Wednesday, August 16, 2017

Pink Hats 27: Deju Vu

Christmas parties in the first two years of medical school tend to be few and far between, or so it was in Jessie's experience. There just wasn't the time. The last week before the holidays was dedicated to exams and if you had time to party, you slept instead. It's tough and everyone knows it.

Actually being able to put on a dress or at least something other than scrubs and spend a social evening -- unless she was on-call -- with her "working family" was one of the perks Jessie loved about Maine Med. She'd gone through residency with several of her classmates and established friendships among the medical staff that she cherished. A rumor circulating about an attending position opening up once her fellowship was complete had been confirmed by the departmental director, and she was considered a shoe-in for the job. Christmas parties at Maine Med promised to be a feature in her life for years to 

This year was going to be special for a lot of reasons, not the least of which was an occasion to formally announce her engagement to Bob. The truth is, there was scarcely a soul who didn't know already, thanks to the hospital grapevine. Good news travels like wildfire, especially when Halley Henry is the one with a match. Jessie and Bob spent the afternoon following his proposal with the twins and gave Halley the "Go" command she'd been waiting for. By the following Monday, neither one could walk the hospital hallways without running a gauntlet of congratulatory handshakes and hugs.

Fresh powder had fallen in the White Mountains off and on the week before the Saturday evening event, so Bob and Jessie drove up to Pleasant Mountain ski area near Fryeburg. Jessie skied while Bob spent the morning learning the ins and outs of snow boarding. After a few runs alone, she joined him on the beginner's slope.

"Why, if it isn't Shawn White!" she said, teasingly. "Can I have your autograph, pretty please?"

"Baby, you can have my autograph and anything else you want. I am footloose, fancy free, and all yours!"

She laughed and said, winking, "I can think of a lot of ways to take that."

"I'm sure you can, but this is the bunny slope and that means G rated. With the twins around, you better start getting used to that, Dr. and almost Mrs." he said, winking back.

"Only during the early evening hours -- after they're asleep, anything goes." she said, sidling close and raising her eyebrows.

"I think...I've created...a monster," he said, eyes wide.

"You have no idea. Now come on, you hot snow rider you, show me your stuff!"

Yogi Berra said it, this is like deja-vu all over again.

(Creative Commons image of Shawnee Peak by bobtravis via Flickr)

Sunday, August 13, 2017

My Last Night in Bethlehem

The following is an unpublished essay from medical school I've always liked. I don't know why I never made it public before, but here it is. I hope you like it.

To my final evening of night shift, I say hasta la vista, baby, with mixed feelings. I'm looking forward to walking my dog at sunset and I'm sure he is, too, but all the same, I'll miss a few things. For one, there's nothing like a hospital at night. I've always loved walking the hallways when lights have dimmed and patients gone to sleep. The entire place feels like a warm blanket. Even the obstetrics unit can be like that, though not so much lately. Certainly not this morning around 4.00 AM when all the unborn babies suddenly woke up in their respective wombs and cried with a single voice, "Let me outta here!"

Yeah. It got kinda busy. Fast. The doctors were in surgery and I was on the unit keeping watch over my flock of one, a shepherd mimicking a memorable night in Bethlehem. I was on my way to her room, checking in once again, when the head nurse raced past, calling back over her shoulder, "20 is giving birth -- now -- and I have no doctors!" I waved the cloud of dust she left behind away from my face and tried to quell the wave of panic rising in my gut. A medical student who's only assisted in vaginal births is more hindrance than help at a time like this, so if s/he has a lick of sense, they attend to their patient. And that's what I did. One of the residents scrubbed out and came to the rescue.

A baby's cry and a few minutes later, she was finished in one birthing suite in time to join us in another. My patient was at ten centimeters and it was time to push. She and I held hands and breathed through the contractions together. When her baby finally slipped out, we smiled wearily and gave each other a thumbs-up. Heading back to the residents' lounge, I had the feeling I imagine all doctors must have at times like this: no matter how numerous are my faults, once in my life I did something good.

Mother and daughter will be gone by the time I show up Monday morning, like all the parents and newborns I've gotten to know this week. It's a privilege -- being allowed to share in a dream come true. The woman with whom I held hands through labor and delivery was a stranger when I walked onto the unit. She was alone with the exception of her mother who was in and out of the room. By the time the night was over, we were much more than strangers.

All on my last night in Bethlehem.

(Public Domain image of Bethlehem, 1882, via Wikipedia)

Wednesday, November 18, 2015


"Paranoia strikes deep.
into your life it will creep..."
~ Stephen Stills

Of all we could say about paranoia, one thing is pretty clear: it's a symptom of something gone wrong. When we're coping well with life, we aren't generally suspicious or mistrusting without reasonable cause. Even under stress, when we are compensating, as we say in "shrink lingo," we're able to distinguish between real and imagined threats. True, we may not be able to cover every single solitary possibility imaginable -- no one's perfect -- but we do our best. And most days, in most situations, that's good enough.

In extraordinary situations, however, things can change rapidly. With good coping skills and a healthy ego, we're okay, maybe even better than okay. With poor skills or a weak ego, it's not so good. It may even get scary once in a while. Especially to those of us who are on the outside looking in. 

I'm referring specifically to the rash of paranoid ideations that have found their way into video and print in response to the terrorist attack in Paris. Don't let those Syrian refugees into America, they say, you can't tell the good guys from the bad guys. Well, maybe not, but haven't bad guys been able to enter the United States for a long time? What self-respecting, evil, scheming bad guy is so stupid that he'd masquerade as a refugee and expose himself to serious scrutiny, when he could simply walk through customs with a legal passport on any other day?

That's the problem with paranoia, especially the socially-acceptable kind. It checks its brains at the door and starts shouting about the sky falling when the issue is actually much closer to the ground. It becomes irrational even when couching its rhetoric in rational terms. It is true, America has endured terrorist attack before and it only makes sense to be prepared. Once burned, twice cautious. To become obsessed with the possibility to the point we abandon our leadership role on the world stage isn't caution. It's more like crazy.

These are times for brave, sensible people. People like the Parisian father who explained to his young son that memorial flowers and candles were there to protect them from bad people with guns. He's too young to grasp the concept that flowers and candles represent the collective will of good, solid, brave people who refuse to give in to terror. Someday he will, though. When he does I hope he also understands that paranoia is a warning, not a watchman to be heeded.

Creative Commons image by Katlew via

Sunday, August 24, 2014

The White Coat Brigade

Although I wasn't running late, it still felt that way. It was my second day of residency and a meeting with the psychiatry training director had me intent on arriving early. At my hospital, residents have access to a parking garage, unlike lowly medical students. Having been one of them for so long, the garage looks to me like the Taj Mahal. Anyway, after driving round a couple of minutes and coming up empty-handed, I spied an empty space marked, "Physician Parking Only." Wouldn't you know it? I thought, may as well have Dirty Harry guarding it. I started to drive past when the lights came on. 

"Wait a minute, that means me."

If there was a single thing typifying the impact of residency thus far, this incident depicts it. Over and over something happens -- entering the resident's lounge for the first time, hearing my name called with the title "doctor" appended to it, having other residents smile in greeting -- something happens to remind me I'm not in Kansas anymore. Medical school really is finished, I really did graduate, and I really am here, at long last.

It's kind of funny, when you think of it, the way reality creeps up and sinks in. I don't know if it affects other people like this, but I can't help thinking about how everything feels. Maybe that's why I'm in psychiatry: just being here isn't enough; I have to take it in and digest it. And unlike some third year rotations I was glad to bid farewell to, I want these first six months of inpatient psychiatry to poke along at pace that would make a snail impatient.

It's weird, though.  I feel like a buck private who's been given a battlefield commission. Only a few years ago I was an enlisted man, now I'm at the opposite end of the food chain -- or chain of command, as the case may be. Sort of. As a first year resident, I'm little more than a medical student with a title. But the people I work with didn't know me back then or in my life before that, on the front lines of mental health care. They only know me as I am now, a member of the White Coat Brigade. It's up to me to let my behavior spell out what I learned while serving on their side of the coin. 

Nothing is automatic, but it's all as pleasurable as it is satisfying. Especially sitting down with patients for therapy knowing it's partly what I'm getting paid for. I'm here to learn everything I can, but I'm also here to work and at this point, psychotherapy is something I can do quite legitimately. It's one of the tools I've had rattling around in my backpack the past few years, waiting for its time to come.

(Creative Commons image by Kids_Safari2 via Flickr)

Thursday, June 5, 2014

His Final Breath

The invitation was a Father's Day special that read, "What did your father teach you or how did he inspire you with regard to medicine?"

It would have been much easier had it been, "What did the Old Man have to say about the Big Slab (biker slang for the interstate)?" Then I could respond, in my best gravely ZZ Top growl, "He had me on a Hogg before I could walk. Why, he and mom almost named me 'Harley,' you know, as in Don Henry's song, Harley?"

There was a motorcycle mama and her man
With a wind-burnt tan and a Harley
Roarin' through Bakersfield when her water broke
They pulled into a hospital and for a little joke

They named him Harley
They bought a sidecar
And a small bandanna band
And they loved their Harley

Leaning closer and jutting out my long ZZ Top beard, I'd look at you over the tops of my Ray-Ban sunglasses and whisper with mock menace, "You do know Don Henry --  don'tcha?" 

But, that wasn't the question and my father never owned a Hogg or any other kind of motorcycle, much to my distress as an adventure-seeking teenager. Much to his relief, I might add.

Nope, my father didn't teach me a thing about motorcycles except I could get killed riding one. I came close one Fourth of July weekend, racing my uncle's beat-up Vespa scooter round his property as fast as first gear would take me. A patch of soft soil brought an end to my dirt bike career. They say speed kills, but in my case, it just knocked me out. No, I wasn't wearing a helmet -- in those days we didn't worry about head injuries quite so much and besides, my uncle didn't have one, anyway.

Dad did teach me a great deal about horses, though, mostly how to love them like your best friends. For a tough guy -- not a gruff guy -- he had a soft spot for horses. I remember the night he woke me up and led my mother and I out to the barn where we watched a baby colt being born. It was my first "childbirth." There was poetry in his relationship with horses and he taught me how to write my own over the years.  

He also taught me a lot about hard work, accepting responsibility, taking risks, and following your heart, all of which he exemplified regularly. It's been sad that he didn't live to see me through medical school. I would have dearly loved to share the folly and fun of my daily efforts to become a physician with him. Some of the situations I managed to get myself into would have had him laughing until he cried. Others wishing he could board a plane, despite his illness, to stand alongside his son when he experienced hard times.

If my father taught me anything about medicine, apart from how to "doctor" horse injuries. it was that I never knew as much as I thought I did. People will surprise you. His own life-long struggle with chronic pain resulting from a back injury at age 19, made him a model of endurance that earned the admiration of his physician. He worked through pain that would have laid me out and did it every day. His determination to wave off the beating wings of the death angel until his final heartbeat was a testimony to his disbelief in the word, "quit." 

So, what did he teach me? Where do I start? He taught me everything worth knowing and then some. He taught me about his fallibility, his fears, and to accept and overcome my own. He taught me to tolerate what I couldn't change and change whatever I could. He taught me how to face the worst life has to offer by going through it with me until I was ready to go through it alone. 

And that's when he took his final breath.

Happy Father's Day. 

(Creative Commons image of Billy Gibbons of ZZ Top by Filipe Neves via Flickr; "Harley" words and music by Don Henry who owns the copyright)

Sunday, June 1, 2014

Warm Days and Woodchucks

I hate moving. I used to think I was good at goodbyes, but you want to know the truth? I
suck at it. It doesn't matter whether there's a really good reason for riding into the sunset, I still find reasons for wanting to stick around long past closing time. Days I couldn't wait to resign my job in Colorado turned into days I loved it, even though I was leaving for medical school at last.

It's the same way now, even though I'm leaving to begin residency, also at long last. Only this time, I don't have to look for reasons, they're all around me. For instance, about ten minutes ago, the dogs and I were making our afternoon rounds along the edge of the hayfield when my big dog pulled up suddenly. I looked down and he was nose to nose with either a big woodchuck or an equally large beaver. They resemble one another and despite my friendly greeting, he didn't seem inclined to introduce himself, so we hurried on.

But things like that make it hard to move.  Cool, quiet, starlit nights, immune to the sounds of the city. and breezes off the freshly mowed hay, later in June, are things I'll miss. Yes, I'll get to see the Detroit Zoo and perhaps hear the Detroit Symphony, but my roots are in the country and I'd gladly trade the zoo for the porcupine that lives under the barn or the woodchuck in the hayfield.

I know this is my "big chance," as they say in show business, and I'll be glad to settle in and get to work. Time passes quickly, I learned in medical school. Residency will, too, and sooner than I imagine, I'll be packing again, to come home. In the meantime, though, warm days and woodchucks make me appreciate the life I've had, here on the farm, that much more.  

(Photo copyright 2014 by the author)

Thursday, May 22, 2014

The Secret Life of Walter Mitty

Beauty doesn't ask for attention. ~ Sean O'Connell

My friend and co-author, Dr. Lynn Smith and I used to talk at length about what we called the "Walter Mitty personality type." Risk-aversive, detail-oriented, traditional (though not necessarily conservative), and inclined to play by the rules. Good, solid people like Bilbo Baggins, who aren't likely to rush out their front door in pursuit of adventure. Their secret is, they'd like to. They dream about it, but they can't let go. Until they have to.

This is the story line for the marvelous film, The Secret Life of Walter Mitty (2014), starring Ben Stiller. By day, Mitty is a quiet, unobtrusive supervisor in the photographic negative department of Life magazine. At any other time, his imagination may have him miraculously rescuing damsels in distress or besting arrogant, narcissistic asses like the one in charge of transitioning Life from a print to online format. In daydreams, he's everything he's not from 9 to 5: creative, brave, articulate, and appealing. In life, he can't even bring himself to speak to the woman who's stolen his heart.

Whatever author James Thurber originally intended, this particular film version depicts a journey of the soul. Mitty is an ordinary guy who's become a worker bee. He contributes, he's efficient, he does his job very well. His life has purpose but no passion. He'd like it to and his daydreams are filled with it, but he's ambivalent. Even his e-Harmony profile is incomplete. He's at a crossroads and needs a guide, a mentor, someone who can show him how to make his own choices and live his own life.

Enter Sean O'Connell, played by Sean Penn. O'Connell is a photographer of the old school. He still uses film and submits his photos for publication by snail mail. He doesn't own a cell phone and would probably misplace it if he did. He's unpredictable and follows his own rules. As it happens, he sends Mitty a roll of film with instructions indicating the last negative on the roll is his preferred photo for the final cover of Life

The problem is, Mitty can't find it. It wasn't enclosed in the packet containing the rest of the negatives. Nearly at wit's end, he notices a photograph of O'Connell and imagines him beckoning for him to follow. Without warning, Mitty dashes out the building and boards a plane for Greenland, O'Connell's last known location. No baggage except a briefcase, no clothes except for what he's wearing on his back. 

Unable to hook up in Greenland, he follows O'Connell to Iceland, and on to ungoverned Afghanistan in the high Himalayas, where he stumbles upon him, photographing the elusive snow leopard. O'Connell explains the negative was in a wallet he sent Mitty as a gift. Ironically, the negative was in Mitty's possession all the time, but he was so focused on where it ought to be he couldn't consider where it might be.

O'Connell thought he was being "playful," assuming his partner would get the joke. Mitty saw it differently. Sixteen years and millions of negatives made him good at his job but lousy at spontaneity. In the course of things, he'd forgotten how to play. He's not alone; a lot of us are like that. The pressures of life and work build until we take everything so seriously. We turn to alcohol or drugs to unwind, but they don't help, not really. They disinhibit, that's all. Play is something more basic, more in touch with what makes life worth living.

Observing O'Connell refuse to take a shot of a snow leopard because the moment itself is too precious, Mitty realizes some things are too special to be captured. They can only be experienced. Moments later, playing soccer with a group of young Sherpas, he learns that play and transcendence are linked, and both can find expression in the work we do. Mitty knew all about work. What he needed to learn was how to play once again.

On returning to New York, Mitty confronts the arrogant narcissist in a way that, unlike his earlier fantasies, doesn't involve physical violence. Having rediscovered himself in O'Connell's company, he is able to speak as a mature man with a secure and certain center, to a spoiled and self-centered child. No longer fearful and timid, being with the archetypal "wild man" has changed him. He commands respect and his words carry weight. 

Does Mitty ever get the girl? You have to see the film to find out. Sorry, I'm only willing to leak so much. Besides, you do want to see why that bloody negative was so important, right? Most of all, The Secret Life of Walter Mitty is worth seeing for a contemporary glimpse at the ultimately spiritual journey to earn and achieve maturity, to become confident, to feel truly capable as a human being. It's a study in contrasts, too, between Mitty, who is willing to undertake the journey, and an arrogant narcissist who for all his posturing, has not and probably never will. 

(Creative Commons image by Sheng Wang via Flickr)

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