Bed and Breakfast

As you can see from my photo, the ordinarily well-behaved stream that runs behind my house, through the hayfield, and down to the river, had a tantrum last night. The ground was already soaked from heavy rains a week ago, so what fell the past two days just skipped merrily along, obliterating the banks of the stream. Birds have been having a heyday, nabbing worms floating in the newly-formed Lake Hayfield, which was taken over this afternoon by a pair of ducks looking for a bed and breakfast. I told them there was no charge, just change the linens when you leave.

Seriously, though, I wasn't expecting quite this degree of flooding, but it's nothing compared to the rest of Southern New England. At least there wasn't tree damage or power loss, and for that, I'm grateful. Things could easily have been much worse.

It's a tribute to Mainers that the most I've heard anyone say is, "That's a lot of water." I think that's one of the things I appreciate about them, it takes a lot to get them agitated. Admittedly, I've only lived up here four years, but I've yet to meet Chicken Little. If there's a blizzard in the forecast, people stock up on candles, flashlight batteries, and lantern oil, but otherwise they're pretty calm. The day after, my snowplow guy drops round and comments, "Yep, that's a lot of snow."

Before coming here for medical school, I'd only visited coastal Maine on vacation. During the summer the seacoast towns are so crowded it's hard to tell the locals from the tourists without a program. In the off-season, however, Mainers come into their own, and for the most part, seem to cultivate a coping lifestyle. They remind me of the ducks out in the hayfield. It rains, the stream overflows, and instead of wringing their hands and wondering when the next shoe's going to drop, they invite a flock of Canadian Geese to join them. I like that.

As long as they change the linens when they leave, that's all I'm asking.


(Photo by the author)

Morning Relatedness

Image via Wikipedia

I'm intrigued by the things that come to mind within the first few minutes of rising -- random thoughts that surface while shaving or making breakfast. Maybe they're the residual of dreams or something that occupied us as we drifted off to sleep, and now they're playing around in the cerebral cortex, stamping through puddles of coffee like a kid in a rainstorm.

I was in the middle of fat-free-frying (try saying that seven times fast) hash browns with scrambled egg beaters this morning, when I started thinking about empathy. As happens occasionally, my thoughts took the form of an internal dialogue in which I was talking to a non-specific someone and mentioned that, at a broad level, empathy, the ability to imagine how it might feel to be in another's shoes, generates the atmosphere which makes relating possible.

That lead me to think about what it must be like living with someone who is so self-oriented as to be incapable of empathy and thus possess an impaired capacity for relatedness. Now, this can take many forms, ranging from attention-seeking and dramatic behavior to out and out manipulation. But it occurred to me that in these situations, a normally empathetic partner might have to become self-interested in the interest of survival.

I think this helps explain why some relationships seem so sterile. Empathy triggers consideration and mutual respect. Without it, partners become defensive whether they're aware of it or not. It doesn't have to be intimate relationships -- even casual ones can involve throwing up walls of self-protection. In the language of recovery, we'd say a particular person wasn't "safe," and their characteristic way of interacting failed to create a sense of comfort in others.

I learned a long time ago to rely on what my dog says about a person. Not that he takes me aside and whispers in my ear, but his behavior tells me whom he regards as approachable. Whether by instinct or intuition, he knows who will appreciate his attention. Lacking whatever it is he has and not always having recourse to a dog's presence, we humans have to work at developing a similar ability, but I think it's well worth the effort.

The Rasputin Bugs

They look like wasps and I've never given them an opportunity to show whether they sting, but it's almost time for them to make their annual reappearance here on the farm. I'm talking about Rasputin Bugs, as I've christened them, because of an exoskeleton that renders them fairly resistant to whacks from the flyswatter and therefore, wickedly hard to kill.

They're namesake was a monk-charlatan who weaseled his way into the court of Tsar Nicholas II of Russia. Legend has it, on the occasion of his murder, he'd been poisoned, beaten, shot four times, and then drowned. I'm guessing someone was either obsessively thorough or had serious anger management issues.

In any case, Rasputin has become an image for the ultimate villain, who is typically, extremely difficult to eliminate. Alexander Godunov, for example, in the original Die Hard (1988), is beaten up by John McClane, hung by a chain, and just when we think he's done for, manages to rise from the rubble of Century City to get blasted four or five times in the final scene. Sound familiar? Film mythology often depicts evil as an animating force exerting its influence when death would have claimed lesser folk. There's something genuinely cathartic about seeing evil incarnate finally getting its due.

This is not to say I enjoy playing Lord of the Flies with the insects. Frankly, I'd prefer they stay outside and do whatever it is they do in Mother Nature's Grand Scheme. My primary concern is the cat's fascination with them and the possibility of having to take him to the vet with a swollen snout. I've tried shooing them out the window but their response has been rather like, "If we wanted outside, we'd go on our own!" Spraying Blag Flag is about as effective as offering them a dash of cologne and smells worse.

So, I'm left with the flyswatter. In case you have a similar problem, I've found the metal handled variety works best. The length provides leverage and the metal can be reshaped after the five or ten blows it usually takes to nail one of these guys. The plastic type breaks too easily. Like I say, they're Rasputin bugs.

13 -- Once Again

While I didn't take out any toes last night, I think I managed to wear out a few partners. I was the only complete novice and until I began to get the hang of things, it must have been a challenge to dance with me. I'm tall, have a long stride, and honestly, I didn't know whether to lead, follow, or get out of the way.

The setting was a typical dance studio in the downtown arts district such as might be seen in White Knights (1985) or Fame (1980, 2009), with floor to ceiling mirrors on both sides of a wooden floor. Never having been in such a place, I didn't realize how helpful it would be to see your reflection as you practiced the steps. It didn't help to be reminded of the extra pounds I've been trying to shed -- or maybe it did, depending on how you look at it.

The instructor was a delightful, energetic fellow with personality to burn. I wasn't certain what to expect from a group lesson, but he's a good teacher and as I walked through Whole Foods afterward, I found myself wanting to practice what I'd learned, though dancing down the aisles seemed a little premature. Gene Kelly could have gotten away with it, but I'm not quite ready.

Most of the students were within range of my age group, but at the dance party that followed, younger partners showed up and I suspect they're from more advanced classes. Figuring I'd done enough damage for one evening, I gave the instructor a thumbs-up and slipped out the door. After I've had a chance to practice, I'll stick around to strut my stuff.

There's more to this scenario, however, than being comfortable with the skills. At the point in the evening where I would have had to ask a woman to dance, I was no longer an adult who had dealt with violent psychiatric patients, coauthored a book, and was now a medical student. I was a thirteen-year-old ninth grader, only this time with no female classmate to come to my rescue (see 12/3/09). Yes, I'll feel better once I'm more confident, but my task is isn't merely to become more proficient on the dance floor. It's to become more comfortable being myself in a setting where I might prefer to run, not walk, out the nearest door. And that's going to take some practice, too.

Oh, by the way, I had fun last night, a lot of fun. My life has become so insular lately, I'd almost forgotten how good it can actually feel being 13 -- once again.


(Creative Commons image by Jerry Daykin via Wikipedia)

Is There an Osteopath in the House?

So, tonight, I'm off to dancing lessons and I have to tell you, I feel a little self-conscious about it. Now, to be sure, anyone else who's going to be there (aside from the instructors) knows about as much as I do, which is next to nothing, so I'm in good company. Ordinarily, I'd be particularly nervous about learning something that involves muscle coordination, but medical school has actually helped in that regard.

As osteopathic students, we're taught techniques that fall under the rubric of Osteopathic Manipulative Medicine, which means we work with the body to diagnose and treat certain kinds of illness conditions. We learn how to be sensitive to changes in muscle, skin, and the various other tissues that make up the body, and how they influence one another. It's just one more tool in the kit to help us help patients, but it's also helped me gain a sense of confidence about using my hands in ways I'd never done previously.

As a result, I don't think feeling uncoordinated is going to be a major problem this evening, though one never knows. Placing your hands in the proper position to correct a muscle spasm is one thing, getting your feet to cooperate with dance steps is, no doubt, another. This is one time when a little OMM from one of my classmates to help me relax might be what the doctor ordered.

In lieu of that, I'll try to remember to breath and avoid injuring anyone's phalanges (the bones in the feet that correspond to the fingers). On second thought, I've got an idea: why not simply get my head examined? I mean, I've gotten through life thus far without having to trip the light fantastic (much), do I really want to alter my track record now? I know, stop making excuses, I'll be fine. You're probably right. I suppose the worst that can happen is someone will step on my toes and then I'll really need OMM. I'll let you know how it goes tomorrow.

In the meantime, just in case, is there an osteopath in the house?


(Creative Commons image by William Hamon (aka Ewns) via Flickr)

Dancing with the Stars? Not Yet

In my dreams, I'm Gene Kelley or Fred Astaire. Mostly Gene because he was so darned athletic and besides, in Singin' in the Rain (1952), he had Cyd Charisse for a partner and she's hot as a pistol. And then there's the scene with the umbrella -- I'd love to do that one. Did you know he had a fever of 103 at the time and most of his moves were made up on the spot? Fred's got style and grace, but he never seems to break a sweat. That's too cool for me. No, Gene's definitely my kind of guy. Patrick Swayze would work, too.

I'm talking about dancing, of course, and not as a metaphor. I realize it's one of my favorites and I try to use it sparingly. This time I mean the real thing, putting my arms around a girl and moving in time with the music without looking like a complete geek. And therein lies the problem. I don't know how to dance. At least not in public and not without getting arrested.

Why worry about it? you ask. Well, a good friend of mine is going to be a June bride and I'm pretty sure there will be dancing at the reception. Begging off one with the bride is not an option and the last thing I want is for her to think, OMG, he's a klutz! If the music was such that I could count on the floor resembling a mosh pit, that's one thing. Raise your arms in the air and sway back and forth. I'm a musician, I've got rhythm, I can do that. No special skills required.

Something tells me, however, I'm not going to be so lucky. Ballroom dancing seems to be making a comeback and that brings me back to ground zero. There's only a little over two months between yours truly and the four opening notes of Beethoven's Fifth Symphony, fate knocking ominously at the door. Short of hiding in the hayloft of my barn, I've got to do something.

Fortunately, there is a local studio that offers a six-week beginner's course in the basic ballroom styles -- foxtrot, waltz, and swing -- so I guess I'll be adding a new element to my current board preparation schedule. I doubt Gene or Patrick will have to worry about competition, six weeks won't qualify me for Dancing with the Stars. As long as it looks like I know what I'm doing, I'll be happy. Sweeping someone off their feet can wait for the "intermediate" class (smile).


(Creative Commons image of Gene Kelly and Cyd Charisse by Korova Interociter via Flickr)

Expression Without Fear

-->Does anyone use a percolator anymore? To make coffee, I mean. The last time I used one was on a Boy Scout camp out. Perhaps the large, spigot-types can still be found at AA meetings, having become almost symbolic of 12-Step communities. Generally, though, they've been so thoroughly replaced by drip makers, some of my classmates may have never seen one.

Percolators work like this: a basket filled with ground coffee and a hollow stem is inserted into a pot filled with water. Usually, an electric current heats the water until it begins to bubble up through the stem and wash over the grounds. My grandmother placed hers on a wood stove and I heated the one I mentioned over an open fire, but the effect is the same. The downside is, if you're not careful using one of these gadgets, you can make the coffee strong enough to practically strip rust from beneath your car.

The upside is they've given us a great figure of speech: bubbling up. And, as you're probably thinking, something has bubbled up for me. If you've followed this blog or looked back over some of the more serious posts, you know I have one or two convictions that I let surface occasionally. One of them I learned as a child, namely, it's a good idea to follow the Golden Rule whenever possible.

I'm troubled, however, and deeply so, when convictions become the basis for hurtful behavior and specifically, I'm referring to hate messages received by members of Congress who voted in favor of the health care reform bill. What concerns me is not the bill itself, but the implication that voting one's conscience is dangerous to health and family. Convictions are powerful things and in a free society, one ought to be able to express them without fear.

And it's the mode of their expression that is at issue. I have friends who fall on opposite sides of the fence when it comes to a woman's right to choose, but our relationships are based on other factors besides politics. We've learned to respect one another because there's more to us than merely this one thing.

And maybe that's the problem. People resort to threats when they don't see how they have any other way to get their point across. Either that, or they've lost sight of what my friends and I have learned, that in the real world, we are more important than the discrepancies between us. Don't get me wrong, I believe strongly in the value of ideas. I just believe we serve them best when we refrain from turning them into baseball bats and threaten to use them to beat other people over the head. Figuratively or literally.

Discovering Serenity

Lately, I've been exploring websites dedicated to the adoption of rescue horses and I'm not entirely certain why. I don't have the disposable income to purchase one, much less care for it, and make no mistake, having horses can get expensive. But I'm intrigued by the fact that, because of rescue organizations, a horse can be obtained for a relatively small investment.

I've noticed registered Thoroughbreds, for example, selling for less than a couple of thousand dollars. That may seem like a lot, but it's small change compared to what the same horse would bring, purchased from a breeder. Not all Thoroughbreds are race horses; the ones interesting to me would be for hunter-jumper type riding, but even there, you could easily lay out five to ten times the amount you'd pay for a rescue horse.

In actuality, it's the concept that lowers the price. Most shelters are smaller operations and turnover is important for maintaining cash flow. The point, however, is to find good homes for animals who've been mistreated or, particularly in hard economic times, given up because their owners can no longer afford them. In that sense, it's no different from going to an animal shelter for a dog or cat, where you'd naturally expect to pay less than if you'd gone to a professional kennel.

This still doesn't explain why I've been looking nor why I've recently dreamed of being held by a horse's gaze. According to one source, horses that are darker in color represent mystery, strength, and endurance. The ones in my dreams have definitely been dark and the look in their eyes is mysterious, so we can put that in the hopper. Mostly, though, I think I just miss their company.

A couple of years ago, one of my fellow students suggested I go out to a local stable and rent one for the afternoon. I thanked him and declined. I want to establish a relationship and renting is too much like hiring a maid in the anticipation she'll act like a wife. She can cook, clean, and iron your shirts, but don't be disappointed when she goes home after a hard day. Not that I'd expect these things of a wife; I'm sufficiently liberated so as to share household duties and can definitely iron a mean shirt.

No, having a horse in your backyard goes deeper -- it's grounding. It connects you with a peaceful center that a walk in the woods imitates but can't quite replicate. Or so it is for me. I notice it going by my neighbor's pasture when her horses have wandered near the lane my dog and I walk. I know them by name, having become acquainted one day when they got loose and trotted gaily past my house. I ran after them, lariat rope in hand, Cowboy Beggar gone back to his roots. Anyway, we stop, I speak, they look back at me intently, and something passes between us that, for all the world, feels like discovering serenity.

(Public Domain image via Wikipedia)

An Immigrant from the West

In a New York Minute, everything can change. ~ The Eagles

New York -- the city? I've never been there. Moving to Boston -- well, that was like relocating to the other side of the world. The moment my dogs and I drove across the Texas-Arkansas state line, everything was new. The Mississippi River, I'd only seen on film, and Memphis was a place where guys like Mark Cohn walked, but not me. Skirting the deep South felt like falling into history with markers on the side of the road pointing to places like Shiloh, where thousands of others fell on a spring morning.

Somewhere along the Blue Ridge Parkway my big dog -- the alpha in a pack of two -- began to vomit. Not a little, but a lot, and moments later I was racing my truck and U-Haul trailer down the highway looking for a veterinary clinic a stranger told me about in a gas station. I pulled off in Lexington, Virginia, the home of Virginia Military Institute, from whence cadets had marched away to halt an advancing Union Army in 1864. It was food poisoning and he lived to see me through my first year of medical school.

Back then, however, medical school wasn't even a blip on the radar screen. I was as green as a boy can be driving into Boston and for weeks afterward, felt like a barefoot hayseed from the country, seeing the big city for the first time. I remember walking into a store in the North End, curious and "just looking." The proprietor eyed me cautiously -- turns out, it had once been a meeting place for the local version of the Mob, maybe it still was. It was like being an extra in a scene from The Godfather, hoping my face wasn't memorable.

Up to that point, for me, multicultural meant Latino and African-American. But in my new neighborhood, Orthodox Jewish persons could be seen on the sidewalk any day but the Sabbath. Waiting for the Green Line train into downtown, you almost needed a handful of dictionaries to decipher the conversations you overheard. There was a real Chinatown, just beyond the southern border of Boston Common. I think it was south -- sometimes I needed a compass to know for sure.

Living there, even for a little over a year, was an eye-opener. I found out about Zeppy's Bagels, pizza by the slice, Patriot's Day, and ran following someone I'd never met who was bearing the 1996 Olympic Torch. In a town where disentangling English from Bostonian was trying at best, people asked me where I was from because they said I had an accent. It never occurred to me to think of myself as an immigrant from the West, but in a way, I was.

One of best things about Boston is the Fourth of July. You go down to the edge of the Charles River, find a spot in the crowd, and wait for fireworks -- the most amazing fireworks. After the show, the city opens Storrow Drive, a major east-west artery, to foot traffic. All the differences Boston embraces 364 days of the year seem to vanish in a New York minute, as joy becomes our common language. I can't help but think it should be that way all the time.


(GNU Free documentation image of Boston Common from the Prudential Center via Wikipedia)

Health Care: Getting Our Priorities Straight

I don't know what economists would think of me. I don't believe in government owning the marketplace, which is what I'd call communism. Nor do I necessarily believe in government competing in the marketplace to the detriment of private companies, which I'd consider as a type of socialism. The first limits freedom by definition, the second by implication.

The government as a purveyor of goods and services is like a therapist dating a patient. Maybe he's seen her only for a consult or initial interview and then referred her to someone else, but a contact has occurred and that renders dating an unequal relationship implying unfair advantage. With governmental participation in the marketplace, a similar unequal relationship exists, which may also result in unfair advantage.

But here's the thing, I don't believe in a completely restraint-free marketplace, either. I think child labor laws are a pretty good idea. Workers ought to be able to organize in order to negotiate the terms of their employment. Unregulated use of the environment does not lead to the self-management of resources. Instead, it leads to species extinction and pollution. I'm sorry, but people are people and if We the People don't take steps to monitor our behavior, excesses ensue. This is why our children need to study history.

I've said all this as a preamble to bringing up health care and the legislation passed in Congress last night. My experience has taught me there is something foul afoot in the insurance industry. It is true that the cost of health care has gone up while the ability to pay has not. It is also true that there is an increasing demand as well as increasing need for high-quality health care services. I just don't believe the solution to this dilemma lies solely within the purview of economics.

I think it comes down to ethics. The things we value most are the things we generally find ways to afford. We may have to sacrifice in other areas, but somehow we manage to get the job done. If I have to forgo a new car to buy shoes for my children, I drive the Chevy another hundred thousand miles. Placing a value on the health of our citizenry means we aren't willing to settle for someone going without. And, by extension, it means we are going to take steps to ensure they have equal and affordable access.

In the course of the current debate, both sides have railed back and forth about cost-containment and where will the money come from. I've been waiting for a practical application of "we pledge to one another our lives, our fortunes, and our sacred honor." If those words were good enough in 1776, why aren't they now?

It seems to me the greatest thing we could do as a nation is demonstrate to the entire world our firm intention to take care of each other. Not because we have to, not because we need to, but simply because we believe it's the right thing to do. Once we've settled the question of ethics, the problems of cost and payment become challenges to overcome, rather than obstacles in the way. The place to begin is by getting our priorities straight.
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Another High School Reunion?

A friend once told me there was a correlation between the year of a high school reunion and its function. The tenth was about strutting our accomplishments and seeing who'd gone farther and faster. Lots of testosterone, in other words. By the twentieth, we were supposed to have grown up enough to begin enjoying one another at last. She couldn't speak about the thirtieth and beyond because she hadn't been down that road yet -- "I'll send you an email about it when I get there," she said.

Well, I missed my tenth, but she was right about the twentieth. It was fun seeing people I'd known, loved, and hadn't heard from in what suddenly seemed like a long time. I was surprised by some of the changes. One "girl" I hadn't recalled for her athletic interests, was running marathons. I'd expected a classmate who was a gifted musician to have gone to Julliard and now he was a corporate officer. There were some I could scarcely recognize and then there was one of my closest friends present with her husband and daughters; I'd have known her anywhere.

So, there were things that hadn't changed. Someone who used to tell me how she wanted to sit down and talk but never did, approached me and said, with a knowing look, "I want to talk with you later on." She slipped away to the dance floor and that was the last I saw of her. We'd known each other since grade school and I couldn't help but smile, wondering what she wouldn't allow herself to tell me. I still wonder, sometimes.

And then there was the friend I realized I'd been an idiot to have failed to ask on a date. She'd grown into a sensitive, thoughtful, and lovely woman, soon to marry some guy who went hiking rather than attend the reunion with her. I remember her standing in the sunshine, light brown hair turned to gold. The one who got away.

I found an email in my box the other day and it's time for another reunion. This one should be interesting. For one thing, my good friend's daughters are old enough to be my classmates. How's that for a turn of events? Their parents are likely contemplating retirement and I'm embarking on the career of a lifetime. I'm curious if I'm the only one or are there others who've had to go backwards in time to find themselves. If there are, that's where my party will be.

Early August is the date set by our committee. I suspect I'll gain not only something worth writing about but also some perspective. It will be like looking through the window in my study and instead of a hayfield, seeing the person I used to be, before beginning clinical rotations as the one I am now. The band will cover the music of The Rolling Stones and Creedence Clearwater Revival and my car stereo will continue to blast out a mix of Rap, Rock, and whoever is newest and grooviest. Wait a second, did I say groovy? Sorry, a little mental lapse. I meant, coolest. Yeah, that's it.

Whew.


(Creative Commons image of a class reunion unknown to the author by davef3138 via Flickr)

The Lessons of Scouting

I'm not going to chase the topic of Gays in the military this morning, though I feel like I have to mention it because it has some connection to where I'm actually going. It seems to me a moot point, because there already are Gay men and women in the military. They've been there for a long time, very likely going back to 1776.
Homosexuality is not an invention of the 20th century."Don't ask, don't tell" strikes me as playing make-believe. But I realize change occurs slowly, for better or worse, and it took a long time before we realized African-Americans had the right to be granted equal status within the Corps.

For several years I was an adult leader in the Boy Scouts. What has gained Scouting national attention over the past few years has been it's position on homosexuality. I've always thought that whole state of affairs was unfortunate, because at the time of my involvement, Scouting was (and still is, by the way) an opportunity to work with our sons or sons of those we knew and help them move toward developing their potential as leaders. From that standpoint, it was an incredible experience. I'd even go so far as to say it was one of the best of my adult life.

Ours was a small troop but that worked to our advantage because it permitted everyone to participate and have some responsibility. The parents, mostly dads, and I took our kids camping, rock climbing, white water canoeing, and spent a week each summer fighting off mosquitoes in the Texas heat at summer camp. The boys sold fertilizer and trash bags, door to door, to raise money for our operating expenses and completed service projects in the community. By the time my tenure was over, if a year went by without one of the guys earning his Eagle badge, we made it up with two the next.

Becoming an Eagle Scout is not a guarantee of success in life, but it does seem to help. I won't list all the famous persons who've earned the rank, you can check that out by following this link. What is important about it, as I see it, is the way it serves as a rite of initiation. I've witnessed boys walk into an Eagle council, where adult leaders evaluate his accomplishments and make the final determination as to whether he has earned the rank, and walk out young men. The transformation was literally visible. I don't know how it happened, I just know it did and it always left me in awe.

Unlike most of the adult leaders I've known, for a number of reasons that aren't important, I wasn't a Boy Scout growing up. Did I miss anything? If I did, I gained it as an adult leader and mostly from the boys themselves. By helping them establish maturing identities and grow in self-awareness, I grew in much the same ways. They taught me how to enjoy life, embracing it fully, and not worry about making a fool of myself. Do I ever owe them for that one. In a lot of ways, we learned the lessons of Scouting together. They learned how to lead and I learned how to parent. It was a true collaboration and I'm grateful to have been a part of it.


(Image of unknown licensing via Wikipedia)

We Were Discussing Eagles...

The first time I came close enough to a bald eagle to consider introducing myself, was one afternoon in Southern Colorado. My dog and I were taking our walk around the lake near my late father's home when I noticed a large shadow on the ground ahead of us. At first I thought it might be a cloud and when I looked, there was an eagle sitting in a tree above me.

"Beg, what's a neagle?"

"It's a bird, like the ones you enjoy watching out the study window in the mornings, though much larger. And it's an eagle, not a neagle."

"Okay."

I was surprised to see one so near civilization, and assumed it was contemplating a trout dinner from the lake. We stood there for a moment, and --

"Beg? What does a neagle eat?"

"Some of the same things you used to eat when you were living on your own: fish, small rodents, sometimes a turkey. You get regular cat food now. Once again, it's an eagle -- when the letter 'a' is followed by a word beginning with a vowel, we add 'n,' making the word 'an.' Why are you asking?

"Because I think there's one out in the hayfield and I'd like to go out and 'make his acquaintance,' if you get my drift."

"I'm sure you would, but he's way too big for you. As a matter of fact, you'd look like dinner to him. And besides that, I don't want you to pick up any fleas."

"I think I could take him, anyway."

"I have no doubt. Now can I get back to my writing?"

"Oh, sure, go ahead. I won't bother you anymore."

So, where was I? Right -- we stood there a moment, me wondering whether our movement might frighten it away, when --

"Beg? What's a flea?"

"It's a little bug that makes you itch! Now, please, can we finish this conversation later? My patience is wearing thin."

"All right, but don't you wear clothes?"

Sigh. My mother told me there would be days like this.


(Public Domain image via Wikipedia)

Day of Days

Well, this is it, the day of days, when most of my entering classmates learn where they'll spend the next four years in residency training. I admit to sitting on pins and needles and I'm not even involved, except as a highly invested bystander. These are my friends and I want them to be happy. We've worried our way through exams together, helped one another cope with stress, and gotten close in ways we couldn't have expected when we began this journey.

I'm not certain we consciously intended to build community, but that's how it has worked out. We had older students, younger ones, several connected with the military, many from New England or the East, a few of us from the West. It wasn't as though there was any one thing that you could say we had in common aside from the desire to become doctors.

We were challenged, though, on the first day of orientation, to resist the temptation to compare grades, and instead of viewing the successes of others as a threat to our own, embrace them as representative of our class as a whole. The real world of medicine, we were told, depended on collegiality and now was as good a time as any to begin practicing it.

I'm going out on a bit of a limb here, but I have an idea that we've enjoyed medical school more because we took those words to heart. This is just my observation, but I've been observing us fairly closely for the past four years and I really believe we discovered that by supporting and encouraging one another, we've gone further as individuals than we might have otherwise. The lone wolf mentality is fine for premeds but once we're in the pressure cooker of medical school, it helps to have someone pull you out of the water once in a while.

To what extent we'll be able to maintain our communal identity over time remains to be seen. We've done fairly well with most of us rotating whole states away from campus. Now that residency is upon most of us, the distance will continue, but I honestly think we've impacted one another in ways that will have lasting effect. We came here for an education and we'll come away having become part of something far deeper and more profound. We'll come away having become part of each other and that is simply amazing.


(Creative Commons image by cygnus921 via Flickr)

The Match: Against the Grain

Against the grain should be a way of life. ~ Chad Kroeger

In case you don't recognize the name, Chad Kroeger is lead singer and lyricist for the Canadian rock band, Nickelback. In case you've ever wondered, the name comes from the days of Kroeger's day job, working at a Starbucks. When giving customers their change, he used to say, "Here's your nickel back." This post, however, isn't about him, the band, or their music.

It's about going against the grain and, yes, it's also about the residency match.

Specifically, it's about making counter-conventional choices, being counter-intuitive, and contrarian when pretty much everyone else is doing otherwise. The kicker here is time. It's perception creates pressure no matter how much of it we've accumulated. If you're a fourth year medical student, your time card is already punched with eight years of higher education and now you're looking down the corridor at four more in residency. You're in debt up to your eyeballs, thinking about marriage and family, and the bloody clock is still ticking.

Mom and dad want grandchildren but they also want us to be happy, so no rush, just remember, they're not getting any younger. As if we needed to be reminded. Exit counselors at school inform us about interest on loans, repayment options, and the effects of managed care on physician income. Like we didn't know what we were getting ourselves into when we started this whole thing. Throw in the Match and it's enough to make a person reach for the Macallan and a glass -- wait, forget the glass, just hand me the bottle.

Into this mess walks a friend of mine who is intentionally taking a year off before starting residency. It's a gutsy move. She's taken a look at what she's been doing and decided to salvage the time and clear her head. She wants 12 months of real life before playing doctor another 48. What most students fantasize about, she's going to do. Her plan is still under consideration; she may do research or simply get a job at Starbucks. The point is to learn what it's like to live outside the rarefied air of academia. I say, Bravo.

You'd expect that response, coming from a guy who's spent most of his life getting the experience she's after. But this isn't about self-justification. I like her. I like her a lot. She's her own person and I value that tremendously. I value her willingness to trust her instincts and respect her own judgment. And, speaking as someone who's been where she's going, I feel confident in saying she'll be a better doctor because of what she's going to learn.

So, maybe you don't match this week, despite everything you've done and you've done everything you could. There's no question this is a loss, but it can also become something more. It depends on what you do with the time. A person doesn't have to be a medical student to run into brick walls that can neither be gone around, under, over, or through. As they say, been there, done that, got the T-shirt to prove it. What makes the difference is how well we go against the grain and turn the luck of the draw into a choice. What we do with it then, of course, is, as always, up to us.

The Match: Round Two

There's nothing like a little humility. Yesterday, I thought I'd struck upon a theme that most of my younger peers might have overlooked, i.e. connecting Matchmaker from Fiddler on the Roof with the residency Match. Thanks to an anonymous reader in New York, I've discovered at least one other blog writer who had the same idea, perhaps near or at the same time. The collective unconscious strikes again.

Anyhow, I can't help thinking, this morning, about students who didn't match. According to the statistics, about 85% of students get one of their three top choices, but 6-7%, for one reason or another, do not match at all in the first round. Today, these students will "scramble" to connect with a program that has unfilled positions. It is to the advantage of programs to accept such students because they have staffing requirements to meet. So, it's not as though you're out of luck if you didn't match on day one, but it's disappointing and stressful nonetheless.

It's easy to identify with someone in a situation like this because, for me, obtaining admission to medical school was anything but straightforward, as I've mentioned previously (see 7/23/09). While many of my classmates had the opportunity to pick and choose among several offers of admission, I didn't. I could have envied their good fortune, but I've chosen to admire them for it, instead. Envy, one of the seven deadly sins, does nothing but reinforce one's sense of deprivation. Admiration, on the other hand, helps us appreciate the quality of our company. Besides, I've gotten what I wanted, and the struggle has made me all that much more grateful for it.

I hope it works out similarly for the scramblers. They may not get their first choice of specialty and, as a result, have to spend some time in a related one and transfer later on. Or, they could opt out of the process altogether, do research or community service and try again next year. They might even find they love the choice they felt forced to make more than the one they'd dreamed of. You can never really tell how these things are going to work out. The discarded oyster contains the pearl of great price. Life has a way of holding off until we've been knocked down in the first round before helping us come back like Muhammed Ali in the second.


(Creative Commons image by Oldmaison via Flickr)

The Making of a Match

Matchmaker, matchmaker, make me a match, find me a find, catch me a catch. ~ Fiddler on the Roof

If it were only that easy. Today is the first of four critical days this week, when fourth year medical students find out if they have been snatched up by one of their choices for residency training. Tomorrow, unfilled positions will be posted and students who did not find placement can pursue alternatives. Thursday is Match Day, when you learn the name of your "dancing partner" for at least the next four years.

There's no village matchmaker for these decisions, unless we count the NRMP (National Residency Matching Program), which takes student applications and residency program evaluations and coordinates pairing-up. It's not automatic that a student gets their first choice and hence, the tension. Today's "will I match?" becomes Thursday's "where did I match?"

The process actually began last fall, as students completed showcase rotations at hospitals where they might like to become residents. These are opportunities to demonstrate your interest and capabilities within a given field. It's a time for evaluating a program and getting well-acquainted with program personnel. Practicing physicians often say residency committees are, essentially, asking of applicants, "Do we like you and can you play well with others?" In short, do we want you around for four years?

Applying for residency is like filling out a list of potential boy or girl friends and then waiting to see if any of them are interested in you, too. The last thing you want is to end up a wall flower waiting for a partner when the music has already started. From the chatter on Facebook, it appears my class has done well and the floor will be crowded in July when training begins -- I couldn't be happier! Two more years of "lessons" and I'll join them, hoping by then to have learned how to dance without stepping on my partner's toes (smile).


(Creative Commons image by angelsk via Flickr)

Hello, 911? I Need Help -- Fast!

I was munching chocolate chip cookies drizzled with a thin, lacy, maple frosting when my stomach grumbled, dragging me out of a sound sleep. Cookies would be nice, I thought, savoring the fleeting memory of dreamland, except I haven't baked any in over a month. A muffin might do the trick or a banana, something to get me through until breakfast -- at 3 AM who's picky?

I started to throw back the comforter when I heard whispering. Now, since I'm the only human in the house and hadn't said a thing, you might regard this as unusual. So did I -- and there it was again, a surreptitious sliver of conversation coming from the left side of the bed. I slowed my breathing, trying to listen closely. "You go," said a tiny, authoritative voice, followed by, "No, if you're so brave, you go!"

Okay, I'm finally having a stroke. All those years of exercise and watching my diet and cholesterol have been a waste of time. I rolled over slowly, intending to reach for the cell phone on the night stand and call 911, when I noticed my cat sitting on the floor. He glanced up at me, placed a paw to his mouth and said (said?) "Shh." Oh, God, this is worse than I thought, first auditory, now auditory and visual hallucinations. I'm a goner for sure!

He must have noticed the panic forming on my face, because he sighed and crept to the edge of the bed as stealthily as only a cat can, leaned close to my ear and said softly, "I'll explain later -- watch and learn." Settling back onto the floor, he whispered with a deep, Darth Vader-like quality, "The cat's asleep. Old and decrepit, he needs his rest."

From beneath the metal heating radiator along the wall I heard a voice echo, "See? I told you, there's nothing to worry about. Go on, now's your chance."

"Wait a minute, don't rush me! Who said the cat's asleep, anyway? There's only you and me here."

The cat glanced up at me, smiled wickedly and winked. "It is I, the Great Mouse who rules over all. Before me felines fall to their knees and tremble!"

"The Great Mouse is a fable -- a fairy 'tail' for baby mice."

"Doubt if you will, but only I can assure you safe passage to the kitchen. Are you hungry? Then either you must starve or leap forward in faith. Come now, be bold!"

By this time I realized if I was really having a stoke, it was a doozy, and well worth a note to the New England Journal of Medicine, if anyone would believe me, that is. I eased up on one elbow to get a closer look, grateful for the night light in the hallway that shed enough dim glow to make things slightly visible. "We haven't got all night," said the first mouse (it was obvious from my cat's deception, what was going on), "get moving -- I'll be right behind you."

"Oh, all right, but if anything happens, tell Maybelle I was thinking of her." Maybelle? Maple? That's curious. Then a small dark figure darted from beneath the register practically running headlong into my cat who, naturally, pounced. Mouse in mouth, he looked up at me, snapped to attention like Snoopy and saluted with one paw, before trotting off with his prize. Without thinking what I was doing, I turned toward the heater and said, "Well, that was stupid. You're friend's toast. What are you going to do now, run home to Maybelle and offer 'comfort?' Don't you mice know anything about loyalty?"

"Loyalty schmoyalty," he said scornfully, "all's fair in love and war. Someone had to distract the cat and, besides, now he can be a hero -- if he lives."

"You give medals for this sort of thing, huh? Going above and beyond the call of cheese in the middle of the night? I'm glad I'm not a mouse. Now do us both a favor, shut up, get back in your hole and let me get some sleep."

At that moment, my stomach grumbled much louder than the first time. Startled, I sat up too quickly, scattering the bed clothes along with the cat, who quickly gathered his composure and began to wash. The dog just stared at me as if to say, "What is it this time?" I turned on the light and said,"Guys, you're not going to believe the dream I just had." They looked at each other and I swear, hand on the Bible, both winked.

"Hello, 911? I need help -- fast!"


(Public Domain image via Wikipedia)

Checking Out Childhood

If you haven't seen Disney's The Kid (2000), you really should. It's a wonderful film that does things with time I'm still trying to figure out despite having seen it so often I can anticipate characters' lines. I don't want to reveal too much of the story, but if I don't say a few things, I may as well stop writing now.

The premise involves a middle-aged guy (Bruce Willis) who is driven, successful, and turning 40. One evening he comes home to discover a young boy in his home, playing with a toy WW-II vintage airplane. Turns out the boy is his eleven year old self and Willis takes on the task of trying to get him back to his own time. In the final scenes, it becomes clear the entire scenario has been set in motion by Willis' 60 year old self.

The story is an enactment of the desire I've often heard people express, i.e. if they could go back in time and redo one particular thing, their lives would be changed for the better. Ever feel that way? And that's what happens with Willis. Like most of us, however, he realizes it's not a pivotal event per se, but himself, that needs adjustment. In order to do that, he needs to see and experience what it was like to be eleven years old once again.

But Willis doesn't want to be reminded of his childhood. In fact, he wants very badly to forget as much of it as he can because it was painful. His mother died when he was eleven, he was overweight and unpopular. Who, in their right mind, wants to re-visit all that? His 60 year old self, however, knows he has to, in order to become open to changing the direction of his adult life. In a sense, the older Willis is living out the positive consequences of having faced the pain of his childhood. He just has to make sure his 40 year old self does, too.

There's no rule that says a person has to dig around in their past to figure out why things aren't going right in the present. At the same time, there is something about the wishes and desires of childhood that remain with us. We assume there is a purity about them that reflects our deepest and truest selves, and why that's the case, I honestly don't know. For some, it's a sufficiently compelling reason to do some soul-searching. It was for me, anyway.

So, if you're of a mind to check out your childhood and feel like you need an inspiration, The Kid is a great way to go. Make sure you've got the box of tissues nearby, because they come in handy. It's not sad, but it is touching and if you're a dog lover, the final scene will get you like it does me, every dog-gone time.


(Low Resolution image of film poster for Disney's The Kid (copyright, Walt Disney Corp. 2000) -- fair use claimed because no other image exists to adequately identify the subject of this essay, the image is not merely used for illustration but to specify the film in question, and the image has been used elsewhere besides this context, via Wikipedia)

Cystic Fibrosis: Living Like Tomorrow Always Comes

Image via Wikipedia

And in the end, it's not the years in your life that count. It's the life in your years. ~ Abraham Lincoln

I rolled my eyes, thinking he didn't see. Oh, God, he's quoting Lincoln again. Here we go, another lecture on what I should do with my life. My grandfather was silent for a few seconds and I hoped the moment had passed, but no such luck. "You don't see it now, because you're young and think you've got plenty of time. Well, I hope you do, but just in case, it doesn't hurt to remember to make the most of what you've got."

Twenty years later, at the advanced age of 33, I was sitting in a doctoral seminar on the philosophical study of religion with four other students, one of whom was 24 and had cystic fibrosis. He announced it that afternoon while we were sharing our personal stories and getting to know one another, waiting for the professor to show up. We didn't know much about CF except it didn't sound good and he went on to explain he was something of an anomaly. He called it an autosomal recessive disorder, meaning both his parents had to be carriers of the gene, and in the mid-1980s, a 24 year old with CF was extremely rare; most didn't live to 25. And yet, there he was, newly married, trying for a baby, and attending graduate school.

It was at that point someone asked the question the rest of us were thinking, "What are you doing here, of all places?" It reminded me of a television program entitled Run for Your Life. Diagnosed with an unspecified terminal illness and given a year to live, the lead character determined to fill his remaining time with all the adventurous things he'd never done. Our classmate responded, "Where else would I be? This is something I've always wanted. Why shouldn't I live as though tomorrow will always come? Aren't you?"

I was chatting, the other day, with a friend of mine who is "older" and considering medical school. He's been getting questions similar to the one addressed to my younger classmate, e.g. why do this to yourself now, shouldn't you pursue something easier to attain, etc. The unspoken presumption being, challenges are the province of the young and the older we get the less inclined to accepting them we should become. Uh-huh.

Lincoln got it right and so did my grandfather. It's not how long we have but what we do with it that matters. Although I eventually lost track of him, my classmate saw thirty as well as his first-born. If he'd done what was expected, he would likely have remained single, skipped graduate school, and stayed home with his parents, waiting to die. Because he chose to live in hope, his child will have graduated college by now. Maybe she's pursuing the degree denied her father or maybe she's in medical school, studying cystic fibrosis.

Wherever she is, she is because of him, because he refused to let death interfere with life.


(Image of unknown license via Wikipedia)

Fed Up With Farmville?

Dear Doc Beggar:

I realize you're not a doctor yet, but I have a problem and I hope you can help. I've tried to talk with my friends about it, but they all look at me strangely. My family won't even talk to me anymore, not since this all started. When I mentioned it to my therapist, she said, "You what?" and then reached for a teddy bear and began sucking her thumb. Is that what they mean by regression? Anyway, the thing is, I hate Farmville -- no foolin'. Is that wrong of me? I like some Facebook apps, but when people ask me for a cow I want to moo-ve away. Do you think I may have a chemical imbalance?

Sincerely,

Fed Up With Farmville

Dear Fed Up:

Thank you for noting my not-as-yet degree status -- the last thing I want to do is risk my license before I've had a chance to get it! That said, if disliking Farmville is evidence of a chemical imbalance, it's a new one on me. Instead, it sounds like you've made a conscious decision to like certain things and not others. From where I sit, and I am sitting, by the way, that's a fairly healthy approach to Facebook. I mean, unless you have a lot of time on your hands, in which case you could read a book (ahem, mine is one suggestion), you can get lost in App-ville.

The truth is, most apps are no doubt created by ordinary people who want to have a little fun and express their creativity. For example, no one, I hope, takes seriously the idea that one's personality type can be determined by which Harry Potter character they admire the most. Meyers-Briggs would be a better choice if you're into self-exploration. As far as games are concerned, some people derive a lot of pleasure from offing one another in Mafia Wars while others would rather watch The Godfather trilogy and call it good. I'm not much of an organized crime fan, so I tend to ignore both and go for 007, but that's me.

You don't mention whether your family and friends actually play Farmville -- clearly, your therapist does (yes, that's regression, all right) -- but I'm assuming they do. To maintain these relationships, I think the advice given me by a good friend might come in handy: "Keep a smile on your face and your big mouth shut." If that sounds a little too much like bottling up your emotions, you can always go for catharsis. Threaten to join Mafia Wars -- I'm guessing they'll really be sorry, then.

I hope this helps.

Beggar


anshu_si via Flickr

Medical School Through the Back Door

For most of my entering classmates, March 18 is Match Day, when they'll learn where they can plan on spending the next four-plus years in residency training. That's the way it generally goes: four years of medical school and then graduate medical education. But I came in through the back door, having gotten a taste of residency before I'd even placed my order for medical school. The good thing is, I know what's coming, I just have to wait for it to arrive.

In 1996, I was a lowly psychology graduate student living in Boston, in need of an internship training site. As part of our education, we were required to get some practical experience, so I sent my resume to every hospital in the phone book that had a psychiatric department. I interviewed with two and one offered me a position in a non-existent psychotherapy internship program. The department had been considering developing something along those lines, the director (who eventually became my best friend) decided I looked like a good guinea pig, and I was more than happy to oblige.

As it turned out, since I was the sole intern, my "classmates" ended up being psychiatric residents, many of whom had already practiced as physicians in other specialties, a few in other countries. I was not only out-educated -- as far as medicine was concerned -- I was out-experienced from the first day and I remember my first day well. I got lost on my way to a seminar on Cognitive-Behavioral Therapy, walked in late and introduced myself to a dozen or so faces, some of which openly questioned what an intern was doing in a seminar for  doctors. I went home that night seriously wondering whether I'd made a colossal mistake and oversold myself.

The following week, in a conversation revolving around resignation, the director assured me that, being older and having gained real-life experience, I'd find a way to fit in and establish myself. "Just give it time," he said, smiling. I appreciated his confidence, but still, it wasn't easy. Medical school is like Marine boot camp and enduring (surviving?) it is formative. I was a civilian wearing fatigues who'd never spent the night in a foxhole. I had to prove, both to myself and everyone else, that I'd earned my stripes even if they came from a different branch of the service.

So, I made it a point to offer an answer to every question posed by the instructors, even if it was the wrong one. I tried to ask meaningful questions and act like I knew what I was talking about, whether I did or not. Eventually, one by one, the residents took notice. I worked hard, knew some things they didn't, and was interested enough in what they did, to learn about it. After a month or two, when they began reminding me of departmental lunches with pharmaceutical reps instead of letting me find out about them on my own, I knew I was "in."

Over the next year and a half, we shared the same office spaces, saw the same patients, and became friends. It's largely due to their faith and encouragement that I'm studying for board exams. They were the ones who said I ought to go to medical school and when I challenged them on the basis of my age, shrugged their shoulders and said not to worry, it was really an advantage. "Besides, you've already been a 'resident' of sorts. You may as well go all the way."

It's really unusual to have a learning experience like this and I was extremely fortunate. I don't think my hospital ever developed a formal internship program, which means I received something even rarer. It wasn't simply an opportunity to witness the life I had always wanted, it was a chance to live it, after a fashion. It's a life my classmates are going to begin in July and one to which I can't wait to return, picking up where I left off. It's made the back door the best door, after all.

The Scientist and the Dog Biscuit

If you think dogs can't count, try putting three dog biscuits in your pocket and then giving Fido only two of them. ~ Phil Pastoret

Right, and I can hear my empirically scientific, animals-don't-think-they-only-have-instincts, Uncle Henry saying, "He smells the third biscuit -- you might fool yourself, but not his nose."

"Okay, Uncle Henry, tell me this: how come after I've given my dog four little ones, all the while leaving the biscuit jar (canine counterpart of the one for cookies) lid off so he can easily smell more, he walks over to his water dish, takes a drink, and gets up on the kitchen love seat? Huh? Tell me he doesn't know 'four' is the limit."

"What he doesn't know is to stay off the furniture."

Oh, brother. "Uncle Henry, here's the deal. I allow my dog on the furniture and my cat, too. They aren't decorations intended to give my house an L.L. Bean 'look.' They're part of the family, so they can sleep pretty much anywhere they like. The question is, how does my dog know 'four' is the limit if he can't count?"

"He knows it because that's all you give him."

"Now you're getting the point. He can tell when he's gotten four -- if that's not counting, I don't know what is."

"All right, for the sake of argument, let's say he's aware that four biscuits signals the end of his fun. That doesn't mean he's ticking them off on his paw pads, like a kid counting on his fingers."

"No, it doesn't. But it does mean he can keep track of them, and isn't quantifying the essence of counting? We're keeping a tally. And even if he knows four is all he's getting because I tell him so, he is still able to grasp the concepts of 'how many' and 'no more.' These aren't instinctual, they're the result of cognitive processing."

"So, now your dog thinks, eh? Next thing you'll be telling me is, he wants to go to medical school, too."

And that's where the conversation ceased. I just didn't have the heart to tell him my dog practically dragged me into the admissions office the other day while taking our weekly walk around the campus.


(Creative Commons image by pixlfarmer via Flickr)

The CIA in a Styrofoam Cup

"Time," Joe muttered, "began with the expansion of the universe."

Not certain I got the connection between his comment and the clinical note I was writing, I asked, "Run that by me again?"

"Time," he said, "it's all about time. You think you never have enough, but we've had time since the Big Bang."

"So, that explains all the psychotic patients we have on the unit today?"

"It doesn't explain why we have them, but we certainly have the time for them."

Joe was forever coming up with bits and pieces of trivia, especially at the end of a tiring shift on the inpatient psych unit. And this had been a long one, beginning with a close encounter with a paranoid patient who had been admitted that morning. Convinced the CIA was after him and his wife, he approached me and asked if I'd accompany him to his room. "I've got something you have to see," he said, and intrigued, I agreed.

We'd just gotten to his door when he stopped and pointed to a styrofoam cup sitting on the floor. "That's what those rats have been doing, and they've been doing it to my wife and I."

I asked in my best and softest therapist's voice, "Who are the rats?"

He thought for a moment -- I wasn't certain if he'd answer -- and whispered conspiratorially, "The CIA -- shh, they're listening."

"Would it help if I took that (gesturing toward the cup) away?" I asked, quietly.

He threw his arms around me and cried, "Thank you! Thank you! You're my friend." I disentangled myself and suggested it would be helpful if he were to lay down on his bed and take some time out. He agreed and I took the "listening device" with me on my way out. Generally, you try to resist cooperating with a patient's delusions, but in this case, he was likely to escalate further unless someone did something about that blasted cup.

It would be a few days before his medication began to work and when I saw him on the day of his discharge, he didn't seem to recognize me. I was standing at the nurses' station, watching him gather his belongings and hand them to his son, when he reached across the counter for an empty styrofoam cup. Oh, no, I thought, wishing I'd anticipated his possible reaction and thrown it away. Turning it over in his hand, he shook his head and smiled, then looked up at me and said, "Funny thing about these cups. You never really know for sure where they come from, do you?"

No, I guess you don't.


(Public Domain image via Wikipedia)