating people?

Part of the answer can be understand by simply substituting the word "family" for "Church." It's home. I may need a break sometimes, but in the end I've accepted an identity that is rooted in the stories, symbols, pains, and hopes of this ancient People.

Another part of the answer is the person of Jesus. I won't go into my understanding of him here - that's a reflection for another day, and perhaps even another blog. But as I've tried to examine how the leaders or founders of religions have lived - not their successors, necessarily, who may have distorted their messages or used power to hurt rather than heal - I've asked myself questions like, Have they valued children and other powerless members of society? Treated women with respect (or disrespect)? Waged war? Regarded human beings as full of worth and wonder? I've concluded that Jesus is still the teacher from whom I want to learn the most important lessons.

So here I am. Still in the fold. Reluctantly at times, and in fact sometimes kicking and screaming and tearing my hair out, but definitely present and participating and trying to make my way. I may not believe some of what other Catholics believe, or express my beliefs in the same way, or even conceptualize Christ or the key ideas of Christian thought the way as many Catholics do, but I have an approach to scripture and an interpretation of Jesus' life that has enriched my own life and work, so for me faith, despite the struggles, has been a positive force.

I've been feeling contemplative lately, more so now that the Triduum is upon us, so stay tuned for "Part Two" wherein I may try to grapple with some questions that are probably thousands of years old.

Oscar Romero

Romero.

August 15, 1917 - March 24, 1980.

Prophet of the people,

voice for social justice, human rights and dignity,

freedom, and non-violence,

killed by an assassin's bullet while celebrating Mass.

Remember him today.

If, like Patricia Hardy of the Texas school board,

you have no idea who he is and what he has done for the world,

learn about him today.

Thirty years later, his light still shines.

May we grow to be worthy of it.

[Icon by Robert Lentz, available at www.trinitystores.com]

For further reading, click here and here.

Too Good Not to Share

For those of you who have cringed when I've mentioned awake intubation, here's a video that might make you feel better...or worse...In any case, I think the Massachusetts General Hospital residents are incredibly fortunate to have such a committed and courageous teacher!

(Click here to watch it on Youtube.)

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Hubby's Birthday Cake

This is the best cake I've ever made, so I want to share all the sinful delight here for posterity (adapted from a ricotta pound cake recipe by Gina DePalma in her book Dolce Italiano):

Preheat oven to 350.

Generously grease and flour a rectangular (13 x 9) cake pan.

In a medium bowl sift together

-2 c+ 3 Tb all-purpose flour

-5 Tb cornstarch

-4 tsp baking powder

In a large bowl cream together

-2 1/2 sticks unsalted butter

-2 1/2 c part-skim ricotta cheese

-2 1/2 c sugar

Add

-4 tsp vanilla (can replace some of this with scrapings from a vanilla bean - haven't tried that yet)

-1 tsp almond extract

-5 eggs, one a time, beating well after each addition

Gradually add dry ingredients + 1 1/2 tsp coarse salt, stirring well after each addition.

Pour batter into prepared baking pan and bake at 350 till inserted knife or toothpick comes out clean (45-55 min).

Top with lemon glaze or buttercream frosting of choice. This cake should be allowed to rest overnight and be served the day after baking because for whatever reason it always tastes better the second day!

Thinking About the First Time

A life in medicine is filled with milestones large and small.

The first time you touch a dead body.

Or hold a human heart in your hands.

The first time you pierce another's skin with a needle.

Or cut it with a scalpel.

The first time you witness a birth.

Or a death.

Your first code.

Your first infant intubation or spinal tap.

Your first solo anesthetic.

Your first job.

Not to mention licensure boards, three different sets.

On top of those, separate written specialty boards.

And of course, oral boards, everybody's favorite.

Recent events have caused me to reflect on the first time I and my classmates performed pelvic exams. As I recall, most of us anticipated this particular lesson with a little dread - at best, some mild anxiety. Physicians and nurses have to do such invasive things - stab people, gaze at parts of them even their spouses or parents have never seen, listen to their secrets, probe the most private areas of body and life. As a woman who has never particularly enjoyed visits to the doctor for a complete physical or to the gynecologist for a check-up, I was particularly un-enthused at having to inflict on even a comfortable volunteer such an invasion of her privacy.

The special instructors hired by my medical school to guide us through the process of examining their pelvic areas were highly trained educators who unselfishly allowed us novices to practice an examination on them that would require, for our patients' sake, our very best in terms of skill, gentleness, and respect. I know I couldn't do what they did - allow myself to be examined and give constructive, moment-to-moment feedback during the exam. I've volunteered my veins for students to practice I.V. insertion - that's about as far as I go.

We were divided into small groups of four, I think. I remember the sound of the speculum rattling as one of the students ahead of me trembled nervously while inserting it. I remember how we giggled nervously when another in the group asked the instructor, "Uh, could you uh, drop your top" and was gently given the feedback, "Perhaps you could rephrase that with, 'could you lower your gown,' or something like that?" I remember thinking how much more comfortable the instructors were with the whole process than I felt, and how embarrassed I was when I let out a surprised "Whoa!" when the woman I was examining did a mega-strong Kegel move while I was doing her pelvic exam.

As with everything in medicine, after a while even the most invasive and intimate action can go from being completely foreign and frightening to being completely familiar and comfortable. Whether I'm the patient lying on the table or the clinician doing the exam or procedure, I have individuals like those pelvic exam instructors during med school to thank for what I or my physician is doing with confidence and competence. I thanked them when they came to school to teach us, but I want to thank them again, many years later. They made a difference they'll never be able to know or see.

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.

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.

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.

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Anatomic illustration above by Patrick J. Lynch, medical illustrator & C. Carl Jaffe, MD, cardiologist